Dr Glynn,
I was very pleased to see a well balanced article on E cigarettes, especially on the ACS website where, previously, the only message was ban E Cigarettes to FDA regulation as a drug and drug device. This would have been a death sentence for one of the highest potential products for a real effect on smoking.
For too long the anti-smoking movement has been headed down a very slippery slope. First to anti-
tobacco, then on to anti-nicotine. A prohibitionist attitude toward all forms of tobacco/nicotine has only a negative impact on overall health. An honest review of relative risk of various products would give smokers alternatives to smoking, the use of tobacco that creates 98-99% of the risks of tobacco use.
I was a 43 year, 2-3 pack a day smoker at the end. I never had any health issues with cigarettes until RIP was added to cigarette paper. This was legislated as a requirement without any long term testing for "safety and effectiveness" and in my mind may have serious health effects long term. For me, it may have been a life saver since the coughing and wheezing that developed convinced me to try E Cigarettes. I had tried to quit using all approved medical and herbal methods dozens of times over the years, only returning to cigarettes. I had given up trying to quit at least ten years ago until my girlfriend started talking about trying this new invention. I was dubious, but gave in. I'm now glad I did.
I immediately went from packs a day to about six cigarettes a day. After six months, I was still unable to stop smoking entirely, but was convinced that, after my best quit attempt length ever, I could find a way. I started asking questions and found out about Swedish snus. I was so convinced, by the propaganda, that smokeless tobacco products were WORSE than smoking that my first response was to dismiss the idea. Then I started reading about the product on the internet and reviewing the medical studies available.
I finally decided to give snus a try and ordered my first product. From my first portion, I stopped smoking entirely. I haven't had a puff on a cigarette in over a year and four months and have no desire to do so either. Today I average four portions (4 grams) a day of Swedish snus (about the equivalent amount of tobacco that I smoked in two cigarettes). I also use my E Cigarette on occasion, but more for the taste than any nicotine hit. I have reduced the level of nicotine to zero nicotine.
I don't believe the health industry has really gotten a good grasp on why smoker's smoke and why it is so hard to quit. I now view the issues as a three headed monster. Yes, nicotine has an addictive effect but not nearly as strong as has been sold to the public over the years. For some, it is quite addicting, much like caffeine. Both have similar health risks and both can and do cause people to use too much of the products.
Underestimated in the smoking "addiction" is the habit aspects. I know much of my problem was the habit of hand to mouth motion. Many E Cig users that have successfully quit smoking using E Cigarettes have done so quickly and reduced their nicotine content just as quickly. These people could not have possibly been "addicted" to the nicotine, they were "addicted" to the habit, perhaps the number one reason people smoke.
The third head of the monster is self medicating. I did not understand why I started and couldn't quit until I was well on this journey. I never took a puff until I was 19 and in the process of getting a college education. No peer pressure, just the pressure of college life and the worry of the Viet Nam war that could certainly effect my life when I'd graduate in a couple years. People smoke to self medicate for various health issues, I did it because of a depressive aspect of my physiology. Tobacco has alkaloids other than nicotine. The E Cig helped my hand to mouth habit, but didn't address those missing alkaloids that have an MAOI effect. The Swedish snus gave me the calming effect I needed to put away cigarettes forever.
There are other harm reduction products out there and I can't see any one product being the one fits all solution. Star Scientific has Ariva and Stonewalls smokeless products, a very compressed tobacco tablet some have found helps them keep off cigarettes. Their latest versions with a BDL designation (an acronym for "below detectable levels" of nitrosamines, I believe) have been ruled to not be a tobacco product at all by the FDA. These may be the perfect stop smoking product for some.
If organizations such as the ACS really want to see the smoking population stop, they really need to consider harm reduction as the best possible alternative.
