Electronic cigarettes in physician practice

Abstract

There is growing evidence for the effectiveness of e-cigarettes as a quitting aid and, although not completely harmless, the scientific consensus is that they are substantially less harmful than smoking tobacco. More research is needed, but there is now sufficient empirical evidence and real-world experience over more than a decade to consider their use as a legitimate tobacco harm reduction tool for smokers who are unable or unwilling to quit with conventional strategies. Smokers should be advised that the highest success rates occur with daily use with nicotine e-liquid and newer e-cigarette models. After quitting smoking, it is preferable to aim ultimately to cease vaping if possible, but long-term use of e-cigarettes is safer than relapsing to smoking.

Electronic cigarettes in physician practice: a complex debate

“…entitled ‘Electronic cigarettes in physician practice’, which advocates for the use of ENDS in smoking cessation and implies that failure to recommend them represents unethical practice. Although this article makes some general points about smoking cessation that we fully support, that is, first‐line smoking cessation therapy should consist of counselling plus approved pharmacotherapies, and that dual use of tobacco and ENDS is likely to obviate any potential benefit of ENDS, we do not agree with his other opinions namely, (i) that there is strong evidence for ENDS to be regarded as a ‘legitimate tobacco harm reduction tool’, (ii) that ENDS can be compared with needle‐exchange and methadone programmes in terms of harm‐reduction and (iii) that failure to recommend ENDS to tobacco smokers is unethical. Since the publication of Mendelsohn’s article and since this article was originally submitted for publication, a randomised trial of ENDS in smoking cessation has shown higher 1‐year abstinence rates in a population of smokers ( n = 886) randomised to e‐cigarettes plus counselling or to nicotine‐replacement of their choice plus counselling .…”

“…Several specific claims in the IMJ Perspective require a direct response. Mendelsohn states that ‘many studies have found significant health improvement when smokers switch to vaping, including improved asthma, chronic obstructive pulmonary disease, blood pressure, cardiovascular health, lung function and reduced pneumonia risk’.…”

“…Understanding the science is key to allowing us to maximise the potential benefits (possible aid to smoking cessation) and minimise the potential risks (gateway to smoking in youth; barrier to smoking cessation through dual use; long‐term adverse health effects) of these devices. In this article, we respond to the recent paper published in the Internal Medicine Journal by Mendelsohn et al . entitled ‘Electronic cigarettes in physician practice’, which advocates for the use of ENDS in smoking cessation and implies that failure to recommend them represents unethical practice.…”