Some U.S. doctors buck health authorities to recommend e-cigarettes in clinical practice
In the paper, author R Street Senior Fellow Dr. Edward Anselm notes that roughly 24.5 million adults nationwide report in surveys that they use e-cigarettes. About one-third of these adult vapors have stopped smoking altogether, while three-fifths continue to smoke. Less than one in 10 report they never smoked cigarettes.
But while British health authorities, relying on an evidence summary from Public Health England estimating that e-cigarettes are 95 percent safer than combusted cigarettes, now recommend dispensing e-cigarettes to encourage smokers to transition, Anselm observes the U.S. Food and Drug Administration recently promulgated costly rules “that will eviscerate the e-cigarette Industry.”
Among the reasons the evidence has been so received differently in the two countries, Anselm notes, are cultural differences between their respective public-health communities. While the United Kingdom has a long tradition of encouraging harm reduction in the context of addiction, U.S. authorities have treated programs like methadone maintenance and needle exchange much more skeptically.
“When framed within the context of reducing the burden of tobacco-related illness, the evidence appears to favor use of e-cigarettes; when framed within a context of unknown harms, uncertainties regarding content, unintended consequences and the potential for utilization by youths, use of e-cigarettes generates red flags,” Anselm writes. “For public-health officials steeped in a precautionary principle, the baseline directive is that no action should be taken until e-cigarettes are shown to be safe.”
Nonetheless, U.S. doctors report two-thirds of their smoking patients ask about e-cigarettes and between one-third and two-thirds of U.S. physicians advise smokers to use them. Anselm notes that changes may also be needed to the current model of treatment, under which smokers who state that they are not ready to quit are provided no treatment. Among the newer approaches endorsed by some are to approach tobacco use as a chronic disease or to adopt an opt-in treatment approach, wherein every smoker seen by a clinician is provided with an intervention, regardless of their readiness for change.
“The use of e-cigarettes for smoking cessation and tobacco harm reduction among adults has become a cultural norm,” Anselm writes. “Rather than resist it, we should do what our counterparts in the United Kingdom already have done: embrace it and find ways to make it even better.”