Smokers need all the help they can get to quit cigarettes. New research reported in the prestigious New England Journal of Medicine confirms that e-cigarettes are significantly more effective than FDA-approved nicotine medicines in helping smokers end their deadly habit.
This study is impressive proof of the scientific concept known as tobacco harm-reduction: the substitution of vastly safer smoke-free tobacco products like e-cigarettes and smokeless tobacco by smokers who are unable or unwilling to become nicotine and tobacco abstinent.
[Related: Youth smoking soared in 2018 and the government blames e-cigarettes]
Decades of scientific studies document that dipping and chewing tobacco are 98 percent safer than inhaling smoke (for example, see here, here, here, here, and here), and the prestigious British Royal College of Physicians observed that “vapour inhalation from the e-cigarettes available today is unlikely to exceed 5 percent of the harm from smoking tobacco.”
The NEJM article describes a British clinical trial in which 886 smokers were given either a refillable e-cigarette and one bottle of liquid, or nicotine medicines — pill, gum, or patch. E-cigarette users were encouraged to experiment with liquids of different strengths and flavors. Nicotine users selected their preferred products and were allowed to use them in combination and to switch them up as desired.
After one year, 18 percent of those in the e-cigarette group were not smoking, compared with 9.9 percent in the nicotine medicine group. That is, e-cigarette users were twice as likely to quit as nicotine medicine users. Another 13 percent of e-cigarette users reduced their smoking by at least 50 percent, compared to only 7 percent of nicotine medicine users.
This study confirms the results of earlier, smaller clinical trials in Italy, also this one, New Zealand, and Greece. More importantly, it addresses the demand of tobacco control activists, including regulators in the FDA, for blue-ribbon scientific proof. That agency’s historic mission has been to judge the effectiveness of medicines before making them available to the public. Their primary assessment tool is the clinical trial, a highly sophisticated and costly experiment in which doctors control the source and dosing of the medicine and all aspects of patient care.
Until now, doctors have considered smoking a disease to be treated with nicotine medicines, anti-depressives, nicotine blocking agents, like varenicline, and behavioral counseling. Clinical trials were used to validate such regimens, but success rates have been abysmally low.
Today, e-cigarettes are upsetting the clinical trial cart. As consumer products, they are widely available to millions of smokers, making it extremely difficult, if not impossible, to conduct controlled clinical trials. Consumers, not doctors, are making the decisions in this environment. Instead of clinical trials, the best evidence for consumer e-cigarette behavior can be gleaned from surveys.
My university research group’s analysis of government survey data shows that e-cigarettes were among the most commonly used quit aids for American smokers in 2013-2014, and they were the only aid that helped quitters more than just quitting cold-turkey. Other studies in the U.S. and the United Kingdom have reported similar results, and together provide population-level, real world proof that smokers are quitting with e-cigarettes.
In the UK, government officials and most medical societies encourage smokers to switch to vastly safer cigarette alternatives. It’s time for their U.S. counterparts to provide American smokers with the same lifesaving options. The new British study adds to the argument against FDA Commissioner Scott Gottlieb’s vow to “narrow the off-ramp for adults who want to migrate off combustible tobacco and onto e-cigs.” That would be a deadly mistake for many smokers.
Brad Rodu is a professor of medicine at the University of Louisville.
