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Opinion: 'E-cigarettes may be an effective tobacco cessation tool but at what cost to society'?

‘We don’t want to solve the problems of current smokers by creating a whole new generation of smokers that the tobacco companies can prey on,’ writes Dr Des Cox.

Des Cox

THERE HAS BEEN a significant discussion regarding e-cigarettes in media outlets recently. The renewed interest comes as a result of a study published in The New England Journal of Medicine on the topic.

The research study conducted in the UK examined tobacco cessation rates using e-cigarettes compared with regular nicotine replacement therapies (NRT) such as patches, sprays and gum.

The report is the largest of its kind to date and demonstrated that those who used e-cigarettes to quit smoking were almost twice as likely to remain off tobacco cigarettes a year later when compared to those who used NRT.

The two groups were also given behavioural support in the form of face-to-face counselling sessions throughout the study.

The number of people who quit smoking on e-cigarettes in the study was 18%, which is close to the success rates published on other tobacco cessation therapies.

Interestingly, four out of five quitters in the e-cigarette group were still using them one year out.

This may imply that most people who successfully manage to quit smoking using e-cigarettes fail to kick their nicotine addiction. 

The study concludes that e-cigarettes are a more effective way of quitting smoking when compared with other Nicotine Replacement Therapies.

However, the data published only covers one year so we don’t have any long-term data on quit rates.

More importantly, we don’t have long-term data on the health impact of chronic e-cigarette use.

The main thrust of the argument for the use of e-cigarette devices has been that they are less harmful than tobacco cigarettes.

Many scientific studies would support this argument but that doesn’t mean that they are harmless. In the same week as the above paper was published, a study from Australia demonstrated that the vapour from e-cigarettes causes damage to lung cells in a laboratory setting.

Similar studies have been published corroborating the finding that e-cigarettes have toxic effects on lung cells.

This creates a dilemma for health professionals. How can we advise our patients on the use of a tobacco cessation device when we have little or no long-term data on its safety?

Is it good enough to simply state to our patients that they’re safer than tobacco products?

You must remember that it was a number of decades before the deadly effects of tobacco smoking came to light.

This delay was largely down to the nefarious tactics of tobacco manufacturers who hid the truth at every opportunity.

Once again, large tobacco companies are flexing their muscle in an attempt to influence the current playing field.

Last year, the largest e-cigarette seller in the US was bought out by one of the biggest tobacco manufacturers in the world.

Apart from making money, what are tobacco companies trying to achieve with this investment strategy?

Tobacco lobbyists want us to believe that tobacco firms aim to create a smoke-free world and switch everyone over to e-cigarettes. One tobacco manufacturer even produced an anti-smoking advertisement last year.

According to recent media reports, the tentacles of tobacco lobbyists recently attempted to infiltrate the corridors of Dail Eireann in order to get them to buy into this idea. Or could there be another agenda afoot?

As a paediatrician, I am concerned that non-smokers, in particular adolescents, are at risk of taking up e-cigarettes in increasing numbers.

There has been a rapid rise in the number of US teenagers using e-cigarettes in the past year. This phenomenon has not yet reached these shores yet but vigilance is needed.

We don’t want to solve the problems of current smokers by creating a whole new generation of smokers that the tobacco companies can prey on.

The newer devices being marketed by the e-cigarette industry are swish, cool looking and of course, come in multiple different flavours. Some of these flavours are clearly aimed at teenagers. 

Would a 60-year-old man who wants to quit smoking really go for a banana milkshake or strawberry bubblegum flavoured e-cigarette?

Also, the fear remains that the increased use of e-cigarettes may renormalise smoking as a behaviour.

So yes, e-cigarettes may be an effective tobacco cessation tool but at what cost to society?

Certain countries are adopting differing stances. The Australian government has now banned the sale of e-cigarettes while the UK has adopted a softer approach to the use of e-cigarettes as a smoking cessation tool.

Yet the smoking prevalence rates in both countries are similar measuring 14% and 15% respectively. In light of emerging evidence, the Department of Health needs to clearly set out their position on e-cigarettes.

A comprehensive review of the current evidence on the topic is needed to inform the public of ongoing developments in the area.

Dr Des Cox is the Chair of the Policy Group on Tobacco at the Royal College of Physicians of Ireland and Consultant in Paediatric Respiratory Medicine at Our Lady’s Children’s Hospital in Crumlin.

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Des Cox

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