A Reply to Dr Mintz on the Electronic Cigarette

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A certain Dr Mintz seems to be changing his mind on the electronic cigarette!

As we recorded at the time, in his original post he wrote:

“…the electronic cigarette is dangerously being promoted as safe alternatives to cigarettes that contain tobacco as well as possible aids to smoking cessation. Make no mistake: these products are not safe, in some ways could be riskier than cigarettes, will not be effective smoking cessation aids, and are scarily unregulated by the FDA and far too available in the US.”

Now he writes he admits that:

“E-cigarettes are likely a healthier alternative to tobacco smoke…Electronic cigarettes are probably less carcinogenic, than tobacco cigarettes.”

He is still attacking the electronic cigarette, however. Here are his arguments, and our replies.

A Rebuttal

1. Regulation

My objection is not that I am opposed to the existence of electronic cigarette. It’s more that e-cigarettes are not regulated.

We strongly agree that electronic cigarettes should be regulated. We’ve actually had to jump through hoops for the Trading Standards to be able to sell them here in the UK (how other companies manage to get away with selling crap I don’t know; I presume these companies are doing so from abroad.) And we believe that one of the biggest dangers to the e-cigarette industry comes from the cheap and poor quality devices being sold all over the net.

Our problem is not with regulation, it’s how the FDA intends to implement it. And that’s by banning the devices until several years of studies and hundreds of millions of dollars have been spent on them – possibly never. As Judge Leon said, it absurd to impose a more onerous system of regulation on devices which are safer than cigarettes.

While these devices are off the market, users will either use smuggled/home made devices, or stop using them and return to cigarettes.

And some of them will die because of it.

2. Nicotine

Dr Mintz writes:

By vaporizing nicotine, and inhaling it, this will lead to very rapid absorption, and high levels of addiction; possibly even higher than real cigarettes themselves.

Actually, every study done so far suggests that the nicotine delivered to users is far lower than that delivered by cigarettes.

i. A New Zealand study found that the electronic cigarette delivered less nicotine than cigarettes, and Dr Murray Laugeson’s main concern is that they do not contain enough nicotine.

ii. The FDA study found that levels of nicotine were lower than those found in cigarettes.

iii. A more recent study found that electronic cigarettes were delivering very low levels of nicotine – as much, claimed the professor, as sucking an electronic cigarette. This has given risen to the discussion that the main success of the electronic cigarette is in acting as a placebo, and that the role of nicotine in cigarette has been overestimated (perhaps deliberately by those with a financial interest in promoting nicotine cessations aids.)

4. NRT Products

Electronic cigarettes might be safer replacement for tobacco cigarettes, but are not designed to get patients off of nicotine. Generally, most of the nicotine replacement products work by giving patients a continuous supply of nicotine, and eventually weaning that level down once the patient has been off tobacco cigarettes for a few weeks.

Surveys, an informal study in South Africa, the success of the e-cigarette forum (with thirty thousand e-cigarette users) suggest that e-cigarette users can either replace cigarettes with e-cigarettes or quit. However, Dr Mitz is right in that there are no long term studies which prove that electronic cigarettes can help you quit. (And if you enjoy electronic cigarettes, why should you?)

But then, nicotine cessation aids don’t help people quit either.

In the UK the MHRA assumes a 5% success rate with nicotine cessation aids over the long term. That’s abysmal, but it’s a lot better than shown in a recent study which demonstrated a 0.8% success rate – substantially worse than the stand alone quit rate. Dr Mitz is promoting a cessation alternative which is, quite frankly, crap.

5.Chantix

Recently there’s been some concern about safety issues regarding Chantix,…  However, these safety concerns have not seemed to have panned out, and more recent studies seem to indicate that Chantix is very safe given certain precautions, specifically worsening of mental conditions.

If electronic cigarettes had caused people to commit suicide they would be banned by now! It is only because of the huge money behind chantix/champix that they are still being sold. Let’s not forget who pays the bills of the FDA and the MHRA!

See Despite 98 suicides and 188 suicide attempts, FDA favours Chantix.

