New study on
e-cigarettes
A new study is likely to influence the discussion
surrounding electronic cigarettes and whether they can be effectively used as a
quit-smoking aid. Researchers in New Zealand found that e-cigarettes were about
as effective as nicotine patches in helping people in the study quit smoking.
Published online September 8, 2013 in The Lancet, the study is the first
to assess whether e-cigarettes work as well as an established quit-smoking aid.
The trial included 657 smokers who wanted to quit. For 3
months, 289 of the participants received e-cigarettes, 295 received nicotine
patches, and 73 received placebo e-cigarettes, which contained no nicotine. The
researchers then followed the participants for 3 more months to determine
whether they had quit smoking. They found that 7.3% of those in the e-cigarette
group had successfully quit smoking, compared with 5.8% in the nicotine patch
group and 4.1% in the placebo e-cigarette group. The differences in results are
not statistically significant, meaning each group had about an equal chance of
quitting.
However, the e-cigarette users who did not quit
completely reported smoking fewer cigarettes at the end of the trial. The
study’s authors interpret this as a positive outcome, because harms from
smoking are generally related to the number of cigarettes smoked as well as
number of years smoking.
What e-Cigarettes are?
The first e-cigarette was developed by a pharmacist in
China. The pharmacist, Hon Lik, was a three-pack-a-day smoker. That was nothing
unusual -- more than 300 million people in China are regular smokers. But when
Lik's father, who was also a heavy smoker, died of lung cancer, Lik decided he
had to come up with an alternative that wouldn't kill him.
Most scientists believe nicotine itself, while highly
addictive, is not what causes cancer for smokers or for the people around them
who breathe their second-hand smoke. Instead, it's the toxic chemicals that are
created when tobacco and filler products burn that is dangerous.
If there was a way to get nicotine addicts their fix
without the burn, you just might avoid the health problems. Nicotine then
becomes as harmless as any other addictive substance, such as caffeine, some
experts say.
So Lik developed an e-cigarette -- a device that uses a
small battery to atomize a pure liquid solution of nicotine. Nothing is burned.
There is no ash. There is no smoke. There is nicotine, and then there is
flavoring added for taste.
Essentially the person using these inhales a kind of
vapor that looks like fog from a fog machine. A recent review of all the
scientific research done on e-cigarettes by Drexel University professor Igor
Burstyn concludes "current data do not indicate that exposures to vapors
from contaminants in electronic cigarettes warrant a concern." In plain
language, Burstyn concludes: "It's about as harmless as you can get."
"I wouldn't worry at all if someone was smoking one
of these by my kids," Burstyn said. "From a pure health perspective,
these are not as bad as a cigarette."
Dr. Michael Siegel, a physician who has spent the past
couple decades working on tobacco control initiatives, has been surprised by
the negative reaction to e-cigarettes from so many people in the public health
sector. Siegel says the studies he's done have shown e-cigarettes are a help.
"True we don't know the long-term health effect of
e-cigarettes, but there's a very good likelihood that smokers are going to get
lung cancer if they don't quit smoking," he said. "If they can switch
to these and quit smoking traditional cigarettes, why condemn them?"
Siegel theorizes the e-cigarettes might look too much
like smoking.
"It's ironic the very thing that makes them so
effective ... drives the anti-smoking groups crazy. But what makes them so
effective is it mimics the physical behaviors smokers have, which is something
the patch can't do."
Reasons for caution
E-cigarettes look like regular cigarettes, but they are
operated by battery. An atomizer heats a solution of liquid, flavorings, and
nicotine that creates a mist that is inhaled. The devices are not yet
regulated, though the US Food and Drug Administration (FDA) has announced its
intention to begin doing so.
According to Thomas J. Glynn, PhD, American Cancer
Society's director of cancer science and trends and international cancer
control, e-cigarettes may one day turn out to be a useful tool to help people
quit smoking. But until the FDA regulates them and more research is conducted, he
says users won’t know for sure what they’re inhaling or how much nicotine
they’re getting.
“The results suggest that e-cigarettes may be useful as a
cessation tool, but no more so than nicotine patches, which are currently a
commonly-used and physician-recommended cessation tool which have undergone
years of testing and research. E-cigarettes are still in the early phases of
testing.”
Until FDA regulation can provide users with a safety
profile and research provides more evidence that e-cigarettes are a safe and
effective quit-smoking aid, Glynn says people should stick to an FDA-approved
quit smoking medication.
A changing industry
Sales of e-cigarettes have risen rapidly since their
invention 10 years ago. According to the Centers for Disease Control and
Prevention (CDC), about 1 in 5 adult smokers of traditional cigarettes in the
US have also tried e-cigarettes.
In addition to requiring that e-cigarette labels list
their ingredients, FDA regulations could also prohibit e-cigarette promotion
and sale to youth. A recent report from the CDC found that youth are using
e-cigarettes in increasing numbers, and calls for strategies to reduce the
availability and attractiveness of e-cigarettes to children and youth.
More than 200 companies manufacture different types of
e-cigarettes, and their quality and type vary considerably. According to Glynn,
this year some of the major tobacco companies – including Lorillard, Philip
Morris, and RJ Reynolds – began entering the e-cigarette market. While it will
take some time to determine precisely what effect this will have, experts
believe that, due to the companies’ long manufacturing history, the quality of
e-cigarettes will improve. That could mean, for example, fewer contaminants and
better nicotine delivery. But there is concern that tobacco companies may also
begin to market e-cigarettes as a companion product to, rather than a
substitute for, regular cigarettes. This could result in fewer people quitting
smoking and, instead, simply using e-cigarettes when and where they cannot
smoke a regular cigarette.
The authors of the study in The Lancet acknowledge
the need for the rapid regulation of e-cigarettes and call for more research to
determine their long-term health effects.
What next?
In terms of medical studies, this was a small one – only
657 people in total. The study, however, is significant in that it will
generate further scientific discussion on the role of e-cigarettes in smoking
cessation. Efficacy of e-cigarettes in reducing smoking and in harm reduction,
their safety over the long term, and the effect of their sale on that of
combustible cigarettes are all issues that need to be further investigated.
If you never smoked e-cigarette as regular cigarette
replacement, you may try and see if you are able to replace the standard
tobacco products altogether and reduce of tobacco consumption. While there is
no proper regulation for such product, choose carefully the e-cigarette
manufacturer to assure the product quality.
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