E-Cigs Still an E-normous Question Mark

“To be brutally honest with you, we are playing catch-up here in a big way when it comes to e-cigarettes,” said Dr. Doug Jorenby, director of clinical services for the University of Wisconsin Center for Tobacco Research and Intervention (CTRI).

“No one foresaw how huge the influx of these things was going to be when they first started to become available in the early 2000s,” he told LifeZette.

Seldom did the same question asked of two physicians get the same response.

Jorenby’s comments follow a new report from Stanford University. It shows that despite the increasing popularity of e-cigs — especially among teens and non-traditional smokers — physicians really don’t know much about vaping at all.

“In this study, we were curious about actual provider behavior — the advice doctors gave in real patient interactions,” the study’s senior author, Judith Prochaska, Ph.D., MPH, associate professor of medicine at the Stanford Prevention Research Center, said in a statement.

Because e-cigarettes are so new, and so few studies have been conducted on them, physicians have little to rely on when patients ask about the devices. For this reason, Prochaska and her colleagues at the Stanford University School of Medicine wondered what doctors typically said — and whether they conveyed that uncertainty.

What the team found after analyzing more than 500 online interactions between patients and doctors was this: Physicians showed a wide range of responses to patients. Seldom did the same question asked of two physicians get the same response.

Related: To Quit Smoking — Let’s All Vape

The study results were published online on Aug. 26 in the American Journal of Preventive Medicine.

[lz_bulleted_list title=”E-Cigarettes” source=”http://www.lung.org”]The FDA found detectable levels of toxic cancer-causing chemicals, including an ingredient used in anti-freeze, in two leading brands of e-cigarettes and 18 various cartridges, in 2009. Levels of toxins in e-cigarette aerosol also vary considerably within and between brands. [/lz_bulleted_list]

The most frequent themes brought up by physicians matched the most frequent concerns of patients: specific side effects of e-cigs and general safety. But doctors often brought up topics not mentioned by patients, including the need for more research and the relative safety of e-cigarettes compared with combusted tobacco. In addition, clinicians tended to mention nicotine more often than patients, frequently expressing specific concern about nicotine addiction.

Researchers also studied the overall tone of the conversations. How physicians spoke to patients seemed to make a difference. The more positive and non-judgmental physicians were, the more receptive patients appeared to be toward the advice. Only 20 percent, though, felt their interactions were positive — perhaps a physician encouraged the use of e-cigarettes as smoking cessation aids. In this study, by the way, 54 percent of doctors did just that.

“The existing research does not indicate that e-cigarettes help people quit combustible cigarettes,” Prochaska said. “This is an area in need of greater study.”

Related: Why E-Cigs are So Deceptive

Prochaska and her colleagues are now using the information to teach doctors what’s known about the health effects of e-cigarettes and how to communicate the benefits and risks of the devices to patients through a continuing education portal at Stanford.

“They’re so ubiquitous — they’re right there in the Quickie Mart by the regular cigarettes, and there are specialty shops out there. I’m not surprised that the Stanford study found a lot of variability. There isn’t a lot that’s solid and evidence-based that we can tell people at this point,” said Jorenby.

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E-cigarettes, which work by heating up liquid nicotine until it vaporizes, have taken off quickly among adults and teenagers since coming on the market just over a decade ago. The U.S. Centers for Disease Control and Prevention estimates 3.7 percent of U.S. adults regularly use e-cigarettes. The devices are often promoted as safer than combustible cigarettes — but there’s little long-term evidence to support the assertion.

Jorenby and the CTRI researchers are studying how often those who want to quit get stuck still smoking, and vaping on top of that. “That’s a real unknown and has some significant public health implications, especially if some of those folks that have become ‘dual users’ could have quit completely had they used evidence based treatments,” he said.

Jorenby said all smoking cessation experts and physicians can do until further research is done is remind smokers there are proven effective ways to quit smoking completely — and offer those solutions as the real alternative.