E-cigarettes -- let's make them available by prescription only

Do e-cigarettes work? Yes they do.

A first of its kind highly scientific randomized study published this week in the prestigious British journal Lancet found that as many people were able to quit using e-cigarettes as using a nicotine patch, which is commonly used.

This study demonstrates an effectiveness for e-cigarettes that will ultimately prove useful, especially since what works for one patient may not work for another. Recalcitrant smokers who have failed other modalities may respond to e-cigarettes.

In fact, Spike Babaian, founder and president of the National Vapors Club, thinks that E cigarettes have a big advantage over the patch, because you put something in your mouth to simulate smoking.

“E-cigs aren't a nicotine replacement therapy, they're a smoking replacement therapy,” she told me in an interview.

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    “Cigarette smokers don't just need nicotine, they need to feel like they're smoking, and that is why e-cigarettes are so effective. You cannot vape or puff or inhale a patch. You cannot inhale a gum. you cannot puff out a nice cloud with the gum or the patch.”


    Are e-cigarettes safe? They are certainly safer than traditional cigarettes, which contain over 4,000 toxins. E-cigarettes, by comparison, have propylene glycol in their vapor, which has not been proven harmful to human health but needs to be further studied.

    The nicotine in e-cigarettes has been shown to constrict the lungs, and it is inhaled in variable amounts depending on the e-cigarette, which begs for FDA regulation.

    The FDA has the authority to regulate tobacco thanks to the 2009 tobacco control act, and it is considering trying to extend that authority to include e-cigarettes. It is crucial that they do so.

    But the larger question, of whether e-cigarettes lead to nicotine addiction and ultimately more rather than fewer smokers has yet to be answered.

    Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, believes that e-cigarettes remain unproven and easily misused.

    A study just out from the CDC shows that 10 percent of high schoolers are using e-cigarettes, double from a year ago, with 80 percent of them also smoking tobacco.

    “We don’t know in the long run whether e-cigarettes will be helpful or harmful,” Dr. Frieden said to me. “But what we do know is it is a real risk for kids. It is very unfortunate if people are misled into thinking that an e-cigarette is proven to help them quit smoking.”

    Twelve states including New York, California, and Colorado have laws preventing minors from purchasing e-cigarettes, but few are paying attention. Minors in those states can still purchase e-cigarettes on line, or borrow them from their parents.

    Something needs to be done. Ninety percent of smokers start when they are teens.

    E-cigarettes may be useful for confirmed smokers as the Lancet study shows, but at the same time they are dangerous for children and teens who are tobacco virgins.

    Is it possible to restrict e-cigarettes to the point where I can use it for my smokers but minors can’t get access?

    I think it is.

    Do I think that is likely to happen with a simple regulation? No, I don’t.

    So what is the answer? In my opinion, e-cigarettes should be prescription-only until they can be properly regulated the way that nicotine patches and gum were. A burgeoning $1.7 billion industry stands in the way of this restriction, but it is the only decision that makes medical sense.