When It Comes to Tobacco Harm Reduction, the AMA Can’t See the Forest for the Trees
Article: Sara Berg, “What doctors wish patients knew about e-cigarettes,” American Medical Association, May 30, 2025.
A recent news article from the American Medical Association (AMA) addresses the declining use of e-cigarettes among middle and high school students in the United States. The Centers for Disease Control and Prevention (CDC) identified e-cigarettes as the most commonly used tobacco product among this demographic for the 11th consecutive year, beating out cigarettes and other tobacco and nicotine products. Though factually correct, the CDC omits an important detail: the decline in use across all tobacco and nicotine products in those under 21. While the article raises some concerns about youth vaping and its health implications, it completely disregards the merits of using reduced-risk tobacco and nicotine products as a tool to help adults who smoke move away from combustion and toward a path to better health. Biased commentary from organizations like the AMA only introduces confusion for those who smoke and slows the migration of adult smokers to less harmful products.
The article focuses heavily on the risks of vaping for adolescents, highlighting nicotine addiction, lung health issues, and impacts on brain development. These concerns are substantiated by research indicating that nicotine exposure in adolescence can alter neural pathways, potentially leading to long-term cognitive and behavioral effects. However, the article does not acknowledge the potential benefits of e-cigarettes as a harm reduction tool for adult smokers. While not risk-free, e-cigarettes are significantly less harmful than combustible tobacco, with studies estimating their risk at 5 to 10 percent less than that of traditional cigarettes. By omitting this context, the AMA article risks perpetuating a narrative that equates vaping with smoking, thereby discouraging adult smokers from switching to a less harmful alternative.
The author asserts that the Food and Drug Administration (FDA) has not approved e-cigarettes as smoking cessation aids and implies they are ineffective for quitting smoking. This claim overlooks substantial evidence supporting the efficacy of e-cigarettes in helping smokers quit. A randomized controlled trial found that e-cigarettes were nearly twice as effective as nicotine replacement therapy in achieving sustained smoking cessation at one year (18 percent versus 9.9 percent) Public Health England has also endorsed vaping as a cessation tool, citing its potential to reduce smoking prevalence. The AMA article’s dismissal of vaping’s role in cessation may confuse readers and undermine efforts to promote evidence-based harm reduction strategies. These and many other well-designed and executed studies produce similar results: Vaping helps those who smoke to quit!
The article advocates for policies to reduce youth access to e-cigarettes and for educational campaigns like the FDA’s “The Real Cost.” While these initiatives play a role in preventing underage vaping, perspectives that support policies preserving access to regulated vaping products for adult smokers are key. For example, flavor bans—intended to deter youth use—may discourage adults from switching from cigarettes, as flavors play a significant role in vaping’s appeal as a cessation aid. A balanced approach would combine stringent youth access restrictions with support for adult access to safer alternatives.
While the AMA article highlights the risks of youth vaping, it lacks a comprehensive discussion of e-cigarettes’ role in harm reduction for adult smokers. Public health messaging should be comprehensive, differentiating between youth and adult use, acknowledging vaping’s relative safety compared to smoking, and supporting evidence-based cessation strategies. By addressing these gaps, the medical community can foster a more nuanced approach to tobacco control that protects youth while empowering adult smokers to reduce their health risks.