Antidote: Mixed messages on e-cigarettes
Marc Siegel, MD
It has been a difficult month for e-cigarettes, mostly because the news media doesn't do a great job with mixed messages. First came a study from CDC showing that the rate of e-cigarette use in middle schoolers and high schoolers has doubled over the past year, with the vast majority of these users also using tobacco. The CDC's justified concern was that e-cigarettes could be a gateway drug for tobacco use. Once addicted to nicotine, an e-cigarette user could be simultaneously smoking cigarettes. Despite the fact that 12 states already ban e-cigarette sales to minors, no one is listening. Teens simply borrow e-cigs from their parents, or buy them on the internet.
So the initial media message was that e-cigarettes were bad. But lost in this message was the information that they do in fact help many recalcitrant smokers to cut down, if not to quit. Luckily, a week later another report came out, this time a well-done randomized trial from Australia published in the prestigious British journal Lancet, which demonstrated that e-cigarettes were at least as effective, and probably more effective, than the nicotine patch when it comes to smoking cessation. This makes sense when you consider that most smokers don't just have a nicotine addiction, they also have an oral fixation.
So how to deal with a burgeoning nicotine industry out of control, combined with the fact that there is also a medical usefulness? FDA regulations may be part of the answer, but are not likely to go far enough to affect real change. I have suggested making e-cigarettes prescription-only to make the point that they contain a dangerous chemical, nicotine, but the chances of this actually happening are about the same as me winning the lottery.
The best we can probably do is understand e cigarettes as both a good guy and a bad guy simultaneously. If we can convey this mixed message in the news media, it will be a major success in terms of public information.