Nearly everyday in my practice I see the tragic, avoidable results of smoking:  A woman with emphysema that requires her to be constantly connected to an oxygen tank, a man with a cancer in his throat that has robbed him of the ability to eat or speak, fatal and debilitating heart attacks and strokes that occur at much too young of an age.  The list goes on and on.  Indeed, nearly 450,000 Americans each year die of complications of smoking.  Anything that can help avoid this great amount of human suffering deserves our consideration.

Accordingly, I offer the following reflections on electronic cigarettes.  First of all, what are they?  As a Medscape article explains:

“Electronic cigarettes — e-cigs — look like cigarettes in size and shape, but they are nonflammable, so you don’t smoke them. Instead, you “vape” them.”

While nicotine is the substance that causes pleasure and addiction to cigarettes, it is not what causes the manifold maladies that result from smoking tobacco.  Rather, it is the other noxious, toxic chemicals in tobacco that harm and kill.  So, do e-cigs have any of these toxic chemicals?  A new study in the journal Tobacco Control analyzed vapors from a dozen e-cig brands and also found some toxic substances.  But these toxins were found at levels 9 to 450 times lower than in regular cigarette smoke. 

While e-cigs don’t appear to expose people to the same high level of toxins that real cigarettes do, they effectively reproduce the nicotine rush produced by inhaling smoke from burning tobacco.  Thus, they have the potential to be a much less harmful way for people addicted to nicotine to continue to get their fix.  Thus, for my patients who are not interested in smoking cessation, I recommend they change to e-cigs as a less toxic option.

Nonetheless, I share some of the concerns voiced by others about e-cigs.  Since using e-cigs might seem to be a safe practice, they may promote nicotine addiction and possibly be a pathway to smoking tobacco.  People who otherwise might have quit smoking altogether may now transition to long-term e-cig use, thus inhaling the low levels of toxins the Tobacco Control study revealed.  Finally, there is the concern that e-cigs are used by some smokers, not to quit their habit, but as a way to smoke (or vape) in public places where smoking tobacco is banned. 

In sum, however, it appears to me that e-cigarettes offer a much less harmful alternative for tobacco smokers who are unwilling or unable to end their addiction.