MDs who blow smoke about vaping

Where do smokers go to learn about e-cigarettes? @NightshiftMD explains why asking your physician might not be the best place to turn.
E-cigarettes are creating confusion in the advertising world (Regis Duvignau /Reuters)

Where do smokers go to learn about e-cigarettes? @NightshiftMD explains why asking your physician might not be the best place to turn. 5:08

Last year, public health officials in England endorsed e-cigarettes as a smoking cessation aid.  And more than a million-and-half Canadian smokers have tried e-cigarettes at least once, according to Statistics Canada. That has a growing number of smokers asking their family doctors about vaping. But a new study raises just how much MDs are in the know.

Turns out it's not as much as one would like, according to a study by scientists at Stanford University's Prevention Research Center. The researchers teamed up with HealthTap, an online health company that allows users to submit medical questions to up to 72,000 physicians that work with the site. Nearly 10,000 questions were about tobacco or smoking, and close to 500 were about e-cigarettes. Despite growing scientific evidence regarding the safety of e-cigarettes, the doctors tended to exaggerate the dangers. Forty-seven per cent of the replies from doctors were negative about e-cigarettes; just 20 per cent were positive. The study is published in the American Journal of Preventive Medicine. (Apologies for the paywall.)

On the one hand, the comments by physicians tended to match up with the most frequent concerns raised by patients, things such as specific side effects and the general safety of e-cigarettes. But a fairly sizable number of doctors affiliated with HealthTap also brought up topics that were not mentioned by patients. These included the need for more research on e-cigarettes, even though public health experts in the United Kingdom say current evidence is strong enough to recommend them. Doctors were also more likely than patients to mention nicotine, and often expressed specific concern about nicotine addiction.

This study looked at the attitudes of US doctors toward e-cigarettes. I'm not aware of any published surveys that test the knowledge of Canadian doctors on the effectiveness and safety of e-cigarettes as nicotine replacement.  Anecdotally, my sense is that key thought leaders in Canada are alarmist about e-cigarettes. They ignore evidence such as a recent study of nearly 6,000 adult smokers showing that e-cigarette users are more likely than users of any other type of nicotine replacement to abstain from tobacco use long term. Despite evidence to the contrary, they tend to believe uncritically that chemicals found in the vapour are more deadly than combusted tobacco. They cling to the notion that nicotine addiction, as opposed to combusted tobacco products, is the paramount health problem.  And, they overestimate concerns that e-cigarettes act as a gateway to regular tobacco use. We heard some of that in our program about the science and spin around e-cigarettes, which we aired last year. 

I suspect that many physicians are unaware of the growing scientific evidence in favour of e-cigarettes. Physicians tend to be a conservative lot. They don't endorse and probably don't even pay attention to a new treatment until key people say it's safe to do so. In the case of e-cigarettes, the main thought leaders in Canada are public health officials and politicians who I think have shown a cognitive bias against e-cigarettes by conflating them with tobacco. I also think they've been fixated on nicotine addiction, when the health related goal should be to reduce heart and lung disease by getting smokers off tobacco.

Why British public health doctors are in favour of e-cigarettes while Canadian counterparts are not is a good question for which I have no answer.  But I'm with my British colleagues.

The authors of the paper in the American Journal of Preventive Medicine have developed an education portal to inform doctors about the health effects of e-cigarettes, and how to communicate the benefits and risks to patients. In my experience, education portals aren't the ticket to better informing doctors.  

The big shift has to come from public health physicians and other thought leaders. The Canadian Public Health Association has taken a big step in that direction, by acknowledging that it's time for Canadian officials to re-examine the tendency to equate e-cigarettes with tobacco, and by highlighting the prediction made by officials at Public Health England  that e-cigarettes would significantly contribute to achieving the health goal of a tobacco-free generation by the year 2025.

Let's hope that legislators and policy makers are paying attention. And as for my colleagues, maybe it's better in this case to look up the facts, or at the very least, to say nothing, instead of dissing a smoke cessation tool with a lot of potential.


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