Rebuttal: Can electronic cigarettes assist patients with smoking cessation?

“Electronic cigarettes (e-cigarettes) can assist patients with smoking cessation, which is all they should be used for!”¹ This is the argument of Dr Kaplan, but it is not yet known if e-cigarettes will be a useful tool in smoking cessation. Few randomized controlled trials have been done and none has been of substantial duration. While it can be acknowledged that the chemical exposure from an e-cigarette is lower than that of a regular cigarette, toxins are still present in variable, uncontrolled quantities. The e-cigarette industry remains entirely unregulated. Studies are emerging showing more adverse effects than originally thought.^2,3

Health agencies and governments must introduce strict quality controls and regulations on this industry so that consumers and physicians can know exactly what they are dealing with. We must also be wary of undermining the gains made in tobacco control over the past few decades and remember that tobacco companies own most of the e-cigarette companies. There are ongoing reports of increased use in teens; however, e-cigarettes are regarded as being in vogue, rather than as a tool for smoking cessation. Provincial authorities are introducing laws to ban vaping in public places and are treating e-cigarettes in the same manner as cigarettes (eg, Bill 44 in Quebec).⁴ We as physicians are responsible for counseling our patients on the risks and benefits of all smoking cessation aids, including the e-cigarette. To do so, we must remain abreast of developments in this rapidly changing industry.⁵ At this time, there are not enough scientific data to recommend this treatment, but dozens of studies are under way.