Friday, April 29, 2011

Are E-Cigarettes a Good Idea or a Bad Idea?


A group of nicotine researchers argue for an alternative.

Electronic cigarettes are here to stay. If you're not familiar with them, e-cigarettes are designed to look exactly like conventional cigarettes, but they use batteries to convert liquid nicotine into a fine, heated mist that is absorbed by the lungs. Last summer, even though the FDA insisted on referring to e-cigarettes as “untested drug delivery systems,” Dr. Neal Benowitz of the University of California in San Francisco--a prominent nicotine researcher for many years--called e-cigarettes “an advancement that the field has been waiting for.” And recently, Dr. Michael Siegel of the Boston University School of Public Health wrote: “Few, if any, chemicals at levels detected in electronic cigarettes raise serious health concerns.” Furthermore, Dr. Siegel took a swipe at the opposition: “The FDA and major anti-smoking groups keep saying that we don’t know anything about what is in electronic cigarettes. The truth is, we know a lot more about what is in electronic cigarettes than regular cigarettes.”

Harm reduction advocates are ecstatic. But do e-cigarettes simply reduce harm by eliminating combustion by-products--or do they perpetuate nicotine addiction, frustrate the efforts of smoking cessation experts, and give false hope to smokers that they can have their cake and eat it, too?

Dr. Siegel conducted a survey of e-cigarette users and found that 66% reported a reduction in the number of cigarettes smoked at the six-month point. “Of respondents who were not smoking at 6 months, 34.3% were not using e-cigarettes or any nicotine-containing products at the time.” Pretty impressive--although Siegel himself refers to the findings as “suggestive, not definitive”--and seemingly a giant leap forward for harm reduction.

However, even though they have dramatically altered the harm reduction landscape, e-cigarettes will not change anything for smokers who are attempting to completely quit using nicotine. When they inhale their last e-cigarette mist, several hours later they will begin to suffer the same withdrawal pains as regular cigarette smokers: “Irritability, craving, depression, anxiety, cognitive and attention deficits, sleep disturbances, and increased appetite,” as NIDA summarizes it. Current smokers are keenly interested in the new products, partly because of health concerns, and partly, it seems safe to venture, because a new generation of nicotine-based products like e-cigarettes “will enable them to put off the need to quit smoking,” as Dr. Dorothy Hatsukami, director of the Tobacco Use Research Center at the University of Minnesota, has asserted.

Harm reduction advocates for the electronic cigarette often make it sound like once the smoker is only inhaling nicotine, his or her problems are solved. But nicotine, of course, is the addictive part. Nicotinic receptors are present in moderate to high density in the brain areas containing dopamine cell bodies--the ventral tegmental area and the nucleus accumbens—the same pattern as almost every other addictive drug.

Even that part wouldn’t be a problem if addiction to nicotine were utterly benign. But it isn’t--although you wouldn’t know it from the pro-electronic cigarette propaganda. Nicotine in the blood is correlated with increases in arterial vasoconstriction, and is strongly suspected of playing a role in arteriosclerosis and other cardiovascular diseases. Nicotine increases LDL cholesterol, causes brochoconstriction, and has been implicated in the origin of lung tumors. There are also strong suggestions of links between nicotine and low birth weights in newborns.

So, it’s important not to kid ourselves about the hazards of nicotine, even though it may also be a medicine under certain conditions, like many other addictive drugs. Nicotine, you may recall, found industrial use as a farm crop insecticide. A poison, in other words. Nonetheless, what nicotine is NOT linked to certainly matters as well. Nicotine does not cause chronic obstructive pulmonary diseases, like emphysema—a huge plus. Nicotine won’t worsen asthma, as cigarettes do. And in the form of the electronic cigarette, it won’t cause secondhand smoke—another major plus for the e-cig.

There is another approach to regulating the harm caused by cigarettes. A group of scientists has been calling for a major effort at reducing the amount of nicotine in cigarettes so that, over time, a non-addictive level of nicotine would be reached--and cigarettes would no longer be addictive. Study after study has shown that if such were the case, about 80 to 90% of smokers would quit. And teens who experimented with truly low-nicotine cigarettes wouldn’t get hooked—unlike the “light” cigarette scandal, where the supposedly safer cigarettes may actually have turned out to be more dangerous because they forced smokers to smoke more in order to get the desired effect. Dr. Hatsukami and five other prominent nicotine experts contend that extremely low-nicotine cigarettes do not cause smokers to smoke more, “because it is harder to compensate for very low nicotine intake,” according to Hatsukami. Especially if there are no high-nicotine alternatives for sale—legally, at least. Mitch Zeller, who along with Hatsukami, co-chairs the National Cancer Institute’s Tobacco Harm Reduction Network, painted this picture: “Imagine a world where the only cigarettes that kids could experiment with would neither create nor sustain addiction."

