ASAM Weekly Editorial Comment

Sorry, Professor McLuhan. It’s not the medium. It really is the (neurotransmitter) message. | 2.5.2019

by Dr. William Haning | Feb 04, 2019

Chronic disease paradigm, again


The New York Times  produced a piece this past week with the following headline and subtext: “E-Cigarettes Are Effective at Helping Smokers Quit, a Study Says:
A yearlong, randomized trial in England showed that e-cigarettes were almost twice as successful as products like patches or gum for smoking cessation.” The article cites a study in the 30 January online edition of New England Journal of Medicine by Peter Hajek et al., In which a sample of 886 participants were randomized to standard nicotine replacement therapy or electronic cigarette (vaporizer) use . The conclusion was that e-Cigarettes were more effective for smoking cessation.


Whether the article proves a boon to the nicotine cartridge and e-cigarette device manufacturing industries, there is an important distinction to be emphasized. As noted in one of the editorials accompanying the New England Journal article (Borelli & O’Connor), few of those using the electronic delivery system remained abstinent of nicotine in some form, with 80% still vaping at one year (vs. persistent nicotine use by 9% of conventional NRT users). That they did stop use of combustible tobacco may be seen as reducing the risk for pulmonary disease or exacerbation of existing respiratory disorders. But it would be disingenuous to suggest that very much other than this has been achieved.  The target outcome of the study was smoking cessation, not nicotine cessation.  Unfortunately we have at least partially brought this upon ourselves with the Fifth Edition of the Diagnostic and Statistical Manual, which persists in describing the addictive condition in question as “Tobacco Use Disorder;” rather than, rightfully, as a nicotine use disorder.  Tobacco use wants relegation to a risk category for pulmonary disease, similar to the role of coal dust in pneumoconiosis.  What has been achieved is support for reduction of harm, with a far lower yield in nicotine cessation than is seen with conventional nicotine-replacement therapy.



- W. Haning, MD