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e-Cigarettes: benefits in the balance

e-Cigarette use and marketing should be subject to the same restrictions as tobacco cigarettes, according to a review published recently in Circulation.1

Although e-cigarettes are marketed as healthier alternatives to tobacco smoking, useful for quitting smoking and reducing cigarette consumption, health claims and claims of efficacy for quitting smoking are unsupported by scientific evidence to date, the authors say.

There has been rapid market penetration of e-cigarettes despite many unanswered questions about their safety, efficacy for harm reduction and cessation, and total impact on public health, they continue. The individual risks and benefits and the total impact of these products occur in the context of the widespread and continuing availability of conventional cigarettes and other tobacco products, with high levels of dual use of e-cigarettes and conventional cigarettes at the same time among adults and youth, the authors add.

It is important to assess e-cigarette toxicant exposure and individual risk, as well as the health effects of e-cigarettes as they are actually used, to ensure safety and to develop an evidence-based regulatory scheme that protects the entire population, they conclude.

E-cigarette study  pic

Dr Stanton A Glantz (University of California, USA)

Speaking to BJC Arrhythmia Watch, co-author Dr Stanton A Glantz (University of California, San Francisco, USA) expressed scepticism that e-cigarettes will help with cessation beyond smokers who are highly motivated to quit. “More often than not, e-cigarettes are marketed as a way around smoke free policies…This idea that people will transition naturally from regular cigarettes to e-cigarettes and quit is not true. They’re being marketed as a product to use indefinitely, not as a quitting aid,” Dr Glantz said.

“You now have e-cigarette advertising on TV here in the US, re-normalising something that looks like smoking. Including e-cigarettes in broadcast ad branding is part of the overall impact – we have found that some smokers who quit years ago are relapsing to cigarettes because they see the ads on TV,” Dr Glantz added.

“The whole idea of harm reduction and nicotine replacement therapy, which originated in England…was a sensible view 23 years ago. However, while nicotine isn’t as harmful as tar, it does have effects on cardiovascular function and endothelial function – the main mechanism through which smoking affects cardiovascular risk,” he continued. “The assumption is that e-cigarettes are a lot safer because they deliver fewer carcinogens – but my guess is that although they will be less toxic, they will still carry most of the same cardiovascular risk as conventional cigarettes,” Dr Glantz concluded.

References

1. Grana R, Benowitz N, Glantz SA. E-cigarettes: a scientific review. Circulation 2014;129:1972–86. http://dx.doi.org/10.1161/CIRCULATIONAHA.114.007667

Published on: August 5, 2014

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