2023-12-13 08:00:00
How do you get as many smokers as possible to switch to e-cigarettes and at the same time prevent young people and non-smokers from starting to smoke e-cigarettes? A report from the E-Cigarette Summit in London.
Iakov Kalinin/AdobeStock
“E-cigarettes containing nicotine can help people quit smoking for at least 6 months. It has been proven that they work better than nicotine replacement therapy and probably better than nicotine-free e-cigarettes.” This is the key message of a Cochrane review entitled “Electronic cigarettes for smoking cessation”*). It is one of those meta-analyses that Cochrane continually updates. The new version will be published soon. “I’m not allowed to reveal the exact results yet,” explained Prof. Dr. Peter Hajek (Queen Mary University of London), one of the co-authors, at the E-Cigarette Summit in London. But he leaves no doubt that the evidence has continued to solidify: “So far, 40 randomized controlled studies have been included in the review. Now there are 47.”
The UK is the only country in the world where this scientific evidence has been taken up by health policy and implemented into a program. In the UK, e-cigarettes are actively promoted and used by authorities and health care institutions to wean smokers off combustion cigarettes. At the E-Cigarette Summit, which took place in November at the Royal College of Physicians in London, experts from the Anglo-American region discussed new findings and the current health policy situation: The British public, but also parts of science, are negative towards e-cigarettes.
Many are convinced that the e-cigarette is a gateway to smoking, especially for young people. This “gateway hypothesis” is the subject of an as yet unpublished study that was presented at the E-Cigarette Summit. This is not a Cochrane review, although the authors have imposed the same strict rules. The majority of the studies included in this meta-analysis contradict the hypothesis that the e-cigarette is, in a sense, the gateway drug to the combustion cigarette. Rather, e-cigarettes are primarily used to get away from combustion cigarettes. The two studies that support the “gateway hypothesis” are also those that the study authors attest to be highly biased. “It really hurts me when people keep claiming that there is inconsistent data on the benefits of e-cigarettes. At the same time, these people believe that they can extract supposedly clear evidence from the same data that vaping is the gateway to smoking,” says Prof. Dr. Jamie Hartmann-Boyce (University of Massachusetts Amhers), one of the authors of the study.
“Of course the e-cigarette is not free from health risks,” admits Prof. Dr. Sanjay Agrawal (University Hospitals of Leicester). “But the fact that 64,000 people died from cigarette smoking last year and several hundred thousand people fell ill as a result of smoke is usually not mentioned when it comes to e-cigarettes.” It is now the case that many adults are convinced that that the e-cigarette is just as dangerous or even more dangerous than the combustion cigarette.
Health policy must pursue two goals in parallel, explains Prof. Dr. John Newton (University of Exeter). The first goal: to get as many smokers as possible to switch from combustion cigarettes to e-cigarettes. Because e-cigarettes – like the newer tobacco heaters that are therefore not taken into account in many studies – are less harmful to health than combustion cigarettes. The second goal: prevent young people and non-smokers from starting to use e-cigarettes. “We have to try to dance at these two weddings at the same time,” says the epidemiologist.
“We have to accept that there are no perfect solutions to complex problems,” adds Agrawal. For a large number of smokers, the e-cigarette is the best available method of getting away from combustion cigarettes. Therefore, ways must now be found to prevent non-smokers from starting to use e-cigarettes again.
The E-Cigarette Summit, London, 16.11.2023
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