CMA review proves e-cigarettes are most effective way to quit smoking

There have been a flurry of media with headlines such as E-cigs don’t help people butt out: Study and Heart Institute Review Confirms No Evidence of E-cigarettes Effectiveness for Cessation.  Though the message seems clear and direct there is no evidence presented –  no information given so that we might understand the basis for the statement, As presented it is entirely unsubstantiated.  Since the study itself is being withheld from the public there is no way to know if the review was comprehensive or how in any way the gathered data related to the conclusions.  Therefore my headline might be as accurate as the media ones proclaiming the opposite.

It would not be the first time the data actually support the opposite conclusion to the headline.

If you can access to the study you can judge for yourself but when someone tells you something but not why you have to then decide whether they are generally trustworthy.

Historically the Canadian Medical Association has argued for supporting pharmaceutical interests (subsidizing nicotine replacement therapies) while standing against alternative safer nicotine sources. In general, they have been very anti-tobacco while unsupporting of tobacco harm reduction – a common yet self contradictory position.  The point is, that given their past, their conclusions in this area should be scrutinized for ideological confounding.  They need to make clear why we should accept their conclusions despite their support of the pharmaceutical replacement industry which has the most to lose if e-cigarettes are perceived as effective smoking replacement or cessation.

So what can we actually glean from the press release that might tell us something about how this was conducted?

It is said that there are 5 things physicians should know about e-cigarettes:

1. Electronic (e-) cigarettes are cigarette-shaped canisters used to simulate the action of cigarette smoking.

I guess you have to start somewhere.

2. E-cigarettes are not regulated or approved for sale in Canada

Although the prevalence of cigarette smoking has decreased over the past few decades, consumer interest in e-cigarettes is rising.

First of all, approval is not relevant to considerations of health.  Second, you are given the impression that smoking and vaping are equally bad (little different from saying, and I realize this is a weak analogy, “although drinking alcohol has decreased over the last years, consumer interest in low alcohol beverages is rising.”

3. Although perceived by cigarette smokers as a safer alternative to tobacco smoking, e-cigarettes have not been evaluated for their safety

It is unknown whether inhalation of the mixture of chemicals found in the vapour of e-cigarettes is safe. Available literature suggests that e-cigarettes contain trace amounts of impurities and carcinogenic tobacco-specific nitrosamines. Concerns exist regarding the potential to maintain nicotine dependency in current smokers or induce addiction in nonsmokers.

The last sentence is also irrelevant to the issue of health (it might not harm them but they keep doing it and that’s just wrong). As far as the rest, it implies that these researchers have not considered relative harm that is, yes, some studies have found impurities but these are fractions of what exist in cigarette smoke. If you are discussing e-cigarettes as a cessation or replacement method you cannot ignore how safe they are in comparison to cigarettes.

4. E-cigarettes have not been fully evaluated for their efficacy as smoking cessation aids

To date, one 6-month randomized controlled trial has investigated the efficacy of nicotine containing e-cigarettes as a smoking cessation aid; statistical power was insufficient to conclude e-cigarettes were superior to nicotine patches.

This one is the kicker.  Randomized controlled trials are useful tools but not when studying how people change behaviors in the real world. While there is no doubt that e-cigarettes have not been “fully evaluated” the insinuation is for a negative rather than a positive outcome.

5. Effective smoking cessation interventions are available for smokers wishing to quit.

Several pharmacologic and behavioural interventions have been found to improve smoking cessation rates.

And now a word from our sponsors.  And a plug for products with a success rate so dismal that they would have been removed from the market if basic consumer product standards applied.

Overall, the main complaint I have with the views expressed in this release is that e-cigarettes are being judged solely on whether they are effective total cessation devices rather than finding it worthwhile that they are useful smoking replacement devices, healthier alternatives, whether or not the individual ever quits smoking.

Isn’t it a little like letting a driver have seat belts only if they use them 100% of the time?

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