Study Says: E-Cigarette’s Don’t Help People Quit Smoking

Study on E-Cigarettes and Quitting Smoking

New Study on Cancer Patients & E-Cigs

A study was released on Monday which followed cancer patients who had a desire to quit smoking over the course of one year. In this study, over 1,000 patients were enrolled in a tobacco treatment program. Patients were followed up at 6 months to one year to see if they had made any progress. During the course of the study, each patient was asked whether they were using e-cigarettes.

According to the study abstract, “E-cigarette users were more nicotine dependent than nonusers, had more prior quit attempts, and were more likely to be diagnosed with thoracic and head or neck cancers,” and “E-cigarette users were as likely to be smoking at the time of follow-up as nonusers.”

Medical News Today picked up on the study, remarking that “No findings were made to support oncologists suggesting e-cigarettes as an option to cancer patients as a means to quitting smoking.” One of the study’s authors, Dr. Jamie Ostroff, recommends that oncologists continue to urge patients to quit smoking using FDA-approved methods.

Yet, there is already controversy…

In the same article, two leading researchers of e-cigarettes and tobacco products in the UK, Professors Peter Hajek and Robert West, call into question the study’s methods, saying that many vapers dropped out of the study before it was completed and so were not counted in the final results.

They claim that, as a result, only those who tried to quit and failed were counted in the final results of the study – anyone who succeeded in quitting smoking, using e-cigarettes or otherwise, were not counted.

So what is really going on here?

According to the full text* of the study, over the course of two years all patients presenting for treatment at a cancer clinic were screened for tobacco use. Those who were identified as current smokers were referred to a tobacco cessation program, and those who wished to participate in the program were thus included as subjects in this study. Patients in the program were offered a variety of quit-smoking assistance methods, including therapy and suggestions for medications.

In addition to screening for smoking habits, the patients were also asked if they had used an e-cigarette in the last 30 days. Follow up information was collected from patients between 6 and 12 months after initiating treatment – these outcome assessments focused on detailing current smoking behavior and did not inquire about continued e-cigarette use.

Data fudging – er, “analysis”

As with all studies, many patients were lost to follow up. As it so happens, 66.3% of vapers dropped out of the study, while only 32.4% of nonvapers dropped out. This discrepancy is huge and unusual, yet the study authors make no attempt to explain exactly why that is. Instead, they resort to statistical fudging to make up for the loss:

“Abstinence rates were calculated with 2 methods for handling missing data: 1) a modified intent-to-treat (ITT) analysis, assuming all participants lost to follow-up were smoking; and 2) complete case analysis (CCA), in which participants lost to follow-up were eliminated from the analysis.”

Now, to be fair, it is typical to consider those who dropped out of the study as simply non-existent for the purpose of statistical analysis. However, it is odd that for one of the two analyses they chose to assume that all who were lost to follow up were still smoking. In doing so, wouldn’t it make sense to run another analysis assuming that all who dropped from the study actually quit? Apparently the authors didn’t think so.

Could it be that they did not run a third analysis assuming that those lost to follow up (most of whom were vapers) had successfully quit because they knew that would make it look like e-cigarettes work, confusing their results and making it impossible to come to a clear conclusion? Hmm…

… and now, the results!

The authors state that almost all of the e-cigarette users in their study were dual users – this is consistent with the fact that they were studying patients who had elected to be part of a smoking cessation program, as not many non-smoking vapers would feel the need to do so. In addition, as noted previously, many who may have quit smoking simply dropped out of the study – this could be due to the fact that not many who have succeeded in quitting would feel the need to stay in a smoking cessation program.

As a result, at the outset of their study the majority of e-cigarette users were still smoking. The authors state that “E-cigarette users appeared to be smoking more cigarettes per day than nonusers.” Yet the statistics they cite do not show a statistically significant difference.

In addition, they found that the dual users (who they are simply calling “e-cigarette users”) had higher rates of nicotine dependence and higher rates of thoracic, head and neck cancers. Both of these may be due to these patients having been heavier smokers before initiating e-cigarette use; yet, of course, they did not collect data on how much these patients smoked before they began vaping, so we will never know for sure.

The authors mention that some of the patients quit smoking by the end of the study, but fail to show how many.

So what does this study prove then??

This study proves that if someone enrolls in a smoking cessation program and stays in it for 6 to 12 months, they are unlikely to have quit smoking by then. That’s about it.

The study hints at the possibility that dual users may be more dependent on smoking and nicotine and thus more vulnerable to smoking related disease, but it does not prove that. More studies are needed to show a clear relationship here. If this is the case, as I stated earlier it may be simply because they were heavier smokers to begin with, i.e. it most likely has nothing to do with their e-cigarette use.

This study says absolutely nothing about people who vape exclusively, or those who eventually replaced smoking with vaping completely. Those patients were apparently lost to follow up.

The dilemma

The researchers state in their conclusion that, based on their results, there is no reason to believe that e-cigarettes can help people quit smoking. They say that from what they’ve seen, vaping is far more likely to lead to dual use with tobacco cigarettes than to complete smoking cessation.

