New Articles on Linked-In

I am now posting my articles on Linked-In. Please visit my page and connect with me there. 

Here are links to my recent articles on LinkedIn:  

July 19, 2016: "A Brief History of E-cigarettes" 

July 15, 2016: "Can it Possibly Take at Least 30 (or hundreds) of Attempts to Quit Smoking?"

June 13, 2016: "Are e-cigarettes really 95% less harmful than traditional cigarettes?"

May 28, 2016: "You Can Lead a Horse to Water..."
May 17, 2016: "It's All About the Chemistry with E-cigarettes" 

Should you be concerned about the flavorings in e-juice?

I am not a chemist but my concern is not the nicotine in e-juice but the flavorings. Currently there are about 7,000 different flavors with a couple hundred being added each month. Many of the flavorings used are GRAS (generally recognized as safe). But this designation is used for chemicals that are ingested, not inhaled. 

When you eat something, it goes into your stomach and mixed with gastric juices, then goes into your intestines where the broken down food is passed into your blood system. It is then filtered by your liver. 

With inhalation, the chemicals go into your lungs and pass through to your blood system and are pumped to your brain. Inhalation is the quickest way to get any substance to your brain. This blood is not filtered by the liver and your lungs are more delicate tissue than your stomach. 

The Flavoring and Extract Manufacturing Assn. (FEMA) is the agency which issues the GRAS designation. This is from their website: 

• E-cigarette and flavor manufacturers and marketers should not represent or suggest that the flavor ingredients used in e-cigarettes are safe because they have FEMA GRASTM status for use in food because such statements are false and misleading.
• E-cigarette manufacturers and marketers should take appropriate action to assure the safety of flavor ingredients used in e-cigarettes.  FEMA GRASTM status for the use of flavor ingredients in food does not mean that FEMA GRASTM flavor ingredients are safe for use in e-cigarettes.

Safety Assessment and Regulatory Authority to Use Flavors: Focus on E-Cigarettes

The concern about vaping is clouded by the history of the tobacco companies. The tobacco companies used to say that while the individual components of their product might be harmful, they were in such small amounts that it didn't matter. "The dose makes the poison" as Paracelus said.  

In the BBC documentary, "Death in the West", one of the scientists for Phillip Morris stated that anything can kill you if you get enough of it, even applesauce. The interviewer said that he didn't think applesauce was killing very many people. The scientist replied, "They're not eating enough."

A disease profile will likely emerge from long term vaping, but it will take decades before we see what the cumulative effect may be and if it is only some flavors that cause a detrimental effect. 

It may be that vaping just becomes another vice like drinking. Many people drink responsibly and have no ill effects, however others are addicted which can compromise their health.

Teens reacting to old cigarette ads and comparing them to current ad for e-cigarettes.

Click here to see teens reacting to old cigarette ads

Cigarette commercials have been banned from TV since the 1970's. While the first health reports of harm from smoking came in the early 1950's, it wasn't until 1964 with the Surgeon General's Report on Smoking that it became widely known that smoking caused lung cancer.

For many years there were no restrictions on tobacco advertising and the tobacco companies made many claims that have since been shown to be either false or an outright lie. Is the same thing happening now with e-cigarettes? There are currently no restriction on e-cigarette advertising and the manufacturers of e-cigarettes are making many claims that at this time we don't know whether they are true or not.

The question is should e-cigarettes have the same restrictions on advertising as cigarettes? Should their claims need to proven? Do we need to wait for another 20 years before seeing the harmful effects from vaping? Let me know what you think.

I switched to e-cigarettes and I cough less, have a better sense of smell and taste, and I feel healthier, what's the problem?

Just because you feel better doesn't mean that you are "healthier". We don't know the long term effects from vaping yet. It certainly will NOT be the same as with traditional cigarettes but e-cigarettes will have their own disease profile. 

Part of the problem is with the flavors--while they may be GRAS for ingestion, most have not been tested for inhalation. 
e.g.  Lawsuit Filed Against Butter Flavoring Companies and Popcorn

https://www.femaflavor.org/safety-assessment-and-regulatory-authority-use-flavors-focus-e-cigarettes


What may be harmless when eaten, may be toxic when inhaled. Just as the tobacco leaf has about 600 chemicals in it but when lit turns into about 7000 chemicals, the few chemicals in an e-cig may turn into other chemicals when heated. We do know that the temperature influences how many chemicals are created int he vapor, which can be different for every user because everyone uses their devises differently. 

