We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Note |

If Only Electronic Cigarettes Were Effective Smoking Cessation Devices

Mitchell H. Katz, MD
JAMA Intern Med. 2014;174(5):813-814. doi:10.1001/jamainternmed.2014.167.
Text Size: A A A
Published online


Harm reduction is one of the pillars of modern public health. For example, when people criticized methadone treatment as only substituting one drug for another (heroin), public health advocates pointed to research showing that methadone use led to users decreasing or ceasing their heroin use and living more functional lives. Thus, as a harm reduction proponent, I would be willing to put aside the fact that any product with the name “cigarette” (e- or otherwise) causes me reflex tachycardia and support electronic cigarettes (e-cigarettes or electronic nicotine delivery systems) if there were good data indicating that they helped smokers to stop.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment
Question about methadone maintenance analogy
Posted on May 12, 2014
D L Keller
Conflict of Interest: None Declared
You stated "methadone use led to users decreasing or ceasing their heroin use and living more functional lives". As a libertarian, I am curious to know to what extent those same benefits could have been achieved by legalizing heroin, at least for established heroin addicts. Much of the harm done to heroin addicts is caused by the fact that heroin is illegal, which makes it expensive (causing the need for addicts to steal), of uncertain potency (leading to overdose deaths) and impure (causing infections). Many heroin addicts continued to shoot up while on methadone maintenance, which negated its value for them. Haven't other countries had greater success in reducing the burden of overdose deaths, infections (including HIV) and crime rates by legalizing heroin, morphine and other injected opioids for registered addicts?
Let the bad be the enemy of the truly horrendous
Posted on May 10, 2014
David L. Keller, MD
Conflict of Interest: None Declared
Much of the harm of smoking is known to be due to inhalation of hot smoke, carbon monoxide, and other products of tobacco combustion. E-cigarettes deliver nicotine to the lungs as a cooler vapor, absent combustion products. While nicotine is an addictive drug known to increase the risk of heart attacks, the argument for making e-cigarettes available to smokers is that e-cigarettes are predicted to cause far fewer lung cancers, due to the absence of carcinogenic "tar" particles or hot irritating gases in their vapor. In addition, e-cigarette users are not inhaling the carbon monoxide found in cigarette smoke, which contributes to coronary ischemia among other ill effects. Even if the use of e-cigarettes does not cut down the number of cigarettes smoked, at least we know that when a chain-smoker is inhaling from an e-cigarette at a given moment, he is not also smoking a regular cigarette at that same time. Smoking causes lung cancer and heart attacks, while e-cigarettes cause "only" the latter. Using e-cigarettes is a bad choice, but this is a case of letting the bad be the enemy of the truly horrendous. I advise my patients neither to smoke nor to e-smoke, but if I had to choose one vice, it would be the latter.
Your wish for evidence may have come true!
Posted on May 21, 2014
David L. Keller, MD
Conflict of Interest: None Declared
Your wish may have come true!The latest study concludes \"Among smokers who have attempted to stop without professional support, those who use e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation. This difference persists after adjusting for a range of smoker characteristics such as nicotine dependence.\"(1)Would you please write an editorial entitled \"If only there were a cure for Parkinson's disease\"? I would personally appreciate that, and although it seems unscientific, your editorials seem to get results in a remarkably quick fashion ;-)Reference1: Brown J, et al. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction. Pre-publication online at: http://onlinelibrary.wiley.com/doi/10.1111/add.12623/abstract
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

1 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...