Is it advisable to shift from smoking cigarette sticks to electronic cigarettes (e-cigs)? For patients trying to quit smoking, are e-cigs really a better option?

This subject remains a controversy and will be one of the topics for discussion at the 14th Postgraduate course of the Manila Doctor’s Hospital (MDH) entitled “I.M. (Internal Medicine) for Juan: 40 Years of Teaching and Healing the Filipino.”

It will be held on June 29-30 at the Diamond Hotel, Roxas Boulevard cor. Dr. J. Quintos St., Manila City.

Dr. Albert Albay is the main lecturer on e-cigs.

Simplified diagnostic and treatment approaches of other commonly encountered medical problems will be discussed by a distinguished faculty of 29 consultants at MDH, including such medical luminaries as Dr. Dante Morales, Dr. Camilo Roa Jr., Dr. Anthony Leachon, Dr. Edsel Salvana, Dr. Robert Mirasol and Dr. Paul Lee.

Dr. Karla Kristine Silverio-Fernando and her committee prepared a clinically oriented, real-world-relevant scientific program that can help update internists, family physicians, nurses and other healthcare professionals.

I’m looking forward to how Dr. Roa and Dr. Albay will present both sides of the e-cig controversy.

I allow my patients to use e-cigs as an alternative to nicotine replacement therapy while they’re trying to quit smoking. But it should only be a temporary option not an indefinite substitute to smoking cigarettes.

E-cigs should be prescribed with counseling for smoking cessation.

A lot safer

E-cigs heat liquid nicotine from cartridges, converting the addictive substance into inhalable vapor. Hence, it’s also called “vaping.”

There’s a small device inside the e-cig that heats up the liquid nicotine into a vapor that smokers inhale and exhale.

Since it does not contain tar and other chemicals found in cigarettes, its manufacturers claim that using it is a lot safer than tobacco smoking.

E-cigs have become less risky. There are significantly less cancer-causing substances in e-cigs than in tobacco especially with the higher quality of e-liquids being used now.

In a study published earlier this year, e-cigs were used among lung cancer patients who were so addicted to smoking, they simply could not abruptly quit it, and had to be weaned away from smoking with the use of e-cigs for weeks.

In countries where e-cigs are regulated, its main ingredients such as propylene glycol, vegetable glycerine and nicotine are pharmaceutical-grade quality with a markedly reduced quantity of impurities. The flavorings are almost all food grade.

Toxic impurities

So long as e-cigs and their vaping components, including e-liquids, are required to be evaluated and approved by the Food and Drug Administration (FDA), there is some assurance of their quality and relative safety.

I’m not sure if our local FDA, headed by Director General Nela Charade Puno, has issued such a directive on e-cig components. If not, I suggest it should, and treat all e-cig vaping liquids as drugs to be subjected to standard regulatory evaluation, as all nicotine replacement treatments are.

In countries where e-liquids are not registered with the FDA, over-the-counter e-liquids have sometimes been shown to contain toxic impurities. Hence, if not evaluated by the FDA, these e-liquids should never be assumed to
be safe.

Some smoking-cessation experts still think that a nicotine patch is more advisable during weaning from smoking because it also weans the smoker from the habit of lighting a cigarette, holding it with one’s forefinger and middle finger and lifting it to one’s lips to suck in the smoke
or vapor.

Using e-cigs is still smoking. And for an effective smoking cessation regimen to work and be sustained, one must also avoid the behavioral simulation of the vice—like the act of holding a cigarette, or what looks like it, and gently inhaling the smoke or vapor.

So, I say yes to e-cigs as a weaning tool away from smoking, provided all the vaping components are approved by the FDA. But no, if it is sustained as an “alternative lifestyle.”

The goal is still to quit all forms of smoking—including vaping with e-cigs. Promoting e-cigs as the safe alternative to cigarette smoking sounds more like a half-truth.