A review published by the Cochrane Collaboration – which serves to compile and make accessible evidence from clinical trials – has found that electronic cigarettes do help smokers reduce smoking or quit altogether.
The results show beneficial effects of electronic cigarettes, but are limited by the small number of trials and limited sample of people who were analysed in the studies. About 9% of smokers who used electronic cigarettes were able to stop smoking at up to one year. This compared with around 4% of smokers who used the nicotine-free electronic cigarettes. When the researchers looked at the data on reducing cigarettes in people who had not quit, they found that 36% of electronic cigarette users halved the number of conventional cigarettes. This compared with 28% of users who were given the placebos.
Clearly, as always, more research is needed, but these findings confirm what many vapers have been saying – that given the option they will choose the safer form of nicotine over the more dangerous.
Some will inevitably see any good news for nicotine addicts as a plot by Big Tobacco, in contrast to the Economist which might be interpreted as suggesting that the problem is not enough Big Tobacco, and too much plucky startup:
Moreover, unlike conventional cigarettes, which are made by the zillion by big tobacco companies, using standardised industrial processes, e-cigarettes are manufactured by hundreds of firms of varying sizes, most of which are located in China. Their quality is therefore variable. Some have been found to have heavy metals from the heating element in the supposedly clean nicotine mist. Others have fibres of silica, which could irritate users’ lungs, in the vapour.
Such things will, no doubt, change as more reputable firms displace the less reputable. And more data on the effectiveness of e-cigarettes are now being collected. The study’s authors have identified nine trials now under way. If these, too, come back positive, then grounds for scepticism will be much diminished.
Too often this debate ignores the potential for harm reduction and squabbles over where the front line in the culture war against smoking should be, as I’ve written before.
And when the cannabis e-cigarette arrives, apparently THC-free and therefore legal, will the culture war again set its face against harm reduction and personal liberty?
Soon it will be impossible to tell what recreational drug or prescribed medicine somebody is taking in vapour form, and it will be impossible to police bans on selected drugs without routine invasion of medical privacy.
* Joe Otten was the candidate for Sheffield Heeley in June 2017 and Doncaster North in December 2019 and is a councillor in Sheffield.
24 Comments
Joe, the home office will ban the cannabis e-cig soon. It’s inevitable, and what they do with ‘legal highs’ each time somebody comes up with a new compound.
Anyway, what is interesting about the Cochrane report is that it explicitly treats e-cigs as cessation/reduction devices, ie medical products rather than lifestyle choices. This is an argument for MHRA regulation and greater restrictions on sales.
I smoked from my early teens until my mid thirties and spent at least ten years actively trying to quit. From hypnosis to patches and gum I went through just about everything on the market at the time. My view is that anything that helps people to quit is a good thing. Yes there may be the need to introduce some quality controls but let’s not throw out the baby with the bath water as some anti vaping articles seem to want….
I quit smoking for 3 years before then started again in 2012 due to stress of losing my 14 year old dog.
Now my partner has just been diagnosed with angina and is going in for surgery in January, so as of the 1st January we are both giving up again.
I will be using e-cigarettes and hope to god they work for the other half because I know how moody I got when I gave up the first time, our house is going to be hell if we are both throwing hissy fits 🙁 lol
Selective quotations and headlines can be misleading.
You might have chosen the headline —
” Only 9% of smokers who use electronic cigarettes quit smoking”
These facts were included in the Cochrane summary —-
“..,,.The team of researchers from the UK and New Zealand found two randomised trials that had analysed data from 662 current smokers. ….
The team also considered evidence from 11 observational studies.
The results …. are limited by the small number of trials and limited sample of people who were analysed in the studies.
About 9% of smokers who used electronic cigarettes were able to stop smoking at up to one year. ”
Unlike some, I do not favour one form of nicotine addiction over another. I also do not reject the research of those who look at the marketing as opposed to the medical element of this debate. If the marketing of traditional tobacco cigarettes is enhanced by the marketing of electronic cigarettes then the take up of smoking by a new generation of children will result in the continuing horrific death toll from smoking.
