Okay, so a concerning statement I have been hearing seems to be coming from more and more patients lately. That being, “I vape doc so that does not count as really smoking, right?” The debate on vaping and risk is ongoing and there is clear evidence that no it is not safe. While there are less chemicals in vaping than in smoking cigarettes that does not equate to safe. To consider it as safe because there are less chemicals in it is like saying it is safe to jump from a three-story building instead of a six-story building.
It is true that people that vape do not get the tar as they do from the tobacco cigarette and that there are significantly less chemicals in vaping than burning tobacco. But this does not translate to an acceptable risk to recommend it as a means to quitting. It has been argued that because E-cigarettes have less chemicals, vaping is safer than smoking cigarettes. Time will tell if this is true, but we have not studied vaping long enough to make this claim. Arguing that vaping is safer and therefore acceptable to recommend to people to help them quit smoking tobacco cigarettes may be premature and, in my view, an irresponsible recommendation from the medical community.
It is clear to me from talking to my patients about this that what the community is hearing from this option of using vaping to quit smoking that vaping is safe and okay. I hear more often from my patients that smoke using E-cigarettes that they are hearing that vaping does not count as smoking and does not have health concerns. This is quite simply false. Some E-cigarettes use formaldehyde and chemicals used in antifreeze that are known to cause cancer to produce the smoke appearance that smokers expect.
Smoking kills approximately half a million people per year in the United States alone, so it is reasonable to consider anything that can reduce tobacco use in the population. Perhaps, by using vaping cigarettes, maybe over the next fifty years or so we will be able to notice a decline in smoking related deaths, but it is going to take that long to have a large enough sample size of people to tease out that difference. Arguably with less chemicals in e-cigarettes, they may be safer than burning tobacco for users but that may not translate to a reduction of risk for secondhand smoke at all.
Tobacco is an enormous business and E-cigarettes are an enlarging piece of that pie. Dollars spent on smoking promotion by the cigarette companies continues to increase. Looking at statistics available from 2016 more than 9.5 million dollars were spent by cigarette companies which translates to 26 million dollars per day or over one million dollars per hour. A major concern is marketing of this product to kids with options like bubble gum or watermelon flavor etc. A clear connection has been made between children that vape and eventually graduating to smoking tobacco cigarettes. It was not until 2016 that law was created requiring a person be of 18 years of age to purchase E-cigarettes and they cannot be sold in vending machines unless in establishments that only allow adults entry.
Nicotine replacement can help curb cravings and withdrawal symptoms, but it is clear there is a psychological addictive component stronger than the physical addictive properties of tobacco use. Quite frequently I see people in the hospital that smoke heavily, and the large majority do not have any nicotine withdrawal symptoms of significance. May have even told me that they did not even think about smoking while in the hospital, but as soon as they got out and back home, they have the strong urge to light up again. This clearly suggests a situational and psychological addictive component which is why nicotine replacement has not been successful for people to quit.
Looking back at healthcare spending in the U.S. by 2010, 8.7% of annual healthcare spending could be attributed to cigarette smoking, amounting to $170 billion per year. More than 60% of this burden was covered by public programs, including Medicare, Medicaid and other federally sponsored programs. So, from a dollars-and-cents standpoint regarding healthcare expenditure it is easy to consider making a recommendation to the population to try vaping as a way to help curb or quit smoking. But population study recommendations do not necessarily translate to appropriate recommendation to an individual person by their physician and I feel it is irresponsible of me to consider this recommendation without giving an individual every opportunity and option to quit smoking entirely. This includes financial support for smoking cessation products and medication options for those that quitting “cold turkey” is not an option. Many insurance programs finally offer some level of coverage for smoking cessation. I am hopeful that because of this more people will be successful at quitting.
Smoking has been the plague of the twentieth century and if we can get better control of tobacco use in the population we will hopefully improve mortality rates. Whether or not vaping is an appropriate option to suggest to people to help cut back tobacco use is still up to debate. Regarding the future, it appears the plague of the 21st century will likely be obesity.