Not coughing can also be a problem since coughing is the body's way of clearing out the lungs. Smoking paralyzes the cilia of the lungs interfering with the lungs ability to clear out the components of smoke. Not clearing out the lungs can lead to more respiratory infections.

Just as other vices have their own risks and benefits, users need to weight those risks and benefits and make their own decision but until we have long term health information, the actual risks are unknown.

Can e-cigarettes help me quit smoking and are they safe?

I have been doing a lot of research into electronic cigarettes since that is what my next book will be about. There have been many confusing headlines, some saying that they are just as harmful as tobacco cigarettes, while other headlines will tell you they will help you quit. The truth is somewhere in the middle.

The controversies that make headlines are often not the real issues, such as-cig containing formaldehyde--that chemical was only created at very high temperatures--a temperature that no vape users would realistically use.  While w-cigs do have some carcinogens, they are amounts that are 9 to 450 times less than traditional cigarettes.

1. The biggest problem is dual use long term, using electronic cigarettes while you are continue to  smoke and continuing this practice long-term instead of quitting smoking. Using an e-cig for short term while trying to quit, probably isn't a problem, but with dual use, even reducing the number of cigarettes doesn't help with the damage smoking does to your cardiovascular system. Unlike cancer where exposure to a carcinogen is linear (the more exposure, the greater the risk of developing cancer), heart disease is not linear: 50 to 80% of the damage to the cardiovascular system from smoking occurs within the first 3 to 5 cigarettes. For those who do use e-cigs to quit smoking but continue to use them long term, there are no long term studies as to the health effects. Very likely it will not be the same as smoking but e-cigs will have their own unique disease profile and associated risk.

2. The cig-a-likes don't deliver enough nicotine to really help with cessation. The mods or tanks do a better job of that. A lot has to do with the particle size in the vapor. If the particle is either too small or too large, the vapor isn't absorbed. For example, the MarkTen offers some of the highest nicotine content (44mg) but very little of that is absorbed by the smoker, so you can't count on the nicotine content. It is not what is in the liquid but what is absorbed that is important. Almost all users start with a cig-a-like and either find them unsatisfying and go back to smoking, or they switch to a tank/mod which delivers enough nicotine to satisfy.

3. While there are some health risks with nicotine, the real problem is with the flavorings. Vapor shop owners will say that the flavorings are "FDA" approved--which most are--as a food, but not as an inhalant. (Actually flavorings are not FDA approved but approved by FEMA--Flavoring and Extract Manufacturing Assoc and given a "no objection" letter by the FDA). Digestion and inhalation are two very different delivery systems. When eaten, a flavor goes through the stomach and digestive tract where it is subject to gastric juices and then is filtered by the liver where toxins are removed. When inhaled, substances go straight to your blood system with no filtration. Some flavorings are toxic when inhaled--like cinnamon, buttery flavor and cherry. There are probably more but little or no testing has been done on the over 7000 e-cig flavors available. 

4.Users like the hand to mouth use of e-cigs and when compared to the nicotine inhaler which also mimics this motion, users say that e-cigarettes give a better throat hit than the nicotine inhaler, (which is an FDA approved cessation device for cessation). A common issue with people using NRT is that they don't get enough nicotine from one delivery system, so we now suggest combination therapy, such as the patch or bupropion with either the inhaler, gum, lozenge, or nasal spray. This pairs one long acting agent with a short acting one. I have heard of many people using both chantix and bupropion together with great success but I haven't seen any research studies on it, only anecdotal.

5. Up to 90% of these devices are made in China (regardless of what the label says--no one is looking to see if the labels are true), where there are no manufacturing standards, the batteries can be defective and blow up, poorly made atomizers can leach metals into the vapor, contents of the e-liquid can be very different than the label--for example instead of using pharmaceutical grade nicotine, a less pure grade could be used or instead of propylene glycol, they could use diethylene glycol--which is cheaper but toxic. Plus there are many counterfeits on the market, so even if the manufacturer is one who is trying to create a good product, you may not know if the one you buy is real or counterfeit. This is a common problem with products made in China: Lumber liquidators, toothpaste, dog and cat treats.

