by Dr. Eric Johnson

GRAND FORKS — According to the Centers for Disease Control and the U.S. Surgeon General, tobacco kills about 480,000 persons every year in the United States.

In 1964, about 41 percent of adults were cigarette smokers. Today, that rate is down to a little more than 18 percent. Significant strides have been made over the past five decades to reduce smoking and the tremendous health and financial burden it puts on our society.

In North Dakota alone, tobacco use still contributes to about $250 million in health care expenditures.

Encouraging people to quit tobacco remains a high priority with regard to the health of Americans, yet only two states in the nation — Alaska and North Dakota — fund anti-tobacco programs at levels recommended by the CDC.

In North Dakota, our efforts continue to be supported by the public. Public sentiment, expressed at the ballot box and in polling, shows that reducing tobacco use remains a high priority for North Dakotans. In 2008, voters approved Measure 3 to support funding of anti-tobacco programs; and in 2012, the statewide smoke-free law — passed as a ballot measure — got 67 percent of the vote, winning support from a majority of voters in every legislative district.

Some 89 percent of North Dakotans polled in 2013 think the funds designated for tobacco control should stay there.

What works to help people quit tobacco? The U.S. Preventive Task Force and the Surgeon General endorse medications that have proven effectiveness with a known, Food and Drug Administration-approved, safety and side-effect profile.

These include nicotine replacement products such as gum, patches or lozenges, as well as prescription medications such as Chantix (Varenicline) or Wellbutrin (Buproprion).

Proven counseling programs, such as NDQuits (available free to all North Dakotans who use tobacco), also are very effective, particularly when combined with an FDA-approved medication.

Electronic cigarettes (e-cigs) are increasingly popular products that fall into the unproven category. First invented in the 1960s, their popularity has continued to increase as large tobacco companies buy small “mom-and-pop” manufacturers. With more than 250 brands on the market, (“Blu,” “NJOY” and “Vuse” popular in America), e-cigs are battery-powered (some disposable, some rechargeable) with a vaporizer and mouthpiece attached.

When used, commonly referred to as “vaping,” the vaporizer boils the liquid inside, which most frequently contains three major ingredients — humectants (propylene glycol/glycerin, used in fog and smoke machines and antifreeze), nicotine (at varying levels) and flavoring (fruit flavors, bubble gum, cotton candy, bacon and coffee, to name a few).

Unlike other medications that are used to promote quitting tobacco, e-cigs are largely unregulated by the Food and Drug Administration; and to date, we have no real data to show that they are effective as a cessation product nor any data to show that they are safe.

Furthermore, some of these manufacturers have been cited for contaminants in their products, including nickel, arsenic and chromium.

Without FDA oversight, these products aren’t taxed, they can be sold to anyone of any age, and there are no restrictions on advertising, which is why we see and hear ads on TV, in magazines and on the radio.

Though the industry denies it, it’s apparent that these products are being marketed to children (unless we’re supposed to believe that “Hello Kitty” e-cigs are popular among adult users).

E-cig manufacturers, rather than relying on science, really are trying to “normalize” smoking again for the next generation. The recent national Youth Tobacco Survey showed a spike in use of e-cigs by youth, doubling to more than 10 percent in just one year.

In addition, many who use e-cigs become dual users, continuing to use other tobacco products at the same time.

Last but not least, the industry is playing on the desperate idea that anything else would be better than smoking traditional cigarettes. If that’s true, ask yourself why these same companies are so resistant to producing the data to back up their claims.

It’s disappointing that e-cigs have been marketed for more than 35 years and have yet to collect or publish any significant data to show they are safe for users or that they actually help people quit.

Considering these products increasingly are manufactured and marketed by Big Tobacco, I’m not anticipating we’ll see such data any time soon.

The FDA has made it very clear that e-cigs cannot be marketed as smoking cessation products as a result.

As a health care provider, I would love a good, new and novel option to help people quit smoking. Like other conditions I treat as a physician, I want to provide the best possible treatment for my patients, and that means practicing strategies and using medications that have scientific proof that they work and have an established safety profile.

To date, when it comes to quitting tobacco, that answer is not found in electronic cigarettes.

Dr. Johnson is a family physician at Altru Health System in Grand Forks.

From the Grand Forks Herald