6. Children

I’m also bothered that electronic cigarettes are sold in our shopping malls, and can potentially be purchased by children.

First, I don’t know a respectable retailer that sells to children. On many sites you have to enter your age before you can buy a site.

Then there’s what Adrian Payne told us:

I’m not aware of any evidence that this is, or is even likely to be, the case. In the first place, E-cigarettes are not ‘pocket-money’ devices. Secondly, I don’t think anyone has raised the same concerns about pharmaceutical nicotine inhalators which, in the UK at least, are available over the counter. Similarly I’m not aware of any evidence of adult non-smokers using either E-cigarettes or pharmaceutical nicotine inhalators in any number as a gateway to smoking – if there were I’m sure we would have heard of it by now. Bad news travels fast!

Read more: http://www.ecigarettedirect.co.uk/interviews/adrian-payne-interview.html

One objection I have to the gateway to smoking argument is that if children are going to go out and buy this sort of device, wouldn’t they be the type of children who are going to buy cigarettes anyway?

7. Conflict of interest

We understand that it is quite normal for opinions to be given by people receiving money from companies with a financial interest in the issue. (We certainly have a financial interest in electronic cigarettes!) However, Dr Mitz perhaps ought to declare  his pharma ties. His failure to do so has caused problems in the past, when he defended the pharmaceutical products on a Forbes blog without declaring that he had been paid funds by the companies that manufactured the products (see A Forbes Guest Blogger and His Pharma Ties.)

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12 Responses to “A Reply to Dr Mintz on the Electronic Cigarette”

  1. Dr. Matthew Mintz March 13, 2010 at 5:45 pm #

    My response to your response

    1. Regulation- We are in agreement that e-cigarettes should be regulated. I am unaware of an FDA plan to ban the product for several years until proven safe. If this is the case, this is not a good idea. Rather, the FDA should hold e-cigarettes to the same standards as other products (i.e. what the company says is in the product is actually in the product, without other contaminants) including how they are sold and marketed, while doing ongoing safety evaluation.
    2. Nicotine- the more recent study (small and with errors) which you cite gives further support to the argument that these products should be studied more. Most of the data comes from the manufacturers. Though drug companies also provide most of their data, this data is highly regulated in the US by the FDA. My other point about nicotine is that no level of nicotine is known to be healthy. As a physician, my job is to look out for the best interest of my patients. I can not recommend unhealthy behaviors such as excessive drinking, over-eating, and use of nicotine. Even if e-cigarette use is healthier than tobacco cigarette use, if done more than rarely, it is not healthy, and therefore I do not recommend it.
    4. (Not sure where #3 went). We agree that long term studies have not been done on e-cigarettes and smoking cessation. I disagree with you statement that “nicotine cessation aids don’t help people quit either.” There are many studies (see here http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hsahcpr&part=A28372) that show that nicotine replacement and/or medications will double quit rates, at a success rate of about 25-30%. Granted, 25-30% isn’t fabulous, but far from “crap.” In addition, most smokers require multiple quit attempts.
    5. Chantix. Smoking cessation causes worsening of neuropsychiatric symptoms, including suicidality. It remains unclear whether any of these side effects seen with Chantix were due to the medication, or getting off cigarettes. More recent analysis since the media stories have broke have concluded that it is unlikely that Chantix alone caused these symptoms. Though not a perfect drug (and few are), this is a safe and effective drug that has gotten a bad rap.
    6. Children. I can only speak to what I see in the US. I have personally seen e-cigs being sold in shopping malls (which are usually frequented by US teens) at carts/kiosks. Though I have not witnessed any being sold to children, there are reports that this has happened. In the US, there are several products (including both cigarettes and nicotine replacement) that are sold “behind the counter”, where ID is required to prevent underage use. The reason e-cigs are not sold behind the counter (yet), is because they are not currently regulated by the FDA. This is another reason why I want them regulated in the US. I want these products behind the counter where they can only be purchased by adults.
    7. Conflict of Interest. This was a huge mistake and believe me I have paid for it. Though Forbes had my CV and was aware of any conflicts, and the process in which writers submit posts has no section to declare conflicts; I should have realized that I needed to be proactive about this. Believe me, I had no intention of hiding any conflicts of interest. If Forbes had any concerns, I really wished they had asked me before tarnishing my name across cyber-space. Again, I should have known better, so I can only blame myself. Blogs are not journalism, and so the issues of the need to declare conflicts remain unclear. However, on my own blog (www.drmintz.com) there is a section which I declare all potential conflicts.

