Friday 18 November 2022

Vaping proven to be the best way to quit smoking, media look the other way

The media love stories about vaping so it is odd that only the Daily Mail covered the latest Cochrane Review when it was published yesterday. Cochrane Reviews are at the very top of the evidence pyramid and only include randomised controlled trials (RCTs). 

There is an argument that RCTs are not best way to measure the benefits of vaping for smoking cessation because smokers tend to switch to vaping organically, sometimes gradually, and often without intending to quit. Nevertheless, RCTs have still shown vaping to be more effective than nicotine patches and placebos. The last Cochrane Review in 2020 concluded that there was 'moderate-certainty' evidence that e-cigarettes are effective in helping smokers quit.

The new review upgrades that to 'high certainty'. 

We included 78 completed studies, representing 22,052 participants, of which 40 were RCTs. Seventeen of the 78 included studies were new to this review update. Of the included studies, we rated ten (all but one contributing to our main comparisons) at low risk of bias overall, 50 at high risk overall (including all non‐randomized studies), and the remainder at unclear risk.

There was high certainty that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (RR 1.63, 95% CI 1.30 to 2.04; I2 = 10%; 6 studies, 2378 participants).

The previous review's statement about moderate certainty was the last straw for harm reduction deniers to cling to. The 2020 SCHEER report, which informs EU regulation, even claimed that there was only "weak evidence for the support of electronic cigarettes’ effectiveness in helping smokers to quit". 

Surely nobody can claim that now. 

It's just a shame the media took so little interest in this evidence. I'm sure it will be a different story next time an unpublished conference poster claims that vaping causes brain cancer based on a weird experiment on rainbow trout.

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