Electronic cigarettes: stop smoking aid or gateway drug?

The debate over whether e-cigarettes are truly stop smoking aids or a gateway to real cigarettes rages on with a ferocity seldom seen since the ancient times when Lilliputians and Blefuscudians couldn’t agree on which end to break their eggs – the smaller or the larger. The latest development is a study published in The Lancet Respiratory Medicine which says that adult smokers who use e-cigs are 28% less likely to quit smoking. “As currently being used, e-cigarettes are associated with significantly less quitting among smokers,” former clinical fellow at the UCSF School of Medicine and first author Dr. Sara Kalkhoran, currently at Massachusetts General Hospital and Harvard Medical School, wrote. “E-cigarettes should not be recommended as effective smoking cessation aids until there is evidence that, as promoted and used, they assist smoking cessation.”

This is not just another study of the many that have reached opposing conclusion on the subject; in fact, it is the largest to date. And bigger is better, right? Kalkhoran and colleagues systematically reviewed and meta-analyzed 38 previous studies that assessed the relationship between e-cigarette use and smoking cessation in adult smokers, including real-world observational analyses and clinical studies. The researchers then narrowed them down to 20 studies that had control groups of smokers not using e-cigs, and combined the results. “The irony is that quitting smoking is one of the main reasons both adults and kids use e-cigarettes, but the overall effect is less, not more, quitting” professor of medicine and director of the UCSF Center for Tobacco Control Research and Education and co-author Stanton A. Glantz, PhD, UCSF said in a statement. “While there is no question that a puff on an e-cigarette is less dangerous than a puff on a conventional cigarette, the most dangerous thing about e-cigarettes is that they keep people smoking conventional cigarettes.”

A number of experts, such as senior scientific advisor to the American Lung Association Dr. Norman Edelman, claims that electronic cigarettes hinder quitting efforts rather than expedite them. “It tells us simply switching from one nicotine delivery system to another nicotine delivery system doesn't lead to quitting the first nicotine delivery system,” Edelman told Health Day. “People will not naturally give up cigarettes, even though in most venues e-cigarettes are cheaper and people consider e-cigarettes to be safer.” Similarly, Dr. Daniel Neides of Cleveland Clinic's Wellness Institute told CBS News that “patients using e-cigarettes may end up using higher amounts of nicotine with the e-cigarettes because they are using the devices more frequently throughout the day and when they feel like they need a stronger nicotine content, they transition to cigarettes.”

On the other hand, Director of the Tobacco Dependence Research Unit at Queen Mary University of London Peter Hajek said the study was “grossly misleading.” “The studies that are presented as showing that vaping does not help people quit only recruited people who were currently smoking and asked them if they used e-cigarettes in the past. This means that people who used e-cigarettes and stopped smoking were excluded. The same approach would show that proven stop-smoking medications do not help or even undermine quitting,” Hajek said in a statement. Even one of the authors of the reviewed studies, Deputy Director of the UK Centre for Tobacco & Alcohol Studies and a professor at King's College London Ann McNeill, called the research “not scientific.” “The information included about two studies that I co-authored is either inaccurate or misleading,” she said. “I am concerned at the huge damage this publication may have - many more smokers may continue smoking and die if they take from this piece of work that all evidence suggests e-cigarettes do not help you quit smoking; that is not the case.”

So it’s safe to say that the jury is still out on that one. And it will probably remain so; like many things in life, there are no absolutes concerning e-cigarettes. The safest bet is to say that they help some people quit and lead others to smoking actual cigarettes. Would they help you? There’s only way to find out. But there’s also a third alternative, like tried-and-true smoking cessation methods such as nicotine gum or nicotine patches, both available at Discount Medical Supplies.

Related: Smoke two and call me in the morning? Smoking to quit