Vaping as a Smoking Cessation Tool?
Welcome to the second blog in the Knowledge is Power series. Today we will be discussing vaping as a smoking cessation tool. We have all heard and seen the back and forth in the media. Vaping is dangerous, vaping is completely safe, vaping helps people stop smoking, vaping has no effect on people trying to quit, and on and on it goes. How can so many scientists come up with so many completely opposite stances?
The FDA3, who have called for severe regulations, have only gone so far as to say “E-Cigarettes have not been fully studied so consumers currently don’t know whether there are any benefits associated with using this product.” The World Health Organization4 (WHO), who has called for a complete ban on indoor smoking and strict flavor and marketing regulation, on e-cigarettes has stated “there is currently insufficient evidence to conclude that e-cigarettes help users quit smoking.” Both organizations have stated that there needs to be more information and studies about e-cigarettes. In response to the FDA and WHO’s request for more information, Cancer Magazine1 recently published the results of a study of 1074 participants recently enrolled in a tobacco treatment program, where different nicotine replacement therapies (NRT) such as nicotine gum, nicotine patch and e-cigarettes, were given as a smoking cessation tool to cancer patients at a comprehensive cancer center. They found using an intention-to-treat analysis that E-Cigarette users were twice as likely to be smoking at the time of follow-up as nonusers. Meaning, the cancer patients in this study who used e-cigarettes were twice as likely to be still smoking analogs at the end of the study than those using other forms of NRT. There was a media frenzy in response to these findings with articles like WebMD’s2 ‘E-Cigs Don’t Help Cancer Patients Quit Smoking”. Yet, is that the full story?
Contrary to the findings above, Addiction Magazine7 also published a survey of 5863 adults who smoked and had attempted to quit at least once in the past 12 months, studying the quitting effectiveness of e-cigarettes compared to other NRT’s. They published, “Among smokers who have attempted to stop without professional support, those who use e-cigarettes are [95%] more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation.” So, how can Addiction Magazine come up with such drastically different results from Cancer Magazines research?
To try and answer this question, we can look to an article published by E-Cig Advanced Magazine5 published in response to Cancer Magazine’s study titled ”Here’s What’s Wrong with the Latest ‘E-Cigs Don’t Work’ Study.” In the article Michael Siegel, Professor in Department of Community Health Sciences at Boston University School of Public Health6 is quoted as “taking issue with the particular community the [Cancer Magazine] study chose to follow – cancer patient smokers, some of which had already tried to quit using electronic cigarettes. This is perhaps the single most resistant community to cessation and therefore any quitting whatsoever would be a surprise.” Also in response to Cancer Magazines published study, Michael Siegel stated in his personal blog, “It’s not clear to me why researchers who oppose electronic cigarettes are so anxious to condemn these products that they are willing to use inappropriate research designs to fulfill such an aim….. Unfortunately, as it stands now, we don’t have the data we need to determine the changes in smoking behavior that result from the use of electronic cigarettes.” Essentially, Mr. Siegel seems to be saying that the basis of the study was flawed based on the type of subjects the study focused on. That leads to concerns of the data being intentionally skewed to support the result those who conducted the study wished to achieve.
Dr. Lynne Dawkins, Experimental Psychologist and lead of the Drugs and Addictive Behaviours Research Group at University of East London stated in a video titled ”We should encourage smokers to try E-Cigs”8 stated “They [e-cigarettes] deliver nicotine and also offer that hand to mouth activity of smoking, and smokers strongly endorse the physical sensation of smoking. We’re seeing long-term, complete cessation rates of around 7%-13%. So, slightly exceeding NRT… even if they’re only as effective as NRT, the fact that they have an unprecedented reach overall means they could have a huge effect on public health.”
