Sunday 8 September 2013

E-cigarettes at least as effective as patches - official

A study published by The Lancet today confirms that e-cigarettes are at least as effective as nicotine patches for people trying to quit smoking.

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.


Junican said...

The constant use by the Zealots of the 'may cause...' argument is becoming wearisome. It really needs to be knocked over right away as soon as it raises its head. And there is a straightforward, simple response, "I'm sorry, but MAY is simply not good enough. It can neither be proven nor disproven. If you have any sort of evidence which shows that it WILL have xxx effect, then tell us what it is"

Ivan D said...

This story has been covered by the BBC and once again the comments are interesting. They are broadly supportive with many of the lowest rated comments are from the usual antis. One hate filled anti called Breuddwyd writes:

"The other concern is how many smokers us these just to be able to get a hit of their drug in a place they aren't allowed to smoke. A friend described it as giving a one finger salute to people who wont let them smoke."

I congratulate all smokers who do find themselves able to stick not one but both fingers up at the likes of Breuddwyd and encourage them to do so on as many occasions as possible.

I am not sure who Breuddwyd is but the name translates from Welsh as dream. Wales has more than its fair share of anti-tobacco extremists.

Jonathan Bagley said...

Of course the ecig won't keep you off cigs if the nicotine is restricted. What a pointless exercise. Were they being deliberately thick?

Jonathan Bagley said...

Wouldn't it be better for the cause of ecigs if they were shown to be absolutely useless as a quit aid. They could not then be regulated as medicines but left as recreational nicotine delivery devices. Maybe this is the Pharmaceutical Industry being very cunning.

Fredrik Eich said...

There is a discussion on the PMA site regarding your chart and pub closures in general.

The bone of contention seems to be that there were far too many pub closures in 2007 as it came in half way through the year but I thought the numbers ran from April to April.

See here

I just wondered if you had any information as to whether the figures run from April to April in your numbers for the years after 2006?

Christopher Snowdon said...

Hi Fredrik,

I'm not sure what the methodology is, but biggest declines came in 2008 and 2009, with the first major drop coming in 2007. The last six months of 2007 was certainly long enough for some landlords to decide to sell up. Indeed, many would have known what was going to happen and got out of the business as soon as they could. Note that these figures for the UK and therefore include pubs in Scotland that closed as a result of its own smoking ban which began in spring of 2006.

Fredrik Eich said...

Chris, chees for that.

Junican said...

Wasn't the most important point that mounting closures began shortly after the bans were introduced, first in Ireland, followed by Scotland and then by England?

Jonathan Bagley said...

Very good World Service programme on ecigs. I'm beginning to like Professor Robert West just a little bit. Never thought I'd say that about a member of the Anti Tobacco Industry. The World Service seems be left alone to say what it want - not many voters listen to it.

Christopher Snowdon said...


Decent programme. Thanks for letting me know. Robert West has always been sound on harm reduction. Back in the 80s he was one of a very small number of people who questioned the wisdom of the snus ban (I mention it in The Art of Suppression). It's so sad that politicians and so-called public health people have forgotten the lessons of recent history.

Unknown said...

Electronic cigarettes are just device that gives you feel of a real cigarette. E-cigs are considered much safer and cheap than a traditional cigarette that’s why most of the people have stopped smoking and started vaping.

Charlie Electra said...

It is fascinating to know how can a electronic cigarette can replace the traditional cigarettes but it has happened only because it has nos side effects and a huge number of smokers have already quit smoking after using it.

Charlie Electra

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Unknown said...

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