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BMJ (1) reported on the new Cochrane Collaborative report, ”Electronic cigarettes for smoking cessation” (2), with the headline “Vaping helps adults quit smoking better than traditional methods.” Like earlier Cochrane reviews, this review focused on randomized clinical trials that are designed to study effectiveness of medicines delivered under clinical supervision, not e-cigarettes as consumer products used in the real world without clinical supervision.
There is nothing new here. While the Cochrane reviewers considered 78 studies, the conclusions about e-cigarettes and quitting came down to just six studies (Analysis 1.1 on page 261). More important, their conclusion that the relative risk for cessation is 1.6 is virtually identical to the 1.6 relative risk we (3) reported two years ago.
The Cochrane authors did identify a single study (4) comparing varenicline with ecigs for cessation (Analysis 2.1, page 268); varenicline tripled the odds of cessation compared to ecigs (OR 0.31; 95% CI 0.11 , 0.82, favoring varenicline). The Cochrane Review did not mention this interesting result in the abstract.
More important, while RCTs are the gold standard for evaluating medicines, but they are not useful when assessing population effects of consumer products. The population studies show no association of e-cigarettes use as consumer products with cigarette smoking cessation (3, 5).
In addition, the more recent population studies that are longitudinal studies of the FDA PATH data show that smokers who use e-cigarettes are much more likely still be smoking three years later than smokers who did not use e-cigarettes (6, 7).
It is also telling that, to date, no tobacco company has submitted RCT data (what Cochrane keeps re-analyzing) to drug approval authorities anywhere in the world as part of an application to approve e-cigarettes as clinical cessation medicines.
But, until they do, analyses such as what Cochrane has done, despite its length, do not provide useful information to regulators around the world (including the US FDA Center for Tobacco Products) who are charged with making decisions about e-cigarettes as consumer products (3).
References
1. Mahase E. Vaping helps adults quit smoking better than traditional methods, says Cochrane. BMJ 2022;379:o2782. doi: 10.1136/bmj.o2782
2. Hartmann-Boyce J, Lindson N, Butler AR, et al. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2022(11) doi: 10.1002/14651858.CD010216.pub7
3. Wang RJ, Bhadriraju S, Glantz SA. E-Cigarette Use and Adult Cigarette Smoking Cessation: A Meta-Analysis. Am J Public Health 2021;111(2):230-46. doi: 10.2105/AJPH.2020.305999 [published Online First: 2020/12/23]
4. Ioakeimidis N, Vlachopoulos C, Georgakopoulos C, et al. P1234Smoking cessation rates with varenicline and electronic cigarettes in relapsed smokers with a history of acute coronary syndrome. European Heart Journal 2018;39(suppl_1) doi: 10.1093/eurheartj/ehy565.P1234
5. Hedman L, Galanti MR, Ryk L, et al. Electronic cigarette use and smoking cessation in cohort studies and randomized trials: A systematic review and meta-analysis. Tob Prev Cessat 2021;7:62. doi: 10.18332/tpc/142320 [published Online First: 2021/10/30]
6. Osibogun O, Bursac Z, Maziak W. Longitudinal transition outcomes among adult dual users of e-cigarettes and cigarettes with the intention to quit in the United States: PATH Study (2013-2018). Prev Med Rep 2022;26:101750. doi: 10.1016/j.pmedr.2022.101750 [published Online First: 2022/03/09]
7. Chen R, Pierce JP, Leas EC, et al. Effectiveness of e-cigarettes as aids for smoking cessation: evidence from the PATH Study cohort, 2017-2019. Tob Control 2022 doi: 10.1136/tobaccocontrol-2021-056901 [published Online First: 2022/02/09]
It may be true that vaping may be able to wean people from smoking tobacco. That is not an indicator about the safety of vaping.
Already much is known about Vaping Associated Lung Injury and EVALI.
It is postulated that vaping may adversely affect brain and heart.
Vaping still has the adverse effects of tobacco. It does cause harmful effects on those who received second hand smoke from vaping.
There is a possibility of explosion with vaping.
More worrying reports are about nonsmokers taking to vaping as a novelty and becoming addicted to vaping or even shifting to conventional ways of tobacco use.
