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A major new study provides the strongest evidence to date that vaporization can help smokers quit, with e-cigarettes almost twice as effective as nicotine gums and patches.
British research, published Wednesday in the New England Journal of Medicine, could influence what doctors say to their patients and shape the debate in the United States, where the Food and Drug Administration is under pressure to more closely regulate the burgeoning industry in a context of teenage outbreaks.
"We know that patients are asking questions about e-cigarettes and many doctors do not really know what to say," said Dr. Nancy Rigotti, a tobacco treatment specialist at Harvard Medical School, who was not involved in the treatment. 39; study. "I think they now have more evidence to approve electronic cigarettes."
At the same time, Rigotti and other experts have warned that no vaping product has been approved in the United States to help smokers quit.
Leading cause of preventable death
Smoking is the leading cause of preventable death in the world, responsible for nearly 6 million deaths a year. Stopping smoking is notoriously difficult, even with decades-old nicotine aids and newer medications. According to government figures, more than 55% of American smokers attempt to quit smoking each year and only about 7% do so.
Electronic cigarettes, which have been available in the United States since about 2007 and now represent $ 6.6 billion a year, are battery-powered devices that typically heat a flavored nicotine solution to an inhalable vapor.
Most experts agree that steam is less harmful than cigarette smoke because it does not contain most of the carcinogenic by-products of burning tobacco. But there is virtually no research on the long-term effects of chemicals in vapors, some of which are toxic.
At the same time, there have been conflicting studies of whether e-cigarettes actually help smokers get rid of this habit. Last year, an influential group of American experts concluded that there was "little evidence" of their effectiveness.
In the new study, researchers tracked nearly 900 middle-aged smokers randomly badigned to receive either electronic cigarettes or nicotine replacement products, including patches, gums and lozenges. . At the end of one year, 18% of electronic cigarette users were smoke free, compared with 9.9% of those who used other products.
"All that helps smokers avoid heart disease, as well as cancer and lung disease is a good thing, and e-cigarettes can do it," said Peter Hajek, co-author of the study and addiction specialist at Queen Mary University in London.
More rigorous
The study was more rigorous than the previous ones, which largely questioned smokers about the use of the electronic cigarette. Participants in this experiment underwent a chemical breath test.
Smokers in the electronic cigarette group received a $ 26 starter kit, while those in the nicotine substitute group received a three-month supply of the product of their choice at a price of about $ 159. Participants were responsible for purchasing follow-up supplies.
"If you have a more effective and less expensive method of helping people with smoking cessation, it should be of great interest to anyone providing health services," said Kenneth Warner, retired public health professor at the University. from Michigan. not involved in the study.
Several factors may have improved outcomes: All participants were recruited into a government cessation program and were likely motivated to quit. They also received anti-smoking tips for four weeks.
Researchers have not tested e-cigarettes for new drugs such as Pfizer's Chantix, which has had higher success rates than older nicotine-based treatments.
This study was funded by the UK government, which adopted the e-cigarette as a potential tool for tobacco control through state-run health services. Some of the authors were paid as consultants to manufacturers of anti-tobacco products.
Long-term issues
US health authorities have been more reluctant about product support, in part because of unknown long-term effects.
"We need further studies on their safety profile, and I think no one should change its practices based on a study," said Belinda Borrelli, a psychologist specializing in Smoking cessation at Boston University.
The American Heart Association supported electronic cigarettes in 2014 as a last resort to help smokers quit after trying out approved and approved products. The American Cancer Society took a similar position last year.
An editorial accompanying the study and co-authored by Borrelli recommended electronic cigarettes only after smokers tried and failed to quit smoking with FDA-approved products. In addition, doctors should have a specific schedule to stop the use of the electronic cigarette.
Borrelli noted that after one year, 80% of the electronic cigarette users participating in the study still use the devices. Nine percent of participants in the other group still used gums and other nicotine replacement products.
No vaping company has announced its intention to seek FDA approval for its products as a way to quit smoking. Obtaining such support would require major studies that can take years and cost millions of dollars.
The FDA has largely adopted a nonchalant approach to vaping. It has not scientifically examined any of the electronic cigarettes available on the market and has postponed to 2022 some key regulations. FDA Commissioner Scott Gottlieb said he did not want to over-regulate an emerging industry that could offer a safer option for adults. smokers.
The delay was hotly criticized in a teenage vaping explosion, mainly because of devices like Juul, which looks like a USB key. Federal law bans sales to under 18s, but one in five students said they were vaping last year, according to a government poll. It showed that teenage use had increased by 78% between 2017 and 2018.
Tank against cartridge
Matthew Myers, of the Campaign for Tobacco-Free Children, said the UK study uses so-called tank-based electronic cigarettes, which allow users to personalize their aromas and nicotine levels. In the United States, these devices have been overwhelmed by Juul and similar devices with pre-filled nicotine cartridges. Any advantage of e-cigarettes depends on the individual product and how it is used, he said.
"It's a fundamental mistake to think that all electronic cigarettes are alike," said Myers. "And in the absence of FDA regulation, a consumer has no way of knowing if the product that he uses has the potential to help him or not."
The Myers Group is one of many anti-smoking organizations to sue the FDA in court so that it immediately begins examining e-cigarettes.
Ian Armitage was skeptical about the electronic cigarette as a way to quit smoking, claiming that he had been trying to run out of steam a few years ago, but that he "s not sure. had quit after being shaken by nicotine withdrawal.
"I tried it for a month, but it just did not do it for me," said Armitage, an audio-visual technician in Washington. "I always wanted a cigarette after."
Armitage, who has been smoking for 15 years, said he had also tried nicotine patches, but had found that they were irritating his skin.
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