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.
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.
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.
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!
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!
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.)