In a randomised controlled trial, subjects were given e-cigarettes or nicotine patches. The abstinence rate after 1, 3 and 6 months were as follows:
Another group of subjects was given nicotine-free (placebo) e-cigarettes. Their abstinence rate after 6 months was 4.1%. In sum, the 6 month abstinence rates were highest amongst the e-cigarette group (7.3%), followed by the patches group (5.8%) and the placebo e-cigarettes (4.1%).
The abstinence rate amongst e-cigarette users is lower in this study than in a couple of recent studies. The researchers suggest that this may be because the e-cigarette group was given one cartridge a day which was the equivalent of only 20% of the normal nicotine intake of a smoker. Whatever the reason, this study shows that e-cigarettes appear to meet the minimal condition of being at least as effective as nicotine patches.
The lead researcher said:
"The quitting rates were about 25 per cent better than patches for the e-cigarettes, but statistically we're more confident with saying that they were comparable, rather than superior," says Bullen.
The study also finds that smokers find e-cigarettes more appealing and are much more likely to recommend them to their friends than patches. Amongst those who failed to give up entirely, a third of e-cigarette users were still using them after 6 months (and had cut down their cigarette intake) while only one in ten of the patches group were still using patches.
The study is accompanied by a sound commentary by Peter Hayek who addresses all the usual scare-mongering objections of e-cigarettes' opponents (who are surely busy right now looking for flaws in the study), such as their wibble about 'gateway effects' and 'renormalising' smoking. He also explains the importance of keeping the e-cigarette market free and innovative—which will not happen if it is subjected to heavy-handed medical regulation.
The key message is that in the context of minimum support, e-cigarettes are at least as effective as nicotine patches. E-cigarettes are also more attractive than patches to many smokers, and can be accessed in most countries without the restrictions around medicines that apply to nicotine replacement therapy or the costly involvement of health professionals. These advantages suggest that e-cigarettes have the potential to increase rates of smoking cessation and reduce costs to quitters and to health services.
The main untapped potential of e-cigarettes, however, might not be in treatment of the minority of smokers seeking help with quitting, but rather as a safer consumer product for use by smokers in general. Such use could ultimately lead to the disappearance of combustible tobacco products and to the end of the epidemic of smoking-related disease and death. To rival cigarettes in providing what smokers want, e-cigarettes need to develop further, but under the pressure of market competition, they are currently undergoing a fast evolution and are likely to keep improving.
Concerns have been expressed that rather than reducing or even replacing traditional smoking, e-cigarettes could increase smoking rates by attracting new recruits and reducing quit attempts. This situation is usually implied by the phrase “renormalising smoking”. Such an outcome seems counter-intuitive and contradicted by the present study and by other data currently available, but it is theoretically possible. There is an obvious source of evidence as to whether use of e-cigarettes leads to an increase or reduction in tobacco smoking: the trajectories of sales of e-cigarettes and tobacco cigarettes.
If growing sales of e-cigarettes coincide with increased sales of tobacco cigarettes, tobacco control activists arguing for restriction of e-cigarette availability would be vindicated. If traditional cigarette sales decline as e-cigarette sales increase, it would suggest that e-cigarettes are normalising nonsmoking and that it is in the interest of public health to promote and support their development rather than try to restrict it.
The European Union and UK are currently proposing to regulate e-cigarettes as medicinal devices, while leaving cigarettes available on general sale. If this regulation goes ahead, tobacco cigarettes will retain their market monopoly and we will never learn whether e-cigarettes would replace traditional cigarettes if allowed to continue evolving and competing with smoked tobacco on even terms.
The Lancet is usually very statist and illiberal so it's nice to see a bit of common sense in its pages for once.
I'll put the link to the study and commentary up as soon as it goes live.
