Some demonize it, for others it is the key to smoking cessation: the e-cigarette. Who is right?
Transcript of the interview with Prof. Dr. Martin Storck on the topic: e-cigarettes. This is a 1:1 transcript of what was said in the video. Customer: What exactly is an e-cigarette and how exactly is it different from traditional cigarettes or other cigarettes?

Professor Martin Storck: In short: According to many scientific analyzes the vapor from e-cigarettes contains more than 90% fewer harmful substances. We are not talking about smoke here, but about evaporation, one also speaks of steam. So it is not smoking at all, while smoking involves inhaling toxic tobacco smoke. And I think that's the main difference. And there you can always argue that it is basically a nicotine replacement, in a much less harmful way, if not entirely harmless and by no means healthy. So you can't say that.

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Customer: You have already repaired the damage. Direct follow-up question: How harmful is an e-cigarette compared to conventional cigarettes or heated tobacco?
Storck: That is the crucial question that nobody can really answer. Currently we have 50-70 million e-cigarette users worldwide. According to Debra's research, 35 people over the age of 16 smoke in Germany, while only about 5 percent use e-cigarettes. So it's not that common, but it's growing all over the world. The harm is natural, say many critics of e-cigarettes, pulmonologists and many cardiovascular associations: Until we can assess the long-term harm, we don't want to start recommending e-cigarettes for smoking cessation.

Of course, ethically this is a small problem. Quit or die, so either quit smoking altogether or keep smoking while the e-cigarette otherwise provides many other methods, such as treatment, nicotine patches, chewing gum and of course speech and motivational therapy, which unfortunately are not available in Germany . is still not paid nationwide and therefore not implemented. It must therefore be recognized that the harm caused by e-cigarettes is relatively small based on current knowledge.

There are several ways to study it scientifically. When you do cell culture experiments, you blow very concentrated vapors into the endothelium of the lungs, which are pneumocytes, and then you say that certain reactions occur and the cells are destroyed. Of course, this does not correspond to reality. Others say: Compared to smoking, improvements in lung function can be measured months later. And all the mannitol stress tests that Mr. Rüther himself studied in Großhadern. In cooperation with pulmonologists and addiction doctors, things get better. This means that there are no noticeable disadvantages when switching to an e-cigarette. It has also not been proven that the number of heart attacks is increasing. The most important study on this topic had to be removed from JAMA for methodological reasons. It was even a minor scientific scandal. Customer: So there seems to be arguments both for and against the recommendations. Can you be more specific and what would you say: Can e-cigarettes be recommended for smoking cessation or not?

Storck: I'm not the only one who has this point of view, but everyone who says that harm reduction, as they say in modern German, is a way of limiting the damage when other methods of quitting smoking don't work . . You have to imagine that in Germany only 8 people actively want to quit smoking, but most of them don't manage to do so. It's very frustrating when you then relapse and offer to give them an e-cigarette as a gift, other smokers too, that you won't leave them alone and say we really don't want to recommend an e-cigarette. , we can give you pills and patches and try talk therapy. It doesn't work, and that's why I belong to the group that says: Of course we also recently discussed these pros and cons with pneumologists in Deutsches Ärzteblatt. I'm one of those who say e-cigarettes are a tool that should be offered even when there is no other way to quit smoking.And the damage is caused by smoke, not nicotine.

By the way: There are currently over 7,000 flavors and some of these flavors are not safe to heat. We really need to switch the conversation to more flavors and also this mess that we had in the US, this EVALI syndrome where people have died, even young people because of hemp or hemp mixed, that's obviously one thing. that should not be. Unfortunately, there is no regulation or control over the liquids sold. Therefore, we need to separate the discussion between the e-cigarette, the flavors used and the nicotine content. These are very complicated issues.
Customer: There is also mixed consumption at the moment. People who smoke normal cigarettes and, for example, also smoke e-cigarettes because they like the taste. You already mentioned flavors. How do you see the health risk there?

