E-cigs for quitting smoking? A cautious thumbs-up from American Cancer Society
The American Cancer Society is recommending — with caution — to health care clinicians that they add electronic cigarettes and vaporizers as a smoking-cessation option.
The nonprofit group stressed Tuesday its policy statement is directed strictly at adults, including strongly recommending against e-cig use by the young.
The organization also said that it will closely monitor e-cigs innovations and research.
“The ACS has always supported any smoker who is considering quitting, no matter what approach they use; there is nothing more important that they can do for their health,” the group said.
“Based on currently available evidence, using current generation e-cigarettes is less harmful than smoking cigarettes, but the health effects of long-term use are not known.”
The group’s shift on e-cigs “is very encouraging,” said David Sweanor, an adjunct law professor at the University of Ottawa and the author of several electronic-cigarette studies.
“To see the most significant health- focused non-governmental organization in America recognizing the importance of the continuum of risk that FDA Commissioner (Scott) Gottlieb has identified as an essential component to reducing the toll from smoking.”
On July 28, Gottlieb announced plans for a sweeping regulatory “road map” on tobacco and nicotine products.
It calls for lowering the nicotine level in traditional cigarettes to nonaddictive levels; limiting or eliminating flavorings, such as menthol in traditional cigarettes and candy and fruit flavors in e-cigs and vaporizers, which the FDA says appeal to young people; and establishing rules to make product review more efficient, predictable and transparent for manufacturers, while upholding the agency’s public-health mission.
The ACS said it encourages the federal agency to use its full authority to regulate tobacco products, including reducing tobacco use through regulation.
Scott Ballin, past chairman of the anti-smoking alliance Coalition of Science or Health, said he hopes the ACS will expand its statement to include potential reduced-risk tobacco and nicotine products such as snus.
On Nov. 30, the FDA announced creating a nicotine steering committee to “re-evaluate and modernize” its regulatory approach. Gottlieb and other FDA senior managers said the committee’s main focus will be on the development and regulation of nicotine-replacement products.
Most of those products are sold over the counter as gum, patches and lozenges, including Zonnic, a gum made by Reynolds American Inc. subsidiary Niconovum.
The ACS said clinicians should advise their patients to use FDA-approved cessation aids that have been proven to support successful quit attempts.
“Some smokers, despite firm clinician advice, will not attempt to quit smoking cigarettes and will not use FDA-approved cessation mediations,” the ACS said.
“These individuals should be encouraged to switch to the least harmful form of tobacco product possible; switching to the exclusive use of e-cigarettes is preferable to continuing to smoke combustible products.”
The ACS said it “strongly discourages the dual use of e-cigarettes and combustible cigarettes, a behavior that is far more detrimental to a person’s health compared to the substantial health benefit of quitting smoking.”
Sweanor said the ACS statement “is still a long way from their pragmatic counterparts in the United Kingdom, who go into detail on the magnitude of the differences in risk and more actively encourage smokers to switch to non-combustibles.”
“So there is still a long way to go to facilitate informed personal health decisions by people who smoke. But it shows that science and good public health ethics are changing the debate on nicotine.”
The ACS statement comes about a month after a congressional-mandated review on e-cigs failed to clear the vapor on the public-health benefits of using the products as an alternative to traditional cigarettes.
The review by the National Academies of Sciences, Engineering and Medicine was sponsored by the FDA. It encompassed more than 800 peer-reviewed studies.
Some of those studies, including one by the Royal College of Physicians, have claimed that e-cigs and vaporizers are up to 95 percent less harmful than traditional cigarettes.
Other studies claim that e-cigs and vaporizers are not less harmful and also can serve as a gateway to smoking traditional cigarettes, particularly by teenagers.
“While we welcome any public pronouncement that may help in correcting misconceptions about vaping products in the public health community, a short policy statement can only do so much,” said Gregory Conley, president of the American Vaping Association.
“We are hopeful that the Cancer Society will change the way they handle this issue when communicating with legislators and the public.
“It is difficult to claim that you support smokers who choose to quit smoking with vaping if you are simultaneously arguing for cigarette-style taxation and flavor bans that lead to the closing of vapor retail stores,” he said.
The pro-e-cig advocacy group Consumer Choice Center said Wednesday that "given the growing body of evidence in the U.S. and around the world that suggests the need to support the use of lower-risk nicotine products to quit smoking, the ACS was forced to either stubbornly continue its opposition to e-cigarettes, or lose their scientific credibility."
Jeff Stier, a senior fellow with the group, said that "the ACS took a step in the right direction by recognizing this important harm-reduction method."
"I continue to call on the American Heart Association and other major health organizations to reverse course and support smokers who wish to quit smoking with the use of e-cigarettes, heat-not-burn tobacco, or smokeless tobacco, all of which are significantly less harmful than smoking."