It remains true that 50% of smokers will die as a direct result of being smokers.
It remains true that the vast majority of smokers become addicted to nicotine when still children.
Preventing smoking by another generation of children remains the highest priority.
The evidence from marketting experts has to be taken into account alongside the medical evidence of the 9% of existing smokers said to have quit with the help of this novel product.
@john Tilley “Unlike some, I do not favour one form of nicotine addiction over another”
Really – you dont think the one which kills a large % of its addicts rather horribly is worse than the one which has no proven ill effects ?
Did the study also look how vaping affects the number of people who start smoking tobacco cigarettes?
If smoking is primarily induced by peer pressure, then perhaps e-cigs give people a way to bowing to that in what they feel is a safe way. I don’t know, I’m asking. Then what happens if you’re out socializing and you’ve forgotten your e-cig machine? For some, the easiest solution could be to buy tobacco that one time, and then continue.
Can e-cigs provide a route to disaster in much the same way that a Venus fly trap traps flies?
Good article. The Cochrane review (modestly) confirms what all vapers know – ecigs work. I started smoking when I was 12. I tried cold turkey, gum, patches, hypnosis, counselling, Allen Carr … nothing worked. Now in my mid-40’s I have finally managed to stop smoking by using an ecig. My health, wealth and self-esteem have all improved dramatically.
A few things to note about the Cochrane review:
– both of the RCTs used old tech: low powered ‘cig-alike’ devices. There are now far more effective ecigs available
– one study used 16mg liquid, which is quite low for new switchers, the other used 7.2mg which is extremely low. Better results would be expected with higher strengths.
– a nicotine-free ecig is not truly a control for a RCT. A big part of what makes vaping work is that it replicates lots of the behavioural aspects of smoking. These are all still present in a zero nicotine device and in fact some people find them effective even without nicotine.
– participants in one of the studies didn’t even want to stop smoking
There’s a new study out here which has produced some very promising results:
http://www.ncbi.nlm.nih.gov/pubmed/25358095
g – ‘Anyway, what is interesting about the Cochrane report is that it explicitly treats e-cigs as cessation/reduction devices, ie medical products rather than lifestyle choices. This is an argument for MHRA regulation and greater restrictions on sales.’
This doesn’t make sense. Why would you want to restrict the sale of something that works when cigarettes are so freely available? MHRA regulation would be a disaster. It would reduce the market to one or two dull products that nobody wanted to use, probably produced by tobacco companies because they’re the only ones with enough cash to comply. Further reading here: http://www.clivebates.com/?p=1351
JohnTilly – ‘Only 9% of smokers who use electronic cigarettes quit smoking’
This is a good result compared with over-the-counter NRT and, crucially, smokers WANT to use them.
‘Unlike some, I do not favour one form of nicotine addiction over another.’
I do. I favour a form that doesn’t have a 50% chance of killing me.
Only a tiny number of never-smokers are using ecigs (see for eg. the recent ONS figures http://www.ons.gov.uk/ons/rel/ghs/opinions-and-lifestyle-survey/adult-smoking-habits-in-great-britain–2013/stb-opn-smoking-2013.html) and smoking rates, including among youth, are falling – with the exception of a few countries that have banned ecigs. The ‘gateway’ theory has no evidence behind it at all. All the evidence suggests that the gateway works in the other direction: out of smoking.
Richard Dean – ‘Then what happens if you’re out socializing and you’ve forgotten your e-cig machine? For some, the easiest solution could be to buy tobacco that one time, and then continue.’
This happened to me after about 6 months of vaping – I ran out of eliquid and ended up having a couple of roll-ups. They were disgusting! Don’t forget, as ex-smokers we have regained our sense of taste and smell. The next day I switched straight back to vaping without a second’s thought. I feel more relapse-proof than I ever have when I’ve tried quitting before. The only time I’d end up back on the fags now is if ecigs were banned or regulated off the market.