Having said all that, I do believe that once some of these issues are addressed through FDA regulation, there is a place for e-cigarettes as a harm reduction device which will help a smoker quit tobacco cigarettes and hopefully will only be used for a short time instead of continuing a nicotine addiction. 

Is Nicotine an Alternative Vice and Should We Prohibit it's Use?

A colleague of mine shared that she had met a man who had quit spit tobacco by switching to nicotine gum. He uses 3 or 4 pieces at a time. He was happy that he quit spit and had no desire to stop using the gum. She wondered what she could say to him about his addiction to nicotine gum. Other colleagues gave her suggestions as to how to get the NRT user to change his behavior but no one really answered WHY he should change his behavior. Here is my thoughts: 

When compared with continued smoking/chewing, there is no question that long term use of NRT is preferable but when you compare it to using nothing, I don't think we really know what the relative long term risk of using medicinal nicotine (see links below). We talk about nicotine being a poison yet---the poison is in the dose.  How harmful are low doses of nicotine over a long term? 

In the FDA webinar this week, a presenter made the statement that he thought that within 10 years, if we could get e-cigarettes properly regulated and manufactured to deliver sufficient nicotine, that we could put the tobacco companies out of business. Wouldn't that be a good thing? The very next day during a different webinar, someone posed the question --"How do we put the e-cig manufacturers out of business?" Is this in a smokers best interest or is tough regulation better? 

With e-cigarettes there are other components in the vapor that need to be studied. But I think the long term use of both in regards to nicotine is similar----NRT was not designed for enjoyment as e-cigarettes are, but people do use nicotine (NRT) for their enjoyment. Is nicotine really the demon we need to be fighting, even though it is addictive? It seems to me that there are some people in tobacco control who want to prevent the use of nicotine for enjoyment in any form regardless of it's relative risk strictly because it is addictive or is it our puritanical nature to deny people its pleasure? If addiction is the only criteria, is that enough to warrant its prohibition and the desire to put e-cigs out of business?

Humans use a variety of substances for enjoyment from alcohol, caffeine, marijuana, and now nicotine. With the invention of e-cigarettes, I see using nicotine as a new (or alternative) vice for some. Should it be our job to stop them? Or is this a futile attempt at prohibition again? Although I'm not really sure we can compare nicotine to any other substance. We want to stop the addiction to heroin, meth, cocaine because of the detrimental health effects but so far we don't see that with nicotine addiction. Years ago the policy at the Betty Ford Center (not sure if this is still in effect) was to deny patients all access to caffeine--but they could smoke. To me this is giving the message that ingesting caffeine is more dangerous than nicotine. We know that nicotine is more addictive than all these other substances but is that reason enough to want to prohibit its use? 

http://cancerpreventionresearch.aacrjournals.org/content/4/11/1719.full.pdf+html

http://circ.ahajournals.org/content/94/5/878.full

http://www.webmd.com/smoking-cessation/features/addicted-to-nicorette

https://quitsmokingcommunity.org/nicotine-gum-side-effects-stories/

Are E-cigarettes safe? Notes from the FDA December Workshop

I love technology. I was able to attend a two day conference held by the FDA in Washington DC without leaving home. The entire event was available live-stream. The only downside was it started at 8am east coast time and I live on the west coast, so I was getting up early.

This conference was a public workshop about E-cigarettes. Presenters included researchers from around the country, including a few delivered by representatives from the tobacco companies. There was a lot of science discussed and while I'm not a scientist, I could follow most of the discussion.

I'm not going to go into all the details and information that was presented but here are the highlights that I gleamed from this workshop:

• Everything presented at this workshop is already out dated. E-cigarette technology is expanding so fast that it is almost impossible to keep up with the advancements. 

• The evolution of e-cigarettes may hold great promise to curb the tide of death and disease from traditional smoking. However, because of the lack of product standardization, manufacturing  and product standards, there is the potential for a great deal of harm.

• Studies regarding impurities, contaminants and toxicants vary greatly in outcomes because there are over 450 manufacturers of e-cigarettes and many different variations in product type. Levels of most toxicants are significantly lower that those in traditional cigarettes but the range is very wide depending on the manufacturer. There is a concern that high amounts of harmful chemicals are created with higher voltage batteries.

