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Editor's Note
May 2014

If Only Electronic Cigarettes Were Effective Smoking Cessation Devices

JAMA Intern Med. 2014;174(5):813-814. doi:10.1001/jamainternmed.2014.167

Harm reduction is one of the pillars of modern public health. For example, when people criticized methadone treatment as only substituting one drug for another (heroin), public health advocates pointed to research showing that methadone use led to users decreasing or ceasing their heroin use and living more functional lives. Thus, as a harm reduction proponent, I would be willing to put aside the fact that any product with the name “cigarette” (e- or otherwise) causes me reflex tachycardia and support electronic cigarettes (e-cigarettes or electronic nicotine delivery systems) if there were good data indicating that they helped smokers to stop.

Unfortunately, the evidence on whether e-cigarettes help smokers to quit is contradictory and inconclusive. Grana and colleagues increase the weight of evidence indicating that e-cigarettes are not associated with higher rates of smoking cessation. Using longitudinal data from a web-enabled panel, they found that among smokers use of e-cigarettes was not associated with quitting 1 year later or smoking fewer cigarettes.

Although there are no data showing that e-cigarette use helps with cessation, there is potential harm. In particular, e-cigarettes are currently unregulated. Therefore, the tough restrictions on the sale of tobacco to minors do not exist for e-cigarettes. Also, the limitations on where people can smoke do not currently apply to e-cigarettes, with the result that the progress on changing social norms through smoking bans may be threatened. Finally, we simply do not know what potential harm e-cigarettes may cause to their users.

E-cigarettes should be regulated by the US Food and Drug Administration as a drug-delivery device. I agree with Grana and colleagues that sellers of e-cigarettes should not be able to advertise them as smoking cessation devices without sufficient evidence that they are effective for this indication.

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