Drs Avdalovic and Murin1 raise an important question: What do we say to our patients and others who inquire about electronic cigarettes (e-cigarettes)? I disagree with their dogmatic stance that in the absence of definitive proof that e-cigarettes are safe, we must assume that they are not. The science indicates that a more nuanced response will best serve the health interests of these patients.
e-Cigarettes are not cigarettes at all, since they do not contain tobacco and they are not combusted. Essentially, they are a new form of nicotine inhaler. Failure to acknowledge this fact has led to an emotion-based, not evidence-based, response to e-cigarettes. Combustible-tobacco cigarettes have been, and remain, the number one preventable cause of heart disease and lung cancer, responsible for one-half million premature tobacco-related deaths each year in the United States, and 6 million worldwide. Despite evidenced-based campaigns for smoking cessation, smoking rates remain steady in the United States and are actually increasing in less affluent countries.