E-cigarettes are in the middle of an image war. The $1.5 billion e-cig industry says the nicotine vaporizers are a less harmful alternative to smoking tobacco. Public health officials, on the other hand, warn that vaping may be an on-ramp for kids to start smoking tobacco, and seeks more restrictive rules. The science is inconclusive, and for now the Food and Drug Administration has landed somewhere in the middle: It recently proposed rules to bar sales to minors, but stopped short of cracking down on advertising or flavored e-cigs that critics say appeal to children.
Doctors who specialize in helping people quit smoking say confusion about vaping’s benefits for smokers who want to stop makes their job harder. “We don’t have any real evidence that they help people stop smoking,” says Dr. Richard Hurt, who ran the Nicotine Dependence Center at the Mayo Clinic in Rochester, Minn., for 26 years. While he says there’s no question that puffing an e-cig is less harmful than smoking tobacco, “they’re not safer than just breathing clean air.”
Most current smokers want to quit and have tried at least once. About 85 percent of e-cig users said one of the reasons they vaped was to help them quit smoking, according to a four-country survey (PDF) published in the American Journal of Preventive Medicine. But “quitting did not differ between users and nonusers,” the paper noted.
The lack of evidence hasn’t stopped some e-cig makers from promoting their products as smoking cessation aides. Vapor Shark last year published a blog post lamenting that the FDA won’t allow e-cig manufacturers “to educate smokers on the efficacy of these products for smoking reduction and cessation.” The FDA rules apparently didn’t stop Vapor Shark from making an expansive claim in the blog post’s title: ”Let’s Just Call it Like it Is … Electronic Cigarettes Are Useful as Smoking Cessation Tools.”
As evidence, Vapor Shark cited a study using a focus group of 11 people. There’s a dearth of rigorous evidence on e-cigs’ role in smoking cessation. Hurt says no one has done a large-scale, randomized, double-blind trial comparing e-cigs containing nicotine with placebo e-cigs to see if those with nicotine make any difference for people trying to quit. That kind of science is the gold standard in medical research, and it’s what the FDA wants to see before allowing new therapies on the market. ”Until that’s done, we’re never going to recommend that they be used,” Hurt says.
Research has been conducted on medically approved smoking cessation aides such as nicotine patches, gums, and lozenges, which make up a $4.5 billion global market, according to GBI Research. Pharmaceutical companies that have sold those products widely since the 1990s want to avoid muddying the line between vaping and established therapies.
Gums and patches deliver controlled doses of nicotine to ease withdrawal symptoms, says Dr. Beloo Mirakhur, U.S. medical director of GlaxoSmithKline (GSK) Consumer Healthcare, which sells Nicorette and Nicoderm CQ. An e-cigarette, by contrast, “gives [smokers] nicotine in uncontrolled fashion,” Mirakhur says. Vaping also reinforces the “hand-to-mouth behavior,” which may make it harder for smokers to kick the habit, she says.
The Centers for Disease Control says that most smokers who try to quit don’t use evidence-based treatments, and just because there’s no proof that e-cigs effectively help people quit doesn’t mean that individual smokers won’t feel they help. The same can be said for hypnosis, acupuncture, laser therapy, or any number of ideas.
At the same time, regulators and public health officials need to rely on evidence when they craft public policy, and smoking remains a pressing public health problem. Cigarettes are blamed for the deaths of nearly 500,000 Americans each year, according to the CDC—a death toll equivalent to four Boeing 777s crashing every day with no survivors. At the moment, there’s no evidence that e-cigs help avert that daily disaster, the Mayo Clinic’s Hurt says, and the buzz about them ”distracts us from the things we know that do work.”