Advice From the Trenches

Advice from the Trenches: e-Cigarettes

ecigDear C:
I have tried to quit many times, but I still smoke. Don’t give me a lecture, I know all about the dangers, but I have too much pressure in my life right now to add more by going cold turkey and neither the patch nor nicotine gum worked for me. Then I discovered e-cigarettes. I tried them and I gotta say — it’s not really smoking, but I can live with it.

Now I hear that e-cigarettes are just as bad for you and encourage people to smoke who wouldn’t otherwise. All I know is if I quit them, I’ll just go back to smoking.
Do you know anything about this?
Smokey Joe

Dear Smokey,
If you’d asked me this question a few months ago, I would have handed you a list of reasons that you are just kidding yourself. Now I am not so sure. Should people smoke? With all of the known risks, including the dangers of second hand smoke, the answer is, of course, “No!” But can everyone stop smoking? Realistically? No.
Public Health England (PHE), an agency of England’s Department of Health, has taken a stance that has raised eyebrows: They regard it a responsibility toward public health to “encourage smokers to switch to e-cigarettes.” This attitude is diametrically opposed to that in the US, where we focus primarily on abstinence.

First, the big question: Is nicotine, in its pure form, really bad for you? The answer is a resounding “maybe.” Nicotine is undeniably addictive, and people smoke mostly because of nicotine. However, nicotine users die mostly because of the tar and additives in cigarette smoke. Take those away and what dangers are left?

The negatives: Nicotine’s greatest risks are to the unborn. Used during pregnancy, nicotine makes children more susceptible to birth defects and, later in life, for type 2 diabetes, obesity, hypertension, neurobehavioral defects, respiratory problems and infertility. In vitro studies also show an increased risk for cancer.

What about adults? In patients with coronary artery disease, nicotine may cause coronary artery vasoconstriction. At high enough doses, nicotine is lethal. However, although cigarette smoking is conclusively linked to cancer, carcinogenicity has not been conclusively proven for nicotine itself. Nicotine is actually used medically to help patients quit smoking.

Are there any medical benefits? I was a hard-sell on this because I am an adamant non-smoker myself. I watched the habit slowly erode my own mother’s health; cigarettes would eventually kill her. But if I put emotions aside, I have to admit that there is some evidence that nicotine, NOT cigarettes, has certain benefits.

Nicotine enhances performance, alertness and focus. Double-blind studies concluded that nicotine had a positive effects on fine motor abilities and memory. GI studies show that nicotine therapy provides some protection against colitis. Nicotine is also suspected as the reason for the lower incidence of Parkinson’s Disease among smokers.
Psychologically, for many people, nicotine decreases stress and anxiety, and reduces panic. Those suffering from some mental illnesses experience great relief from nicotine, which is probably why so many psychiatric patients smoke.
The Center For Disease Control in the US sees e-cigarettes as having a “gateway effect” and that encourages non-smokers to start. But in 2014, the antitobacco organization Action on Smoking and Health (ASH) reviewed the evidence and concluded that e-cigarettes were being used largely by current or former cigarette smokers. ASH also found scant evidence that bystanders could be harmed by the vapor from e-cigarettes. Since their primary goal is harm reduction, ASH considered this good news for assisting smokers who could not or would not give up cigarettes.

So, what is the answer? It really depends on you. Do you honestly think you can’t quit? E-cigarettes do not pose nearly as many health risks as cigarettes and the vapor isn’t a second-hand danger to those around you. But the medical goal of nicotine is NOT to switch from one drug delivery system to another, The goal is to set you free. E-cigarettes cost even more than regular cigarettes. However you ingest it, nicotine is costly and addictive. That monkey on your back may weigh a little less, but in the long run, it’s still a monkey.

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