Storck: You are now dealing with so-called dual use. And that's also something that vape critics keep bringing up and saying yes, people smoke vape and they don't stop. So there is different data on this. There are also countries like South Korea where smoking behavior has been recorded as a country from an economic and medical point of view, so to speak. And it can only be said that the dual use of cigarettes, i. If the number of cigarettes smoked is reduced to three per day, there will initially be partial success. Of course, that's not what we mean, but it's not at all that dual use is worse than continuing to smoke, but you have to look at it this way: continuing to smoke is the worst thing, e-cigarettes. Spectrum and ending are the best. E-cigarettes are on the rise, dual use is rare. But this is certainly progress and one can only hope that cigarette consumption will continue to decline and eventually interest in cigarettes will wane. The problem is in understanding or in cognitive recognition, it's called cognitive dissociation, which means that if someone knows that smoking is harmful, then they continue to smoke, and electronic cigarettes can take them away because somehow nicotine is also added to them. also with cigarette warmer.

And the rapid absorption of nicotine leads to a reward at the core, at the core. And now, when too little nicotine quickly gets into those clusters, it's not the same thing that decade-long smokers need for a quick nicotine rush. And that is possible with an electronic cigarette. In this regard, you can serve the addictive behavior with an e-cigarette and then gradually reduce the nicotine content. Therefore, addiction researchers also assume that the addictive behavior of e-cigarettes is natural. Addiction is not easy to get rid of. Therefore, if you start using nicotine at a young age, i.e. before the age of 18, you will become addicted and will not be able to get rid of it for the rest of your life. It is possible to quit tobacco, however, and e-cigarettes can help. Dual use is also a way, but of course not ideal.

Client: Given this conflicting body of research, how can physicians advise patients who specifically ask about e-cigarettes as a smoking cessation aid?

Storck: The first important message is that e-cigarettes are by no means more dangerous or as dangerous as cigarettes, but only 10% more dangerous. It must be said that it is still full of risks. But about 10 percent. The mathematical models come from other European countries, England and the Netherlands. There we calculate: How big is the risk of cancer when switching to e-cigarettes? That means you can start recommending e-cigarettes right now. That's how it is in Germany, compared to the European tobacco regulations, we are in 35th place out of 37 countries. We're not very good at it. Here are some active tips. The Federal Center for Health Education makes little or no comment on this. And even in professional circles, electronic cigarettes are still portrayed as evil with a kind of cover-up tactic.

It also has to do with the fact that I think there is a lobbying war behind the pharmaceutical industry against the tobacco industry. It doesn't have to be like this. Instead, we have to look at the concrete data, the scientific studies that are on the table. And there is no one to prove that e-cigarettes are more harmful than cigarettes. Conversely, a successful switch to e-cigarettes usually only has clinical advantages. In this context, I would say that according to Daniel Kotz, if someone wants to quit smoking, the ABC rule applies, so A is an offer to talk, B is advice and then C is training. So this new GBA-funded study is about 15 to 20 video interviews. This is called motivational interviews, where the problem is first set out that smoking is generally a problem, that smokers see themselves as problematic. This usually doesn't happen. "I'm fine and Helmut Schmidt was also 90 years old."
 
  This means that, on the other hand, we expect better remuneration for these psychological interventions, including telemedicine and psychological counseling. This can also be done via telemedicine using pills or electronic cigarettes. And this study proves once again, so to speak, the value of the e-cigarette compared to other methods with data from vascular patients. It takes place in North Rhine-Westphalia and we are very satisfied with the results of this study.

Customer: Are there any guidelines on this, and if so, what about smoking cessation recommendations? Storck: Yes, the AWMF even has S3 guidelines. It was released just over two years ago. However, not much new research has been incorporated yet. A gradual approach to smoking cessation is recommended, the e-cigarette is hardly mentioned and only mentioned in a footnote by the German Society for Addiction Medicine, which takes a different view.

That's always the problem with guidelines, they're majority decisions. And the expert group positioned itself somewhat differently. But you can read about it there. I guess, and also my colleagues Rüther and Anil Batra from Tübingen, they are all involved in these guidelines, including addiction doctors. They give a little more space in the next version of the e-cigarette guide, because the data situation has simply improved, in the reviews e-cigarettes also lead to smoking cessation, although many pulmonologists and cardiologists only say in general: "We still do that not.” I would like to recommend it. And how is it going?” And we want to give the others a counter argument and say harm reduction is so important to smokers who need to quit smoking now that it doesn't go against the guidelines on today's e-cigarette recommendation.