Richard, see here
http://www.ons.gov.uk/ons/rel/ghs/opinions-and-lifestyle-survey/adult-smoking-habits-in-great-britain–2013/stb-opn-smoking-2013.html
“E-cigarettes are almost exclusively used by smokers and ex-smokers. Almost none of those who had never smoked cigarettes were e-cigarette users.”
This is also relevant to John’s point.
Joe Otten
E-cigarettes in the UK have thus far been marketed at existing smokers. So it is hardly surprising that at the moment those are almost exclusively the people who buy them and use them.
Not so in some states in the USA where Big Tobacco is promoting the sale of e-cigarettes to teenage boys along with nicotine sweets and other nicotine products akin to snus.
So there may just be something in the questions that Richard Dean asks. Such question are not looked at in the research reported in Cochrane .
SpookyBird
doesn’t make sense. Why would you want to restrict the sale of something that works when cigarettes are so freely available? MHRA regulation would be a disaster. It would reduce the market to one or two dull products that nobody wanted to use, probably produced by tobacco companies because they’re the only ones with enough cash to comply. Further reading here: http://www.clivebates.com/?p=1351
I am saying Cochrane’s approach is to consider e-cigs, at least in this study, as medical products with a clearly defined endpoint of reducing nicotine consumption. If you want to argue they’re not, then go ahead, Bates argument is certainly worth considering in this respect, but is outwith Cochrane’s frame of reference.
Spookybird, also, on the subject of the availability of cigarettes, the presence of e-cigs on the market is a strong argument for much tighter restriction on the former, possibly even an outright ban, due the presence of the latter which is far, far safer.
JohnTilley – The Cochrane review had a specific remit: to evaluate the efficacy of vaping as a way to stop or substantially cut down smoking. No study can be expected to cover all aspects of a topic. If you are concerned about ‘gateway’ effects you might want to look at this article which rounds up recent research and some apalling attempts at anti-vaping spin by certain public health professionals:
http://reason.com/blog/2014/12/17/vaping-rises-to-record-highs-smoking-fal?n_play=549467e6e4b02ae495b8085d
‘Not so in some states in the USA where Big Tobacco is promoting the sale of e-cigarettes to teenage boys along with nicotine sweets and other nicotine products akin to snus.’
Do you have any sources for this?
Vaping fans are all missing the point.
Nobody wants to ban vaping (despite frequent references to a non-existant “anti-vaping” lobby). Nor is anybody seriously claiming that vaping is as harmful as smoking. I think everybody accepts that it would be better for smokers to take up vaping as an alternative to smoking.
None of this has got anything whatsoever to do with the real debate, which is over whether vaping in enclosed public spaces should continue to be permitted. It’s a different issue.
Two things of note from the Cochrane press release :-
“Only one of the trials looked at the effects of electronic cigarettes compared with patches and this suggests similar efficacy of the two treatments.”
If that finding were confirmed, it would blow away one of the justifications for public vaping. Vapers could simply switch to patches instead. (Or do as smokers do now and go outside.)
Concluding statement :-
“Cochrane’s Editor in Chief, David Tovey, said this is an important study. ‘This review provides a timely reminder of the challenges faced by smokers who find it hard to stop smoking. The results so far need to be strengthened with further comparisons between electronic cigarettes and other traditional ways of stopping smoking such as chewing gum and patches, and evidence on long term safety.'”
i.e. more research is needed – a point which the vaping fans seem unable to grasp.
SpookyBird 19th Dec ’14 – 6:37pm
If you read my earlier two comments you will see that at no point have I tried to suggest that the Cochrane report is anything other than it is.
I was suggesting that people note what the report actually says and the limitations of the report as set out by Cochrane.
Stuart on a slightly different tangent makes the point – ” more research is needed – a point which the vaping fans seem unable to grasp ”
Quoting selectively from medical research and pretending the conclusion is other than it actually is at best letting wishful thinking get in the way of objectivity. At worst it is dishonesty.
g, the public health angle here is the reduction in smoking. Reduction in nicotine use is relatively insignificant by comparison.
Stuart, vaping has been banned in many public places, in a thoughtless knee-jerk reaction. I’m not clear why you would ban vaping in public places but allow nicotine patches. What is the difference? Ban one purely because it is more enjoyable than the other?