  2. admin March 14, 2010 at 12:18 pm #

    We’ll be posting our own response soon. However, David Atherton from Freedom2Choose asked us to leave this response as he was having problems leaving a comment:

    On NRT recently in Australia (1) a report found that “Research shows that two-thirds to three-quarters of ex-smokers stop unaided,” and that “53% of the ex-smokers said that it was “not at all difficult” to stop, 27% said it was “fairly difficult”, and the remainder found it very difficult.” (2) More disturbingly is “….controlled trials of NRT found that while 51% of industry-funded trials reported significant cessation effects, only 22% of non industry trials did that…” Is this pharmaceutical publication bias?

    How successful is nicotine replacement therapy (NRT)? A success rate as low as 1.6% as is written in a letter to the British Medical Journal (BMJ) by Professor Michael Siegel. (3) A more recent study piles on the agony at 0.8%, “The actual number of subjects who achieved one-year continuous abstinence with the nicotine patch was 5, or only 0.8% of the sample.” (4) This in the BMJ study stated “The long term (that is, greater than six months) quit rates for OTC NRT was 1% and 6% in two studies and 8–11% in five other studies. These results were not homogenous; however, when combined the estimated OR was 7% (95% CI 4% to 11%). Conclusions: OTC NRT is pharmacologically efficacious and produces modest quit rates similar to that seen in real world prescription practice. ” (5)

    7% is hardly a stunning success.

    Also is NRT as safe as you make it out to be? This study came out in 2009 with commentary from Professor Michael Siegel. (6&7) “A new study published online ahead of print in the journal Cancer Research reports that the use of nicotine gum is associated with significant exposure to a potent carcinogen and concludes that oral nicotine replacement therapy (NRT) use therefore poses a potential carcinogenic hazard to some users….Of note, experts estimate that 36.6% of nicotine gum users are long-term users. Thus, these concerns are not just hypothetical ones…How can the Campaign for Tobacco-Free Kids, the American Heart Association, the American Lung Association, Action on Smoking and Health, and the American Legacy Foundation justify their calls for a ban on electronic cigarettes – which have not been shown to pose any carcinogenic hazard – while they remain silent about the risks of oral NRT use – which has now been shown to pose a significant carcinogenic hazard in a substantial proportion of users?” (6&7)

    Nicotine patches were viewed to be safe. Dr. Mintz I have every reason to believe you are a physician of integrity but in my opinion much of the anti nicotine lobby, largely funded by pharmaceutical companies, euphemistically I will just say, sails close to the wind ethically with conflicts of interest. In the UK ASH have or do own shares in Glaxo SmithKline and helped get their NRT accepted in our state health system, this is a letter written by ASH to GSK’s Chairman. “We have worked with GSK under the auspices of the WHO-Europe Partnership Project on tobacco dependence and at various one-off opportunities. ASH was instrumental in securing greater government commitment to smoking cessation products in the NHS National Plan and we have helped with PR for both Zyban and Niquitin CQ…. ASH has a small shareholding in GSK and I will be attending with others to question you and the Chairman on this situation.” (8)

    One of the most honest and revealing comments is from Bill Godshall, executive director of Smokefree Pennsylvania, in a letter sent to the New Jersey senate: “Proponents of [the bill banning indoor use] have grossly and intentionally misrepresented the health risks of e-cigarettes in order to scare legislators into voting for this unwarranted legislation that threatens (instead of improves) public health. Smokers who have recently quit and/or are trying to quit need support, not harassment and ostracism.”

