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Are e-cigarettes safe? Doctor lays out benefits and harms

A new report featuring a physician from Mass. General looks and the good and bad of e-cigarettes.
e-cigarettes, smoking, ecigs, cigarettes
What should doctors say if a patient asks about c-cigarettes? Photo: Getty Images

There’s plenty of evidence that smoking is bad for you, but the ruling on e-cigarettes isn’t so clear. Do they help people quit smoking, or do they get people to pick up the habit?

Nancy Rigotti, a physician at Massachusetts General Hospital and a Harvard Medical School professor, hopes to shed more light on what doctors should tell patients who ask about e-cigs.

In a piece published this week in the journal Annals of Internal Medicine, Rigotti lays out the benefits and harms of e-cigarettes.

"E-cigarettes have the potential for enormous benefit if they help smokers quit,” Rigotti writes. “[But] this benefit must be balanced against potential harm if e-cigarettes entice youths who would not otherwise have become cigarette smokers to try e-cigarettes, become addicted to nicotine and then switch to combustible cigarettes."

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Rigotti is a member of the National Academies of Sciences, Engineering and Medicine (NASEM), which released a report on the public health consequences of e-cigarettes last month.

That report was commissioned by the Food and Drug Administration and involved NASEM experts like Rigotti; Ava Navas-Acien, an environmental health professor at Columbia University; cancer researchers, policy experts and more.

That report’s main finding was that using e-cigarettes is less hazardous than continuing to smoke regular, or combustible, cigarettes, because e-cigarettes do not burn tobacco.

Switching completely from cigarettes to e-cigs will likely lower smoking-related health hazards, the experts found — but those who continue to smoke both types don’t see these benefits.

The NASEM committee also found no evidence that e-cigarettes increase someone’s risk of cardiovascular or pulmonary disease, cancer or other “adverse outcomes.” However, in her new writing, Rigotti warns that “lack of evidence does not equal evidence of no risk.”

More research on the long-term effects of e-cigs are needed, Rigotti cautions.

Though the use of e-cigarettes may increase the chances that teens who don’t smoke will try combustible cigarettes, the NASEM report concluded overall that the net effect of e-cigarettes is positive and that they’ll likely save lives over the next 50 years of use in the United States.

The NASEM report didn’t, however, give advice for what doctors should tell smokers about these electronic versions. That’s why Rigotti added her own guidance in this week’s publication.

"I tell patients that using e-cigarettes is less harmful than continuing to smoke cigarettes, but because e-cigarettes are so new, I caution them that many questions about their long-term safety remain unanswered,” she writes.

Essentially, Rigotti wants to tell people who want to try e-cigarettes that they should switch over to the devices completely to stop smoking combustible cigarettes. Eventually, they should try to stop smoking e-cigarettes, too.

"Overall, the message I aim to convey,” she writes, “is that I will continue to support and assist patients on their journey to becoming nonsmokers.”