“Poorly Designed, Conducted, and Interpreted” Research Deters Smokers From Life-Saving Safer Cigarette Substitutes

 

I recently published research in Internal and Emergency Medicine demonstrating that a dozen prior articles describing diseases in vapers were flawed and unreliable.  Subsequently, the journal editors commissioned a commentary on our work from eminent tobacco harm reduction experts Riccardo Polosa and Konstantinos Farsalinos.  Following are extracts from their article.

“[Rodu and Plurphanswat] have provided cogent and convincing evidence based on a creatively simple assessment of data from the first wave of the PATH survey that smoking-related diseases…were only rarely diagnosed in respondents who had initiated e-cigarette use prior to the age of diagnosis of these disorders...these diseases were nearly always diagnosed following (mostly many years after) the…initiation of smoking…97% of all cases for COPD, 96% for emphysema, 98% for myocardial infarction and 93% for stroke. Indeed, most of these diseases were ultimately diagnosed in respondents who initiated smoking prior to 18 years of age.”

“What [Rodu and Plurphanswat] accomplished was so conceptually simple and fundamentally important that we are very surprised that no one, particularly any of the authors of the PATH survey publications, had carried out a similar assessment previously.  Moreover, reviewers of the many PATH, BRFSS, and NHIS based papers showing a relationship between e-cigarette use and smoking-related diseases appear not to have considered the critical importance of the timing of events.

“And this relates to the next question. How was it possible that the peer review process at highly respected scientific Journals has failed to detect such fatal flaws and has allowed publication of low-quality papers lacking inclusion of such key factors essential for the interpretation of their analysis? The unopposed acceptance of these (low-quality) papers by prestigious journals is symptomatic of a significant dysfunction in scientific publishing, which is distorting the practice of science.”

Polosa and Farsalinos provide an insightful observation:

“Research on tobacco harm reduction (THR), and particularly on electronic cigarettes (e-cigarettes), remains a highly controversial topic in the scientific community. The controversy is also sustained by research, which is often poorly designed, conducted, and interpreted [1]. Dissemination of inaccurate information on smoke-free alternatives in the media contributes to public skepticism and uncertainty, particularly among smokers, who as a result are discouraged from adopting reduced-risk lifestyles.”

Jacob Sullum, an editor at Reason and a long-time supporter of THR, covered my article and the Polosa-Farsalinos commentary here.  He concluded: “The bias against e-cigarettes, in turn, shapes public perceptions. Although authoritative sources such as the Food and Drug Administration, the Royal College of Physicians, and the National Academies of Sciences, Engineering, and Medicine acknowledge that vaping is far less hazardous than smoking, surveys find that most Americans believe otherwise.”

E-Cigarettes Prove Effective for Smoking Cessation

The scientific foundation for tobacco harm reduction is well established.  My comprehensive reviews of the evidence in 2006 (here) and 2011 (here) were based on 279 articles published primarily in medical and scientific journals.  Dozens more articles were published in the past year.

Tobacco prohibitionists remain blind to this evidence. 

On September 11, the Oklahoma House of Representatives’ Public Health Committee convened a hearing on tobacco harm reduction.  Daniel McGoldrick, Vice President for Research at the Campaign for Tobacco-Free Kids, told legislators that “Tobacco harm reduction is a complicated and risky strategy that currently lacks an evidence base…” 

A particularly vulnerable target of anti-tobacco forces is the e-cigarette, which has been on the market for less than a decade. Even in that short time-frame, scientific studies have emerged to put the lie to “no evidence” charges.  For example, a clinical trial conducted at Italy’s University of Catania and the UK’s University of Southampton (available here) concluded that “…the e-cigarette can help smokers to remain abstinent or reduce their cigarette consumption.  By replacing tobacco cigarettes, the e-cigarette can only save lives.”

Lead author Riccardo Polosa and colleagues enrolled 40 healthy adult smokers who were not interested in quitting into a prospective trial where they were invited to use e-cigarettes with 7.4 mg cartridges at no cost over 24 weeks.  The authors note that “…no emphasis on encouragement, motivation and reward for the smoking cessation effort were provided…”  Twenty-seven participants completed all study visits.

One-third (n=13) of the participants reported a sustained 50% reduction in the number of cigarettes smoked, from 25 per day at enrollment to six per day at completion.  Further, nine participants had completely quit smoking, with six still using e-cigarettes at the end of the study. 

These reports were confirmed by testing carbon monoxide levels in exhaled air.  High levels were measured in all smokers before the study; levels at study’s end confirmed little or no smoking.

Few side effects, including mouth and throat irritation and dry cough, were seen, mostly at the beginning of the study; they were not present at study completion.

In summary, this small clinical trial from Italy demonstrates that use of e-cigarettes resulted in smoking reduction or elimination in 55% of smokers who did not intend to quit.  The evidence base is solid and growing.