If you want a truly frustrating job in public health,try getting people to stop smoking. Even when researchers combine counselling and encouragement with nicotine patches and gum,few smokers quit.
Recently,though,experimenters in Italy had more success by doing less. A team led by Riccardo Polosa of the University of Catania recruited 40 hard-core smokersones who had turned down a free spot in a smoking-cessation programand simply gave them a gadget already available in stores for $50. This electronic cigarette,or e-cigarette,contains a small reservoir of liquid nicotine solution that is vapourised to form an aerosol mist. The user vapes, or puffs on the vapour,to get a hit of the addictive nicotine (and the familiar sensation of bringing a cigarette to ones mouth) without the noxious substances found in cigarette smoke.
After six months,more than half the subjects in Polosas experiment had cut their regular cigarette consumption by at least 50 per cent. Nearly a quarter had stopped altogether. Although this was just a small pilot study,the results fit with other encouraging evidence and bolster hopes that these e-cigarettes could be the most effective tool yet for reducing the global death toll from smoking.
But theres a powerful group working against this innovationand its not Big Tobacco. Its a coalition of government officials and antismoking groups who have been warning about the dangers of e-cigarettes and trying to ban their sale. In the past,conservatives have leaned toward abstinence only policies for dealing with problems like teenage pregnancy and heroin addiction,while liberals have been open to harm reduction strategies like encouraging birth control and dispensing methadone.When it comes to nicotine,though,the abstinence forces tend to be more liberal,including Democratic officials at the state and national level who have been trying to stop the sale of e-cigarettes and ban their use in smoke-free places.
Theyve argued that smokers who want an alternative source of nicotine should use only thoroughly tested products like Nicorette gum and prescription patchesand use them only briefly,as a way to get off nicotine altogether. The Food and Drug Administration tried to stop the sale of e-cigarettes by treating them as a drug delivery device that could not be marketed until its safety and efficacy could be demonstrated in clinical trials. The agency was backed by the American Cancer Society,the American Heart Association,Action on Smoking and Health,and the Center for Tobacco-Free Kids.
The prohibitionists lost that battle last year,when the FDA was overruled in court,but theyve continued the fight by publicising the supposed perils of e-cigarettes. They argue that the devices,like smokeless tobacco,reduce the incentive for people to quit nicotine and could also be a gateway for young people and nonsmokers to become nicotine addicts. And cite an FDA warning that several chemicals in the vapour of e-cigarettes may be harmful and toxic. But the agency has never presented evidence that the trace amounts actually cause any harm,and it has neglected to mention that similar traces of these chemicals have been found in other FDA-approved products,including nicotine patches and gum. The agencys methodology and warnings have been lambasted in scientific journals by Polosa and other researchers,including Brad Rodu,a professor of medicine at the University of Louisville in Kentucky.
Both sides in the debate agree that e-cigarettes should be studied more thoroughly and subjected to tighter regulation,including quality-control standards and a ban on sales to minors. But the harm-reduction side,which includes the American Association of Public Health Physicians and the American Council on Science and Health,sees no reason to prevent adults from using e-cigarettes. In Britain,the Royal College of Physicians has denounced irrational and immoral regulations inhibiting the introduction of safer nicotine-delivery devices.
Nicotine itself is not especially hazardous, the British medical society concluded in 2007. If nicotine could be provided in a form that is acceptable and effective as a cigarette substitute,millions of lives could be saved.