Elektronische Zigaretten – Schadensminimierung oder Schadensverlängerung?

Zusammenfassung

Der Beitrag befasst sich mit der Frage, ob Elektronische Zigaretten (E-Zigaretten) den erwiesenen Schaden des Rauchens von Tabakprodukten minimieren können oder zu einer Schadensverlängerung führen. Während das britische Royal College of Physicians Rauchern E-Zigaretten als Substitut für Tabakprodukte empfiehlt, rät die Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin Rauchern von der Nutzung der E-Zigarette ab. Drei Hypothesen liegen der Schadensminimierungsstrategie zugrunde. Hypothese 1: Es wird davon ausgegangen, dass E-Zigaretten gesundheitlich weniger Schaden anrichten als Tabakzigaretten. Hypothese 2: Es wird postuliert, dass Raucher motiviert sind, von konventionellen Zigaretten auf E-Zigaretten umzusteigen. Hypothese 3: Es wird vermutet, dass E-Zigaretten ein nebenwirkungsarmes, effektives Mittel zum Rauchstopp sind. Obwohl die langfristigen gesundheitlichen Folgen des E-Zigarettenkonsums nach wie vor unbekannt sind, mehren sich die Befunde, dass E-Zigaretten toxisch wirken, schädlich für das Herz-Kreislauf-System, die Gesundheit der Atemwege und möglicherweise krebserregend sind. Bevölkerungsrepräsentative epidemiologische Erhebungen zeigen, dass drei Viertel aller aktuellen E-Zigarettennutzer in Deutschland gleichzeitig Tabak rauchen. E-Zigaretten haben in wenigen randomisierten klinischen Studien im Vergleich zu Nikotinersatzprodukten höhere Erfolgsraten. Als frei verkäufliche Konsumprodukte unter Realbedingungen findet sich in einer Vielzahl von Studien kein Vorteil für E-Zigaretten. Zudem verlängern E-Zigaretten im Vergleich zu Nikotinersatzprodukten die Nikotinabhängigkeit. Die Hypothesen der Schadensminimierungsstrategie mittels E-Zigaretten müssen nach derzeitigem Kenntnisstand als widerlegt angesehen werden. Daher erscheint es ethisch nicht unproblematisch, wenn Ärzte ihren Patienten E-Zigaretten als Substitut zum Rauchen empfehlen.

Abstract

This paper deals with the question of whether electronic cigarettes (e-cigarettes) can minimize the proven harm of smoking tobacco or may lead to a long-term harm. While the British Royal College of Physicians recommends smokers to use e-cigarettes as a substitute for tobacco products, the German Society for Pneumology and Respiratory Medicine advises smokers against using e-cigarettes. The harm reduction strategy is based on three hypotheses. Hypothesis 1: It is assumed that e-cigarettes cause less damage to health than tobacco cigarettes. Hypothesis 2: It is postulated that smokers are motivated to switch from conventional cigarettes to e-cigarettes. Hypothesis 3: It is assumed that e-cigarettes are an effective means for quitting smoking with few side effects. Although the long-term health consequences of e-cigarette use remain unknown, there is increasing evidence that e-cigarettes are toxic, harmful to cardiovascular system, respiratory health and potentially carcinogenic. Population-representative epidemiological surveys have shown that three-quarters of all current e-cigarette users in Germany smoke tobacco at the same time. In a few randomized clinical trials, e-cigarettes showed higher success rates compared to nicotine replacement products. As over-the-counter consumer products, a large number of studies have found no advantage for e-cigarettes under real conditions. In addition, e-cigarettes prolong nicotine dependence compared to nicotine replacement products. According to the current state of knowledge, the hypotheses behind the harm minimization strategy using e-cigarettes must be regarded as refuted. It therefore appears ethically problematic when doctors recommend e-cigarettes to their patients as a substitute for smoking.

Schlüsselwörter

Rauchen - E-Zigaretten - Schadensminimierung

Keywords

smoking - e-cigarettes - harm reduction

Publication History

Received: 30 January 2023

Accepted after revision: 09 February 2023

Article published online:
28 March 2023

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