E-cigarettes help up to 22 000 smokers in England quit each year
BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1243 (Published 01 March 2016) Cite this as: BMJ 2016;352:i1243
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Wise'sarticle is titled “E-cigarettes help up to 22,000 smokers in England quit each year”.(1) Public Health England, fooled by the “harm reduction” motto as lay people were before with low tar and light cigarettes, claimed “e-cigarettes were 95% less harmful than normal cigarettes”.(2) In France, the High Council for Public Health went further in February when updating its recommendation with: “The e-cigarette can be an aid to smoking cessation for those who want to quit smoking and a way of tobacco harm reduction".(3)
Sadly, smoking is a pediatric epidemic. Among US youths, E-Cigarette use is an intention to initiate but not to quit smoking, and the US and the Centers for Disease Control and Prevention reported a dramatic increase in E-cigarette use among high school students from 1.5 percent in 2011 to 13.4 percent in 2014.(4) The American Academy of Pediatrics warned that E-cigarette have the potential to addict a new generation of youth to nicotine, reversing more than 50 years of progress in tobacco control.(5)
In 6 months Altria spent $35 million in advertising MarkTen, becoming the top spender on e-cigarette advertising. In the US, E-cigarette advertising spending for 2014 reached $88.1 million, mostly by the big tobacco, a 52 percent increase from 2013( http://truthinitiative.org/research/rapid-increase-e-cigarette-ad-spendi...). Who could believe that the inclusion of young adult imagery in advertisements by the Big tobacco is aimed at smoking cessation? Big Tobacco has understood that nicotine plus flavour is a gateway for addiction.(6)
The craze for electronic cigarettes is an indicator that the system avoids tobacco control policies and is unable to assist smokers and provide them access to evidence-based treatment for cessation (such as combination of various form of nicotine replacement therapy, psychotherapy (support and cognitive behavioural interventions) or varenicline). In the U.S., the use of smokeless tobacco parallels smoking prevalence and tops it in Kentucky and West Virginia, where tobacco farms are concentrated.(7) Finland, which was the first country in the world to set the endgame objective by law, has prohibited sale of nicotine cartridges.
1 Wise J. E-cigarettes help up to 22 000 smokers in England quit each year. BMJ 2016;352:i1243
2 Britton J, Bogdanovica I. Electronic cigarettes: A report commissioned by Public Health England. May 2014. Available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...
3 High Council for Public Health. [Risk-benefit of the electronic cigarette for the general population.] 2016, Feb 24. Available at http://www.hcsp.fr/explore.cgi/avisrapportsdomaine?clefr=541
4 Park JY, Seo DC, Lin HC. E-Cigarette use and intention to initiate or quit smoking among US youths. Am J Public Health 2016. Published online Jan 21.
5 Etzel RA, Wilson KM, Balk SJ, Farber HJ, Groner JA, Moore JE. Electronic Nicotine Delivery Systems. Pediatrics 2015;136:1018-26.
6 Benowitz NL. Nicotine addiction. N Engl J Med 2010;362:2295-303.
7 Braillon A. Electronic cigarettes: from history to evidence-based medicine. Am J Prev Med. 2014;47:e13
Competing interests: No competing interests
West et al: Commentary on the utilisation of “unreliable assumptions”.
The calculations made West et al letter published in the journal Addiction (1) utilise, in stage 5 of their calculations, the Cochrane Review of Electronic Cigarettes (2) and “Real World” observational follow-up data from Brown et al (3). These are central to calculating the next step in their reasoning: the proposed superior efficacy of electronic cigarettes over “licensed nicotine products” in smoking cessation.
As the West et al Step 5 states:
“Evidence from RCTs and from surveys in England indicate that using an e-cigarette in a quit attempt increases the probability of success on average by approximately 50% compared with using no aid or LNP bought from a shop – similar to use of a licensed medicine with limited behavioural support but less than medication plus specialist behavioural support.”
1) The Cochrane Review clearly states itself that: “We could not determine if EC was better than a nicotine patch in helping people stop smoking because the number of participants in the study was low.”
2) It further states: “. . . under the GRADE system the overall quality of the evidence for our outcomes was rated ‘low’ or ‘very low’ because of imprecision due to the small number of trials. A ‘low’ grade means that further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. A ‘very low’ grade means we are very uncertain about the estimate.”
3) Indeed, Jamie Hartson-Boyce, one of the co-authors of the Cochrane Review, with co-reviewer (4), has very recently stated that:
“Electronic cigarettes and other electronic nicotine delivery devices — These are currently not prescribable in most countries and have a very small evidence base. A Cochrane review showed weak evidence that electronic cigarettes containing nicotine were more effective for helping people to quit smoking than those without nicotine.”
4) A further recent systematic critique of The Cochrane Review (5) states that:
“Overall the quality of the evidence appeared to be low. The studies were from developed countries only. The limitations include the small number of studies and study participants in the RCT and inadequate data from both RCT and observational studies to assess all outcomes that were planned.”
5) A further, very recent meta-analysis of the available RCTs (6) in fact goes further:
“Limited low-quality evidence of a non-statistically significant trend toward smoking cessation in adults using nicotine e-cigarettes exists compared with other therapies or placebo. Larger, high-quality studies are needed to inform policy decisions.”
The calculations made by West et al, utilising the data available, appear to be a case of “Evidence about electronic cigarettes: a foundation built on rock or sand?” (7). However, they make the statement that others (8) have made calculations utilising “unreliable assumptions” (1). This appears to be contradictory with their own methods, which rely on weak and poor quality data, and which produce subsequently, their own, unreliable assumptions.
Subsequent to Step 5, the words “assumed” and “estimated” are utilised on multiple occasions, and all of these are calculations are unreliable, due to the nature of the data. However, as Professor West notes with regard to calculations, “. . . the numbers of users of electronic cigarettes successfully quitting is not as many as some e-cigarette enthusiasts claim” (9). Moreover, as per the West et al letter, the devices are having a devastating effect on “foot fall” at Stop Smoking Services, which all agree currently hold the highest level of efficacy for smoking cessation.
1) http://onlinelibrary.wiley.com/doi/10.1111/add.13343/abstract
2) McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. The Cochrane database of systematic reviews. 2014;12:Cd010216.
3) Brown J, Beard E, Kotz D, Michie S, West R. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction (Abingdon, England). 2014;109(9):1531-40.
4) http://static.www.bmj.com/content/352/bmj.i571
5) http://www.sciencedirect.com/science/article/pii/S2213398416000038
6) http://link.springer.com/article/10.1007/s00038-016-0786-z/fulltext.html
7) http://www.bmj.com/content/351/bmj.h4863/rr-0
8) Kalkhoran S, Glantz SA. Modeling the Health Effects of Expanding e-Cigarette Sales in the United States and United Kingdom: A Monte Carlo Analysis. JAMA internal medicine. 2015.
9) http://home.bt.com/news/uk-news/891000-used-e-cigarettes-to-try-and-quit...
Competing interests: No competing interests
Re: E-cigarettes help up to 22 000 smokers in England quit each year
Fast smoking cessation proved better than long term nicotine replacement therapy, like e-cigarette nebulised medicinal puffs.
Abrupt quitting smoking cessation is achieved by the second most common, and most effective non pharmacological treatment method used worldwide, clinical hypnotherapy.
Even a single hypnotherapeutic session proved more effective than long term nicotine replacement therapy.
Long term smoking abstinence after completed hypnosis therapeutic sessions is well documented.
References
http://www.ncbi.nlm.nih.gov/pubmed/25888475
http://www.ncbi.nlm.nih.gov/pubmed/24559809
Competing interests: No competing interests