From the Journals

Lifesaving future seen for electronic cigarettes

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Comment by Eric Gartman, MD, FCCP

Dr. Eric Gartman
This study seems to affirm the belief that e-cigarettes are a safer alternative to traditional cigarettes, and the thought "if patients are going to smoke, they are better than real cigarettes." While the available evidence mostly supports this, it must be recognized that there are significant assumptions being made regarding the relative safety of e-cigarettes - especially since there are no industry standards regarding their quality control or product contents. There exist significant conflicting data on both their safety and ability to serve as a cigarette alternative (for cessation or otherwise); and as with most things this complex, the truth probably is somewhere in the middle.



A switch from cigarettes to e-cigarettes has the potential to prevent almost 90,000 premature deaths in the United States in the year 2026, according to a study examining e-cigarette substitution scenarios.

The investigators’ “optimistic scenario” – in which new smokers use e-cigarettes instead of cigarettes, smoking prevalence falls to 5% over a 10-year period, and e-cigarettes have a 5% excess risk over regular cigarettes – projects 380,832 premature deaths from smoking in the year 2026. Under a “status quo scenario,” which projected current cigarette initiation and cessation rates and did not include e-cigarettes or other tobacco products, there would be 470,743 deaths, reported David T. Levy, PhD, and his associates (Tob Control. 2017 Oct 2. doi: 10.1136/tobaccocontrol-2017-053759).

Premature deaths under e-cigarette substitution scenarios
Their “pessimistic scenario,” which would involve more young people starting to use both e-cigarettes and tobacco, smoking prevalence falling to just 10% over a 10-year period, and e-cigarettes having a 40% excess risk over regular cigarettes, resulted in 456,297 premature deaths in 2026, only 14,446 fewer than the status quo scenario, said Dr. Levy of Georgetown University in Washington and his associates.

Further projections suggest that the optimistic scenario could result in almost 6.6 million fewer premature deaths and 86.7 million years of life gained by the year 2100, compared with the status quo scenario, while the pessimistic scenario would prevent 1.6 million deaths and add an extra 20.8 million years of life, they noted.

Since “a strategy of replacing cigarette by e-cigarette use can yield substantial gains, even with conservative assumptions about related risks … an endgame scenario for cigarettes might well be within reach, if new technologies for delivering nicotine with substantially less harm, but sufficient satisfaction, are harnessed with sufficient passion and political will to aggressively phase out tobacco cigarettes,” Dr. Levy and his associates wrote.

The study was funded by grants from the National Institute on Drug Abuse and the National Cancer Institute. One investigator received a research grant from Pfizer and served as an advisory board member to Johnson & Johnson, which manufactures smoking cessation medications. No other conflicts of interest were declared.

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