Can Vaping Help People Quit Smoking? It’s a Fact

 

Simon Chapman, emeritus professor in public health at the University of Sydney in Australia, is a long-time anti-tobacco activist and frequent contributor to The Conversation, which bills itself as “the world's leading publisher of research-based news and analysis.”  Undercutting that claim is a May 3 article Chapman authored, titled, “Can vaping help people quit smoking?” Chapman predictably answered that “It’s unlikely.”

His vaping analysis in support of that finding is grossly flawed.

Chapman starts with the “Myth of ‘hardened smokers’” -- “die-hard addicts: frequently relapsing smokers who just can’t quit.”  He asserts that their existence is a myth because the “average number of cigarettes smoked per day would be rising.”  That number has, in fact, fallen, but for entirely unrelated reasons, such as the imposition of a range of barriers to smoking, both social and economic, over a period of 20 years.

Chapman follows with a sweeping statement: “In other words, there is no evidence long-term smokers are impervious to the suite of tobacco control policies and campaigns that have driven hundreds of millions of smokers around the world to quit.”

No evidence?  There is definitive evidence: 480,000 dead smokers every year in the U.S.

Next, Chapman says that “Vapes don’t help smokers cut back.”  He’s talking about smokers who also vape, and there may be some truth in that, but the larger reality is that Chapman and his anti-tobacco allies in government and academia have been waging for years a very successful misinformation campaign, convincing smokers that vaping is as, or more dangerous than smoking.

Chapman asks how effective vapes are for smoking cessation, and answers with this: “The most recent Cochrane review of randomised controlled trials compared vaping with nicotine replacement therapy (such as drugs, gums and patches). It found about 82% of people who vape are still smoking when followed up six or more months later.  This was better than those using nicotine replacement therapy: 90% were still smoking.”  That answer is both humorous and revealing.

It’s amusing because I have made the same claim about medicinal nicotine for decades, and I agree that “trials also poorly reflect the ways vapes and nicotine replacement therapy are used in the real world and aren’t representative of all smokers wanting to quit.” (here)  In fact, population success with medicinal nicotine is only 7%.  But his answer is also revealing, since his point that 82% of those vaping are still smoking means that 18% quit with vapes, compared with only 10% relying on nicotine medicines.  Why would anyone deny smokers, who could be facing life-threatening illness, the option to quit by vaping?

Chapman posted his article in support of Australia’s crackdown on access to vaping products. Clearly, that government initiative and his pseudo-scientific analysis are woefully flawed.

 

Wisdom From Smoking Cessation Pioneers

 

A search of the medical literature on the topic “smoking cessation” finds 32,446 published articles, yet, surprisingly, there are no articles linked to this topic until the year 1980, and only 27 articles were published from 1981 to 1990.  Medical researchers primarily focused on smoking cessation in the last three decades -- 1991 to 2000 (4,481 articles), 2001 to 2010 (10,976 articles), and 2011 to the present (16,964 articles).  Despite this impressive volume of research, the U.S. still records 480,000 deaths annually due to smoking.

I was interested to learn more about the 1981-1990 period, as it preceded my entry into the field in 1994 (here, here and here).  I found that several prominent scientists and academicians, who are strong supporters of tobacco harm reduction, populated that period’s author list.  Here they are, followed by PubMed links: John Hughes (here and here), Jed Rose (here), Lynn Kozlowski (here), Ken Warner (here), Jack Henningfield (here), Ray Niaura (here), David Abrams (here) and Saul Shiffman (here).  Three of these articles, and their authors, deserve special mention.

Ken Warner’s 1989 article, “Implications of a Nicotine-Free Society,” clearly shows that this University of Michigan professor has been one of the most forward-thinking leaders in the tobacco research and policy field for many years.  He understood in 1989 that a “nicotine-free society” was not a panacea, and he boldly criticized both sides in the debate: “The tobacco industry implies that the demise of tobacco consumption would wreak havoc with the economy. By contrast, some antitobacco activists suggest that the end of tobacco use would yield a multibillion dollar fiscal dividend. Each argument is fundamentally flawed. The economic impacts of a nicotine-free society would be modest and of far less consequence than the principal implication: a significantly enriched quality and quantity of life.” 

I have some personal insight into Professor Warner’s commitment to tobacco harm reduction.  In 1999, US Tobacco made its first grant to the University of Alabama at Birmingham to support my work.  I contacted numerous well-known tobacco researchers, offering to fund my own travel in order to make presentations on an alternative approach to cessation for inveterate smokers.  The only person to respond was Ken Warner.  He hosted my speech and invited colleagues from across the Michigan medical center.  It was a rigorous event, at which my research and ideas were seriously challenged.  I was, and remain, profoundly grateful to Professor Warner for this amazing opportunity.

