In evaluating the potential public-health impact of e-cigarettes, we need to bear in mind the staggering toll of death and disease caused by cigarette smoking throughout the world. In this context, we should not discourage promising new approaches that might change this picture.
As with any new potentially therapeutic approach, we must evaluate e-cigarettes based on the information currently available, while recognizing that an exhaustive analysis of all of the potential long-term effects will require many years of study. And the information we have now shows that electronic cigarettes can safely help people quit smoking.
The U.S. Surgeon General and other experts have linked the vast majority of smoking-related disease to the combustion products of smoke, not to the nicotine that is present both in tobacco and in electronic cigarettes.
Nicotine is a powerfully addictive substance, but it is not the cause of cancer, lung disease or vascular disease seen in smokers. While quitting all nicotine-containing products may be an ideal goal, smokers who try to stop on their own have less than a 5% chance of long-term success, and only about a 10% chance with the assistance of a medical provider.
In this setting, the ability to switch from tobacco cigarettes to e-cigarettes that contain nicotine but do not burn offers enormous promise as a means to save lives.
Researchers from highly credible organizations, among them the U.K. Center for Tobacco and Alcohol Studies and the University of Geneva’s Institute of Social and Preventive Medicine, have concluded that e-cigarettes are helpful in reducing or eliminating tobacco use. And recently the British government’s drug regulatory authority approved an e-cigarette as a quit-smoking medicine.
This position is also supported by common sense, considering that every other form of nicotine replacement studied to date has been shown to help people stop smoking, including nicotine patches, gum, lozenges, nasal spray and inhalers.
What’s more, compared with those treatments, e-cigarettes can more effectively satisfy a smoker’s craving by delivering nicotine as rapidly as a cigarette, while also satisfying the habitual aspects of smoking. As e-cigarette technology improves, these devices will almost certainly become more-effective tools to aid smokers in breaking their addiction to combustible cigarettes.
Available evidence also overwhelmingly supports the view that e-cigarettes are reasonably safe and—most important—far less risky than cigarettes.
Despite expert consensus to that effect, some researchers have focused their attention on exaggerated health concerns. These reports have a sensational quality and often gain wide coverage by the press. For example, some early reports suggested that e-cigarettes produce formaldehyde, a toxic substance found in cigarette smoke. More recent research, however, has shown that under normal operating conditions, e-cigarettes release far less formaldehyde than tobacco cigarettes.
Moreover, because there are numerous carcinogens in cigarette smoke, the formaldehyde component of cigarette smoke has been estimated to raise smokers’ risk of cancer by less than 1 part in 1,000. Thus the overall cancer risk presented by formaldehyde in e-cigarette vapor is likely to be insignificant.
Still, it will take many years to fully establish the long-term safety of electronic cigarettes—during which time millions of tobacco smokers will needlessly die if they are discouraged from using alternatives that are almost certainly far less harmful.
Another report examining population data suggested that e-cigarettes may not be effective for smokers who want to quit. This report gained wide press coverage but was flawed because smokers who turn to e-cigarettes may be a self-selected group that finds it especially difficult to quit smoking.
The gold-standard scientific method for assessing effectiveness is the randomized clinical trial, and two trials to date have shown e-cigarettes can help smokers quit.
Having worked my entire career to develop effective smoking-cessation treatments, I have realized that current approaches are ineffective for the vast majority of smokers. Alternative approaches are urgently needed. The World Health Organization predicts a billion deaths will be attributable to smoking during the 21st century.
Electronic cigarettes have an unparalleled potential to reduce the public-health impact of smoking, by allowing smokers to replace the habit and nicotine of smoking without the toxic effects of combustion.
Dr. Rose is a professor of psychiatry and behavioral sciences and director of the Duke Center for Smoking Cessation at Duke University. He can be reached at email@example.com.