Honestly, there isn’t an overwhelming amount of studies out there to say definitively whether vaping should be officially classified as a smoking cessation tool. However, I would argue that there is enough data, such as the higher quit rates and the reach e-cigarettes have in the public discussed by Dr. Dawkins, to show promise. Dr. Bruce Becker9, Professor of Emergency Medicine and Behavioral and Social Sciences at Brown University summed up the idea of “We don’t have a lot of new things to work with. There haven’t been any new medications for smoking in more than 10 or 12 years. Why not e-cigarettes.”
Dr. Dawkins also mentioned in the “We should encourage smokers to try E-Cigs” video also brought up the idea of people continuing an addiction to nicotine, using e-cigarettes permanently instead of quitting completely, which raises the next question. How many are simply switching their method of receiving nicotine instead of quitting altogether, and if they are just switching their method of receiving nicotine, is that a bad thing? Dr. Lynne Dawkins8 addresses these questions as well, “Switching to e-cigarettes might leave some smokers permanently addicted to nicotine. Nicotine is relatively safe, so I’d argue that nicotine addiction in a percentage of the population is favorable to the death and disease caused by smoking.” Dr. Amy Fairchild9, Professor of Social Media Sciences at Columbia University has also expressed a similar view, while interviewed in the “Thank you for Vaping” video, “[harm reduction stance] recognizes that drug use is going to continue, and that cessation doesn’t necessarily have to be your goal. But if you were to get somebody to switch from traditional tobacco cigarettes to be a lifelong e-cigarette user, they would be far better off. A world filled with people vaping is not the same as a world filled with people smoking.” Julie Netherland, New York deputy state director for the Drug Policy Alliance is quoted in her blog10 saying, “Rather than opposing substitution and maintenance therapies, like e-cigarettes, the public health community should be embracing them. It’s time for us all to acknowledge that some people will always use nicotine…” So, it would seem, that these experts at least, do not consider switching from smoking to vaping without fully quitting the nicotine habit altogether as necessarily a bad thing.
Looking at all of the information we have found, we are confused as to the extreme reactions of the FDA and WHO regarding vaping. Perhaps Dr. Thomas Farley9, Former New York City Commissioner of Health answered that question in the “Thank you for Vaping” video when he said “The question is this, 5-10 years from now, if we were to find that these were really really bad for your health, and it’s a multi-billion dollar industry, and there are e-cigarette lobbyists crawling all over city hall, state legislatures, and Washington, do you think we could take action against them then?” Based on this comment, it seems as though the reactions requesting bans and regulation are based in the fear of not having absolute control over a product that they do not fully understand.
There seem to be two views of thought on the subject of vaping as a smoking cessation tool. The precautionary principle, the stance taken by the FDA and WHO, if in doubt, don’t. Meaning, if something is not proven to be 100% safe it should not be introduced into the marketplace. The other stance is the harm reduction principle that understands there will always be people using nicotine, and if we can provide a safer alternative than tobacco, which we know kills thousands of people, that we should offer that option to the public. Anecdotal evidence suggests that vaping is safer than smoking. We make no claim that it is 100% safe, nothing in life is. However, when we think about smoking, a product that kills literally half of it’s users, how can we let fear or ignorance stop us from allowing people the opportunity to utilize a tool that could ultimately save their life?
We touched on the question of the safety of nicotine in this discussion in the past. Check back next week when we take a much closer look at the health effects of nicotine, and how nicotine is different than tobacco. Meanwhile, we would love to hear your personal experiences regarding switching from smoking to vaping, or utilizing vaping to quit altogether.
Written By: Michelle Harnden
3 FDA Website: Public Health Focus
4 WHO Website: Backgrounder E-Cigarette
5 E-Cig Advanced magazine “Here’s What’s Wrong with the Latest “E-Cigs Don’t Work Study”
6 Michael Siegel – Professor Department of Community Health Sciences, Boston University School of Public Health: Tobacco Analysis
7 Addiction Magazine Study
9 “Thank you for vaping” video
10 Julie Netherland – NY deputy state director for the Drug Policy Alliance: E-Cigarettes and Maintenance Therapy A Smart Public Health Approach