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New Zealand Study of Cessation Effectiveness

The medical journal The Lancet reported last month (September 2013) on a New Zealand study (funded by the Health Research Council of New Zealand) comparing the success rate of electronic cigarettes and nicotine patches as smoking cessation devices. The e-cigs were slightly more effective, although the difference was not robust enough to establish statistical significance. 

There was a robust difference, however, between the number of would-be quitters who reduced their smoking by 50% or more using e-cigs and those who did so with the patch. The difference was 57% to 41% at 6 months.

The study was conducted between September 2011 and July 2013 on 657 adult smokers wishing to quit, recruited through newspaper adverts. They were assigned randomly to e-cigarette and patch groups, with a smaller group assigned to non-nicotine e-cigs.

The smoking reduction statistic is the most significant finding of the study, but anti-e-cig enthusiasts are likely to ignore it, as they tend to rail against "dual use" as an evil comparable to heavy smoking. Although they give no reason why smoking less is not preferable to smoking more, excoriating dual use is a consistent theme of their pronouncements. Of course this relates to the fundamental distinction between harm reduction and cessation among those seeking to limit death rates from smoking. In a recent interview with Tom Ashbrook on the call-in show On Point (along with harm reduction activist Michael Siegel), the nonsmokers' rights activist Stanton Glantz told a caller that one cigarette per day is every bit as harmful to the heart as many, although the cardiologist failed to produce evidence of the illogical claim. Tim McAfee of the Center for Disease Control also spoke negatively of dual use in an interview on The Diane Rehm Show last summer. It would seem that the objection to dual use is based in an esthetic and moralistic revulsion, and not based on firm scientific grounds.

The CDC recently reported with horror that e-cig use has risen among minors, but Michael Siegel of the Boston University School of Public Health suggests (in the Ashbrook interview) that the dual use of almost 90% of these youngsters may actually suggest that they are seeking to limit their smoking, rather than responding to some kind of "re-glamorization" of smoking through the e-cigarette (as prohibitionists fear).

Another finding of the New Zealand study is that the e-cig group of would-be quitters was far more likely to continue use of the product, and to recommend it to friends. This, along with the dual use statistic, suggests significant potential for continued harm reduction. Cessation zealots continue to fear, however, that e-cigs will lead to a return to smoking by many. Amanda Chan of the Huffington Post, in her article on the New Zealand study, has proposed a simple yet elegant way of deciding which of these predicted outcomes is more likely. Here is what she says:

"There is an obvious source of evidence as to whether use of e­cigarettes leads to an increase or reduction in tobacco smoking: the trajectories of sales of e­cigarettes and tobacco cigarettes. If growing sales of e­cigarettes coincide with increased sales of tobacco cigarettes, tobacco control activists arguing for restriction of e­cigarette availability would be vindicated. If traditional cigarette sales decline as e­cigarette sales increase, it would suggest that e­cigarettes are normalising non­smoking and that it is in the interest of public health to promote and support their development rather than try to restrict it."

Reports indicate that cigarette sales are down while e-cig sales continue to soar. This would seem to argue in favor of Chan's second probability.

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