Do e-cigarettes help people quit smoking?

Electronic cigarettes, known as E-cigarettes, are not comparable to FDA-approved nicotine-delivery devices that have been shown to help people quit smoking. At this time, their dosage, manufacture, and ingredients are not consistent and the products are not clearly labeled, thus making their use by smokers wanting to quit an uninformed proposition.

More importantly, the manufacturers of e-cigarettes have not submitted the requisite applications for FDA approval of these products for smoking cessation. Only one small clinical trial, funded by an e-cigarette manufacturer has been published on their efficacy as a smoking substitute (but not as a cessation aid). The FDA has rejected claims by e-cigarette makers and distributors that their devices are safer than real cigarettes and mitigate the harm of smoking. While some distributors have implied that their products help people quit smoking tobacco products, the FDA views them as unapproved synthetic nicotine delivery devices with unknown safety and efficacy.

In 2008, the World Health Organization (WHO) noted that, “Contrary to what some marketers of the electronic cigarette imply in their advertisements, the WHO does not consider it to be a legitimate therapy for smokers trying to quit. WHO knows of no evidentiary basis for the marketers’ claim that the electronic cigarette helps people quit smoking. Indeed, as far as WHO is aware, no rigorous peer-reviewed studies have been conducted showing the electronic cigarette is a safe effective nicotine replacement therapy.”

Whether e-cigarettes can safely help people quit smoking also is unknown, but with their fruit and candy flavors, they have a clear potential to entice new smokers, especially teens. In addition, because of the unregulated dosing of nicotine, they clearly can be addictive. It is evident from what little information we have that the concentration levels of the nicotine and other compounds are variable, and that there are toxins and carcinogens present. Thus, controlled trials and test market studies are needed to determine if they are safe and effective as a smoking cessation device as is being reported in the media and on the manufacturers’ Web sites.

Similar to concerns regarding the manufacture and sale of tobacco products, the actual content, performance as a nicotine delivery device, safety, and purity of e-cigarettes is largely unknown. Due to the lack of rigorous chemical and animal studies, as well as clinical trials on commercially available e-cigarettes, neither their value as therapeutic aids for smoking cessation nor their “safety” as cigarette replacements is established and remains speculative.

Read the AMA Council on Science and Public Health Report on “Use of Electronic Cigarettes in Smoking Cessation.” http://www.ama-assn.org/resources/doc/csaph/a10csaph6ft.pdf

Russell W.H. Kridel, M.D.

Does bottled water have fluoride in it?

Most bottled water is low in fluoride and lacks sufficient fluoride levels to prevent tooth decay.

However, most municipal drinking water sources do include fluoridation to reduce dental caries.

Drink tap water.  Your dentist and your bank account will be happier.

Read the AMA Council on Science and Public Health Report on “Safety of Bottled Water”.

Russell W.H. Kridel, M.D.

Why is salt the new target in the media?

You may have seen or read about a subway ad campaign that kicked off this week in NYC by the city’s Department of Health that urged consumers to reduce salt consumption.

NYC Subway Campaign

The concern over public salt consumption and salt levels in common food products is not really new news. In a 2006 Report on the Promotion of Healthy Lifestyles, the AMA Council on Science and Public Health addressed the issue of reducing the population burden of cardiovascular disease by reducing sodium intake. You can read a summary of the report here.

The CSAPH stated the public health advice to reduce sodium intake, such as that recently in NYC, is intended to influence the overall distribution of sodium intakes and, thereby, the incidence of hypertension in the population. With an appropriate food industry response, combined with consumer education and knowledgeable use of food labels, the average consumer should be able to choose a lower sodium diet without an inordinate level of dietary restriction, inconvenience, or loss of food enjoyment.

If we could change what the food companies and restaurants do, we can change the consumer’s mindset. And the result will be less cardiovascular disease and improved health overall for our population.

Russell Kridel, MD

 

Are flu vaccinations just for high-risk groups, like the elderly?

No. Flu vaccinations are not just for high-risk groups. The current policy states that routine annual influenza vaccinations are recommended for all adolescents and adults age 6 months and older.

Optimally, vaccination should occur before the onset of influenza in the community. Therefore, vaccinations are offered as soon as a vaccine is available to the public.  In addition, vaccinations are made available throughout the flu season as long influenza viruses are circulating in your community.

Previously, it was recommended that persons at high risk for complications from influenza should be the priority.  But, that is no longer the case.

Read the AMA Council on Science and Public Health Report on Influenza and Influenza Vaccine.

Russell Kridel, MD

Why is there so much concern about sugar-sweetened beverages?

Consumption of sugar-sweetened beverages has been strongly and consistently associated with obesity and a number of related cardiometabolic conditions such as type 2 diabetes and coronary heart disease. A child’s risk of becoming obese increases by 60% for every additional sugary drink consumed per day.  And, women who drink one sugar-sweetened beverage each day have almost twice the risk of diabetes.

Americans consume 200 to 300 more calories each than we did 30 years ago.  And, nearly half of these extra calories come from sugar-sweetened drinks, often displacing other foods and drinks rich in nutrients from a diet, such as skim milk and whole fruit. For example, a 20-oz serving of a sugar-sweetened  soda contains the equivalent of 16 packets of sugar.

Limiting consumption of sugar-sweetened beverages will improve your health.  An average person would lose about 9 pounds a year by eliminating sugar-sweetend beverages from their diet.  For example, substituting water for one 20-ounce soda will save you about 240 calories.

Read the AMA Council on Science and Public Health Report on sugar-sweetened drinks.

Russell Kridel, MD

As a 40+ female, should I get a mammogram? There seems to be different points of view in the media.

Mammography is a proven method for detecting breast tumors, with demonstrated reductions in mortality for women who undergo regular screening.

Every woman age 40 years and older who wants a routine screening mammogram and whose physician believes it is clinically appropriate should receive one, regardless of her insurance coverage status.

Read the report from the AMA Council on Science and Public Health about the importance of women over 40 having a mammogram.

Russell Kridel, MD

Is bottled water healthier or safer than tap water?

The oversight and safety of public drinking water in the U.S. is of such high quality that in the vast majority of cases little medical need exists for the public to choose bottled water over public drinking water other than convenience and social habit.

Although bottled water is generally no healthier or safer than most tap water, consumers are paying 1000-2000 times the cost of tap water to obtain bottled water, which in many cases is simply municipal water that has been subject to additional treatment. Read the AMA Council on Science and Public Health Report on “Safety of Bottled Water”.

Russell W.H. Kridel, M.D.