Medical professionals should support but not promote the use of e-cigarettes in smoking cessation attempts, says the American Heart Association (AHA) in a new policy statement on the products.
“When repeated efforts with conventional treatment fails, is intolerant, or rejected by a patient who wants to utilise e-cigarettes to help them quit, clinicians should not discourage their use by the patient,” the education and advocacy group said in a statement published yesterday.
But medical staff should be “educated so they can inform patients that e-cigarettes are unregulated, may contain low levels of toxic chemicals, and have not been [approved by the U.S. Food and Drug Administration, or FDA] as cessation devices.
“The association also proposes that given the lack of long-term research studies on e-cigarette safety that it’s appropriate for a healthcare professional to suggest that a patient set a quit date for their e-cigarette use.”
The new guidance on e-cigs was published in Circulation, the journal of the long-established AHA, which claims 22.5m supporters and volunteers.
Despite its guarded support for e-cigs as a cessation aid, the AHA generally shares the tone of many medical organisations in the U.S. and globally by calling for stricter regulation of the category and warning of possible dangers to both individual and public health.
Its CEO Nancy Brown urged the FDA to finalise its rules for e-cigarettes and other newly-regulated tobacco products by the end of this year – something that is unlikely to happen, since the agency first has to wade through about 80,000 submissions received as part of a recently-closed public comments process – and said “we fear that any additional delay of these new regulations will have real, continuing public health consequences”.
To address these, the AHA wants all U.S. tobacco rules to apply to e-cigarettes containing nicotine, at the state as well as federal level, “if the change can be made without weakening existing laws”.
“E-cigarettes have caused a major shift in the tobacco-control landscape,” said Aruni Bhatnagar, chair of cardiovascular medicine at the University of Louisville in Kentucky and lead author of the Circulation article. “It’s critical that we rigorously examine the long-term impact of this new technology on public health, cardiovascular disease and stroke.”
Like many health organisations which have expressed concern over e-cigarettes, the AHA is particularly worried about use by youth and about the possibility of smoking becoming re-normalised. Like many, too, it calls for further research. Before its most recent statement, it had already asked the FDA to move more quickly on regulation earlier this summer, and in the spring had written to president Obama with a similar hurry-up message.
What This Means: Coverage has focused on the AHA’s misgivings about e-cigarettes, but these will come as no surprise to those in the industry; broadly speaking, they are the usual list. What may be more significant here is that the association does, albeit warily, acknowledge the potential role of the products in smoking cessation.
Of course, this is most likely just a case of recognising the fact that individuals are widely employing e-cigs for the purpose, and some healthcare professionals are recommending or at least supporting their use – it’s hardly a fervent endorsement. But it is another hint that the debate could be moving away from a complete reluctance to accept e-cigs on the cessation agenda at all, and toward dealing with them as a reality.
– Barnaby Page ECigIntelligence staff