Alarm Bells for E-Cigarettes Premature and Misguided, Siegel Says

Posted on: September 27, 2013 Topics: Community Health Sciences

Negative effects of electronic cigarettes have been wildly overblown, clouding the important benefits of e-cigarettes as smoking-cessation devices. A growing body of research suggests that e-cigarettes were as effective as nicotine patches in helping people quit smoking.


The headlines were startling:

"E-cigarette Use Among Middle and High School Students Skyrockets, CDC Data Show," the Washington Post proclaimed.

"Democratic Senators Pounce on E-Cigarettes After CDC Study Shows Teen Use Spike," said US News & World Report.

The recent media storm was prompted by a report by the Centers for Disease Control and Prevention that found the percentage of high school students who said they had used an e-cigarette jumped from 4.7 percent in 2011 to 10 percent in 2012. Use also doubled among middle school students, the CDC reported.

Meanwhile, around the same time, a small study of smokers published in the journal Lancet added to growing research suggesting that electronic cigarettes were as effective as nicotine patches in helping people quit smoking.

mbsiegel.jpgMichael SiegelWhat to make of the conflicting reports? According to Michael Siegel, professor of community health sciences at the BU School of Public Health, the negative effects of electronic cigarettes have been wildly overblown, clouding the important benefits of e-cigarettes as quit-smoking devices.

E-cigarettes are battery-powered devices that look like cigarettes but do not burn tobacco. Rather, they deliver nicotine, flavor and other chemicals in the form of a vapor. Because of the limited research into e-cigarette use, their risks and benefits remain uncertain and subject to widespread debate.

With only about 6 percent of cigarette smokers successful in quitting the habit, and the tobacco industry free to continue its marketing despite known health effects, Siegel worries that the government's focus on the potential harms from e-cigarettes will detract from their quit-smoking benefits.

Question: CDC Director Tom Frieden said the findings of increased use by teens were "deeply troubling," deeming e-cigarettes essentially a gateway drug to a lifelong addiction to nicotine and regular cigarettes. How do you counter that?

Siegel: "Well, first, it's important to point out that this alarming conclusion is premature. There is no evidence that electronic cigarettes are serving as a gateway to a lifelong addiction to nicotine and conventional cigarettes.

"There is something that Dr. Frieden didn't mention. The overwhelming majority of the youths who reported experimenting with e-cigarettes were already smokers. So the fact that these smokers are experimenting with e-cigarettes is not really a problem. The concern would be if nonsmokers were using electronic cigarettes, and then moved on to regular cigarettes. But the prevalence of nonsmokers experimenting with e-cigarettes in the CDC study was only 0.5 percent. Moreover, the study did not document any examples of youth starting to smoke as a result of first trying electronic cigarettes.

"While there is every reason to be concerned about the potential for electronic cigarettes to become popular among youth, there is no reason to be alarmed at this point. It is essential that we continue to carefully monitor this. It is also important that the FDA promulgate regulations that will help prevent the use of electronic cigarettes by youth."

Q: What do we know about the rising number of people using e-cigarettes, in terms of their use as actual quit-smoking devices?

Siegel: "We do know that the predominant reason why so many people are using e-cigarettes is that they want to quit smoking in order to improve their health. While we don't have a lot of quantitative studies about the effectiveness of e-cigarettes in smoking cessation, a clinical trial published recently found that e-cigarettes are just as effective as the nicotine patch for smoking cessation. Unfortunately, the e-cigarettes tested were a first-generation product that did not deliver nicotine very well. It is possible that more advanced products could actually surpass the nicotine patch in their effectiveness."

Q: What do you make of the intense government focus on e-cigarettes' potential negative effects?

Siegel: "It is certainly reasonable to carefully scrutinize any consumer product like this. However, what I have a problem with is the fact that the FDA has given its seal of approval to the irredeemably toxic regular tobacco cigarettes -- while they are doing everything they can to discourage people from switching to the much safer fake ones. That makes no sense from a public health perspective."

Q: Are you worried about reports that big U.S. tobacco companies, such as Altria and Reynolds, are now stepping into the e-cigarette business, given the type of marketing they might do?

Siegel: "There are actually some benefits to having the major tobacco companies become players in the e-cigarette field. For one thing, they have better access to large retail outlets, and it is possible that their entrance into the market may greatly expand the access that smokers have to these products.

"In terms of marketing practices, it is essential that the FDA allow companies to tell the truth about the intended use of these products -- that they are intended to be used for smoking cessation. That would avoid the need for companies to resort to some sort of glamorized marketing campaign that glorifies smoking behavior."

Q: Most scientists believe nicotine itself, while highly addictive, is not what causes cancer for smokers or the people around them exposed to second-hand smoke. Has there been any scientific research into the negative health effects of e-cigarettes?

Siegel: "It is very true that nicotine is not the main component of tobacco smoke that is responsible for most of the adverse health effects. Because electronic cigarettes deliver nicotine without most of the tens of thousands of other chemicals --and without the more than 60 known carcinogens -- it is clear that electronic cigarettes are much safer than tobacco cigarettes.

"The scientific research conducted so far suggests that electronic cigarettes are much safer than regular cigarettes and that, in particular, they carry a greatly reduced risk of lung cancer, other cancers, and chronic obstructive lung disease. Evidence presented just recently suggests that they also likely present a lower risk of heart disease.

"We need more research to understand whether there may be long-term adverse effects. But what we can say for sure is that they are much safer than the real cigarettes."

Q: How did you get interested in e-cigarettes?

Siegel: "I have been following the issue of electronic cigarettes since they entered the U.S. market several years ago. My interest was piqued by the response that these products received from public health and anti-smoking groups.

"Rather than embracing these products as a potential way to get thousands of smokers to quit smoking, anti-smoking groups have attacked these products and discouraged smokers from quitting by using them. This is so contrary to the principles of public health that it caught my attention -- and I continue to be puzzled by this inane public-health response.

"The only hypothesis I have come up with is that the ideology in the anti-smoking movement is so strong, that the very thought of condoning a behavior that "looks" like cigarette smoking is just something that these groups are not capable of doing -- even though it is likely saving the lives of thousands of ex-smokers."

Listen to Michael Siegel discussing e-cigarettes during an interview with WBUR's On Point