Nonsense, counters Dr. Gilbert Ross of the American Council on Science and Health. “Asserting that smokers won’t smoke more cigarettes to get the nicotine they crave is a fairy tale,” he said. “The likely result is a major increase in cigarette-related diseases.”

These are the competing visions of our nicotine-addicted future. In one scenario, smokers stay addicted to nicotine, with its accompanying heath risks and all the other negative aspects of being addicted. But the immediate harm to their health is lessened due to fewer inhaled carcinogens, and they don’t create secondhand smoke. In the opposing scenario, smokers continue to smoke, and society continues to deal with secondhand smoke through no-smoking policies, while medical research agencies, under government mandate, oversee the gradual reduction of nicotine in cigarettes to a level below what is needed for addiction.

The optimistic thought here is that either of these approaches would bring much-needed improvement to the semi-controlled anarchy and hypocrisy of the current situation.

Photo Credit: http://whyquit.com 

25 comments:

The Devil's Thadvocate said...

If e-cigarettes could be proven to help smokers quit using nicotine they would be subject to tight controls on therapeutic products that would effectively ban them for several years. Ironically, if e-cig manufacturers do not make those claims but leave it to consumers to figure out that although they may not have "quit" using recreational nicotine/tobacco, technically speaking....By definition, they HAVE STOPPED (or at least sharply reduced) SMOKING. Any conceivable risks from a half-teaspoon of air sanitizing vapor can not reasonably be compared to the myriad hazards and byproducts of combustion from chronic smoking.

Vapor is not smoke. Nicotine is not a carcinogen. How could it POSSIBLY be a bad idea to replace smoke with smoke-free nicotine vapor? How dangerous can a battery-powered fog machine possibly be??

Michael Siegel said...

Dirk,
This is a really nice summary of the "harm reduction" debate in tobacco control as it relates to electronic cigarettes. The only thing I would point out is that one potential problem with the idea of cutting nicotine levels in cigarettes is that reduction in nicotine has been shown to cause compensatory increases in cigarette smoking amount and intensity. Thus, it is quite possible that by greatly reducing nicotine levels in cigarettes, as some have proposed, MORE disease and death would result because the delivered dose of tobacco toxins and carcinogens would increase.

Also, the idea that there is a level of nicotine low enough so that it cannot sustain addiction is only a theoretical one. Studies which support this idea have been done in a climate where subjects can easily resume smoking regular cigarettes. If all cigarettes had nicotine levels that were very low, there would be no option to switch to a higher nicotine cigarette, so it is very possible that such an intervention would result in no major decline in cigarette smoking.

Thanks for a very nice and well-balanced summary of this important and provocative issue.

Dirk Hanson said...

Dr Siegel:

Thanks very much for your informative comments on the e-cigarette debate, and your kind words about the post. I have tried to present the debate as evenhandedly as possible, and your comments as a leading tobacco expert will help readers decide for themselves about e-cigarettes.

I originally viewed e-cigarettes as simply a workaround that smokers could use to evade no-smoking laws when necessary. Whether they evolve into systems for tobacco (and nicotine) cessation remains to be seen. Their harm-reduction advantage is obvious. But one potential problem, I think, is that the e-smoker, still hooked on nicotine, is at constant risk of a return to the original--and far more satisfying--habit of smoking tobacco.

Thanks again for taking the time to respond.

Dirk Hanson said...

For The Devil's Thadvocate:

--pure nicotine as possible carcinogen: "Nicotine Potentially a Multifunctional Carcinogen?"
http://toxsci.oxfordjournals.org/content/79/1/1.full

--pure nicotine as teratogen: "An assessment of the long-term developmental and behavioral teratogenicity of prenatal nicotine exposure."
http://www.ncbi.nlm.nih.gov/pubmed/15033289?dopt=Abstract

Sam Munro said...

I concur with Mr Seigel's thoughts, by recucing the level of nicotine content in a cigarette, the user will have to smoke more to sate his or her craving. The problem being that although the nicotine is at a safer level the tar and other chemicals will not be. thus there will be a disproportionate increase of toxicity intake.

