If you talk to almost any clinician like the ones who have been writing these books, if you think of the experiences of Dr. West and Dr. John Britton in England, they have much more experience with e-cigarettes than we do.
I could tell you some success stories. I have a patient with emphysema and he could hardly walk a block without stopping. He used to be in the construction business. He had to stop two or three times when walking from his car to the clinic. He used to come to the emergency three or four times a year because of exacerbation of his emphysema. He was admitted about once a year. He was taking prednisone and antibiotics every two months. We gave him Zyban, Champix, patches, gum, and lozenges. I did not invent that recipe. If you look at the publications coming from the Mayo Clinic, Dr. Hurt over there is doing those sorts of things. We were unsuccessful. So last October....He was our first patient and he was smoking more than 75 cigarettes a day. He switched to the e-cigarette and now he is still on the e-cigarette at a nicotine concentration of about 5 milligram per millilitre. He has had no exacerbation of his COPD this year, no antibiotics, no cortisone, no admissions to the hospital, no visits to the emergency. Now he has taken one of his rooms to build himself a gymnasium to exercise.
These are the types of success stories that we have, so it's difficult to say that it doesn't help people to stop smoking, and it doesn't help people to improve their health.
I had this young lady who was an asthmatic. She had not jogged for five years and she was on inhaler medications. She started to use the e-cigarette and when she came to the clinic, she didn't want to tell her chest physician that she stopped all her pumps, but she did and she has resumed jogging.
We have patients who have switched to the e-cigarette, even if they haven't stopped completely using tobacco cigarettes—like I said before, many of them are only smoking two or three—but they are planning to stop eventually. All of them, 100%, are feeling better.
However, to carry out prospective studies, especially with hard-core smokers, to tell you the truth, I think it would be unethical at the moment with the experience that we and other clinicians have about this. We have to rely on well-documented, retrospective studies.