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Bloomberg: “E-cigs as good as patch”

Something outgoing New York Mayor Bloomberg said, on the occasion of his signing of the city's public use ban on e-cigarettes, has been sticking in my mind ever since.

When asked whether electronic cigarettes could be considered an effective smoking cessation method, Bloomberg said: "It works about as well as patches, which is to say it really doesn't work". This extraordinary comment deserves a bit more attention than it's gotten, and in fact is worth examining in some detail.

Nicotine patches, sold over the counter, are a "nicotine replacement therapy" involving a patch placed on the skin, which releases a consistent supply of nicotine to the body. There are other over-the-counter NRTs, gum and lozenges, but the patch is generally mentioned first on all sites offering smoking cessation recommendations (such as the US government's, so it is safe to say that it is in the front rank of cessation devices, the leading cessation method, if you will. Of course quit-smoking specialists always recommend that NRTs be used in the context of counseling and support.

For Mayor Bloomberg to say that e-cigs are as effective as the leading method pre-existing them is high praise indeed. This makes the second part of his statement a bit hard to understand: "which is to say it really doesn't work." Nicotine patches don't work?! Mayor Bloomberg!!!

In any case, the data the Mayor was referring to may be found in a randomized and controlled study conducted in New Zealand in 2013, and published in the prestigious journal of medical research, The Lancet. To say that e-cigarettes and nicotine patches performed "about as well" is technically correct, but needs to be understood in the context of the scientific usage of the term "about". Universally accepted scientific guidelines require a +/-3% difference in order to be "statistically significant", so that with a difference of less than 3%, two variables are considered to be "about the same". In the New Zealand study, the rate of successful quit attempts for e-cigarettes was 7.3%, compared with 5.8% for nicotine patches, for a difference of 1.5%. It would be more precise to say that e-cigarettes performed slightly but not significantly better than the current leader. In a photo-finish, e-cigs won by a nose.

So why would a product that ever-so-slightly outperforms the current leader need to be banned? One possibility is that the product is dangerous to the user or those around him or her, but this is ruled out by a recognized study released last Fall at Drexel University, showing zero harm to users or bystanders in the short term. Of course the scientific method requires such a study to be backed up by confirmation studies by other scientists in the field, and those will surely be forthcoming in the next few years. But when vaping ban advocates repeat the oft-heard litany that "there are no studies yet," they are simply not telling the truth. There is one reputable study awaiting confirmation by others. The scientifically accurate way of presenting such a situation is to say "preliminary studies point...". Unless of course those preliminary studies point in a direction you don't want them to. Of course long-term studies will be forthcoming as well, but cannot be completed until... like "duh!"... the long term. (And in any case, nobody expects the long term harms, if there are any at all,  to be anywhere near those of smoking.) Waiting for those studies, and restricting a "slightly but not significantly better" product in the interim, just in case, will cost lives. Is it worth it for an admittedly slight risk?

There is one other possible reason often mentioned for restricting something that works "slightly but not significantly better" than the current leader – the possibility that the product will tempt young people to smoke. This is often mentioned by vaping ban zealots, usually with the strong implication, if not the outright statement, that it is a proven fact. In fact, "preliminary studies point" in the opposite direction: a scientific paper presented last Fall in Oklahoma found no such gateway effect, and that study also awaits confirmation by other scientists. Even more significantly, a study released at the University of Michigan last month, about the same time as Mayor Bloomberg was enacting his ban, showed a dramatic drop in smoking among teens, during precisely the same period when they were beginning to use e-cigs in ever greater numbers, according to the Centers for Disease Control. The converging data points of these two studies, which have been largely ignored, could not possibly point toward a gateway effect for e-cigarettes. If anything they point the opposite direction, suggesting that youth may be using e-cigs to quit, just like mom and pop!

So thanks for the kudos to e-cigs, Mayor Bloomberg. If we can't use them in public buildings, we'll just relax with them in our new vaping lounges, and create a whole new social movement.

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