    Bill also on Michael Siegel’s blog goes further than I would ever have dared in describing opposition to E-cigarettes. (9)

    “While drug company funding is one reason why some organizations have been advocating a ban on e-cigarettes, there also are other reasons including:

    - some are tobacco/nicotine prohibition ideologues,
    - some don’t want to be reminded of cigarettes (which occurs when they see an e-cigarette),
    - most haven’t actually read the research and empirical evidence on e-cigarettes,
    - some truly believe the inaccurate and misleading claims by FDA and others,
    - some prefer letting all smokers die if doing so prevents even one youth from using tobacco/nicotine, and
    - some would be fired by Campaign For Tobacco Free Kids (CTFK), ALF, American Cancer Society (ACS), American Heart Association (AHA), American Lung Association (ALA), etc. if they told the truth about e-cigarettes”

    A lie can travel halfway around the world before the truth can get its boots on.” Most will cite Mark Twain as the author but apparently it is Charles Haddon Spurgeon in 1855. (10)

    While I have every confidence in your integrity Dr. Mintz, but please excuse our cynicism. The anti nicotine industry not only appears to have conflicts of interest but seems to be a junk science industry extraordinaire. The Third hand smoke argument just insults the intelligence and the second hand smoke argument invented by Sir George Godber in 1975 (“..foster an atmosphere where it was perceived that active smokers would injure those around them, especially their family and infants or young children who would be exposed involuntarily to the smoke in the air.” (11) and admitted by Dr. Alvan Feinstein “Yes, it’s rotten science, but it’s in a worthy cause. It will help us to get rid of cigarettes and become a smoke-free society” Yale University epidemiologist writing in Toxological Pathology in 1999 on passive smoking.” (12)

    So pardon the raised eyebrows at pharmaceutical funded NRT industry with peer reviewed success rates of 0.8%-7% compared to Allen Carr’s 53% and Ecigs 45% and the NRT industry is going into overdrive to get them banned.

    1. http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000216

    2. Marsh A, Matheson J (1983) Smoking behaviour and attitudes. London: Office of Population Censuses and Surveys. Social Survey Division.

    3. http://www.bmj.com/cgi/content/extract/338/apr29_1/b1730

    4. http://www.annals.org/content/152/3/144.abstract

    5. http://tobaccocontrol.bmj.com/content/12/1/21.abstract

    6. http://cancerres.aacrjournals.org/cgi/content/abstract/0008-5472.CAN-09-1084v1

    7. http://tobaccoanalysis.blogspot.com/2009/10/new-study-finds-that-nicotine-gum-may.html

    8. http://old.ash.org.uk/html/conduct/pdfs/garnier.pdf

    9. http://tinyurl.com/preview.php?num=y85p7la

    10. http://www.rd.com/content/printContent.do?contentId=134607&KeepThis=true&TB_iframe=true&height=500&width=790&modal=true

    11. http://iarnuocon.newsvine.com/_news/2007/10/17/1028570-secondhand-smoke-mirrors

    12. http://www.lcolby.com/colby.htm

    David Atherton

  3. admin March 14, 2010 at 12:44 pm #

    And here is my response:

    1. Regulation

    Yes, I do agree that there should be regulation.

    Regulation is absolutely in the interest of manufacturers. If the product is regulated consumers will have more confidence in it. Sellers of a quality product have to compete with cheap shoddy products brought in from China which can be sold at a lower price because of lower standards, no insurance, no independent lab tests – frankly, a lack of regulation puts us at a disadvantage.

    What we oppose is:

    i. Removing the product, as the FDA intended to do (and started to do so by blocking imports, seizing e-cigarettes and so on.)

    ii. Regulating it as a medicine, as the MHRA in the UK intend to do. Why should one restrict access in any way to a device which is safer than a freely available and legal alternative?

    I think it is a huge step forward for you to admit that it would be bad for the electronic cigarette to be banned.

    2.1 Information on nicotine is wrong?

    “Nicotine- the more recent study (small and with errors) which you cite gives further support to the argument that these products should be studied more. Most of the data comes from the manufacturers.”