Vicks - Personal Vapes said...

One thing that I must point out, and seems to be missed by a large level of the experts in both tobacco control and the anti-smoking groups:

SMOKING is the act of lighting a tobacco-based substance on fire, and inhaling the results of that combustion into your lungs.

When it's stated that E-Cigarette users are sustaining their smoking habit by using nicotine suspended in glycol, it is a falacy. E-Cig users who no longer light a cigarette are NOT SMOKING.

The debate here seems centered around 2 different values: SMOKING cessation and NICOTINE cessation - 2 entirely different goals for those who are smoking, vaping, using Pharma NRT's beyond the package directives, going with other smoke-free alternatives such as snus, dissolvables and etc.

anyone who no longer ignites a tobacco and sucks that smoke into their lungs is NOT smoking...irregardless of wether or not they are still consuming nicotine.

Please get this vital distinction straight!

Dirk Hanson said...

I take your point, but outside of the doper community, "vaping" isn't a very commonly understood term. For the average person, if it heats up, and you inhale it, and you puff out the inhalation as a visible mist--it's smoking. Undoubtedly that will change with time.

The Devil's Thadvocate said...

Dirk, the carcinogenic tobacco-specific nitrosamines mentioned in the first article are found in identical quantities in pharmaceutical nicotine products. Likewise the possible impacts of nicotine usage during pregnancy is certainly an issue that obstetricians must keep in mind before prescribing NRTs, but most doctors agree that risks of continued smoking during pregnancy far outweigh the risks of pharmaceutical nicotine replacements.

It is clear that nothing is 100% safe and complete nicotine abstinence may be the best choice for some people, but should it not remain a CHOICE? In spite of decades of "denormalization" of tobacco, draconian taxes and regulations, and repeated attempts to quit, one out of five people continue to use tobacco in one form or another.

Rather than attempting to ascribe moral value to recreational choices or physical dependencies, why can't we simply encourage inveterate smokers to switch to Smoking Replacement products like e-cigarettes?

Both of the studies you cited about the risks of nicotine would equally apply to pharmaceutical nicotine products. However, unlike the nearly identical Ariva or Stonewall tobacco products, NRT products AREN'T required to warn consumers that it is "Not a safe alternative".

On the other hand, the comparative risks of continued smoking are allegedly so terrible as to justify the continued sales of varenicline in spite of multiple reports of DEADLY side effects.

A drug that has been linked to cases of otherwise sane people suddenly committing acts of violence against themselves and others is being advertised on TV as a good way to stop smoking...and you are seriously questioning if switching from smoking to a smoke-free alternative tobacco product is a good idea?

Again I ask, how much damage do you think 1ml of 2% nicotine liquid can do? Worst case scenario: If every person on the planet started using e-cigarettes, do you think that would cause more people to have their health worsen than there are vapers who have already reported that their health improving since they switched?

Dirk Hanson said...

In the post, I write: "Nicotine does not cause chronic obstructive pulmonary diseases, like emphysema—a huge plus. Nicotine won’t worsen asthma, as cigarettes do. And in the form of the electronic cigarette, it won’t cause secondhand smoke—another major plus for the e-cig."

Don't know how I could be much clearer about the obvious health benefits conferred by e-cigarettes. What I attempted to point out is that, since e-cigs are not part of any formal stop-smoking procedure that I am know of--unlike gum and patches and sprays--any claims that e-cigs conduce toward nicotine abstinence are not well supported. And nicotine is not only addictive, but bad for your health in and of itself. Anybody who says they know the health effects of smoking 30 liquid nic cartridges a day is kidding themselves. That's the part e-cig fans don't want to confront.

The Devil's Thadvocate said...

"Anybody who says they know the health effects of smoking 30 liquid nic cartridges a day is kidding themselves."

Cartridges are not smoked, they wick a small amount of liquid onto the atomizer during use. A 1ml cartridge generally produces enough vapor to replace 10-20 cigarettes (YMMV). I'm not sure it is POSSIBLE to vape 30 cartridges in one day, but it would surely be far less harm than the equivalent 2 CARTONS of cigarettes.

Even the above extreme example, 6 teaspoons (30ml) of propylene glycol is less than is used by a fog machine during a single song in a dance club or stage performance. Are fog machines to be considered a public health menace? I hope not, since propylene glycol is used as an AIR SANITIZER in schools and hospitals.