This is consistent with recent, widely-touted concerns of the FDA and many public health officials that dual use is the norm for vapers, and that it can lead to a decreased likelihood for smoking cessation.  Mitch Zeller, head of the Center for Tobacco Products at the FDA, has even stated publicly that dual use may lead to someone smoking for longer than they would have if they had simply made another quit attempt.

However, many have countered that dual use does lead to a reduction in the overall number of cigarettes smoked per day, and that it may eventually lead to smoking cessation.

Is there any evidence that vaping leads to a reduction in smoking rates?

Dr. Hajek, one of the critics of the study discussed above, conducted a comprehensive review along with his colleagues on all available e-cigarette research to date. In it he discussed a handful of studies which show clear evidence that vaping can lead to smoking cessation, including one where “in a large population sample, smokers attempting to stop smoking with the help of EC [e-cigarettes] were more likely to succeed than those using NRT bought from a store (without any professional supervision) or trying to quit unaided.”

He also noted that in this study, “Among ‘dual users’, 46% quit smoking altogether after 1 year.”

Also noteworthy is “In the United Kingdom, where the use of EC to assist smoking cessation has now overtaken use of NRT, and detailed figures are available on month-to-month changes in smoking behaviour, the rise in EC use has been accompanied by an increase in successful quit attempts and a continuing decrease in smoking prevalence.”

Many more studies have been conducted on the efficacy of vaping to reduce smoking rates. One comprehensive list of studies can be found here.

The available evidence suggests that dual use is not a significant problem, and that it can in fact lead to a significant reduction of smoking, even to complete cessation.

So why is there still so much debate?

The authorities (FDA, CDC, etc.) and public health officials are still claiming that there simply isn’t enough evidence to support the hypothesis that vaping reduces smoking.

Part of this is because of conflicting studies like the one discussed earlier. It is clear to me that the study was flawed, yet it would not have been so clear if all I had access to were the results. Similarly, many public health officials are not reading the full text of each and every study that crosses their desk looking for flaws in the research, so there is bound to be some confusion.

Also, for some it is a deeply ingrained belief that complete cessation of all tobacco and nicotine products is the only way to eliminate smoking related disease. For them, anything that does not lead to total abstinence is not good enough, and no amount of proof will suffice. As such, the debate rages on.

However, as much proof as we have that vaping can reduce smoking rates, more research is necessary to prove that widespread vaping will reduce smoking in the greater population, rather than simply supplement it. Many of the currently available studies on e-cigarettes show them to only be a little better at reducing smoking than nicotine replacement therapies, and nearly all of these studies use older, outdated e-cigarettes. There is some evidence that newer vapor products are far more effective at achieving and maintaining smoking abstinence, but there aren’t any studies to prove that yet.

In other words, while there is enough evidence to suggest that vaping can reduce smoking, there is still not enough evidence to prove that widespread vaping will decrease smoking significantly.  We need more comprehensive research to clearly show the impact vaping will have on the average smoker.

Further research

Dr. Michael Siegel of Boston University announced Monday that he is planning to conduct one of the largest, most comprehensive studies on electronic cigarettes to date, and is seeking funding for his research. Click here to read more about his proposed study.  UPDATE: This study has been canceled as of 9/27.

* A link to the full text of this study can be found with the abstract, but in order to access it you need a Wiley account. If you are a college student or alumni, you may be able to access the full text through your university’s online library.
11 COMMENTS
  • Wynne 09/26/2014

    Say whaaaat??? All I have to do is look around at all the vapers I know including myself, and my husband to know this can’t be right. My God, if this is what passes for a scientific study in this country then we are all in trouble…but what truly saddens me is the study author’s urging of doctors to completely ignore something that has the potential to save their patient’s lives, and continuing to recommend the traditional nicotine replacement therapies that have been proven to have a very low success rate. Doesn’t that seem to go against their Hippocratic oath?

  • Daniel 09/27/2014

    All I know is I was told I had to quit smoking by my doctor and I picked up a battery with a clearomizer in a gas station and four days later smoked my last cigarette. From the forums I been going to I see a lot of people who did the same thing, started vaping and quit smoking. I personally know two other people who are trying vaping and have cut down from over a pack a day smoking to four cigarettes or less a day and are on the verge of quiting.
    Like with any scientific study, the results are what they want them to be, or who is paying for them wants them to be.

  • John Engle 09/27/2014

    I gotta call MAJOR BULLSHIT on this article. This is clearly bought and paid for propaganda by Big Tobacco. I quit a 35 year 2 pack a day by switching to vaping. And I was absolutely convinced that nothing would ever take the place of my cigarettes. I was dead wrong. I literally quit overnight. I know hundreds of people that quit using vaping. Truth is this : There is no profit in something that is a safer alternative. The FDA, CDC and the government can’t make any money off of it. But if they give you something they deem harmful, regulate it to death and tax the living daylights out of it, then they have a money maker. Not only can smokers quit by switching, but they have total control over it. You control the nicotine level. Zero if you want. You control what flavor you want. You control how many or how few puffs to take. Vaping is completely customizable so you can tailor it to your personal needs. No other method offered allows for this much control. This what Big Tobacco, the FDA and our government doesn’t like….. the fact that you have control and not them. This is not about public safety. It never has been. It is about MONEY. Plain and simple. Billions of dollars in tax revenue and bribe money are going to be lost due to vaping. They could care less about what people put in their bodies. But they do care how much money they can suck out of you in the name of keeping you ‘safe’. That, is the absolute truth. If you think otherwise, then you are among the many that these people have brain washed. Smoking is dead. Vaping IS the future. And the future is NOW.