    It is true that the first study was carried out by Murrray Laugesson of Health New Zealand for a fee. Murray Laugesson is a highly respected scientist operating an independent lab. He has decades of experience in tobacco control and received the World Health Organization Tobacco or Health medal and citation “for achievements deemed worthy of international recognition in promoting the concept of tobacco-free societies.”

    If you are trying to imply that his data was supplied by e-cigarette companies, I think that is unfair, unsubstantiated and frankly strange for a man who both defends pharmaceutical products and receives payments from pharmaceutical. The same goes for the analysis of our NJOY e-cigarette, also by an independent lab.

    As the second study we cited was the FDA, it is clearly nonsensical to state that this information came from suppliers.

    As for the last study we cited, I would be interested in knowing the errors in this small study. I too am sceptical that the e-cigarette does not provide nicotine.

    2.2 Nicotine is dangerous?

    We find it interesting that nicotine was not attacked as a dangerous substance until electronic cigarettes became popular. No one seemed to be worried about them when they were just in NRT products!

    Leaving that aside, experts we have interviewed have said:

    i. That nicotine on its own can not be nearly as dangerous as nicotine with thousands of other chemicals and carinogens (although the THR institute maintain the danger of smoking lies in combustion rather than in the chemicals/carinogens contained with in.) http://www.ecigarettedirect.co.uk/interviews/michael-siegel.html

    ii. Dr. Joel Nitzkin, among other experts, argues that e-cigarettes, assuming the nicotine is pure, have about one percent of the risk of cigarettes. The risk has also been equated to that of a cup of coffee. http://www.ecigarettedirect.co.uk/interviews/joel-nitzkin-electronic-cigarette.html

    iii. The MHRA (The UK Medical and Healthcare Products Regulatory Agency) state:

    “Inhaled nicotine is strongly addictive and stopping smoking results in cravings
    and withdrawal symptoms, but nicotine itself is not a major primary cause of
    smoking-related disease.” (http://www.mhra.gov.uk/home/groups/pl-a/documents/websiteresources/con2023239.pdf)

    To the extent there is a risk, we believe that, once users have been informed of whatever risks there might be, it should be up to them whether they wish to take the risk of using them, just as it is up to them whether to take the risk of smoking or other dangerous activities. If users are unable or don’t want to quit nicotine, using electronic cigarettes would be a logical choice.

    You state:

    “As a physician, my job is to look out for the best interest of my patients. I can not recommend unhealthy behaviors such as excessive drinking, over-eating, and use of nicotine.”

    We market the electronic cigarette to smokers who can’t or don’t want to quit – would you really recommend that it is better for smokers to stay with cigarettes than it is to use e-cigarettes?

    Looking at your other examples, wouldn’t you prefer someone who ate excessively to cut down their weight even if they did not quite reach their ideal weight?

    And if you are happy to recommend NRT products which contain nicotine, what is your problem with recommending electronic cigarettes on the basis they contain nicotine?

    4. “We agree that long term studies have not been done on e-cigarettes and smoking cessation.”

    Obviously, no long term studies have been carried out. I hope you also agree that it can not be ruled out as an NRT. You also get the placebo effect and the hand to mouth action and the assocations which you don’t get with NRT. However, we promote the electronic cigarette as an alternative to smoking, not as NRT.

    “I disagree with your statement that “nicotine cessation aids don’t help people quit either.” There are many studies (see here http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hsahcpr&part=A28372) that show that nicotine replacement and/or medications will double quit rates, at a success rate of about 25-30%.”

    i. According to the MHRA: “A literature review in analysis by the
    Department of Health included a Yudkin et al (‘Abstinence from smoking eight years after participation in randomised controlled trial of nicotine patch’, 2003, BMJ, 327, pp. 28-29) paper, which found that 5% of smokers who quit using NRT remained quit after 8 years, and are assumed quit thereafter.” (MHRA consultation document.)

    (Incidentally, The MHRA have also found that long term use of NRT products, in addition to being a better alternative to e-cigarettes, bore no danger to eventual cessation attempts.)

    ii. Some nicotine cessation studies show a clear attempt to manipulate data. For example, the study we noted (which you did not comment upon) hailed nicotine cessation aids as a success despite a 0.8 effectiveness rate when measured at 12 months.

