The general impression is that e-cigarettes are much healthier than conventional cigarettes. Although conventional cigarettes are severely unhealthy, e-cigarettes are far from safe.
Clare Meernik, MPH and Adam O. Goldstein, MD, MPH of the Department of Family Medicine at the University of North Carolina at Chapel Hill, recently published an article advising that doctors should never routinely recommend e-cigarettes to patients who smoke as a healthier alternative to conventional cigarettes.
Drs. Meernik and Goldstein provide four reasons for their opinion: inadequate safety, poor effectiveness, little regulation, and an ethical commitment to do no harm.
There is a lack of strong evidence to prove that electronic nicotine delivery devices (ENDS) are safe, and in fact, there is plenty of evidence that points to harms, both potential and real. Many studies and reports have proven that ENDS may have lower levels of toxins in the e-liquids they use, but it is still more than enough to pose a hazard to a person’s health.
There is also a real danger in inhaling the flavor additives, which often contain diacetyl, a chemical linked to a serious lung disease called bronchiolitis obliterans. It is an incurable lung disease better known as “popcorn lung,” and is only treatable by lung transplant.
Utilizing e-cigarettes as a means to smoking cessation isn’t a good idea, according to Drs. Meernik and Goldstein. Using ENDS to quit is “questionable at best, potentially ineffective at worst, and significantly poorer than existing FDA-approved optimal therapies, such as combined nicotine replacement therapy (NRT) or varenicline, with intensive behavioral treatment,” they write.
Regarding regulation, the FDA has recently announced new regulations for e-cigarettes, making them subject to the same regulations as cigarettes and other tobacco products. “From a regulatory approach, nicotine concentrations found in ENDS can be markedly different than the labeled content, and some supposedly nicotine-free products contain varying concentrations of nicotine,” Drs. Meernik and Goldstein say.
The two doctors also believe that ethical decisions are in question, as well. The pair believe that the ethical duty of medicine is to do no harm. They compare e-cigarettes as a “better” alternative to conventional cigarettes to jumping off the 10th floor of a burning building rather than the 15th floor – there’s no real benefit.
Instead, the doctors have strongly suggested that clinicians should turn to the safe and effective smoking-cessation treatment that they already have on hand. “Encouraging clinicians to utilize such best practices should be a priority,” the article reads. “Until more independent data on ENDS safety and effectiveness emerges, clinicians should be advised against routinely recommending ENDS to their patients who smoke.”