Dr. Mintz on E Cigarettes

January 31st, 2011

Previously we interviewed Brad Rodu (which you can find here). However, e cigarettes are relatively new, and thus opinions from the medical community on them vary. Because of this, we tracked down Dr. Mathew Mintz, an expert on repertory disorders, and asked him about his opinion on the subject. You can find more at Dr. Mintz’ Blog.

AllTreatment: Mathew, what is it that you do?

Mathew Mintz: I am an internist at an academic medical center. I have several teaching responsibilities at the medical school but also see patients in the outpatient clinic. I have also done some research both in the areas of medical education and respiratory diseases. I have published several articles and written a book for primary care physicians about respiratory disorders.

AT: Do you believe that e cigarettes are a viable alternative to smoking?

MM: I believe that e-cigarettes are probably better than tobacco cigarettes as far as total health risk. Nicotine has some health risks, specifically when it comes to cardiovascular disease. However, tobacco based products have not only the risk of nicotine, but other toxins that lead to respiratory disorders and lung cancer. Chronic Obstructive Pulmonary Disease (COPD) is now the 3rd leading cause of death in the US (just surpassed stroke), and much of COPD is caused by tobacco cigarettes. Thus, I think e-cigarettes may have a role in harm reduction. However, I am very concerned about e-cigarettes because they are not regulated. They are made overseas and can be sold anywhere. The few FDA studies indicate there are toxic ingredients in e-cigarettes and nicotine levels varied (some e-cigarettes were found to have no nicotine). I am very disturbed that these are sold at kioks in shopping malls. Given that they come in flavors and are sold by young adults, I am very concerned that children could purchase these product. Thus, I would really like e-cigarettes to be regulated by the FDA, just as they do other nicotine products such as the patch and gum, to ensure they are safe. Then, I would consider using them for harm reduction.

AT: Would you recommend them to those whom are quitting? What about those who are, for one reason or another, determined not to quit?

MM: I don’t think e-cigarettes are good for someone trying to quit smoking. The purpose of quitting is not just to get off the tobacco, but the nicotine as well. There are many products which have proven to be effective in getting people off tobacco cigarettes. The main principle is a continuous, but lower dose of nicotine, which decreases withdrawal symptoms and is eventually weaned down.

There is a nicotine inhaler which has been shown to be more effective than placebo in getting people to quit. I personally do not prescribe this because I think it just replaces one cigarette for another, and why I would not recommend the e-cigarette for quitting. However, I would like to see studies done comparing either medications such as bupropion or chantix, or even the patch to e-cigarettes. If regulated by the FDA (so I know they are safe) and proven effective (with studies), e-cigarettes could be a possible option for quitting. However, until this happens I would not recommend this to patients.

AT: In our interview with Brad Rodu, he states, “many tobacco products that are just as satisfying as cigarettes but vastly safer This includes a range of smokeless tobacco products, including pellets, mini-pouches, e-cigarettes and more. The public is being denied this information by government officials and nongovernmental organizations…”. Would you agree with this statement? Would you suggest to a quitting smoker to use one of these alternatives?

MM: I think that the public has the right to know all the risks associated with all nicotine and/or tobacco products. However, as above, I would suggest that patients only use FDA approved medications to quit. Most studies seem to indicate that pills (bupropion and chantix) are more effective than nicotine replacement (patch, gum), so I generally recommend these medications first.

S. Cody Barrus
Managing Editor

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