Quitting Tobacco Necessary to Save Lives, Not Switching to Different Tobacco Product, Says American Lung Association Chief Medical Officer

Statement of American Lung Association Chief Medical Officer Albert Rizzo, M.D., FACP, in response to “A Randomized Trial of E-Cigarettes versus Nicotine Replacement Therapy” released January 30, 2019, in the New England Journal of Medicine:  

“The recent study published in the New England Journal of Medicine (“A Randomized Trial of E-Cigarettes versus Nicotine Replacement Therapy”) fails to resolve outstanding issues and provide clarity to smokers on how to quit smoking, instead this study only serves to further confuse the millions of Americans who want to end their addiction to nicotine. 

“No e-cigarette has been found safe and effective by the U.S. Food and Drug Administration in helping smokers quit – and indeed, that is borne out in the results of this study as well. Over 90 percent of smokers prescribed nicotine replacement therapy (NRT) ended their nicotine addiction entirely, which is in marked contrast to smokers given e-cigarettes as an aid in quitting: 80 percent of that cohort did not quit but switched to e-cigarettes, putting them at potential risk for other serious health harms, continued addiction and return to conventional cigarettes.

“The full extent of the long-term health effects of e-cigarette use are simply not known but substituting one type of poison for another continues to jeopardize smokers’ health. Continued and long-term use of e-cigarettes mean prolonged exposure to ingredients that we know cause serious and irreversible lung disease and contain carcinogens. Because e-cigarettes are a relatively new product – and have not been evaluated as the FDA-approved cessation products currently on the market have been – the long-term health consequences of e-cigarettes remain unknown.

"In addition to NRT treatments, which have been found by the Food and Drug Administration to be safe and effective in helping smokers quit, there are two other FDA-approved treatments that are more effective than NRT that smokers should talk with their medical providers about – bupropion and varenicline – both of which have much higher rates of helping smokers quit than NRT.  Those treatments were not evaluated in this study.

“Moreover, this study also has serious methodology flaws, including that the study was not double blinded per standard practice, as well as additional concerns raised by Borelli and O’Connor in the accompanying editorial.

“The American Lung Association wholeheartedly agrees that more must be done to make available new treatments that the FDA has determined to be safe and effective in helping smokers quit. Last year, the American Lung Association filed comments with the Food and Drug Administration, urging them to do more to bring additional safe and effective tobacco treatments to market. The American Lung Association and our partners have also written to FDA Commissioner Scott Gottlieb, M.D., urging FDA to encourage the development and approval of products that will be even more effective in helping smokers quit.”

“To realize a world free of lung disease, it’s essential to help smokers quit entirely, not switch to another form of tobacco and nicotine addiction through e-cigarettes. The American Lung Association stands ready to help smokers quit with proven effective methods to end the nation’s leading cause of preventable death and disease – tobacco use.”