A new approach to smoking cessation

Quintessential ad man Don Draper from the hit TV series Mad Men, when his ad agency lost their account with Lucky Strike, penned a letter for publication in the New York Times saying, “For over 25 years, we devoted ourselves to peddling a product for which good work is irrelevant, because people can’t stop themselves from buying it. A product that never improves, that causes illness, and makes people unhappy. But there was money in it. A lot of money. In fact, our entire business depended on it. We knew it wasn’t good for us, but we couldn’t stop.” Smokers understand the dilemma. They always talk about quitting, but actually doing it is a different matter. Should you quit smoking? Certainly, and according to the American Cancer Society, 98 percent of tobacco-related deaths are caused by cigarette smoking, and combustible tobacco products (cigarettes) are the single greatest cause of cancer and kill about 7 million people every year worldwide. But when it comes down to the decision on how to quit, there are a lot of different methods available, and not all of them pleasant. The “cold turkey” method – a full stop – causes difficult side effects, including anxiety, irritability, headache, trouble sleeping, fatigue and hunger. There are psychological side effects of withdrawal, but make no mistake, quitting smoking has a physical impact on your body. There are positives – almost immediately, your heart rate and blood pressure will improve and the carbon monoxide in your body will return to a normal level, but it will be challenging to get through the side effects for the first few weeks. Because of those side effects, which can impact one’s ability to work and function in daily life, many people choose one of several smoking cessation tools, ranging from nicotine patch delivery systems to hypnosis. The nicotine patch delivers the nicotine but without the smoke, so the side effects are minimized. The emerging vaping industry has also made claims, which have been substantiated scientifically, that vaping is equally useful as a smoking cessation tool, and some may prefer this to a nicotine patch, if for no other reason that it gives the user the pleasant social experience of smoking (again without the actual smoke), and the psychological impact of having something in hand. Vaping as a smoking cessation tool is controversial in some circles, but as a useful tool for smoking cessation there is legitimate science behind it. The American Cancer Society’s position paper on vaping, issued in February 2018, says “Based on currently available evidence, using current generation e-cigarettes is less harmful than smoking cigarettes.” The ACS does of course, recommend against using any type of nicotine product, but the agency is interested in exploring and promoting any type of system that aids in the cessation of combustible tobacco products, including vaping. According to their position paper, “The ACS has always supported any smoker who is considering quitting, no matter what approach they use; there is nothing more important that they can do for their health.” The ACS first recommends that clinicians advise their patients to use FDA-approved cessation aids, but acknowledges that, “Many smokers choose to quit smoking without the assistance of a clinician and some opt to use e-cigarettes to accomplish this goal.” The vaping industry has been a responsible player in promoting its products, unlike the Wild West days of Big Tobacco, where unfounded claims were commonplace. Todd Skezas, CEO and co-founder of San Diego-based Vapor Authority, notes that the vaping industry does acknowledge the effectiveness of its products as a tool for smoking cessation. “As noted in the American Cancer Society position paper, any smoking cessation tool should be encouraged, including the use of e-cigarettes. With independent studies showing that vaping is less harmful than combustible tobacco, it has become a legitimate option that many have chosen, and many have used it with great success as a way of quitting cigarettes.” In cases when smokers do not choose to use FDA-approved cessation medications, the ACS further states that, “These individuals should be encouraged to switch to the least harmful form of tobacco product possible; switching to the exclusive use of e-cigarettes is preferable to continuing to smoke combustible products.” The ACS also recommends that, if e-cigarettes are to be used, a complete switch be taken, and discourages the concurrent use of combustible cigarettes and e-cigarettes, which would be more detrimental than e-cigarettes alone.