Wellness and prevention information from the experts at the Penny George Institute for Health and Healing

Weighing in on the debate: Are e-cigarettes a healthy tool for quitting or a gateway device to smoking?

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By Courtney Baechler, MD

If you’ve taken the time to follow our wellness blog, chances are you’re not a smoker. But perhaps you’ve heard about the heated debate around e-cigarettes, or e-cigs. I wanted to weigh in and offer up some facts.

E-cigarettes, introduced in 2007, offer synthetic, liquid nicotine that is vaporized to promote the sensation of smoking. They deliver nicotine, but don’t expose the user to the dangerous, cancer-causing agents found in the tar of cigarettes.

On the surface, e-cigs can seem like a logical solution to helping people quit smoking. After all, one of the evidenced-based recommendations that doctors turn to in helping people quit is nicotine replacement. So, why not use e-cigs for nicotine replacement? E-cigarettes also have the benefit of letting people maintain their “oral fixation” and smoking habit, which can be hard to break.

So, what is all the fuss about?

The challenge is e-cigarettes make the claim that they are “safer” than traditional cigarettes and should be used as a substitute, but we really don’t know that to be true.  The medical community has never studied what happens to people exposed to large amounts of nicotine overtime.  We know nicotine is highly addictive and the potential for abuse is large. It’s also unclear whether there is harm from “secondhand vapor.”

Another problem is e-cigarettes are a rapidly growing business that isn’t being regulated. You might have noticed e-cigarette shops popping up everywhere. Their owners have a lucrative product and an addicted consumer base that is likely to come back for more. In just a few years, e-cigarettes have grown to a $1.7 billion industry.  Wall Street projects that e-cigs will take over the $90 billion tobacco industry within the next decade.

Unlike the traditional cigarette industry, which is highly regulated, there is no legislation to say where you can and cannot use e-cigs. I saw someone light up an e-cig in a nail salon. A colleague saw someone do the same at a meeting.

For traditional tobacco, we have come a long way with laws like Freedom to Breath. It not only curbs issues around second-hand smoke, but also helps to change cultural norms by sending a message to kids that smoking is not OK. There is the potential to “renormalize” tobacco and subsequently increase in the number of adolescents taking it up. From afar, it’s unclear whether someone is smoking a cigarette or “vaping” an e-cig.

There also are no restrictions around marketing to children and adolescents. The e-cig companies even offer flavored products that appeal to youth.

In fact, experimentation with e-cigarettes doubled  among students in grades six through 12 from 3.3 percent in 2011 to 6.8 percent in 2012, according to the Centers for Disease Control. The numbers were even higher among high school students, 10 percent of whom reported trying an e-cigarette in 2012 ― more than double the share over 2011.

The strongest predictor of whether someone becomes a lifelong smoker is how early he or she starts experimenting, and the concern is that experimentation with e-cigarettes could be gateway to tobacco.

From a public health perspective, e-cigarettes raise two questions: How harmful are they? And, regardless, will they lead to smoking cessation or, perversely, reinforce the tobacco smoking habit?

My question for you to consider is why we would ever encourage something that is known to be highly addictive? Is this where we want to move as a society? Something to think about.

Courtney Baechler, MD, is a practicing physician with and the vice president of the Penny George Institute for Health and Healing. She has a master’s degree in clinical epidemiology from the University of Minnesota’s School of Public Health.

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