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Electronic Cigarettes said...

A drug that has been linked to cases of otherwise sane people suddenly committing acts of violence against themselves and others is being advertised on TV as a good way to stop smoking...and you are seriously questioning if switching from smoking to a smoke-free alternative tobacco product is a good idea?

kelly said...

When a student kills himself because his mum was too poor to pay for a school exhibition trip, is the "school outing cessation" the reason why the student killed himself?

Smokeless cigarettes industry puts the blame for death and suicide tendancies of quitting smokers on "smoking cessation" and tries to put eCigs in good light.

They underplay the harms of nicotine and although an eCig has 4,000 lesser toxins than cigarettes, they replace those with Propylene Glycol (diethylene glycol). So now, smokers get to be guinea pigs because no one knows for sure what long term effects of inhaling P.G. is.

And there are lies spread about eCigs being endorsed by 2 organizations. If you dig deeper, they were endorsing smokeless CHEWED tobacco (and even so, chewed tobacco has it own harms like oral cancer.)

I don't see how anyone wants something more than oxygen - the only 'gas' you need.

Everytime a new product is invented, they need ways to market it. If people need to sell something, they need to have the ethics to sell things which are not harmful to environment (which is what nicotine liquid is when exposed to children), animals and humans.

Rosalyn said...

I have quit smoking Regular Ciggaretts and am using the e cigg. I feel a huge improvement in not only how much I smoke as compared to before but, a major improvement in lung capacity! I have also gained the gift of more money in my wallet!! I am well on my way to quitting both but, for now I feel it is the same as nicotine delivery in patches or other stop smoking aids..no?

Anonymous said...

As someone who once smoked a pack a of cigs a day i can say that ecigs have saved my life. I purchased e cigs to help me with my cravings once i decided to quit. I purchased filters with lower levels of nicotine and gradually lowered the nicotine to the lowest level sold in stores. While i may have been ingesting some harmful chemicals with ecigs it certainly was less than a pack of cigs a day. Why cant we just be happy with progress.

Anonymous said...

As a recent adopter of the e-cig I think the above is a fantastic discussion of the main issues.

Like many (most?) smokers, I cannot give up smoking permanently but desperately want to. I am concerned about the long-term consequences of vaping but for now its obviously better for me than smoking.

It is quite interesting to note that one of the biggest criticisms (and certainly most logically coherent!)of e-cigs is that ex-smokers may simply use them to maintain nicotene addiction. Hello? What do you think I and thousands (millions?) of other smokers are doing with NRTs. Yes that's right we use them for years and years to maintain nicotene addiction!

A good by product of using e-cigs is that I am no longer dependent on BIG FAT PHARMA and BIG FAT TOBACCO to service my nicotene habit.

Hopefully, the ability to control nicotene dose with e-cigs will allow more research into nicotene addiction and better ways to stop nicotene addiction.

Dirk Hanson said...

Thanks for frankly stating that many smokers use NRTs to continue using nicotine in a (hopefully) less harmful form. The danger here, I think, remains the same as it is with tapering--that at some point, you'll no longer find it satisfying enough and flip back to cigarettes....

Anonymous said...

Thanks Dirk...but nothing is ever as satisfying as a real cigarette :-)

I suspect there is a lot we dont know about nicotene addiction. I also suspect a lot of smokers like myself are far more expert on this topic than a lot of the experts! Problem has been that smoking is a moral issue as much as a health issue for many people who adpot a strong anti smoking stance or health care regulators. Little do the realise that they are as addicted to smoking as a smoker. Several govts could simply not afford to lose the massive tax revenues from tobacco. Arguments that these only partly offset the health care costs are ridiculous. In Australia total tax revenues from tabacco could fund several 5000+ bed hospitals every year!

The curious thing about nicotene is that, despite what many believe, it has absolutely no positive reward value for the smoker, just diminishes the negative effect of nicotene withdrawal. Its a vicious cycle that can persist for a lifetime once nicotene tolerance is intially established. Maybe after your first few cigarettes?

I have smoked for 30 years and have been trying to give up for at least 25 of those. I have tried various quit smoking programs and there is not much about NRTs I dont know (patches, gums, lozenges, mini-pills, inhalers, nasal sprays). If you know of ANY research of the long-term use of those products please let me know! Certainly something big pharma and the FDA choose to ignore.

