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Science still lacks hard proof that electronic cigarettes help people quit smoking, concludes a new meta-analysis that bucks the fervent claims of many vaping disciples who swear e-cigs snuffed their tobacco addictions.
Canadian researchers culled 24 separate studies that investigated both the efficacy and safety of e-cigarettes, ultimately finding little reliable data that the devices put users on the path to permanently ditching traditional cigarettes.
“The quality of the existing evidence is still poor, so we’re still very uncertain about e-cigarettes and smoking cessation,” said Dr. Matthew B. Stanbrook, a pulmonologist and associate professor in the Department of Medicine at the University of Toronto. He supervised the meta-analysis, presented Sunday at the 2015 American Thoracic Society International Conference.
E-cigarettes are nonetheless widely promoted as a method to conquer the habit. In fact, smokers facing a cancer diagnosis and who suddenly want to quit often ask: “Should I use an e-cigarette?” said Donna Manders, a certified tobacco treatment specialist at Seattle Cancer Care Alliance.
“I get that question a lot. And my answer is: Use the known methods. Use nicotine replacement therapy like patches, gum and lozenges in combination with [prescription] Chantix, which is considered a first-line therapy,” Manders said.
“We know the outcomes of those. We do not know the outcomes of using electronic cigarettes — especially for people facing a serious health diagnosis.”
The upside of quitting after cancer
Smokers who quit after a cancer diagnosis can boost their survival rates, Manders said. Dumping cigarettes also can reduce the side effects of chemotherapy, radiation, surgeries and transplants, other studies have shown.
If no Americans ever smoked, one out of every three cancer deaths in the U.S. would not happen, reports the Centers for Disease Control and Prevention. Cigarettes can cause cancer of the bladder, blood, colon, kidney, liver, lung, pancreas, stomach, throat, mouth and at least six other areas.
But among U.S. cancer survivors aged 18 to 44, more than 40 percent still smoke, according to the CDC. Compare that to the overall U.S. smoking rate for that same age group: about 23 percent.
“That’s very significant, very sobering,” Manders said. “Even though they are very motivated by their diagnosis, the likelihood is high that they will go back to tobacco use. I mean, this is a big deal.”
At Fred Hutchinson Cancer Research Center, smokers are paid $105 to participate in an online, smoking-cessation study called WebQuit. The confidential program places smokers into one of two behavioral interventions to see which one works better to quell their habits.
And at WebQuit, e-cigarette users are fully welcome, said Dr. Jonathan Bricker, a psychologist and smoking cessation researcher at Fred Hutch. He’s the principal investigator for the WebQuit study.
“A lot of people say, ‘I want to use e-cigarettes also,’ and we say, ‘that’s great’ because we’ve always believed that the combination of some kind of pharmacotherapy plus behavioral therapy is the best way to quit smoking. It’s not an either or,” Bricker said.
“There are a lot of people who swear by e-cigarettes. We don’t want to take that away from them in terms of helping them quit. If they want to combine them, go for it. Why would you want to alienate them?”
The ‘agnostic’ view on e-cigs
In fact, Bricker critiques as “really too strong” a summary from the University of Toronto’s analysis: “Electronic cigarettes achieve higher rates of smoking cessation at 1 month than placebo, but limited available data suggests that this effect may not be sustained over longer time periods.”
“So these e-cigarettes — are they better than the patch? Because, certainly, they’re more popular than buying patches at the drug store,” Bricker said. “The story is: We don’t know yet.
“E-cigarettes may be helpful or they may be not. I’ve been agnostic because we just don’t have the data to tell us. And I listen to data. So that’s where I would disagree with the author of the abstract. I think they’re overstating the negative case for e-cigs.”
Until several large, randomized trials on e-cigarettes are completed in about two years, scientists should remain “in limbo” on the issue, Bricker said.
What’s driving the e-cig fervor?
But that evidence void is — for now — filled with the loud declarations of e-cig devotees who preach their cessation benefits.
“They say it helps them quit, and that’s great,” Bricker said. “We don’t know if that’s true. But an impassioned testimonial is very important to pay attention to.”
At the University of Toronto, Stanbrook hears the same impassioned assertions and acknowledges there is something “noteworthy” about the current volume of the pro-vaping crowd. After all, fewer ex-smokers people seem to get this jazzed about the nicotine patch.
“There are several reasons behind that,” Stanbrook said. “One big part that isn’t talked about enough is the role of the tobacco industry.
“They have bought into [e-cigarettes] in a big way. Because their money, their messaging and their social media use is behind this, it is no accident that people are talking differently about e-cigarettes,” Stanbrook said. “Because, in a sense, the tobacco industry is manufacturing the enthusiasm around this.”
Bill Briggs is a former Fred Hutch News Service staff writer. Follow him at @writerdude. Previously, he was a contributing writer for NBCNews.com and TODAY.com, covering breaking news, health and the military. Prior, he was a staff writer for The Denver Post, part of the newspaper's team that earned the Pulitzer Prize for coverage of the Columbine High School massacre. He has authored two books, including "The Third Miracle: an Ordinary Man, a medical Mystery, and a Trial of Faith."
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