Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit After a Hospitalization: A Prospective Study
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Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit After a Hospitalization: A Prospective Study. Ann Intern Med.2018;168:613-620. [Epub 27 March 2018]. doi:10.7326/M17-2048
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Smokers Should Be Encouraged to Vape
An oblique attack upon the utility of e-cigarettes (1) fails to raise the intuitive and profound procedural flaws in both the study-methodology and the results-assessment; incomplete disclaimers in the discussion section yield only the boiler-plate conclusion that “more research is necessary” when exhaustive support for Electronic Nicotine Delivery Devices (“ENDS”) has already been established, both over the years (2) and recently (3).
Indeed, it was oxymoronic to draw any conclusions regarding the efficacy of ENDS when their potential use by smokers was overtly poisoned in the stated methodology: “Counselors did not recommend e-cigarettes to smokers; rather, when asked, they advised that the safety and efficacy of e-cigarettes were unknown, and they encouraged smokers to use tobacco cessation medications approved by the U.S. Food and Drug Administration (FDA).”
The outcome was further skewed by the provision of “sustained” smoking cessation counseling (that promotes Big Pharma drugs and opposes vaping) and free Big Pharma drugs; absent was any gesture to teach any patients (neither the aforementioned nor the “standard care” cohort) how to vape, let alone to provide ENDS paraphernalia or to encourage attempts in this arena.
Furthermore, omitted was the fact that workplace vaping (including in hospitals) had been banned in Massachusetts in 2011 and at the University of Pittsburgh Medical Center a year hence.
These selection-bias flaws are notably glaring because the prospective design was primarily, allegedly directed at assessing the efficacy of ENDS; presumably, smokers were to vape only if they stumbled upon hearing of its potential utility and chose to contravene recently-delivered inpatient admonitions.
The negative impact of the publication of such studies is illustrated by having accompanied this academic article by a patient-handout that would predictably dissuade smokers from even trying to vape; it is amplified when the results are misrepresented by claims that “smokers who use e-cigarettes are significantly less likely to quit” (4).
The study simply shows that smokers who didn’t stop smoking by following recommended treatments may have been more likely to try ENDS than those who quit successfully; no data allow for the assessment of the efficacy of ENDS.
It is oxymoronic to withhold a recognized and effective cessation-method due to stated-intent to await the analysis of studies that could not be completed for years, if not decades (5), particularly when the investigators fail to ensure the smokers are apprised—in a “fair and balanced” fashion—of the desirability of risk-reduction.
1. Rigotti NA, et al. Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit After a Hospitalization: A Prospective Study. Ann Intern Med. 2018;168(9):613-620. [DOI: 10.7326/M17-2048].
2. Godshall B. THR Updates. Accessed at http://www.ecigarette-politics.com/bill-godshall-thr-updates.html on 5/28/2018.
3. McNeill A, Brose LS, Calder R, Bauld L & Robson D. E-cigarettes and heated tobacco products: evidence review. Public Health England (Last updated 3/2/2018). Accessed at https://www.gov.uk/government/publications/e-cigarettes-and-heated-tobacco-products-evidence-review on 5/28/2018.
4. Glantz S. 18th Study Shows that Smokers Who Use E-cigs Are Significantly Less Likely to Quit Smoking. UCSF Center for Tobacco Research Control & Education. Accessed at https://tobacco.ucsf.edu/18th-study-shows-smokers-who-use-e-cigs-are-significantly-less-likely-quit-smoking
5. Sklaroff, R., Godshall, W., & Gambescia, S. F. (17 March 2017). Vaping isn't smoking, it's a disease prevention method. The Hill. http://thehill.com/blogs/pundits-blog/healthcare/324534-vaping-should-be-recognized-as-a-disease-prevention-public
Disclosures: No conflicts