Electronic Cigarettes- NOT!

467090685Electronic cigarettes or e-cigarettes appeared to get some great press this week with the release of a study published in the journal Addiction, and one of the line-up Rick and I discuss on PodMed . The study's superficial conclusion is that folks who were attempting to quit smoking and who used e-cigarettes to support their efforts were more successful than either those who used other forms of nicotine replacement or those who tried to go cold turkey.  But hold up, everyone, turns out that a closer look at the methodology of the study as well as the interpretation of the data reveals a lot of holes, and doesn't really answer the question the study purports to ask: do e-cigarettes help people who'd like to stop smoking do so?  Let's see what they did.

Researchers in the UK enrolled almost 6000 adults who had smoked within the previous 12 months and made at least one attempt to cease smoking during that time. Of that number, the majority elected to make the attempt without use of nicotine replacement therapy bought over-the-counter (NRT), where the majority of nicotine replacement products in the UK can be found, while 1922 did utilize OTC NRT, and 464 used e-cigarettes. Surveys were administered to the subjects as part of the ongoing UK Smoking Toolkit Study, which is attempting to gather information about smoking behaviors in England. For this study data from July 2009 through February 2014 was aggregated with the following exclusions: folks who combined methods such as e-cigarettes and NRT, prescription NRT use, or behavioral therapy. The primary outcome measure was self-reported smoking cessation.

Briefly, the study finds "the adjusted odds of non-smoking in users of e-cigarettes were 1.58 (95%CI 1.13 to 2.21) times higher compared with users of NRT bought over-the-counter and 1.55 (95%CI 1.14 to 2.11) times higher compared with those using no aid. In another model that included another measure of dependence (HSI; missing data 3%, n=172), the adjusted odds of non-smoking in users of e-cigarettes were 1.63 (95%CI 1.15 to 2.32) times higher compared with users of NRT bought over-the-counter and 1.43 (95%CI 1.03 to 1.98) times higher compared with those using no aid."  Simply put, those who used e-cigarettes were 1.5 times more likely to quit successfully compared to those using other methods.  Now, what about the holes?

Importantly, Rick points out, there was no assessment of durability of self-reported quitting. In contrast to almost all of the available evidence, this study pans NRT, at least as obtained over-the-counter.  And clearly, we wouldn't be true to our biases if we didn't state that the best and most convincing evidence remains to be gathered: a prospective, blinded, randomized trial of a large number of matched smokers comparing the methods of achieving smoking cessation over a prolonged period of time.  Wonder if e-cigarette manufacturers, so reluctant to have their products regulated as smoking cessation aids, would step up to such a funding opportunity?

Other topics this week include two from JAMA: genetic analysis and lung cancer treatment, and bronchitis and antibiotic treatment, and one from Diabetologia on the risk of cardiovascular disease in women with diabetes.  Until next week, y'all live well.



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