Even the most ardent e-cigarette enthusiasts hardly ever claim that e-cigarettes are “medicine.” And, by conventional standards, they aren’t. While Chinese pharmacist Hon Li, creator of the first commercially viable e-cigarette, did hope to create a smoking cessation aid, the people responsible for the design and marketing of today’s products mostly aim to create things that are pleasurable and profitable. Since e-cigarettes contain a stimulant (nicotine) that’s associated with elevated heart disease risk, it’s hard to argue that using them could ever be considered “healthy” for those who do not already smoke.
That said, accepted current medical practice both among clinical professionals and the insurance industry suggests that people really should be open to considering e-cigarettes as a form of “medicine,” at least in some cases. This is already the practice the United Kingdom and the U.S. — as well as every other country — should consider the same.
The line between “medicine” and “everything else” is actually a lot blurrier than it may first appear. Dish soap with antibacterial ingredients is considered an over-the-counter “drug” under the law, but it’s almost always going to be shelved with cleaning products rather than medicines. Likewise, while nearly all doctors agree that regular exercise is very important to health, hardly anybody expects them to provide advice on specific workouts, and nobody thinks health plans should cover running shoes. On a day-to-day basis, factors like severity of the problem, patient preference and treatment efficacy and effectiveness lead to a range of choices and decisions.
An example can help illustrate this. Primary care doctors treating back problems — a notoriously uncertain business — have a range of choices. If the problem seems transitory and resulted from unusual exercise, doctors might recommend simple, over-the-counter medicines like ibuprofen along with rest. Serious problems that indicate spinal stenosis would mandate a referral to a musculoskeletal specialist. But somewhere in-between these two extremes, there is a range of other options. Some patients and doctors find chiropractic effective, while others might suggest a massage at a day spa. Of course, the latter isn’t a medical treatment at all as most understand it: massage therapists aren’t generally considered medical professionals and most people who get massages do so simply in order to feel good. While some insurance companies will pay for doctor prescribed massages, this is rare. Furthermore, the overwhelming majority of people seeking massage therapy do so for a variety of reasons but in large part simply because they enjoy it. It almost certainly will not cure serious back problems the way surgery or powerful medicines might. But it’s also easier, less expensive and more pleasant.
So, in just the same way she might recommend a massage to treat a back problem, therefore, a doctor might be justified in suggesting a patient switch from smoking to vaping if the patient enjoys smoking, benefits from nicotine or simply can’t quit. Of course, it is advisable that current smokers make an effort to quit altogether, but e-cigarettes provide an alternative for those who aren't successful. Likewise, some doctors and some patients may try other approaches ranging from drugs like Chantix to over-the-counter nicotine replacement therapies made by big drug companies. But, given that it’s considered to be at least 95 percent safer than combustible cigarettes, vaping could and should be considered a form of medicine in some cases — and worthy of doctors’ recommendations.
Of course, only doctors and patients can actually make medical decisions and, for now, many are skeptical that switching from smoking to vaping improves health. But, if it is more healthful, current practice throughout the medical system suggests it should be considered a “medical” intervention of sorts — at least in the same way as your new running shoes or a massage might be.
Eli Lehrer (@elilehrerdc) is a contributor to the Washington Examiner's Beltway Confidential blog. He is president of the R Street Institute.
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