I have also used champix and zyban in combination with NRTs and have been able to give up smoking for at least 12 months with this...but never ever without nicotene.

I think for many smokers giving up is not something you decide to do and then forget about, its a decision you need to make hourly, daily for years and years and years. It only takes a single cigarette to reignite that vicious cycle, regardless of NRTs and tapering or not.

My hypothesis is that its the speed of delivery. Smoking provides the shortest interval between the behaviour (smoking) and effect (nicotene entering the brain).

Smoking also provides a greater correlation between nicotene blood levels and behaviour. These two aspects of smoking are ignored by the experts and the reason why I think e-cigs may provide the only viable long-term alternative to smoking for many nicotene addicts.

Time will tell I guess but as Alber Ellis once said, "I'm just a dirty nic addict".. at least with e-cigs I can forget the dirty!

Dirk Hanson said...

When I tell people that most smokers wish they didn't smoke, don't like it anymore, and would quit if they could, a lot of people don't believe it. If it's not pleasurable, why would you do it compulsively. Well, obviously to compulsively chase away a greater unpleasantness--nicotine withdrawal. Never-smokers simply don't realize how strong that grip is. And so they add in all sorts of ill-conceived psychosocial theories about it.

Anonymous said...

I agree entirely Dirk, that seems a point lost on many...smokers may not have as much choice about smoking as many believe.

I have a pet conspiracy theory that the secret tobacco company research people always refer to was not about the health effects of smoking but the phenomonally addictive nature of nicotene. I bet they found those little rats could be electrocuted to the point of BBQ and would still want the nicotene!

If you and I are right about smoking I think tobacco will rapidly become a thing of the past. e-cigs have gone viral now and anyone can make their own atomisers, mix their own juice and even extract their own nicotene (can be sourced from a variety of plants, not just tobacco). With Govt's, big pharma and big tobacco suddenly out of the nicotene picture there are no longer any BIG obstacles to developing a permanent cure for nicotene addiction.

It's interesting to note that the e-cig was invented in 1963 (see wiki) and dissapeared until a chinese chemist reintroduced it in the mid 80's. I wonder why? I wonder how much death and disease could have been avoided if it was developed earlier?

I also predict that we will see a big reversal of the anti e-cig/vaping stance taken by organisations like the WHO and FDA. Very disturbing that these organisations have been so moronic in their initial reactions to e-cigs!

I think its obvious to anyone with some education and intelligence (and access to the internet)that e-cigs or vaping nicotene is infinitely better than the only alternative many nicotene addicts have - smoking tobacco.

Juvo said...

I find it quite interesting to observe that the 1st comment on this piece was in April 2011 and the last one is in Aug 2012 and both are part of the same unbroken thread of argument.

Unfortunately looks like nothing much has changed in over a year. People on both sides of the debate continue to hold their positions.

I have been a 1/2 pack a day smoker for about 7 years. Now I'm using e-cigarettes and havent smoked cigarettes in over a month. I hope to keep that trend going.

My 2 cents..

While I am absolutely on board with the point that e-cigs are better than smoking tobacco - no question about it - thats why I'm trying to switch. At the same time there are other complexities in the issue which e-cig proponents need to acknowledge i.e.

a) Unfortunately e-cigs are not well regulated by anyone and hence the level of standardization and quality control which you would expect are sadly missing. I would be very happy for a regulator to start defining minimum standards of safety and quality that these products should adhere to and hold them accountable to that standard. I believe that standards do exist for cigarettes which prescribe minimum/maximum levels of nicotine, tar etc. (correct me if i'm wrong on the last point)

b) There is a concern that if e-cigs get labelled as safe to use it may encourage people who are otherwise non-smokers to take up "vaping". I feel this is also an important issue and hence the possible reluctance from authorities in accepting these products as safe.

However, the argument which I find very difficult to buy is the one which says that e-cigs make it easier for a person who has quit to re-start smoking. Quitting smoking is difficult and requires a lot of will power. Not just at the instant when you quit but on a continuous basis. My experience with other NRTs like chewing gum which I've tried is that these really do not do much to alleviate the "craving" for cigarettes and hence a person is actually far more likely to give up and go back to smoking.

In my case at least, e-cigarettes have significantly eased the "cravings" and hence I'm actually far less likely to give up and go back to smoking.

Juvo said...

I find it quite interesting to observe that the 1st comment on this piece was in April 2011 and the last one is in Aug 2012 and both are part of the same unbroken thread of argument.

