The good and bad: E-cigarettes may help some patients quit smoking but could be gateway for teens to smoke

The jury’s still out when it comes to how doctors feel about electronic cigarettes, but a plurality says they cause more harm than good.

U.S. physicians can see benefits, in that e-cigarettes or vaping may help patients quit smoking. But on the other hand, they worry the products may get a new generation addicted to nicotine as their popularity grows with teens.

A new poll by the physician social network SERMO found 45% of U.S. physicians said e-cigarettes produce more harm than good. Another 23% said e-cigarettes are more beneficial to public health and nearly one-third (32%) said they see no change to public health because of e-cigarettes.

Globally, doctors were even more tolerant of e-cigarettes when asked if their introduction has been more harmful or beneficial for public health. Of the 2,936 physicians who responded to the survey, 37% worldwide said e-cigarettes are more harmful, 28% said they are more beneficial and 35% said they create no change.

Pros and cons

Doctors see the benefit of e-cigarettes as a means to quit a bad habit. “I have had numerous patients quit smoking using vape and e-cigs for months as a crutch, then stop. I am strongly in favor of their use as a means to completely quit, otherwise, [it’s] just exchanging one lung toxin for another,” commented one U.S. internist in the survey.

But there’s also the fear that e-cigarettes could be a gateway for people, especially teenagers, who normally wouldn’t smoke to go down that path. “We were making big advances in reducing teen smoking. This is not helping,” commented a U.S. pathologist.

A report from the Centers for Disease Control and Prevention found about 2.4 million middle and high school students were current users of e-cigarettes in 2014. Most e-cigarettes contain nicotine, which causes addiction, may harm brain development and could lead to continued tobacco product use among youth, the agency said. The CDC also found that e-cigarette ads reach approximately 70% of U.S. teens.

“The science clearly shows that they are harmful,” says Linda Girgis, M.D., a family physician in South River, New Jersey, in an interview with FierceHealthcare. “These products are not free of nicotine and cause the same addiction.”  Additionally, they contain vapors that are absorbed into the lungs and some of those chemicals are toxic as well as carcinogenic, she says.

No benefit to public health

A study published earlier this month in PLOS One came down clearly on the side of doctors who say e-cigarettes have no benefit to public health. The study said vaping has led more people to develop a smoking habit, rather than avoid tobacco or quit in favor of e-cigarettes.

Like the anonymous internists who commented as part of the survey, Girgis says she has had a few patients use e-cigarettes to try and wean themselves off regular cigarettes. “Most have ended up trading one addiction for another,” she says. There is no evidence that e-cigarettes work to help people quit and the Food and Drug Administration has not issued any recommendations for that use, she notes.

And like other doctors, she is worried e-cigarettes will lead people to smoke tobacco. Even if teens are vaping, they can potentially become dependent on those e-cigarettes, she says. “Many may just continue vaping and I expect we will see more and more teens vaping.”

In a previous SERMO poll, 90% of 2,558 U.S. physicians said there should be restrictions on advertising for e-cigarettes, similar to restrictions on traditional cigarettes. Girgis agrees. “There should be warning labels the same as for cigarettes. Marketing should not be aimed at teens,” she says.

The FDA has recently stepped up efforts to keep teens and others from smoking. The agency announced Tuesday it is exploring options to address the role of flavors, including menthol, in tobacco products, which appeal to kids and get them started smoking. It also recently issued an advance notice of proposed rulemaking to explore a product standard to lower nicotine in cigarettes to minimally or nonaddictive levels.

Quitting is a tough battle for patients, Girgis says. She thinks the rates of smoking have decreased, which she attributes to a decline in teens taking up smoking rather than older smokers quitting the habit. Doctors are ready to help, but “nothing is effective in a patient who is not ready to quit. It takes a very determined patient. There are aids to help but it needs great effort from the patient,” she says.