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.

 

E-Cigarette Opponents Torture PATH “One-Puff” Relapse Data to Deny E-Cigarettes’ Cessation Impact

 

You may have seen headlines like this from CNN: “Using e-cigarettes to prevent smoking relapse doesn’t work well, study finds,” with quotes from the study’s lead author, Dr. John Pierce of the University of California San Diego. 

The research, which appeared in the journal JAMA Network Open (here), relied on data from the FDA’s Population Assessment of Tobacco and Health (PATH) Survey, which for five years has followed smokers and other tobacco users. 

Dr. Pierce generated news coverage largely by making a number of hyperbolic claims: 

“This is the first study to report on whether cigarette smokers can switch to e-cigarettes without relapsing to cigarette smoking…[Smokers] who switched to e-cigarettes (or indeed another form of tobacco) were 8.5 percentage points more likely to relapse to cigarettes…If switching to e-cigarettes was a viable way to quit cigarette smoking, then those who switched to e-cigarettes should have much lower relapse rates to cigarette smoking. We found no evidence of this.”

I have worked extensively with the PATH data.  Two years ago, I found that the authors of one study knowingly included vapers who had heart attacks 10 years before picking up an e-cigarette.  That article was retracted by the journal editors. 

In the new JAMA Network Open report, the authors took a different approach to mischaracterize the facts.  They teased and tortured PATH survey data, which collected information on thousands of factors, to fit their pre-conceived narrative about e-cigarettes and smoking relapse.

Pierce and colleagues focused on 13,000 participants who were adult established smokers the first year they participated in the PATH survey.  Pierce then identified 1,228 (9.4%) who became former smokers one year later (Year 1); at that time, 459 were using e-cigarettes and/or other tobacco products, while 769 were not.  A year after that (Year 2), the researchers used this question to determine who had smoked: “In the past 12 months, have you smoked a cigarette even 1 or 2 puffs?”

That’s right, at Year 2 Pierce counted anyone who even took 1 or 2 puffs on a cigarette as a failure.  Using this yardstick, about 50% of former smokers who weren’t using a tobacco product at Year 1 were still totally cigarette-free at Year 2, compared with 42% of those who had been using e-cigarettes or tobacco at Year 1. 

But here is a fact from Pierce’s study that they did not promote: Former smokers who were using e-cigarettes at Year 1 were “more likely to requit and be abstinent for 3 months at [Year 2] (17.0% vs. 10.4%).”

Adding the results for complete and 3-month abstinence, there was virtually no difference between e-cigarette users (42% + 17%) and non-users (50% + 10%). 

This brings up another issue with Pierce’s media statements.  He said that smokers “who switched to e-cigarettes should have much lower relapse rates to cigarette smoking.”  That ignores the fact that 769 former smokers in his study used no tobacco at Year 1, while 459 different former smokers used e-cigarettes/tobacco.  Both produced complete and 3-month abstinence rates that are similar, and both added to the former smoker pool.  It doesn’t matter how they got there. 

Throughout the article and in his public comments, Pierce referenced smokers “who switched to e-cigarettes.”  That is misleading.  PATH collects information on aids that former smokers used to quit.  (My group published a study on this here.)  The only information Pierce et al. reported was whether former smokers at Year 1 were using or not using e-cigarettes/tobacco.  By ignoring the quitting information, they undercut the positive results for e-cigarettes and distorted the public health message.

Finally, most people know that some former smokers, including those who used e-cigarettes, return to smoking.  Given the drumbeat of misleading negative statements about e-cigarettes – they’re toxic, they enslave children, and now, “E-cigarettes don't help smokers stay off combustible cigs” – it is a small wonder that anyone quits smoking and stays smoke-free with vapor.

 

 

CDC Quit-Smoking Ads Lack Real-World Solutions

People regularly ask me why I’ve spent the last 25 years researching and advocating for tobacco harm reduction and related products.  While it’s difficult to provide a succinct answer, a powerful ad campaign from the Centers for Disease Control and Prevention illustrates why I am dedicated to helping smokers. The campaign is called “Tips from Former Smokers”.

For the first 15 years of my career, I was on clinical staff at the Comprehensive Cancer Center of the University of Alabama at Birmingham.  As an oral pathologist I made microscopic diagnoses of hundreds of cancers.  But as a clinician and member of a multidisciplinary team treating countless patients with mouth, throat and lung cancer, leukemia and other serious smoking-related diseases, I was compelled to search for practical quitting options for smokers just like Terrie, the patient in the CDC public service ad above.  Click here to watch the entire ad.

Those smokers reminded me always of my maternal grandfather.  He had smoked for most of his 65 years, despite the onset of heart disease that led to his early retirement from operating a dragline excavator in the coal strip mines of Western Pennsylvania.  I remember my great-grandfather, an underground coal miner who chewed tobacco until he passed away at age 99, pleading with him: “Worthy, every cigarette is another nail in your coffin.” 

My grandfather never quit, and in 1965 he suffered a stroke that left him hospitalized for months before he died.  Every night, my parents drove us 25 miles to visit him. One memory from that sad period is still with me: my grandfather, on oxygen and barely able to move or talk, begging his nurse for a cigarette.

For many tobacco opponents, patients like these are only an abstraction, numbers to be wielded in a fight for absolute prohibition.  Most extremists have never worked with smokers suffering from a devastating disease.  If they had, they would care enough to ensure that smokers are offered every option to quit before it’s too late.

That’s the frustrating thing about the CDC advertising.  It doesn’t endorse the most frequently used, and most frequently successful quitting aids: e-cigarettes.  Instead, the CDC pitches telephone quit-lines and gives smokers trite advice: “keep your mouth busy…do something else…go for a walk or a jog…take slow deep breaths.”  These tips are worthless for most of those who are desperate for their next cigarette. 

What about children?  After my lectures, I am often asked by parents, “What if my child learns about you and your ideas, then starts using smokeless tobacco or e-cigarettes?”

My answer: “What if, despite all of your good intentions and nurturing, your child becomes a smoker?  And what if, after 10 or 15 years, they are unable or unwilling to quit?  As a parent, wouldn’t you want your child to know about safer tobacco products?”

We have to keep tobacco out of the hands of children, but safer cigarette alternatives must not be regulated out of reach of their parents and grandparents, whose smoking habit leaves them desperate to avoid fatal illness.