Vaping helps smokers quit. Kind of.

Smoking is the leading cause of avoidable death in the United States and vaping companies have long claimed that their e-cigarettes can help smokers quit. But what do we really know about their effectiveness?

The short answer: not much.

Until now, there was Only two randomized controlled trials – considered the scientific evidence of reference – on electronic cigarettes, both published in 2013. One of them showed that e-cigarettes "were moderately effective" to help smokers give up smoking and work with nicotine patches. The other showed that electronic cigarettes, with or without nicotine, seemed to help people stay away from conventional cigarettes.

Together, these studies were promising – but did not provide enough evidence to draw clear conclusions. As a result, physicians have continued to question how useful e-cigarettes really are.

Wednesday, the New England Journal of Medicine published another randomized trial on electronic cigarettes. Led by researchers from Queen Mary University in London and funded by the UK National Institute for Health Research and Cancer Research UK, the study found that people randomly badigned to use e-cigarettes stopped to smoke almost double the rate of people randomly badigned to nicotine replacement therapy.

This is an impressive finding: giving electronic cigarettes an even more promising appearance for quitting. But do not expect this to rule the debate about their usefulness – or risk. As usual, there are several caveats to interpreting the results of the study. In this case, many of them are related to the speed with which electronic cigarette technology is evolving and the question of whether this British study will result in an American context. Here is a brief overview.

Electronic cigarettes were twice as effective as nicotine replacement therapy when used with UK counseling

For the new NEJM As part of this study, researchers recruited 886 patients seeking help to stop smoking as part of the National Health Services' UK Tobacco Control Program. (Yes, the national health system has free services to help people quit.)

Study participants were then randomly badigned to one of the two treatment groups. One person was able to purchase free nicotine replacement products at the participant's choice (such as stamps and chewing gum) for up to three months. The other received a free e-cigarette starter kit – initially, an all-in-one starter kit from Aspire, then the cancellation of the 2016 Innokin One Kit. They also received a vial of tobacco-flavored nicotine vaping liquid, as well as the recommendation to buy more e-liquids or flavors of their choice. People in both groups received weekly psychological counseling in person and were followed for one year.

The main conclusions of the study:

• By the end of the year, 18% of people in the e-cigarette group had refrained from smoking, compared with 10% of the nicotine replacement group.
• Participants in both groups said that e-cigarettes and nicotine replacement products were not as satisfying as cigarettes – but the group of electronic cigarettes felt that the devices were more useful and more satisfying than those users of nicotine replacement products.
• It is interesting to note that the graduates of the e-cigarette group still used it mainly after one year, while those who quit smoking in the nicotine replacement group were mostly not ( 80% against 9%). This means that users of electronic cigarettes seemed to be developing an addiction or habit that nicotine replacement users did not have.
• As for side effects, the group of electronic cigarettes had more irritation of the mouth, but was also more likely to report a decrease in cough and phlegm. The nicotine replacement group, meanwhile, experienced more nausea.

Overall, e – cigarettes appeared to be relatively effective cessation aids compared to traditional nicotine replacement therapy.

"I think smokers should be encouraged – if they have trouble quitting – to consider [e-cigarettes] and try to find a product that's right for them, "said Peter Hajek, lead author of the study, director of the Queen Mary University's Health and Lifestyle Research Unit. "Health professionals should now be able to say," If you find it difficult to quit, try this, because there is evidence. "

But not so fast

Electronic cigarettes are perhaps better than the nicotine replacement in the study – but they have only helped a minority of vaping group participants to quit smoking. "Despite concerted efforts and encouraging results, it remains disappointing," said David Liddell Ashley, former director of the science office at the FDA's Center for Tobacco Products. "This underscores the importance of scaling up efforts, such as reducing nicotine in burned products to encourage quitting," he added.

The other researchers I spoke to who were not involved in the study were also less enthusiastic. Although they applauded the size and rigor of the study, they had great reservations, mainly about the possibility of extrapolating the study to a real context outside the UK.

A randomized controlled trial "does not look like the way electronic cigarettes are used in the real world, especially in the United States," said Michael Eriksen, dean of the Georgia State University School of Public Health. and former Director of the Centers for Disease Control and Prevention of Smoking and Health.

Here in the United States, the government does not offer free smoking cessation guidelines, he said, no face-to-face behavioral advice like the participants. There is also "confusing and conflicting messages in the media and public health about the relative safety of e-cigarettes compared to smoking."

In the UK, the government has taken a strong position on harm reduction for e-cigarettes. Public Health England views these devices as a safer alternative to cigarettes and vehicles that can help smokers quit. In the United States, the Centers for Disease Control and Prevention and other government agencies do not actively approve electronic cigarettes. Instead, they seem to be taking a more risk-free approach, considering that any damage to e-cigarettes can be problematic and draw attention to the increasing use of e-cigarettes among young Americans.

"[E-cigarettes] are much more acceptable in the UK as smoking cessation devices and are actively promoted by medical and public health groups. The cultural context is very different, "Eriksen summarized.

Finally, we do not know to what extent these findings are relevant for smokers likely to try to quit with newer products, such as Juul, who devoured three-quarters of the US e-cigarette market. "They only used one type of electronic cigarette in this test," said Linda Bauld, professor of public health policy at the University of Edinburgh, a refillable electronic cigarette second generation very popular in the UK. "Electronic cigarette devices vary enormously, so we can not generalize the results of this test to all electronic cigarettes," she added.

"The study is interesting but less important than it is described," said Matthew Myers, president of the Campaign for Tobacco-Free Children. "It tells you that with medical advice and advice, this particular form of electronic cigarette increases the chances of quitting. That's all that tells you. This is useful information. But that does not tell you anything about other electronic cigarettes, especially when they are used in a non-clinical context. "

The study does not solve the controversy on health related to vaping

Most public health officials agree that e-cigarettes are safer than regular cigarettes – one of the most harmful substances known to human health – and that individual adult smokers will likely benefit from this substitution.

But one wonders if the vapors and particles they release into the body will affect the lungs and cardiovascular system over time, as well as the increased risk of cancer to users. These concerns are particularly serious in young people who do not smoke, but who are now out of breath and whose developing bodies and brains are more sensitive to the effects of nicotine.

"The results are very good news for smokers," said David Hammond, Tobacco Specialist at the University of Waterloo, "[the study] The controversy over e-cigarettes and public health is unlikely to be resolved: the attributes that make e-cigarettes a more attractive mode of cessation for smokers also increase their appeal to young people. "

Javier Zarracina / Vox

According to a new survey by the National Institutes of Health, which tracks substance use among US teens, the number of high school students who claim to have seized nicotine in the last 30 days has doubled since 2017. is the largest increase ever recorded for a substance in the country. 43 years of history of the investigation. And that means that a quarter of Grade 12 students now use, at least occasionally, a so-called nicotine device that we have no idea of ​​its long-term impact on health.

This randomized controlled trial could therefore – and probably should – encourage health professionals to consider electronic cigarettes, at least of the type that has proven effective in the study, as a tool for their smoking patients. But it also shows that e-cigarettes are far from the panacea that some might suggest.