Take 2 on electronic cigarettes
By Rafael Castillo M.D.
Philippine Daily Inquirer
October 4, 2013 at 9:29 pm

A MAN using his e-cig. Photo by RAFFY LERMA

In a previous column (7/20/13), we’ve discussed the pros and cons of electronic cigarettes or e-cigs. Up to that time, there was no scientific data—except obviously biased information from their manufacturers—that would validate their effectiveness and safety as a tool for smoking cessation.

The e-cigs work as a vaporizer which converts a liquid solution into an aerosol mist. There’s a small device inside the e-cig that heats up the liquid nicotine, turning it into a vapor that smokers inhale and exhale.

Earlier this year, the Philippine Medical Association and other health experts have called for a ban on the sale of e-cigs to the public until such time that valid clinical trial data are already available. They pointed out that the sale of e-cigs is unregulated, making them accessible to children and adolescents, who look at them as cool devices to be seen with.

In fairness to e-cigs, a recently published study in the journal Lancet has shown that they (e-cigs) could be as beneficial for smoking cessation as nicotine patches.

3 treatment regimens

In the study, around 650 adult smokers who expressed the desire to quit were randomly assigned to one of three treatments, to be taken as needed for 12 weeks. These three treatment regimens are the 16-mg nicotine e-cigarettes, 21-mg nicotine patches, and placebo e-cigarettes that did not contain nicotine. The study subjects also had access to telephone counseling service anytime they felt they needed it.

After six months, the three groups had similar quit rates (4  to 7 percent). But there were significantly more people in the nicotine-e-cig group than in the patch group who were able to reduce by half their cigarette consumption at six months (57 percent versus 41 percent). There were no red flags to alert the researchers on any possible  side effect of e-cigs compared to nicotine patches after using them for six months.

This study still has some limitations and the results have to be validated in a few more similar randomized studies to see if the results are consistent. But for now, I think it’s reassuring enough for doctors and other health professionals involved in smoking cessation programs to allow or condone the use of e-cigs for individuals who have expressed desire to quit smoking.

Although a cold turkey or abrupt cessation of smoking is still ideal, this is not practicable in most cases and the smoker is likely to slide back into smoking. Nicotine patches are usually recommended to help smokers overcome the strong urge to smoke following nicotine withdrawal.


Now that we have this new study showing that e-cigs are just as good if not better than nicotine patches in cutting by half the number of cigarettes smoked during the weaning process, then e-cigs might be considered as an alternative to nicotine patches in smoking cessation programs.

Can we now recommend e-cigs? I said we can allow or condone its use; but personally, I still have some reservations. I think a nicotine patch is more advisable because it also weans the smoker from the habit of lighting a cigarette, holding it with one’s forefinger and middle finger and lifting it to one’s lips to suck in the smoke or vapor. Using e-cigs is virtually still smoking.

A smoker does not only have to be weaned off from the nicotine addiction, but from the behavioral aspect of being habituated to the act of holding a cigarette, or what looks like it, and gently inhaling the smoke or vapor.

I still believe that e-cigs carry the grave risk of abetting children into learning how to smoke because they may look at them as more of a toy that makes them look “cool.” In this regard, e-cigs with chocolate, caramel, strawberry and even bubble-gum flavors should be banned because there would be more children who would be attracted to these flavors than adults who wish to quit smoking.

It would be better to nip it in the bud before it becomes a fad among schoolchildren.

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