• Every study is limited to what product is used. For the e-liquid there are over 7000 flavors with approximately 200 new flavors being introduced each month. 

• Manufacturing standards are needed. Products in the marketplace currently vary greatly in chemical composition and quality of product. Counterfeit and sub-par products are widely available. Some manufacturers have established some good manufacturing and product standards.

• Some of the concerns are: leaching of metals from the atomizer/cartomizer because of poor quality materials. Some chemicals in the flavors which are considered to be safe for ingestion, are hazardous when inhaled. GRAS (generally recognized as safe) is a designation issued for food products only and any claim that flavors are FDA approved as GRAS is false and misleading. The FDA does not issue approval for food flavors but letters of "no objections". Poor quality batteries can over heat and/or explode. E-liquids made by unscrupulous manufacturers substitute preservatives which are poisonous. Some flavors are toxic. 

As far as how e-cigarettes will be regulated in the future is anyones guess but it is clear that to protect the public that manufacturing and product standards need to be established. Products need proper labeling as to exact contents. E-liquids need to be in child resistance containers, with a limited amount of nicotine available (less than a lethal dose) and a flow restrictor in the lid. Had these last regulations been in place, the death of a young child in New York a few days ago, may have been avoided. 

Looking for e-cigarette stories to be published.

Have you tried e-cigarettes? Did they help you stop smoking or was it waste of money? I'm looking for real world experience with e-cigarettes or personal vaporizers to include in a new e-book I am writing. This will be an informational e-book presenting both sides of the e-cigarette controversy.

For participating I will send you a FREE copy of the e-book once it's completed. You can either leave your experience in the comment section or I can call you and do an interview, whichever is easiest for you. Send an email to : VJSleight@cs.com with your phone number and the best time to call. All comments will be anonymous.

FDA proposes new rules for e-cigarettes

E-cigarettes hit the market with a bang and sales for 2013 were over $2 billion. Until now they have been totally unregulated. It's been a "buyer beware" marketplace. With over 250 different manufacturers it's been hard to separate companies who care about the quality of their product versus ones in it to make a quick buck and are careless with quality control. Some studies have shown that the ingredients can vary greatly manufacturer to manufacturer. The ingredients stated on the package isn't always what is true, even the amount of nicotine has been shown to vary by up to 20%.

The tobacco companies were slow to enter into the e-cigarette market, probably thinking they were a fad that would fade. But as the popularity of e-cigarettes has increased the tobacco companies can see them eating into their profits and are now producing their own e-cigarette products or acquiring existing companies.

The tobacco companies have lied to the public about their tobacco products for over half a century. Does anyone really think the tobacco companies won't lie about this product as well? 

The FDA has issued a proposal to regulate e-cigarettes under the Family Smoking and Prevention Act of 2010. 

The regulations are simple:
1. Don't sell to children
2. Don't lie about the health effects (the long term use of e-cigarettes is unknown at this time)
3. Don't mislabel what's in them (with so many different manufacturers, there are as many different ingredient combinations, some which do contain harmful substances).
4. Have a warning label that the product contains nicotine and that nicotine is addictive. 

The tobacco companies manipulated cigarettes to make them as addictive as possible so that smokers have a difficult time quitting. Does anyone think they won't do the same thing to e-cigs? 

I predict the next market the tobacco companies will be going after -- are the people who have already quit smoking cigarettes. They will lure former smokers back with the promise of the enjoyment of nicotine without the harm and while e-cigarettes are probably less harmful than smoking they are not as harmless as breathing fresh air.

Click here to read the entire FDA proposal.

Click here to read more about e-cigarette batteries blowing up.

