Doctors Are Giving Mixed Messages About Vaping

Are e-cigarettes safe?

According to a new study published Friday in the American Journal of Preventative Medicine, the answer to that question largely depends on who you ask.

A team of researchers from the Stanford University School of Medicine examined 500 medical questions about vaping that had been posted over a four year period on HealthTap, a popular online medical forum which allows users to ask medical questions anonymously which are then fielded by a pool of 72,000 licensed physicians.

The types of questions being asked by HealthTap users ranged from the straight-forward ("are e-cigarettes addictive?") to the specific ("do e-cigarettes cause hair loss?"), and the counsel provided by physicians in response to these questions was equally varied.

To quantify the health advice given by physicians, the researchers used a rubric which appraised questions and answers in terms of whether they were positive or negative about vaping in their tone or message, which themes were mentioned in the exchange, and whether a patient thanked the physician for their response. Overall, the Stanford team found that 34 percent of questions had to do with specific effects of e-cigarettes, 27 percent were about the general safety of vaping, and 19 percent were about e-cigarettes as a smoking cessation or harm reduction tool.

In terms of the physicians' answers, the researchers found that 47 percent of answers gave a negative appraisal of e-cigarette use, and 20 percent of the answers were positive. The positive answers were particularly prevalent when it came to using e-cigarettes as a smoking cessation tool: when specifically asked about quitting smoking, 54 percent of doctors mentioned e-cigarettes as a potential option.

For the researchers, the reason for this variance in physician response is clear: the e-cigarette trend is so new that there simply isn't enough data on vaping's long- and short-term health effects.

"There's been rapid growth in the promotion and use of the products without an evidence base in terms of their safety and efficacy for tobacco cessation," said Judith Prochaska, an associate professor of medicine at the Stanford Preventative Research Center. "The existing research…does not indicate that e-cigarettes help people quit combustible cigarettes."

Although there is recent research suggesting that vaping likely helped a few million people in the EU quit smoking, generally speaking there is a major lack of data on the health effects of vaping, which hinders doctors' abilities to make informed recommendations about e-cigarette use to their patients. Moreover,the Stanford study made it clear that physicians are sorely in need of easily accessible and up-to-date data about the medical effects of vaping.

To this end, Prochaska and her colleagues are creating an online portal which will provide physicians with current research on the health effects of vaping and effective ways of communicating the pros and cons of e-cigarette use to patients. Moreover, as the United States tightens its vaping regulations, this easily accessible data will help lawmakers make informed decisions about the best way to regulate e-cigarettes and related products.

"[This study] is an example of evidence-based medicine in the information age," said Andrea Burbank, a physician and co-lead author of the study. "With this data we were able to rapidly prioritize real-world concerns about e-cigarettes for policymakers and researchers."