PhotoPublic health officials in the United States generally regard e-cigarettes as a new pathway to addiction, unlike those in Great Britain, who look at them as a safer way to feed a nicotine habit or to stop smoking tobacco entirely.

Now, seven top tobacco control experts from around the world are cautioning the U.S. Food and Drug Administration to keep an open mind on the topic.

"We believe that the discussion to date has been slanted against e-cigarettes, which is unfortunate, because the big picture tells us that these products appear to be used mostly by people who aready are or who are likely to become cigarette smokers," said David T. Levy, PhD, a professor in the department of oncology at the Georgetown Lombardi Comprehensive Cancer Center in Washington, D.C.

The FDA has been studying the issue for years and is expected to eventually issue rules about the advertising and sale of e-cigs, devices that deliver nicotine vapor without the use of tobacco.

"We're concerned the FDA, which has asserted its right to regulate e-cigarettes, will focus solely on the possibility that e-cigarettes and other vapor nicotine products might act as gateway to cigarette use," said Levy, lead author of a study funded by the FDA.

Smoking rates 

Writing in the journal Addiction, the researchers review much of the evidence published to date on e-cigarettes and suggest that the devices can lead to reduced cigarette smoking and a potential reduction in deaths.

They note that smoking rates have fallen by 50% since their peak in the 1960s. While tobacco products still contribute to illness and premature deaths, those who use only e-cigs only face about 5% of the risk compared to those who smoke tobacco.  

The researchers also state that studies in the U.S., Canada, and England show cigarette smoking rates have fallen more in the last two years than they have in the previous four or five years, coinciding with the increase in e-cigarette use.

"While e-cigarettes may act as a gateway to smoking, much of the evidence indicates that e-cigarette use encourages cessation from cigarettes by those people who would have otherwise smoked with or without e-cigarettes," Levy said.

Controversial view

The researchers concede that their view will be controversial. 

"We don't want to encourage e-cigarette use by youth and young adults who would not have otherwise smoked. However, the primary aim of tobacco control policy should be to discourage cigarette use while providing the means for smokers to more easily quit smoking, even if that means switching for some time to e-cigarettes rather than quitting all nicotine use," they write in their article.

They also warn that heavy regulation and taxation of e-cigarettes could counteract the benefit that these products can provide.

"Increasing e-cigarette prices by taxing them the same way as cigarettes will discourage youth VNP use, but also discourage use by smokers, especially those of lower socioeconomic status, who are trying to quit," Levy added.

The investigators include lead author David T. Levy, PhD, of Georgetown University; K. Michael Cummngs, PhD, MPH, of the Medical University of South Carolina; Andrea C. Villanti, PhD, MPH, Ray Niaura, PhD, and David B. Abrams, PhD, from Truth Initiative; Geoffrey T. Fong, PhD, of the University of Waterloo in Canada; and Ron Borland, PhD, of Cancer Control Victoria, in Australia.

The FDA, through the Nattional Institute on Drug Abuse, funded the study.


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