Jed Rose at Duke University is another prophet of tobacco harm reduction, and his work long pre-dated and anticipated the recent development of vapor products.  Consider his 1990 article,  “Low-nicotine Regenerated Smoke Aerosol Reduces Desire for Cigarettes.”  His group developed “an aerosol with many of the sensory qualities of cigarette smoke, but with only 3% of the tar and nicotine and none of the carbon monoxide of a typical commercial cigarette… Surprisingly, the smoke aerosol reduced self-reported desire for cigarettes as much as the commercial cigarette. This new method is a promising approach for evaluating the role of sensory cues in smoking, and it may also be useful as a clinical tool for smoking cessation.”          

Finally, there is legendary tobacco researcher Lynn Kozlowski (originally at Penn State, now at the University at Buffalo).  In 1989, he authored “Reduction of tobacco health hazards in continuing users: individual behavioral and public health approaches.”  The article was written for “those smokers who will not stop using tobacco,” for whom “methods are discussed for reducing the risks to health of continued tobacco use… For continuing smokers of cigarettes, fewer cigarettes per day and very-low-tar cigarettes are encouraged, provided filter-vents are not blocked by the smoker. Better yet would be a switch to smoking one or two non-inhaled pipes or cigars each day. Even better would be a switch to use of the minimum acceptable amount of smokeless tobacco or nicotine-containing gum.”  Professor Kozlowski even suggested that “public health measures (e.g., social restrictions, differential taxation, changes in package size) may be the most important means of bringing about less hazardous tobacco use among continuing users.”

In 1994 I started counselling inveterate smokers to switch to smokeless tobacco, and in 2017, my research group recommended “differential taxation” to Kentucky legislators to save smokers’ lives.  I am proud that our proposal was endorsed by Ken Warner and Ray Niaura.

 

 

FDA Commissioner Califf’s Anti-Misinformation Campaign Must Start at Home

 

In a recent interview with CNBC, FDA Commissioner Dr. Robert Califf said that “misinformation” is driving down U.S. life expectancy, which is now three to five years lower than in other developed countries.  Dr. Califf said that combating misinformation is one of his top priorities, and he called for more regulation by “specific authorities at FDA, FTC and other areas to root out misinformation.”

The Commissioner should put his own agency in order first.  U.S. life expectancy has declined for decades largely because some half-million Americans per year have died from burning tobacco and inhaling smoke.  This tragedy has been going on so long that today few see it as a crisis.  For proof, do a Google News search for “crisis” and here’s what you get: banking crisis, housing crisis, plastics pollution crisis, mental health crisis and opiate overdose crisis.  All of these are serious problems, but their severity pales in comparison with smoking-related deaths.

Today, smokers can avoid premature death by switching to e-cigarettes and vaping products.  The British government has seized on this fact, announcing, “One million smokers will be encouraged to swap cigarettes for vapes under a pioneering new ‘swap to stop’ scheme designed to improve the health of the nation and cut smoking rates.  As part of the world-first national scheme, almost 1 in 5 of all smokers in England will be provided with a vape starter kit alongside behavioural support to help them quit the habit as part of a series of new measures to help the government meet its ambition of being smokefree by 2030 - reducing smoking rates to 5% or less.”

Yet here in the U.S., rather than encouraging smokers to switch, the FDA has taken millions of vape products off the market; the only products the agency has approved for sale have been tobacco-flavored.  Imagine if the FDA approved a drug to help people suffering from alcoholism, but only if the product is bourbon-flavored!

The chart, showing data from the National Cancer Institute’s Health Information National Trends Survey (HINTS), reveals the extensive damage caused by the federal government’s campaign against e-cigarettes.  In 2020, only 10% of American adult smokers believed correctly that vaping was less harmful than smoking; two-thirds believed vapes were the same or more dangerous, and a quarter didn’t know. 

Who can blame smokers for not switching from cigarettes to products that most believe are as bad or worse for their health?   

A lot has been written about the 2022 Reagan-Udall Foundation report that criticized FDA tobacco regulations, but for me, the most egregious and deadliest regulatory misstep has been the government’s successful misinformation campaign against safer and satisfying smoke-free alternatives, and against nicotine itself.  Dr. Califf is correct in saying that “misinformation is driving life expectancy in the U.S. down,” but it is his own agency that is spewing the misinformation that dissuades smokers from stepping away from the fire.  It is long past time for the FDA and other public health agencies to reverse course and give smokers the tobacco truth.