Monday, July 13, 2009

First, Do No Harm

In the July 12, 2009 Parade Magazine, Dr. Ranit Mishort writes about electronic cigarettes, the battery-powered devices that allow users to inhale vaporized nicotine. She quotes Dr. Jack Henningfield, a pharmacologist who advises the World Health Organization (WHO), "Its effects, he says, 'are not benign,' especially when breathed into the lungs."

"Not benign" when compared to what? Not benign when compared to breathing regular air? Possibly. Not benign when compared to breathing tobacco smoke into the lungs? How could that possibly be true? Cigarette smoke also contains tars, particulates, and numerous added chemicals that cause heart disease, lung disease, and cancer.

The FDA-approved Nicotrol Inhaler works by having the user inhale nicotine into the lungs. The product carries no warnings about risks of heart or lung disease, or cancer. So where is the inherent danger of inhaled nicotine?

Dr. Mishori discourages smokers from trying the e-cigarette: "For now, if you're a smoker trying to quit, talk to your doctor about other, proven methods." Most smokers have already talked to their doctors numerous times and tried just about every product out there.

Over 11,000 people have signed the petition "Keep life saving electronic cigarettes available!"

Signers were invited to leave a comment. Countless of these comments speak of trying the "approved" products without success. A typical quote: "Nothing worked for me until I started using the electronic cigarette."

The comments regarding health effects are uniformly positive:

"This device allowed me to quit without side-effects or cravings."
"I had my first breathing test after starting to use the e-cigarette. After smoking for 30 years this was the best test that I have had in over 10 years."
"I feel better, more alive, and worry free of cancer now."

Admittedly, this is what researchers call "anecdotal evidence." However to prove scientifically that e-cigarettes are safer than tobacco cigarettes, researchers would have to randomly assign smokers to either continue smoking tobacco cigarettes or use an e-cigarette and then compare rates of heart disease, lung disease, and cancers several years down the road. Would such a research project even be ethical? And why is scientific proof required when plain common sense will suffice?

The success rate of currently available FDA-approved smoking cessation products is abysmal—at best 20%, but realistically probably closer to 5%. Thus, Dr. Mishori is urging smokers to resign themselves to the methods that have a proven FAILURE rate of 80-95%. If e-cigarettes might work better, is it ethical to keep it out of the hands of smokers who want to quit?

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