Changing a way of substance abuse is no way to come out of harmful habits. It is only jumping out of the frying pan into the fire.
Let us not create new avenues for vices.
Arvind Joshi,
MBBS MD FCGP FAMS FICP.
Competing interests:
No competing interests
18 November 2022
Arvind Joshi
Convener Our Own Discussion Group, Consultant Physician
Cochrane Review conclusions e-cigarettes help quit smoking in RCTs is not relevant to decision making for e-cigarettes as consumer products; population studies show no benefit
Dear Editor
BMJ (1) reported on the new Cochrane Collaborative report, ”Electronic cigarettes for smoking cessation” (2), with the headline “Vaping helps adults quit smoking better than traditional methods.” Like earlier Cochrane reviews, this review focused on randomized clinical trials that are designed to study effectiveness of medicines delivered under clinical supervision, not e-cigarettes as consumer products used in the real world without clinical supervision.
There is nothing new here. While the Cochrane reviewers considered 78 studies, the conclusions about e-cigarettes and quitting came down to just six studies (Analysis 1.1 on page 261). More important, their conclusion that the relative risk for cessation is 1.6 is virtually identical to the 1.6 relative risk we (3) reported two years ago.
The Cochrane authors did identify a single study (4) comparing varenicline with ecigs for cessation (Analysis 2.1, page 268); varenicline tripled the odds of cessation compared to ecigs (OR 0.31; 95% CI 0.11 , 0.82, favoring varenicline). The Cochrane Review did not mention this interesting result in the abstract.
More important, while RCTs are the gold standard for evaluating medicines, but they are not useful when assessing population effects of consumer products. The population studies show no association of e-cigarettes use as consumer products with cigarette smoking cessation (3, 5).
In addition, the more recent population studies that are longitudinal studies of the FDA PATH data show that smokers who use e-cigarettes are much more likely still be smoking three years later than smokers who did not use e-cigarettes (6, 7).
It is also telling that, to date, no tobacco company has submitted RCT data (what Cochrane keeps re-analyzing) to drug approval authorities anywhere in the world as part of an application to approve e-cigarettes as clinical cessation medicines.
But, until they do, analyses such as what Cochrane has done, despite its length, do not provide useful information to regulators around the world (including the US FDA Center for Tobacco Products) who are charged with making decisions about e-cigarettes as consumer products (3).
References
1. Mahase E. Vaping helps adults quit smoking better than traditional methods, says Cochrane. BMJ 2022;379:o2782. doi: 10.1136/bmj.o2782
2. Hartmann-Boyce J, Lindson N, Butler AR, et al. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2022(11) doi: 10.1002/14651858.CD010216.pub7
3. Wang RJ, Bhadriraju S, Glantz SA. E-Cigarette Use and Adult Cigarette Smoking Cessation: A Meta-Analysis. Am J Public Health 2021;111(2):230-46. doi: 10.2105/AJPH.2020.305999 [published Online First: 2020/12/23]
4. Ioakeimidis N, Vlachopoulos C, Georgakopoulos C, et al. P1234Smoking cessation rates with varenicline and electronic cigarettes in relapsed smokers with a history of acute coronary syndrome. European Heart Journal 2018;39(suppl_1) doi: 10.1093/eurheartj/ehy565.P1234
5. Hedman L, Galanti MR, Ryk L, et al. Electronic cigarette use and smoking cessation in cohort studies and randomized trials: A systematic review and meta-analysis. Tob Prev Cessat 2021;7:62. doi: 10.18332/tpc/142320 [published Online First: 2021/10/30]
6. Osibogun O, Bursac Z, Maziak W. Longitudinal transition outcomes among adult dual users of e-cigarettes and cigarettes with the intention to quit in the United States: PATH Study (2013-2018). Prev Med Rep 2022;26:101750. doi: 10.1016/j.pmedr.2022.101750 [published Online First: 2022/03/09]
7. Chen R, Pierce JP, Leas EC, et al. Effectiveness of e-cigarettes as aids for smoking cessation: evidence from the PATH Study cohort, 2017-2019. Tob Control 2022 doi: 10.1136/tobaccocontrol-2021-056901 [published Online First: 2022/02/09]
Competing interests: No competing interests