    As a result of extensive manipulation of these and other studies (especially those examining heart attack rates after the introduction of smoking bans), laymen such as myself are clearly sceptical about industry funded studies.

    As Michael Siegel often points out, when a lobby promotes lies trust is lost.

    5. “Smoking cessation causes worsening of neuropsychiatric symptoms, including suicidality. It remains unclear whether any of these side effects seen with Chantix were due to the medication, or getting off cigarettes.”

    I’m sure taking these drugs is safer than smoking. However, if there had been anything like the same assocation of suicide with electronic cigarettes, e-cigarette would have been banned by now! It’s also worth noting that many people in the comments section of our survey compared switching electronic cigarettes very favourably to using nicotine cessation aids. For example, one stated:

    “With all other smoking cessation/nicotine replacement products, the quitting process was agonizing and the side effects were terrible. Switching to e-cigarettes was simple and after noticeable improvements in my health with a few days, it was a no-brainer.” Source: http://www.ecigarettedirect.co.uk/research/comments.html

    And while the electronic cigarette get enthusiastic support from users, try looking up chantix/champix on forums! Here’s one of many comments:

    “Me and my OH tried Champix for about 8 weeks. We had to stop because of the awful side effects. These included feeling depressed and nausea. My stomach swelled up and I was in terrible pain. I am now on nicotene patches and they are much better.”

    I went to my smoking nurse and she was talking to another quit smoking advisor. They were talking aboutChampix and they said figures in our area for young adult male suicides were on the increase and they thought it was associated with Champix. (she told me to keep that quiet) They both said (off the record) that they dont really recomend them because they are still new to the market.”

    britishexpats.com/forum/showthread.php%3Ft%3D528962+champix+forum&cd=4&hl=en&ct=clnk&gl=qa

    I find it particular intersting that these people could only advise against it off the record i.e. they are scared to speak out against the establishment view that Champix is a good thing. Not suprising in the UK when you can go to prison for disagreeing with smoke free legislation!

    6. Children

    The only report I have heard of children buying electronic cigarettes has been when a vendor was deliberately set up by a TV station. The vendor lost his job as a result.

    However, if electronic cigarettes ever approach the popularity of cigarettes, it is inevitable that some children will find some way to buy and try them. Children try anything, which is why one kid died from an overdose of legalised nicotine cessation products.

    Given that there are no studies or evidence that suggest that electronic cigarettes are more attractive to children than cigarettes, and given that the device is safer than cigarettes, do you really think that this a realistic reason to oppose/ban the electronic cigarette?

  4. Mercen March 14, 2010 at 4:50 pm #

    I dont understand what all the humbug is about. I mean I do not think Ecigs should be marketed to minors but If you can buy a pack of smokes in any cornerstore or gas station i do not think that E-Cigs should be submited to such regulation being that they are not full of rat poison and tar like cigarettes. Plus i have found sites such as http://www.libertyvapor.com/ that state :
    “Warning: Nicotine is highly addictive. This product is not intended to diagnose, treat, cure or mitigate any disease or condition. You must be over the legal age in your state to buy and/or use this product with a nicotine option. If you have a demonstrated allergy or sensitivity to nicotine or any combination of inhalants, if you are pregnant or breast-feeding, or if you have heart disease, diabetes, high blood pressure or asthma consult your physician before using this product. Like cigarettes, it is not FDA approved.”

    Maybe most E-Cig companies have thier heart in the right place. And by offering 0% nicotine ecigs they offer a way to quit nicotine completely. Since when did you come across a cigarette with 0% nicotine and tar? I never did. Yet maybe this is more about the Government Collecting TAXES and lobbiest paying off officials than it is about our health.

