February 5, 2019
Paul M Ndunda and Tabitha M Muutu just presented their paper “Electronic Cigarette Use is Associated With a Higher Risk of Stroke” at the International Stroke Conference. They conducted a cross-sectional analysis using the CDC’s Behavorial Risk Factor Surveillance System data from 2016 to assess the risks of stroke and myocardial infarction in e-cigarette users, controlling for cigarette smoking. They found compared with non-users, e-cigarette users had higher adjusted odds of stroke (OR 1.71 [1.64 - 1.8]), myocardial infarction (OR 1.59 [1.53 - 1.66]), angina or coronary heart disease (OR 1.4 [1.35 - 1.46]).
These risks are similar to what we reported based on the National Health Interview Survey.
The fact that two independent data sources yielded such similar results is strong evidence that the association is real.
February 4, 2019
Peter Hajek and colleagues published “A Randomized Trial of E-cigarettes versus Nicotine-Replacement Therapy” in the New England Journal of Medicine. This is a well-done trial comparing e-cigarettes with nicotine replacement therapy among people enrolled in smoking cessation programs in England. In addition to being randomized to e-cigs or NRT, people in the study had ar least 4 weeks of counselling. At one year the cigarette abstinence rate was 18.0% among patients randomized to e-cigs compared to 9.9% randomized to NRT, nearly a doubling of quitting.
The study is thoughtfully designed and cautiously interpreted. The authors also did a nice set of sensitivity analyses to show that the results are robust to the usual kinds of problems one has in doing a randomized controlled trial.
They conclude that “E-cigarettes were more effective for smoking cessation that nicotine-replacement therapy, when both products were accompanied by behavioural support.” I agree with that conclusion.
February 3, 2019
Bonnie Halpern-Felsher and her colleagues at UCSF and Georgia State University submitted this public comment to FDA. It is based on Bonnie's testimony to the FDA meeting on treating youth nicotine addiction. (You can view the slides from the meeting here.) The bottom line from the health testimony at the meeting is that there are not yet proven nicotine addiction treatments for youth and that the FDA needs to concentrate on preventing the addiction in the first place. As this comment discusses, there are a lot of things FDA could and should do right now by simply enforcing existing law. FDA should also stop making statements about the safety and efficacy of e-cigarettes for harm reduction and cessation that would be illegal if a company made them without first demonstrating their accuracy. These statements also promote youth use of e-cigarettes and the subsequent nicotine addiction.
This comment has Regulations.gov tracking number 1k3-980i-sotq; a PDF is available here.
February 3, 2019
Lauren Lempert, Bonnie Halpern-Felsher and I submitted this public comment to FDA. It is based on Lauren's testimony to the FDA meeting on treating youth nicotine addiction. (You can view the slides from the meeting here.) The bottom line from the health testimony at the meeting is that there are not yet proven nicotine addiction treatments for youth and that the FDA needs to concentrate on preventing the addiction in the first place. As this comment discusses, there are a lot of things FDA could and should do right now by simply enforcing existing law. FDA should also stop making statements about the safety and efficacy of e-cigarettes for harm reduction and cessation that would be illegal if a company made them without first demonstrating their accuracy. These statements also promote youth use of e-cigarettes and the subsequent nicotine addiction.
This comment has Regulations.gov tracking number 11kk33--998800ii--qzzmii; a PDF is available here.
February 3, 2019
Maggie Kulik and I have already published two papers showing that, contrary to the “hardening hypothesis,” namely that there is a hard core group of smokers that “cannot or will not quit” that underlies the whole harm reduction ideology that is used to justify promoting e-cigarettes, heated tobacco products, and other new tobacco products. The first of these papers showed that, contrary to the hardening hypothesis, as smoking prevalence fell in the USA and EU, the remaining smokers smoked less and quit more. In other words, rather than hardening, the remaining smoking population is softening. The second paper found the same thing in people with psychological distress, a group with high baseline smoking rates.