Hidden danger of e-cigarettes

At a recent social event a man seated next to me pulled an e-cig out of his pocket he said, "I hope you don't mind, but this isn't a real cigarette, it's only vapor."
"I guess you don't know what I do for a living?" was my response.
Steve had quit smoking 15 years ago. He had smoked two packs a day and quit cold turkey. Now he was using 8 to 10 cartridges a day in his e-cig.
When I asked why he started using the e-cigarette after having quit smoking so long ago, his answer was-- curiosity. But now Steve is hooked on nicotine again and spending up to $150 a week.
Some people in tobacco control have been endorsing e-cigarettes as "harm reduction" which is when a smoker, who either can't or won't quit smoking, switches to an e-cigarette because it is "less harmful" than smoking regular cigarettes. But for Steve this isn't about reducing his need to smoke but re-starting his addiction to nicotine and someone is making a lot of money off of Steve's addiction.
E-cigarettes are big business, expected to generate $1 to 2 Billion in sales in 2013. The tobacco companies are adding e-cigs to their list of products. But could it be that since over half of all smokers have quit, that a new marketplace is opening up? Former smokers who can be lured back into nicotine addiction with e-cigarettes and teens who would never think of lighting up a cigarette but don't see an e-cigarette as anything but a fad to try.
So while the rate of smoking has been declining over the years and we have made great strides in preventing teens from starting, I think the real hidden danger of e-cigarettes is that we will be seeing a rise in the number of nicotine addicts. Since few double blind studies have been done and currently there are no one regulating the manufacture and marketing of e-cigarettes, is this the next tobacco epidemic or will nicotine be just another "harmless" addiction like caffeine?

Why is it so hard to quit smoking?

Becoming smoke free can be one of the hardest changes one makes in their life, but why is it so hard?

For true change to happen it is only possible when the desire to become smoke-free is stronger than the desire to continue smoking and when the smoker has the tools, skills and self-knowledge, that build self-confidence, to take effective action.

Every former smoker will tell nobody quits until they really want to quit, until then it's a struggle. Yet 70% of smokers will say they "want to quit" but in reality, what they want is to continue getting their perceived benefits from smoking (stress relief, enjoyment) and want to avoid the negative consequences (cancer ete.). They want their cake and want to eat it too--but you can't have both. The popularity of the e-cig is that this is the promise they are making. The only problem is they can't back up their promise because no one knows the long term health effects from using the e-cig. To build desire the "WHY: of becoming smoke-free is most important.

When the benefits from smoking are compared with the negatives of trying to quitting, the cigarettes win out but when becoming smoke-free is MORE important than continuing to smoke, the method will appear because the smoker will seek out the tools, skills and self-knowledge that are needed to go through the process of changing to a life of being smoke-free. 

After having a strong "why", the next part is the "how-to" part. Often smoking is considered part of our "self-care" especially when dealing with stress, fear, anxiety. When everything is falling apart, our "friends" are still there to offer comfort. Smoking is a low-effort coping strategy and if like most smokers you have started as a teen--you haven't developed other effective coping strategies because smoking has always been there and has worked. Part of the struggle is to develop other "self-care" techniques but often they require more effort than just lighting up. This differs for every smoker and the tools, skills and self- knowledge.

Allan Carr's book, "The Easy Way to Quit Smoking" is great for motivation because he takes every argument used to continue smoking and rips it apart. He works on the WHY to quit, but not the HOW to quit. In over 20 years of working with smokers, as soon as the WHY to quit is stronger than the desire to continue to smoke, the rest is just gaining the tools, skills and self-knowledge.  This builds confidence and when a smoker feels they have the ability to succeed, they will take effective action. 

Effective action means having a plan in place to deal with the many different aspects of smoking and not relying on just one method to quit. Some smokers are more physically addicted than others and may need medicinal therapy. Habit cigarettes require behavior modification, stress cigarettes require effective stress management. 

As a Tobacco Treatment Specialist, my job is to help a smoker develop the desire, figure out what tools, and skills are needed through self-knowledge and how to develop an effective action plan. 

Rare form of Pneumonia linked to e-cigarettes

Not a day goes by where this blog isn't spammed by an e-cigarette company. Whenever asked about e-cigarettes, I will tell the person to ask their doctor about the nicotine inhaler. It is a similar concept to the e-cigarette but with several important diffierences:

• Inhaler is regulated by the FDA, e-cigarettes are not regulated by anyone. A user is trusting that  the manufacturer is correctly stating what is contain in its product. There is no oversight.
• Inhaler has evidence based studies showing it's effectiveness in becoming smoke-free, e-cigarettes have no independent studies and cannot be advertised as a cessation devise.
• Inhaler has strict manufacturing standands, e-cigarettes have no manufacturing standards or guidelines. A defective battery exploded in one users face. 
• Inhaler has been proven to be safe. A prescription is required because of the risk of addiction due to the speed of delivery of the nicotine.

This last point is very important because the safety of e-cigarettes has not been established. Recently a rare form of pneumonia has been linked to the use of e-cigarettes due to the use of an oil based substance to create the vapor.

