E-Cigs Best Cessation Tool Ever? The Debate Continues

In a recent article published in Medpage Today, a retrospective analysis comparing smoking cessation initiatives found that e-cigarette devices are an effective cessation aid - more effective than use of over-the-counter nicotine replacement aids. However, some experts still have their doubts. Frank Leone, MD,MS, director of the University of Pennsylvania's Comprehensive Smoking Treatment Program stated:

"It's not to say that the study has no value, but it's a big stretch to say that the e-cigarette works better than the nicotine patch."

Dr.Leone was not involved with the study. The study's analysis found smokers who used e-cigarettes during a quit attempt in the past year were 63% more likely to be successful than using an OTC nicotine replacement therapy, and 61% more likely to succeed compared with quit attempts that used no cessation aids. These findings were reported by Jamie Brown, SSA Research Fellow at the Cancer Research UK Health Behaviour Research Centre, University College London, and colleagues reported in psychiatry journal Addiction.

However, some critics question the study's design and allege that it is flawed. They assert that some media outlets that have been reporting the studies findings did not consult outside sources before aggrandizing the benefits of e-cigarettes for smoking cessation.

"The clue that something wrong or inconsistent is the idea that only 10% were able to quit smoking using the patch. That's on the low side. And that people who used nothing did better than those who used the patch is inconsistent with prior studies," Leone said.

However, many well respected medical professionals have given positive commentary on electronic smoking devices and the e-liquid which is vaped in e-cigs. With sales projected in the billions this year e-cigarettes are clearly taking hold, and finding a niche.  There are still well respected voices in this fledgeling industry who point out that using e-cigarettes does not come without risk. 

The Study Findings

Brown and colleagues analyzed data from a U.K. national surveillance program, known as the Smoking Toolkit Study. That study collected information from 5,863 smokers ages 16 or older using in-person interviews and computer-assisted surveys. All participants had made at least one quit attempt in the past year, and the data were gathered from 2009 through 2014.

Among those surveyed, 464 made a quit attempt using e-cigarettes only, 1,922 made a quit attempt with the use of OTC nicotine replacement only, and 3,477 tried to quit cold turkey.

The authors wrote that e-cigarette users reported higher rates of abstinence compared with OTC nicotine gum or patch users (odds ratio 2.23, 95% CI 1.70-2.93) and quitters who used no aid (OR 1.38, 95% CI 1.08-1.76).

After adjustments, Brown et al. reported that quitting rates for e-cigarette users were 1.63 times higher (95% CI 1.17-2.27) than rates among nicotine replacement users, and 1.61 times higher (95% CI 1.19-2.18) than the rates among the no aid group.

Criticism of the Study

The study's detractors question its methodology. For example, a significant limitation of the study was its reliance on self-reported abstinence with no additional testing of blood, urine, or saliva to validate those claims. Moreover, the study population was limited to individuals who reported quit attempts from the last year; no durability of response to the smoking cessation method could be calculated. The study lacked quantitative consumption data. Did smokers go from moderate consumption of conventional cigarettes to living with an e-cigarette in hand? With no clear health benefits calculated into this study, are the results good or bad? Moreover, Dr. Leone added:

"The folks that use e-cigarettes may really want the e-cigarette to work and are therefore much more likely to present the result enthusiastically, more likely to answer their phone, be found, and participate than other folks."

Failed Quit Attempt or Harm Reduction?

In conclusion, the broader debate of the pros and cons of the safety of using electronic cigarettes will continue until more data can be collected and evaluated. Leone points out that it is more likely that those who use e-cigarettes to tackle their smoking habit end up merely reducing their cigarette consumption, saying "Even if e-cigarettes work for some people, for the most part, when you look at large populations of people who use e-cigarettes, they reduce the number of [conventional] cigarettes they smoke and become dual-users." In a recent blog post by the BMJ Group (formerly the British Medical Journal), deputy managing editor, Richard Hurley implies that this reduction in cigarette consumption may result in harm reduction, saying "When the only obstacle to progress on preventing the harms of smoking is the user's dependence, e-cigarettes offer the beguiling prospect of addicted smokers migrating painlessly to safer mechanisms of nicotine recovery."

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