Unfortunately looks like nothing much has changed in over a year. People on both sides of the debate continue to hold their positions.

I have been a 1/2 pack a day smoker for about 7 years. Now I'm using e-cigarettes and havent smoked cigarettes in over a month. I hope to keep that trend going.

My 2 cents..

While I am absolutely on board with the point that e-cigs are better than smoking tobacco - no question about it - thats why I'm trying to switch. At the same time there are other complexities in the issue which e-cig proponents need to acknowledge i.e.

a) Unfortunately e-cigs are not well regulated by anyone and hence the level of standardization and quality control which you would expect are sadly missing. I would be very happy for a regulator to start defining minimum standards of safety and quality that these products should adhere to and hold them accountable to that standard. I believe that standards do exist for cigarettes which prescribe minimum/maximum levels of nicotine, tar etc. (correct me if i'm wrong on the last point)

b) There is a concern that if e-cigs get labelled as safe to use it may encourage people who are otherwise non-smokers to take up "vaping". I feel this is also an important issue and hence the possible reluctance from authorities in accepting these products as safe.

However, the argument which I find very difficult to buy is the one which says that e-cigs make it easier for a person who has quit to re-start smoking. Quitting smoking is difficult and requires a lot of will power. Not just at the instant when you quit but on a continuous basis. My experience with other NRTs like chewing gum which I've tried is that these really do not do much to alleviate the "craving" for cigarettes and hence a person is actually far more likely to give up and go back to smoking.

In my case at least, e-cigarettes have significantly eased the "cravings" and hence I'm actually far less likely to give up and go back to smoking.

Mark the Vaper said...

Some good points stated out on this post particular to the comments section. Dirk, wonderful job on spurring the 'em vapers reactions. Anyways, if I may add, nicotine by far(as of what I researched) is one of the most addictive substance. And this is something that non-smokers do NOT understand. I can't help but be moved myself to your statement that "would quit if they could..." Easier said than done! Trust me, I've tried more than a dozen times to quit and tried alot of NRT products, but none has ever worked(I can't help but give credit to those who actually quitted using 'em, I can't imagine their willpower). But with e-cigs, it has particularly kept me away from the real thing.

I could simply say that nothing has ever come closer to smoking than that of e-cigs. And I think it's one of the reasons why it's so popular now. When I was still on patches I remember particularly missing holding something with my hand(and the popping) and missing the sight that the light effect from burning cigar. But with e-cigs, well you probably figured out my point. Also one thing I noticed that e-cigs do is somewhat divert your cravings slowly from the nicotine to the flavor. Now I'm more into the flavors and have gradually lowered the nicotine strength in my e-cigs.

So if you ask me, "are e-cigarettes a good idea or bad idea?" I definitely would say it's a good idea.

I can't help but be disturbed and wonder by Kelly's comment. One of the questions that run through my mind is, what does P.G. or Propylene Glycol or diethylene glycol do? Are there any severe hazards that we should know about P.G.? Anyone care to enlighten me?

Kind Regards,
Mark J.

Anonymous said...

I am 37 years old and have been smoking since I was 17. I took a break while I had my children but quickly started back. After almost 20 years of smoking I was introducted to vapor cigarettes in in just a week I am down from 2 packs a day of regular cigarettes to 4 cigarettes a day. How anyone can say that is not a GREAT thing is beyond me. I say if it works then stick with it.

Hrothgar Pedersen said...

Didn't they have that non-habit-forming, low-nicotine-dosing cigarette thing going on in the fantasy/sci-fi action flick "The Fifth Element"?

Bruce Willis, with his cigarettes that are 80% filter? I assumed that was what that was about...

In any case, comparing that to the e-cigarette as a realistic solution to a problem that exists here and now is utterly silly.

My grandfather died of emphysema. I will not. If a half-dozen other people avoid such a fate, and if the e-cigarette is even partially responsible, then you have a pretty difficult argument to make to me that it isn't an honest "smoking-cessation" device. But equivocate this issue however you like.

[As of April 2010, The American Association of Public Health Physicians (AAPHP) supports electronic cigarettes sales to adults "because the possibility exists to save the lives of four million of the eight million current adult American smokers who will otherwise die of a tobacco-related illness over the next twenty years."]

Found on Wikipedia. http://en.wikipedia.org/wiki/Electronic_cigarette

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