Case For E-Cigs Continues to Strengthen

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As a physician, I can unequivocally say that about 70 percent of the illnesses I have encountered has been either directly or indirectly related to cigarette smoking.  It is without a doubt an awful habit, and one whose psychological grip on the user is frighteningly powerful.   

At the American Council on Science and Health, we have always championed measures that improve public health outcomes – chief among them, advocating the use of electronic cigarettes.  We have written countless articles on the utility of e-cigarette use and its role in harm reduction.  This is why it was with great excitement when I read the new study, published in the journal Tobacco Control revealing that in a hypothetical best-case scenario, switching from combustible cigarettes to e-cigarettes over a 10-year period could avert 6.6 million premature smoking-related deaths.  And in a hypothetical worst-case scenario, we could see up to 1.6 million less premature deaths resulting from smoking. 

The study, funded by the National Institutes of Health, researchers attempted to demonstrate the potential health impact of replacing all or almost all combustible cigarette use with e-cigarettes over a period of ten years.  In two different models, one called the Status Quo Scenario, focused on cigarette use only and the other model called the E-cigarette Substitution Scenario, which compared a more "optimistic" outlook versus a more "pessimistic" outlook.  The optimistic scenario took into account the current published data available on e-cigarette use and evaluations of harm reduction.  The pessimistic scenario subsumed that e-cigarette use is more harmful than current data suggest. 

The calculations in the e-cigarette substitution scenario, whether best-case or worst-case, suggested significant benefits in a potential gain of life-years and averting premature deaths (deaths that occur before life expectancy). The authors also posit that aside from mortality benefits, other benefits include reduced disability from tobacco-related diseases and exposure to second-hand smoke. 

There are over one billion smokers of combustible cigarettes globally accounting for about five million annual deaths.  Public health efforts to curb smoking have included the following: taxation of smoking, mass advertising campaigns in the media, peer education programs, community mobilization, motivational interviewing, health warnings on tobacco products, marketing restrictions, and banning smoking in public places. The authors argue in their paper that although the implementation of such policies has been successful, the declines in new smokers is not as substantial.  What we ought to be focusing our collective energies toward is the use of less harmful nicotine delivery products. This would likely be a much more realistic goal for any "endgame" strategy (eventual elimination of all tobacco consumption). 

Many critics have alleged that e-cigarettes could be a potential gateway drug or encourage smoking and therefore have pushed to restrict or ban the use of e-cigarettes.  In a recent study we wrote about, evidence supports that, “daily e-cigarette use was the strongest correlate of being quit at the time of the survey, suggesting that some smokers may have quit with frequent e-cigarette use or are using the products regularly to prevent smoking relapse.”  

People are motivated to quit, and thankfully, they have a viable method to achieve long-term, successful smoking cessation. Given the potential to add years to life and other health benefits, making a large-scale switch to e-cigarettes makes it difficult to argue otherwise.