Exogenus lipoid pneumonia is very rare. It is usually seen in elderly patients who use mineral oil laxatives. The lipids (fats or oils) are inhaled into the lungs. Proplene gycol, glyercin and nicotine are the main ingredients, although other substances have been found in a small study done by the FDA. Glyercin is an oil-based substance which is inhaled into the lungs when using an e-cigarette, which appears to cause this rare form of pneumonia in some users. 

More research needs to be done but until then--it's buyer beware when using e-cigarettes. You don't want to end up like the guy in Florida who had part of his face blown off when the battery exploded (again, no manufacturing standards). 

The advantage to many people trying to quit is that the e-cigarette is shaped and feels like a cigarette in your hand. It may work great for that but it doesn't mean you  need to inhale it or turn it on. A prop works just as good or better yet, talk to your doctor about the nicotine inhaler. 

Can personality traits tell which cessation medication will work best?

Every smoker is different and when trying to decide which medication is the best one to use, it is often a matter of trial and error. But over the years I have seen different patterns emerge. It's only my observation and not scientific but it may be better than trial and error.

I always ask smoker to complete the following sentence: "I want to quit BUT......" What I've noticed is what comes after the BUT can influence what medication may work best.

For someone who says "I want to quit BUT I enjoy smoking, it relaxes me, I like it..." Their focus is on the enjoyment and positive benefits received from smoking. Chantix seems to help these smokers since Chantix works by blocking the receptors in the brain which decreases the pleasure a smoker gets when smoking. It also releases a small amount of dopamine (the I feel good neurotransmitter in the brain).

For someone who says, "I want to quit BUT I can't handle the side effects, the depression, irritability, ..." Their focus is on the negative effects of quitting. In this case a combination of Zyban and nicotine replacement products (NRT) helps. It it unknown why Zyban helps smokers quit. It was originally developed as an anti-depressant and over the years, it was noticed that smokers would quit.

For smokers worried about weight gain after quitting, Zyban and NRT have been shown to stave off weight gain during the first 6 months after quitting. But NRT needs to be taken on a regular schedule to be effective. To be helpful oral NRT needs to be used on a regular basis to keep the level of nicotine in the blood steady.

 Often smokers will wait until a craving comes up before they pop a piece of gum or a lozenge but by that time, it's too late and then will say that NRT doesn't work. The reason it's not working is because they were under dosing themselves. When you smoke a cigarette, the level of nicotine in your blood peaks at about 20-25 mcg/L in 5 minutes. At the end of one hour, the level drops to about 8 mcg/L.

In contrast, it takes The Patch 2 to 6 hours to reach the maximum absorption. The absorption is similar for nicotine gum, lozenge and inhaler at about a peak of  8mcg/L at 30 minutes. Only the nicotine spray gives a kick within 5 minutes like a cigarette but at less than half the amount of nicotine as a cigarette.

Experts in tobacco control are now even recommending that smokers start using NRT before they quit to help them cut down. The reason why this wasn't suggested in the past was because the fear of nicotine overdose. But every smoker can spot nicotine overdose symptoms--all you have to do is think  back to your very first cigarette ever--you probably got dizzy, light-headed, maybe had a headache or nausea, maybe even vomiting---these symptoms are nicotine overdose but as you continued smoking your body adjusted to the level of nicotine and developed a tolerance for these side effects.

One reason why the e-cigarette has gained popularity is that is delivers a higher and faster dose of nicotine than NRT's because it was designed to keep a smoker addicted to nicotine instead of helping them wean off of it. There also is probably a placebo effect by having something to hold in your hand that is similar to a cigarette. It tricks the brain into associating the sensory effects.

There are other factors besides personality when making a choice about cessation medication. It depends on your medical and mental health history, how much you smoke, how long, what other medications you take and what you've used before.

