Smoking is the most common preventable cause of death in the US. Steam companies have long claimed that their e-cigarettes could help smokers exit. But what do we really know about how well they work?
The short answer: Not much.
So far, there were only two randomized control studies on e-cigarettes, both of which were published in 2013. The e-cigarette test was considered the gold standard of scientific knowledge. One of them showed that e-cigarettes had "little effect on smoking and smoking" and that they worked roughly as well as nicotine patches. The other showed that e-cigarettes, with or without nicotine, seemed to help people stay away from traditional cigarettes.
Together, these studies were promising ̵
The New England Journal of Medicine published another randomized study on e-cigarettes on Wednesday. Led by researchers at Queen Mary University in London and funded by the UK's National Institute for Health Research and Cancer Research UK, the study showed that people who were arbitrarily assigned the use of e-cigarettes had almost double their smoking ( 19459011) left persons who were randomly assigned to nicotine replacement therapy.
This is an impressive finding – e-cigarettes are even more promising for stopping smoking. But do not expect the debate on their benefits – or their risks – to be resolved. As usual, there are some limitations to consider when interpreting the results of the study. In this case, many of them have to do with how fast e-cigarette technology is changing and whether this British study is being translated into the US context. Here is a brief overview.
E-cigarettes were twice as effective as nicotine replacement therapy when used in counseling in the UK.
For the new study NEJM researchers recruited 886 patients seeking help to dispose of the cigarettes. British National Health Services stopped smoking. (Yes, the national health system has free services that help people quit.)
The study participants were then randomly assigned to one of two treatment groups. For a period of up to three months, free nicotine replacement products of the participant's choice (such as patches and chewing gum) were obtained. The other one got a free e-cigarette starter kit – initially an all-in-one starter kit from Aspire and when that was discontinued, the One Kit 2016 from Innokin. They also got a bottle of tobacco-flavored nicotine vapor and a recommendation to buy more e-liquids or flavors of their choice. The people in both groups received weekly personal counseling for quitting and were followed for one year.
Key Findings of the Study:
- At the one-year mark, 18 percent of the e-cigarette group had waived cigarettes, compared with 10 percent in the nicotine replacement group.
- Participants from both groups said e-cigarettes and nicotine replacement products were not as satisfactory as cigarettes – but the e-cigarette group rated the devices as more helpful and satisfying than the users of nicotine replacement products.
- Interestingly enough, the successful cooks in the e-cigarette group still used it overwhelmingly after one year, while those who had stopped in the nicotine replacement group mostly did not (80 percent vs. 9 percent). This means that the e-cigarette users seemed to develop a dependency or habit that the nicotine replacement users did not have.
- Regarding side effects the e-cigarette group had more irritation to the mouth, but also reported a decrease in cough and phlegm. The nicotine replacement group, meanwhile, experienced more nausea.
Overall, e-cigarettes compared to a conventional old nicotine replacement therapy as quite effective lifting aids.
"I think smokers should be encouraged – if they have difficulty in quitting – to [e-cigarettes] consider and look around to find a product that will hit the boxes for them," said the lead author of Study, Peter Hajek, Department of Health and Lifestyle Queen Mary University. "Healthcare professionals should now be able to say," If you find it difficult to quit, try instead because there is evidence. "
But … not so fast
E-cigarettes may be better than the nicotine replacement alternative in the study – but they only helped a minority of participants in the Vaping group's exit." Despite the combined efforts and encouraging results it's still disappointing, "said David Liddell Ashley, the former director of the Science Office at the Center for Tobacco Products at the FDA." This indicates the importance of further efforts, such as reducing nicotine in burned products to promote smoking cessation
The other researchers I spoke to who were not involved in the study were also less enthusiastic, and while they hailed the size and rigor of the study, they had some rather large reservations – mainly with the question of how the study can be transferred to a real, non-British context.
A ra The ndomed control study "does not resemble the use of e-cigarettes in the real world, especially in the United States," said Michael Eriksen, dean of Georgia State University's School of Public Health and former director of the Office for Disease Control and Prevention for Smoking and Health ,
Here in the US, there is no free guide to stop smoking by the government, no personal behavioral counseling, as the participants got. There are also "confusing and contradictory public health messages about the relative safety of e-cigarettes compared to smoking."
In the UK, the government has adopted a firm stance on e-cigarettes. Public Health England supports these devices as a safer alternative to cigarettes and vehicles that can help smokers exit. In the United States, the Centers for Disease Control and Prevention and other government agencies are not in favor of e-cigarettes. Instead, they seem more likely to pursue a zero-risk approach. Considering any harmful e-cigarettes can be problematic and alert to the increasing use of e-cigs among American adolescents.
"[E-cigarettes] are much more acceptable in the UK as smoking cessation devices and are actively promoted by medical and public health groups, so the cultural context is very different," Eriksen said.
After all, we do not know how relevant these results are for smokers who might try to stop using newer products – such as Juul, which devoured three-quarters of the US e-cigarette market. "Only one type of e-cigarette was used in this study," said a second-generation refillable e-cigarette popular in the UK, said Linda Bauld, professor of health policy at the University of Edinburgh. "E-cigarette devices vary widely, so we can not generalize the results of this study to all e-cigarettes," she added.
"The study is interesting, but less significant than presented," said Matthew Myers, president of the campaign for tobacco-free children. "It tells you that through advice and under medical guidance, this particular form of e-cigarette increased the chances of advancement. That's all it tells you. This is useful information. However, it says nothing about another e-cigarette, especially if it is used in a non-clinical environment.
The study also does not resolve the controversy surrounding vaping
Officials agree that e-cigarettes are safer than traditional cigarettes – one of the most harmful substances known to human health – and that single adult smokers are likely to benefit from the changeover.
There are concerns, however, as to what the vapor – and the particles it releases in the body – will affect the lungs and cardiovascular system over time, and whether it represents an increased risk of cancer to users. These concerns are particularly acute for teens who have not smoked but are now vaping and whose developing bodies and brain are more prone to the effects of nicotine.
"The results are very good news for smokers," said the University of Waterloo tobacco expert, David Hammond, "[the study] will not solve the controversy over e-cigarettes and public health: the attributes that Making cigarettes one more attractive way of smoking cessation procedure also increases their attractiveness among adolescents. "
According to a recent National Institutes of Health survey of substance use among American adolescents, the number of high school graduates is higher Those who said they had evaporated nicotine in the last 30 days, have doubled since 2017. This is the largest increase ever recorded for any drug in the 43-year history of the survey. And it means that a quarter of 12th grade students now at least occasionally use such a new nicotine device that we have no idea how the long-term effects will affect their health – and should this likely – encourage health professionals to To consider cigarettes, at least the type that has proven effective in the study, as a tool for their smoking patients. But it also shows that e-cigarettes are far from the panacea, which some suppose.