  5. Dr. Matthew Mintz March 14, 2010 at 7:11 pm #

    “Looking at your other examples, wouldn’t you prefer someone who ate excessively to cut down their weight even if they did not quite reach their ideal weight?”
    This is true, but the comparrison is tricky. On the one hand, food certainly has addictive properties and many people (especially in the US) use food as a means of dealing with stress, similar to the ways that others use alcohol or nicotine.
    However, you need to eat in order to stay alive. You do not need to use alcohol or nicotine for survival. In addition, nicotine is such an addictive substance that one cigarette can trigger complete relapse, even after years of being nicotine free. This is why slowly cutting down cigarettes is not an effective means of quitting. This is also why I don’t believe that e-cigs are an effective way of quitting. You can probably switch from tobacco cigarettes to e-cigs easily, but getting off e-cigs is probably not that easy to do.
    Would I prefer a patient smoke a half a pack a day as opposed to a full pack a day? Of course. Am I going to tell them that it’s OK to smoke 1/2 pack a day? Absolutely not.
    I don’t think that we are going to get anywhere by debating the value of nicotine replacement therapy for cessation. There are multiple studies showing NRT and medications are safe and effective means of quitting cigarettes, though they are far from perfect. In addition, most smokers require multiple quit attempts before successfully being tobacco free.
    Similarly, I am not going to debate the safety of Chantix/Champix when you use patient comments from surveys or websites. I am not saying that these patients’ statements are not legitimate, but anomymous posts on an e-cig site is far from scientific. Chantix is a safe and effective medication for smoking cessation, albeit far from perfect and not without side effects.
    Here are my main points.
    1. My recommendation is for all patients to get off cigarettes and nicotine products. This is the most healthy thing to do. As a physician, I can not recommend e-cigarettes as a healthy behavior, even if they are probably healthier than tobacco cigarettes.
    2. I do not propose that e-cigarettes be banned. I want to make sure that e-cigs sold in the US are regulated in such a way that they contain nicotine and nothing else harmful, and that they can not be purchased at Kiosks in shopping malls or other places where they may be accidentally or intentionally sold to children.
    3. Even though I doubt e-cigs would be effectivene as a smoking cessation aid (they are really tobacco cigarette replacements, not nicotine delivery designed for the specific purpose of cessation), I recognize that this is a theoretic possibility. That said, just like any product, they should not be marketed or make claims that they are effective as smoking cessation devices (even if they can get you off tobacco cigarettes 100% of the time) until they prove this in a study.

  6. Dave Atherton March 14, 2010 at 7:31 pm #

    Chantix has been banned by the Federal Aviation Authorty (FAA) for pilots and air traffic controllers, this is what their blog says.

    “May 23 (2008)— Less than 48 hours after FAA learned the anti-smoking medicine Chantix might lead to safety problems, it ordered pilots and air traffic controllers to stop taking it immediately. The agency took this swift action after a medical safety group, the Institute for Safe Medication Practices, released the results of a study this week that found evidence for the occurrence of seizures, loss of consciousness, heart attacks, vision problems, and various psychiatric instabilities in individuals who use Chantix.”

  7. admin March 15, 2010 at 12:34 pm #

    I think regarding NRT you are probably focussing on the short term effects while we are thinking about the long term effects. Lots of people can quit cigarettes with NRT products – not so many stay off them in the long term!

    Now, the reason we say that electronic cigarettes can not yet be claimed to be an effective cessation aid is because there is no long term data to support this. I personally have no doubt that the electronic is very effective in the short term! However, there does need to be more studies done to prove this.

    I find this confusing:

    “There are multiple studies showing NRT and medications are safe and effective means of quitting cigarettes, though they are far from perfect.”

    I thought you said nicotine was dangerous? Or is it only safe when it pharmaceutical companies are making money selling it? And do you believe the UK MHRA is wrong when they say nicotine does not cause smoking related diseases? And if nicotine is not dangerous, what is the problem with people who can’t or don’t want to quit switching to electronic cigarettes?

    And you never told me what were the problems with the study carried out into the nicotine delivery of electronic cigarettes!

    Given that you say Chantix is now proven safe, I’d also be interested to know if the FDA is now stating that Chantix is safe and has removed the warning of changes in behavior, depressed mood, hostility, and suicidal thoughts from Chantix products.