“I’m not clear why you would ban vaping in public places but allow nicotine patches. What is the difference?”
I would have thought the answer to that was obvious, so I’m surprised you ask the question. See :-
http://bma.org.uk/news-views-analysis/news/2014/june/call-to-ban-e-cigarettes-in-public-places
And :-
http://bma.org.uk/working-for-change/improving-and-protecting-health/tobacco/e-cigarettes
You will note from both the above articles that the BMA (one of the most prominent voices among the so-called “anti-vaping” lobby) fully recognises e-cigs’ potential for harm reduction and sees them as a less bad alternative to smoking, so many of the points made by vaping fans above are bogus. Just because these devices may play a part in harm reduction does not mean that there are not strong arguments in favour of regulation. These things are capable of both reducing harm (helping some smokers – a very small number apparently – to quit) and generating harm (tempting some other people in to nicotine addiction).
The suggestion that banning vaping in public would drive people back to cigarettes makes no logical sense, since cigarettes are already banned in the places where it is suggested that vaping be banned also.
SpookyBird 19th Dec ’14 – 6:37pm
You asked about sources on the targetting of teenagers with nicotine products in some states in the USA.
My original source was a doctor from the USA who spoke at the ASH Wales conference in Cardiff about six or seven years ago. I have retired since then and my papers from the conference are neatly filed away for my successor but are no longer available to me. So I googled “Nicotine products aimed at teenagers in the USA”. There are lots of sources!
This week USA Today carried this article complete with references to the original sources —
Two studies find big jump in teen use of e-cigarettes
Two new studies have found that far more kids are using electronic cigarettes than previously reported, raising fears that the products could hook another generation on nicotine even as cigarette use is falling.
About 25% of high school students in Connecticut and 29% of teens in Hawaii have used e-cigarettes, according to separate studies. About 18% of the Hawaii teens and 12% of the Connecticut high school students had used e-cigarettes in the past month. Both studies were done in 2013.
Those rates are much higher than the latest data from the Centers for Disease Control and Prevention, which found 4.5% of high schoolers and 1.1% of middle schoolers had used e-cigarettes in the past 30 days in 2013.
Authors of the Hawaii study, published online Monday in Pediatrics, note that e-cigarette use has grown exponentially among kids, doubling every year since 2009. Sales of e-cigarettes in the USA were $11.7 billion in 2013, according to a January report in the New England Journal of Medicine. The Connecticut study was published Tuesday in Nicotine and Tobacco Research.
The Food and Drug Administration has proposed regulating e-cigarettes and other tobacco products, but it has not issued a final rule. The proposed rule would ban sale of e-cigarettes to people under age 18. Manufacturers of e-cigarettes would have to register any new products with the FDA.
Although 40 states prohibit e-cigarette sales to minors, 16 million kids under age 18 live in states where they can buy e-cigarettes legally, according to a report released Thursday by the CDC.
“Two studies find big jump in teen use of e-cigarettes”
Why have you failed to mention that there was also a significant fall in teen cigarette use, JohnTilley?
Stuart – ‘Nobody wants to ban vaping (despite frequent references to a non-existant “anti-vaping” lobby).
Nor is anybody seriously claiming that vaping is as harmful as smoking. I think everybody accepts that it would be better for smokers to take up vaping as an alternative to smoking.’
Well you’d think so, wouldn’t you? Unfortunately the anti-vaping lobby is strong and active. Couple of videos here which are a good intro to what’s happening:
Professor Gerry Stimson speaking at the HIT Hot Topics Conference 2014: https://www.youtube.com/watch?v=ZcvLiDr0KRM
Clive Bates at this year’s Ecigarette Summit: http://vaping.com/ecigsummit2014/clive-bates (scroll down for accompanying slides)
‘None of this has got anything whatsoever to do with the real debate, which is over whether vaping in enclosed public spaces should continue to be permitted. It’s a different issue.’