Avoid any "100 guarantee" product or service to stop smoking

Several services send me daily updates on news items, blogs and other postings on anything to do with tobacco issues. I'm always amazed at the amount of misinformation available and the products that guarantee a smoker will quit. That 100% guarantee should be the tip off that it's just a 100% guarantee that they want your money. Every method will work for some individuals but no method will work for everyone. Many products “work” because of a placebo effect or the belief or positive expectation that it will work. Trying some of these products or services can be harmless but others can have devastating effects. Here are some products and services that have not been shown to be effective:

  

• Acupuncture: No evidence to support efficacy as a cessation method in research studies.
• E-cigarettes: A battery operated devise, not regulated by the FDA that vaporizes nicotine and propylene glycol. No independent safety studies. Mainly produced in China with no safety standards for manufacturing. A small study by the FDA showed some harmful chemicals and inconsistent levels of nicotine. Cannot be advertised as a cessation devise.
• Hypnosis: Anecdotal stories as to efficacy but insufficient evidence to support hypnosis as a cessation method.
• Lobedia: Also known as Indian tobacco, a substance chemically similar to nicotine that used in tablets, gum and vitamins pills. Marketed as a substance to help with nicotine withdrawal. Controlled studies have not shown it to be effective. Banned by the FDA in 1993 as a cessation medication.
• Silver Acetate: A crystalline substance often an ingredient in chewing gum that is claimed to produce a repulsive taste when combined with cigarette smoke. No beneficial effects for cessation have been shown in randomized clinical studies.
• Smokeless tobacco or snus: Tobacco products that held in the mouth. Different products have varying levels of harmful components. Linked to cancers of the mouth, tongue, gums, lips, and cheeks. Causes cavities, tooth loss, stained teeth, gum disease. Swallowing spit can cause heartburn, ulcers and cancers of the voicebox, esophagus, and parts of the throat and stomach. Increases blood pressure and heart rate. May contain more nicotine than cigarettes.
• Welplex: An injection consisting of a combination of atropine, scopolamine and chlorpromazine (thorazine). This combination may cause a temporary mental break including hallucinations, heart palpitations, paranoia and possible coma. Not approved by the FDA for smoking cessation. Atropine is used to dilate the eyes. Scopolamine is used for motion sickness. Chlorpromazine is used for psychiatric disorders such as schizophrenia.

"Quit or Die" or use harm reduction?

Jim quit smoking when he was in his 30's after receiving a diagnosis of Chronic Obstructive Pulmunary Disease (COPD). He took his doctor's advice and switched from smoking cigarettes to using smokeless tobacco or "chew". Thirty years later Jim is in my Stop Smoking, Stay Quit class to stop his nicotine addiction to smokeless tobacco.

This is an example of "harm reduction". The premise is that some individuals are so addicted to nicotine that they just can't quit, so harm reductionists advocate switching to the use of a less harmful tobacco product. Harm reductionists say a "Quit or Die" approach doesn't work and by using a less harmful form of nicotine is a better way to go. While I do believe that the physical addiction to nicotine can be so strong that it seems impossible to quit, that does mean we should just give up on these individuals? The same concept is used with heroin addicts by replacing heroin with methadone but not every heroin addict uses methodone to quit. There are no easy answers.

But there is a new player in mix and that is e-cigarettes. The US District Court in Washington DC just ruled that the FDA does not have the authority to regulate e-cigarettes as a drug device combination. Instead, e-cigs are a recreational product that promotes the use of nicotine in a less harmful way than by smoking cigarettes. There are many antedotal stories of smokers quitting by using an e-cig but they cannot be advertising as such because then the product would fall under the jusdiction of the Food, Drug, and Cosemtic Act (FDCA). While it would appear that e-cigarettes maybe less harmful because there are less components to the vapor of an e-cigarette than the thousands of chemicals found in tobacco smoke, we don't know for sure since there are no long term studies on e-cigs. Since currently there is no regulation on the manufacture of e-cigs, the public must rely on the integrity of the manufacturer. Are they after your money or to better your health?

Switching from smoking cigarettes to chew tobacco most certainly saved Jim's life, yet now he is dealing with the health effects of 30 years of chewing. Jim has gum disease, tooth loss, and has had both a kidney and a liver transplant. His doctor now wants him to totally quit the use of nicotine since nicotine is excreted through the kidneys into the bladder. Jim wishes that when he stoped smoking that he would had tried to stop using all nicotine products, instead of switching to chew.

I think the debate should end and nicotine be declared a drug/medication. You can't have it both ways--it can't be both a recreational product AND one that is so addictive that some individuals are unable to stop using. As a drug/medication, there may be benefits to the continued use of nicotine, just as there are benefits (as well as risks) to every drug/medication that is used.