Nearly 70 percent of smokers say they want to quit. In an effort to help them, the American Lung Association (ALA) recently launched its “Quit, Don’t Switch” campaign. The ALA “believes everyone who uses tobacco products can quit using methods that are proven safe and effective by the FDA….”
Unfortunately, not only does this campaign deliberately avoid acknowledging the benefits of new smoking quit tools, it is embarrassingly out of touch with the people whom traditional quit methods have failed.
As is clear from both research and anecdotal experience, smoking is a tough habit to break. The smoking cessation methods that the Food and Drug Administration deems “safe and effective” include nicotine replacement therapy products like gums, patches and lozenges; prescription medications like Chantix; and counseling programs. Yet academic literature shows that only 5 to 20 percent of smokers who use these methods succeed at quitting long-term. Safe, perhaps. Effective? Not so much.
Fortunately, in recent years, smokers gained a more effective option. E-cigarettes, which researchers have determined are at least 95 percent less harmful than their combustible cousins, are helping smokers quit or substantially cut back on combustible cigarettes at record rates. In fact, e-cigarettes performed nearly twice as well as nicotine replacement therapy products during a randomized trial comparing the two options as smoking cessation treatments. E-cigarettes may not be completely harmless, but combustible cigarettes are deadly, and making the switch is vastly better for smokers’ health.
Indeed, the secret that tobacco control organizations don’t want people to know is that when compared to other addictive substances, nicotine itself is a rather benign chemical. Yet much like other substances, the means of consumption can make nicotine more or less harmful. For tobacco, the health hazard is largely attributable to the combustion process of many tobacco products. E-cigarettes eliminate the combustion process, thereby rendering them much less harmful.
The campaign shows that tobacco control has not evolved beyond the abstinence-only tactics that other areas of public health discarded long ago.
Yet the ALA’s anti-smoker rhetoric inaccurately implies that the harm caused by combustion to nicotine by ignoring that tobacco products exist on a continuum of risk. They state that “Switching to e-cigarettes does not mean quitting. Quitting means ending your addiction to nicotine….” This is especially odd considering that the prevailing opinion of health organizations is that long-term use of nicotine replacement therapy—which supplies users with nicotine to ease withdrawal symptoms—is a safe means of quitting smoking.
In fact, nicotine replacement therapy works in a strikingly similar way to e-cigarettes: The person is still consuming nicotine—whether orally, in the cases of gum and lozenges; through the skin, in the case of patches; or by inhalation, in the case of e-cigarettes— only there is no combustion, no smoke and no tar.
So while the ALA may find it alarming that “[E-cigarettes] were designed to appeal to people who wanted to use something beside[s] a cigarette,” this is actually what makes e-cigarettes successful quit tools.
Remember, it’s hard to quit smoking, and even harder to quit nicotine. E-cigarettes appeal to smokers precisely because they mimic combustible cigarettes in terms of inhalation, hand-to-mouth action, social aspects and pleasure. All of this helps explain why smokers who switch to vaping have a higher chance of successfully kicking their smoking habit than those who use other quit methods.
The ALA notes, “No tobacco product is safe, and that includes e-cigarettes,” meaning that “Quit, Don’t Switch” may eliminate all harm related to nicotine consumption, if successful. But the campaign also shows that tobacco control has not evolved beyond the abstinence-only tactics that other areas of public health discarded long ago.
A harm reduction approach, on the other hand, acknowledges that abstinence-only approaches don’t work for everyone. For people unable to abstain, abstinence-only policies do nothing to reduce risk of harm and may even increase the danger of engaging in high-risk activities by eliminating access to safer options or criminalizing behaviors.
In the tobacco realm, harm reduction advocates embrace all smoking quit methods—including total abstinence, traditional nicotine replacement therapies and e-cigarettes—as having the potential to improve individual and public health. In short, they don’t let achieving the ideal become the enemy of improvement.
By refusing to accept the notion that harm reduction can be part of tobacco control, the ALA and its allies are admitting they have little interest in actually helping smokers improve their health. And by casting harm reduction as a devious marketing tactic rather than a proven prevention strategy, tobacco control organizations are stoking the flames of moral panic and steering the conversation about e-cigarettes toward prohibition—to the detriment of smokers and public health.
“Quit, Don’t Switch” is the latest example of insensitivity by ALA and other tobacco control groups. Since combustible tobacco products are the largest cause of preventable death and disease worldwide, it is shameful to push aside any innovation that allows smokers to consume nicotine in a less harmful way. For the sake of the world’s 1.1 billion smokers, one can only hope that every health organization focuses on the known harm combustible cigarettes cause and the need to extinguish combustible product use through all available means.
* The R Street Institute, the author’s employer, previously provided a restricted grant to The Influence Foundation, which operates Filter, to support production of two reports on harm reduction topics.