Why is this the ‘real debate’? Why isn’t the real debate about the number of lives which could be saved by smokers switching? (‘literally millions’ according to Professor Robert West: http://www.bbc.co.uk/news/health-24914473) What principles are guiding your priorities?
The subject of this article is a Cochrane Review which provides evidence, albeit modest, for the efficacy of vaping. This might not seem important to you but vapers and vaping advocates are repeatedly being told ‘there’s no evidence that they work’ so for us this is an important and welcome result.
‘it would blow away one of the justifications for public vaping. Vapers could simply switch to patches instead.’
Gosh, that sounds a bit illiberal! Why do we need a justification to vape in public? Shouldn’t it be those who want a ban who provide justification? That’s the way things normally work. Patches are rubbish by the way, most of us have already tried them.
‘i.e. more research is needed – a point which the vaping fans seem unable to grasp.’
On the contrary, vapers love good quality research. Lots of us spend hours reading it and discussing it. We collate it: http://www.absolut-vapor.com/addiction-tabac/cigarette-electronique-dernieres-etudes-scientifiques/ , we even crowdfund it: https://www.indiegogo.com/projects/e-cigarette-research-temperature-of-evaporation
“I’m not clear why you would ban vaping in public places but allow nicotine patches. What is the difference?”
‘I would have thought the answer to that was obvious, so I’m surprised you ask the question. See (2 x BMA links)’
Sorry but the BMA’s call for a public ban is not evidence based. Sense About Science asked them over a year ago to provide evidence to support a ban but they have failed to do so: http://www.senseaboutscience.org/blog.php/92/the-welsh-proposal-to-ban-e-cigarettes-in-public-places-following-evidence-trails
Public Health England do not support such a ban and neither do ASH who instead have produced a guide to help individual premises decide what their vaping policy should be: http://www.ash.org.uk/files/documents/ASH_900.pdf
‘These things are capable of both reducing harm (helping some smokers – a very small number apparently – to quit)’
At least 700,000 in the UK so far (although those are last year’s figures so probably lots more by now): http://www.ash.org.uk/files/documents/ASH_891.pdf
‘and generating harm (tempting some other people in to nicotine addiction).’
There is no evidence of this happening. There is some new data from the US that some young people are taking up vaping but this is in tandem with rapidly falling smoking rates. If youngsters are diverted from smoking to a much, much safer product then this represents a big reduction in net harm.
‘The suggestion that banning vaping in public would drive people back to cigarettes makes no logical sense’
Yes it does. They’ll be outside – with the smokers! I can’t think of many better ways to sabotage someone’s quit attempt. Plus of course they’ll be subject to second hand smoke which is a bit rotten if you’re not a smoker.
I know three people who have switched to e-cigs from being heavy smokers. None still smoke. Small sample but 100% success. I am one if the three and have been “clean” for nearly two years now. All of us use tanks and liquids not the ciggie lookalikes. The advantage being that you can gradually reduce the nicotine content. Mine has been zero for some time now and just contains a menthol flavour. Banning vaping in public wouldn’t send me back to smoking but no I don’t want to breath in smoke by being forced to stand next to smokers.
Do these studies distinguish between nicotine levels being vaped. Do they show as an indisputable fact the teens are vaping nicotine, if so at what strength, or does it include 0% nicotine flavour vapers? And what flavours are they vaping? Unlikely to be any of the disgusting tobacco flavours so almost certainly not a gateway to tobacco use.
I can see there are vested interests in the tobacco companies, pharmaceuticals, and the Treasury who must be losing a fortune. So there’s an added bonus. That said I would like some legally regulated quality controls on vaping liquids and I’d be happy to see the ciggie lookalikes disappear. I would also ban TV and billboard advertising.
I switched to electronic cigarettes back on November 8, 2013. I didn’t just “quit”, because I actually enjoyed “smoking”. Fortunately, e-cigs are delicious, and I can continue “enjoying smoking”. (Rather, I enjoy vaping.) I’ve tried cigarettes a few times since I quit, and they were NASTY! It is now April 13, 2015 – I have been cigarette-free for a year and a half.