E-Cigarettes Do Not Help People Stop Smoking and also not an alternative
Electronic cigarettes (e-cigarettes) do not help people Quit Smoking. These are no better than alternative aids to quit smoking. These are unproven and non-therapeutic. These are handheld devices that work by heating a liquid that usually contains nicotine and flavorings. E-cigarette use has risen steeply and mostly without regulation over the past decade. The devices have diversified into a dizzying array of vape pens, tank systems, “mods,” and more mass-marketed and sold to the public. E-cigarettes allow you to inhale nicotine in a vapor rather than smoke. Because they do not burn tobacco, ECs do not expose users to the same levels of toxins that we know can cause smoking-related diseases in people who use conventional cigarettes.
E-cigarettes contain chemicals, including toxicants and potential carcinogens. Some people believe e-cigarettes may help lower nicotine cravings, but there is no conclusive evidence to support their effectiveness in long-term smoking cessation. Research suggests that e-cigarettes may be less harmful than cigarettes, but they can still lead to nicotine addiction and other health issues.
The U.S. Food and Drug Administration (FDA) is reviewing whether to accept thousands of pre-market proposals for the marketing of e-cigarettes as commercial goods. The use of an e-cigarette is known as ‘vaping.’ Most people use e-cigarettes to help them avoid smoking tobacco. In these applications and associated commercials, the owners of the e-cigarette brands say that their goods enable smokers to quit and should thus be deemed “appropriate for the protection of public health,” as stipulated by statute. But a recent comprehensive analysis of the scientific literature on this subject by UC San Francisco researchers brings these arguments to the test.
Electronic cigarettes (or e-cigarettes) are battery-powered devices that contain liquid that is vaporized with inhalation of an e-cigarette without any flame or smoke and consist of a mixture of propylene glycol, vegetable glycerine, different nicotine levels and taste concentrates. In a recent report released in the American Journal of Public Health on 22 December 2020, a team headed by UCSF-based Richard Wang, MD, MAS, explored the scientific community’s interpretation of e-cigarettes and observed that, in the context of mass-marketed commercial goods, they did not lead smokers to quit.
“The question we explored is of both scientific interest and public health interest,” said Wang, assistant professor of medicine, “and we hope that the FDA will pay attention to our study as they try to make these decisions.” Wang was joined in the study by co-first author Sudhamayi Bhadriraju, MD, a former UCSF postdoctoral fellow who is now a pulmonologist at Kaiser Permanente in Redwood City, Calif., and senior author Stanton A. Glantz, Ph.D., professor of medicine.
However, research is required to determine the impact of e-cigarettes on the smoking habits of tobacco smokers in order to advise the regulation and promotion of e-cigarettes. The authors searched the literature, collecting the findings of 64 studies to address this query. The research chosen for formal review included observational studies in which participants were questioned, but not guided, on their use of e-cigarettes, as well as clinical trials in which smokers who were attempting to stop were given free e-cigarettes under medical supervision.
This differentiation was important for their research, Wang said. “In observational experiments, you’re simply telling participants ‘out in the wild’ about their use of e-cigarettes, which they bought themselves from a corner shop, without any clear orders to stop. Although in a randomized experiment, you are testing a substance, using it as a therapy—a medicine—to see whether an e-cigarette or any other product is more likely to avoid.”
In their study of retrospective experiments with groups of people who had both smoked and used e-cigarettes, whether or not they chose to quit, the team found that there was no appreciable effect of e-cigarettes on participants’ desire to quit. In the next group of experiments, which polled smokers using e-cigarettes who showed an intention to stop, the researchers also found no effect.
The team also sought to isolate the results of the level of use—whether people who use e-cigarettes every day could avoid using e-cigarettes at different rates than people who used them less often. Researchers observed that day-to-day consumers left at a higher pace than more infrequent users, although they warned that most participants in U.S. trials fell into the second group.
Finally, they reviewed nine clinical trials, which offered free of charge a form of the e-cigarette to patients who were expressly advised to use the machines to help them quit. Since the equipment and controls used in the studies varied, Wang concluded that the provision of some e-cigarette goods in the sense of the clinical trial contributed to further discontinuation than certain other therapies.
A large number of adults and teenagers use electronic cigarettes, which offer a comparatively modern way to administer nicotine to the addictive drug without burning tobacco. “It is important to recognize that, in clinical trials, when certain e-cigarette devices are treated more like medicines, they may actually have an effect on quitting smoking,” Wang said. “But it has to be weighed against the dangers involved with the use of these instruments. Also, only seven e-cigarette products have been tested in clinical trials. It is not clear if the effect found with these seven devices is the same or different from that of the thousands of other e-cigarette brands available for sale.”
In comparison, the current research does not examine the rise in youth and teenage consumption as a result of e-cigarette advertisement and availability, nor does it equate the harmful health impacts of e-cigarettes to conventional tobacco products. A study is also required to decide whether or not e-cigarettes can help people quit, prevent smokers from quitting entirely, or contribute to existing usage of nicotine by new consumers, including adolescents, especially in an atmosphere where goods continue to grow. With respect to the latest decision before the FDA, Wang said, “The standards to be applied by the FDA for the approval of e-cigarettes as consumer products or therapeutic devices are fundamentally different.”