  8. Kate March 17, 2010 at 11:03 pm #

    I think Dr Mintz is getting a bit mixed up between smoke and nicotine. There’s no doubt that people who swap to vaping are quitting smoking even if they continue to use nicotine.

    Personally I’d rather die than be without the pleasures that keep me from being depressed … I’ll not choose to quit nicotine so I’d like to have a cleaner option for delivery than smoke. To deny that option or oppose my use of a drug is a moral judgement with no scientific validity. It’s not nicotine that is the problem in my scale of thinking, it’s how it’s delivered that’s the issue and the problem.

    Tobacco control, smoke control and nicotine control … as they say on Monty Python ‘now we see the violence inherent in the system’.

    As far as nicotine for quitting is concerned – well who would tell you that you need nicotine to quit nicotine except for someone with a vested interest?

    It’s a recreational drug, a lifestyle choice and my right to choose and enjoy.

  9. Charlatan Mintz March 21, 2010 at 2:18 pm #

    The credibility of Dr. Mintz is ZERO. People are prescribed Chantix and Wellbutrin for depression. Even if you smoke on these mind-altering medications, you will get all the same psychotic symptoms, such as changes in your perception of taste and smell, wild dreams, and suicide attempts. And I’ve never heard anyone trying to pull the plug on their life by quitting smoking. People usually quit smoking to improve their life.

    “5. Chantix. Smoking cessation causes worsening of neuropsychiatric symptoms, including suicidality. It remains unclear whether any of these side effects seen with Chantix were due to the medication, or getting off cigarettes. More recent analysis since the media stories have broke have concluded that it is unlikely that Chantix alone caused these symptoms. Though not a perfect drug (and few are), this is a safe and effective drug that has gotten a bad rap.”

  10. Mr F MANN October 24, 2010 at 5:20 pm #

    Dear Admin
    I opened on to this website to get an opinion on the e.cigarette,to see if it could aid me to give up smoking cigarettes and get a healthier lifestyle.And most of what you said in response to Dr Mintz and his anti e,cigarette campaign is fact.
    May I add,I fully agree as to the success of NRT Products that are recommended by the health body`s, are a complete money spinning waste of time,I Have tried all of these products,to aid myself off cigarette smoking, and have they have failed me and many other smokers wanting to quit.
    I therefore will be, “once seeing my M.D.”Going to try the e.cigarette, as it must be more healthier than smoking tobacco cigarettes.

    As you have quite correctly pointed out, that Dr Mintz, A.S.H, And all the other anti-smoking associations are very bias and contradicting in there reason`s to constantly persecute smokers, and the damage we are doing to the public and environment,My reason for this is this example:-Should it be, that both myself and Dr Mintz and Co.be in his closed garage, and I smoked cigarette after cigarette for a couple of hour`s, I admit, he may be a little ill and intoxicated,But if in the same environment, He switched the Engine of his car on and run it for a couple of hours, I think we would be a little more than ill;.Please think about this Dr Mintz, when you are sitting stationary at a set of traffic lights, with your exhaust pipe at the same level as that mothers baby/child in a buggy on the pavement next to you, while you are contemplating your next campaign moves.Myself in the very same poison smoking a cigarette, would have very little effect on that baby/child.
    We are all wanting a cleaner world environment, and would do anything to help this, As why my other reason to wanting to quit smoking tobacco cigarettes, But mine is not for solely financial means,as is your`s and these other associations.
    Should this be unfounded then please be honest in your campaign, and put your efforts to good use,Stop backing these useless NRT Products,and let new products have a chance.

    With Regards

    Mr. F Mann

Trackbacks/Pingbacks

  1. ecigchronicle.com - March 14, 2010

    Dr Mintz on the Electronic Cigarette (reply and discussion)…

    Very interesting discussion with Dr Mintz on electronic cigarettes, nicotine and politics….

  2. » The new anti-smoking strategy: Get mentally ill smokers to kill themselves and their families - Ashtray Blog: An Electronic Cigarette Blog - April 26, 2011

    [...] I’ve also debated this with a scientist who says that is it no use giving individual examples. [...]

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