You can’t use this study to say e-cigarettes are safe

The Doctor Is In
Jan 31 · 3 min read
Photo by Luther Bottrill on Unsplash

It made big news.

A recent study, published in the prestigious New England Journal of Medicine, found that e-cigarettes were more effective at helping smokers quit smoking:

A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3%, vs. 51.2% in the nicotine-replacement group) and nausea more frequently in the nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette group). The e-cigarette group reported greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than did the nicotine-replacement group (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group differences in the incidence of wheezing or shortness of breath.

Now, lets step back at take a look at the results in perspective. Yes, e-cigarettes were “nearly twice as effective” as nicotine replacement for quitting smoking. It makes for a great headline.

But, the numbers were still abysmal: only 18% quit at one year using e-cigarettes. That’s less than 1 in 5 smokers. Further, of those who quit, 80% just switched from traditional cigarettes to e-cigarettes. They didn’t completely quit “smoking.”

Now, as a Pulmonologist (lung specialist), if I had to choose between traditional cigarettes — with the smoke, tar, carbon monoxide, and numerous carcinogens — and e-cigarettes, I would choose the latter. Still, ideally, I would not have any of my patients smoking at all, regardless of whether they are traditional or e-cigarettes.

I would not use this study as “evidence” that e-cigarettes are safe.

Moreover, e-cigarettes were less effective than other treatments that have been used for smoking cessation, such as buproprion (Wellbutrin), which had a 20% 1-year quit rate, and varenicline (Chantix), which had a 26% abstinence rate at 6 months. Still, this study does indeed prove that e-cigarettes can help smokers quit.

Having said that, I would not use this study as “evidence” that e-cigarettes are safe. First of all, we have no idea what the long-term effects of smoking e-cigarettes are, with all those chemicals in the nicotine liquid.

Furthermore, nicotine is highly addictive, as addictive as heroin. The e-cigarette is still a nicotine delivery device. And, it is quite possible, if not extremely likely, that e-cigarette users will become addicted to the nicotine in the e-cigarette. And, research has shown that nicotine is a gateway drug for other addictive drugs. So, I would take the results of this study with extreme caution.

Bottom line: yes, this study did show that e-cigarettes were effective at helping smokers quit, but most of the smokers who quit just switched to e-cigarettes. I would not use this study to prove that e-cigarettes are safe. If I had my choice, I would have no one using either product. The lungs were designed to process air, not traditional cigarettes or the nicotine and chemicals in e-cigarettes.

The opinions expressed in this post are my own and do not reflect those of my employer or the organizations with which I am affiliated.

The Doctor Is In

Written by

Thoughts of Dr. Hesham A. Hassaballa, a Critical Care specialist and physician leader, author, and writer. His latest book is “Code Blue,” a medical thriller.

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