September 8, 2013

Stanton A. Glantz, PhD

New RCT shows ecig quitting rate no better than nicotine patch

Christopher Bullen and colleagues from the University of Auckland just published a nicely done randomized clinical trial in Lancet that compared ecigs, the nicotine patch and nicotine-free ecigs as cessation aids. They found no difference in 6 month quit rates among the three groups.

Hopefully this study will get ecig promoters to stop claiming that ecigs are better than NRT for quitting.

The trial also encouraged people to use the local Quit line.  Few people did and at about the same rates for all three groups. 

These results are about what I would have expected, since ecigs are a way to deliver nicotine just as NRT.  Because NRT, however, does so with much lower levels of accompanying toxins than  ecigs deliver, clinicians should refrain from recommeding ecigs for quitting.

Because clinical trials tend to overestimate efficacy of interventions in general, I continue to think that the best measure of whether ecigs are effective cessation aids will come from population studies that monitor actual use in the real world.  Of the two good studies that are available, one shows no effect and the other shows that people using ecigs are less likely to quit smoking.

The other, even more, important dimension are whether ecigs will increase youth addiction to nicotine, as suggested by the CDC report released a few days ago, or discourage quit attempts by promoting dual use with cigarettes.  The Bullen study only looked at people who wanted to quit cigs.





Hi Stan, I agree that population-level evidence will be really useful here, given the unknown spill over effects of individual e-cig use onto social norms.  We await with interest. However, if I was a clinician with a patient in front of me who really wanted to stop smoking, but had failed using NRT, I would still quietly recommend/sanction their use of e-cigs.  Whether e-cigs are 'good to go' for population-wide use in the tobacco endgame is a moot point though.  In response to overly pro e-cig media reporting in NZ, I have posted this Health Expert blog that people may find useful. Best, Tony Blakely

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