    • LJF 09/29/2014

      Couldn’t agree more John!!! I too went from 2 packs a day for 40+ years. I have been vaping now for over a year. No desire for a cigarette! Went from 36mg to start and now down to 12mg. Hope to be at 0mg in a years time. Make my own e-juice and love my new hobby! It has saved my life for sure!!! Like you said “Follow the Money”!!!!

    • muddy (@muddyml) 10/11/2014

      same here, john; heavy smoker for 45-50 years, & made the COMPLETE & ENTIRE transition over a year ago, & haven’t craved a “smoke” in just about as long. but, MORE than big tobacco, BIG PHARMA wants to eliminate VAPING as a SMOKING cessation method because, 1, it’s eating into THEIR profit on chems, patches, & rx-related products, but the 2nd, & more dire (for them), VAPING WORKS!!! even the appreciably far LESS of us, who trade off between the two treatments, are IMPROVING their health by reducing smoking (BURNING tobacco), & MORE importantly, the ABSENCE of CARCINOGENS (no burning = no carcinogens).

      but they’re counting on our STOO-PIDDITY to buy into an absurd “having your cake & eating it” too scenario. & don’t forget the added tax revenue to help cover their bosses’ sweet tax deals/cuts. wanna buy some artillery? NO PROB! rob women of their HIGHLY personal & RELIGIOUS choices re their reproductive rights, by the elimination of determining when “life” begins, as instructed by ANY-thing OTHER than their ONE denomination of NARROW christian tenets, belief-systems &/or moral codes? GIVE OVER! alcohol, foods, chems & skin creams containing some of the SAME ingredients? WHOOPE-E-E-E-E!!!!

      the .01%, where ALL of the wealth has been stolen & hoarded, want to keep us poor & inconsequential, with NO influence on the world’s collective condition, nor it’s fate. they want our work & toil for NOTHING, then instruct the govt THEY bought to redirect the taxes WE paid (that THEY get out of having to pay), the $$ MEANT for the social programs we all now need, simply in order to get by, to SURVIVE.

      heh, after my little tangent here, the original topic seems almost petty by comparison.but that’s just it, isn’t it? the .01% repurposing our govt (once AGAIN) to suit THEIR needs, & this is just one more example of it. we’re so bloody stupid as a country; they know it, & the USE it AGAINST us. it takes SO very little on their part (especially with such an eager & willing participant; the media), to stir the pot, & we bite )almost EVERY TIME!). with very little nudging, we’re at each others’ throats, arguing & hating a fellow countryman because of his SKIN COLOUR. or over PERSONAL & RELIGIOUS differences over matters our govt was originally SUPPOSED to keep out of, was supposed to GUARANTEE, unless it directly affected the health, well-being, & LIFE of another.

      our constitution was given AMPLE headroom to accommodate ALL religious & spiritual (INCLUDING those who choose to defer to common sense, sans ANY religious group affiliation). it also left room for philosophical & spiritual wondering/wandering, & the pondering of the definitions & boundaries of life itself, the possibility of the soul, including the where, when, who & why as separate quantities APART from the physical, that though “life,” as we’ve come to understand it, needs both components, the definitions & boundaries of their 4 w’s are an entirely different matter.

      some of the keys to understanding them include eternity of the soul, the physical & circumstantial simply the vessel, the beginning/ending of a soul not being defined by the length, nor even existence, of the other, the vessel. the termination of a vessel in NO way hampers a soul’s opportunities, the world having NO shortage of pregnant women, or phrased another way, the potential of a life, a vessel/fetus. and for simplicity’s sake, a vessel becomes a “life” at birth, which is where the soul steps in. the deeper read, though, is that a soul joins the physical on this plane if, and when, that is it’s destiny. and the end or termination of a vessel/fetus doesn’t include a soul, the 2 never having joined in the absence of any destiny.

      furthermore, the soul as an entity unto itself, rejoins the physical, with different lessons to be learned from each instance, or “life.” and it does so for as many times as that particular soul requires to complete each level/life, until it’s ready to pass over onto the next plane, where perhaps the walls separating the physical from the spiritual are less rigid, where perception is utilized in a more advanced form, with new/newer realities…

      in any event, lesson over; righty-O………

  • Teresa 09/27/2014

    I agree that this study was totally flawed to the point that it should have been thrown out completely. And- it never should have even been a topic of discussion!

    I personally believe that all doctors should offer ECigs as one of the stop smoking aids.

    I have allergies to latex based items-so the patches were ruled out! The medications they tried were terrible! One just made everything taste nasty-even food! Another one made me have horrible nightmares! A third one-just created suicidal thoughts!!! So-I continued to smoke for several more years. Now-If ECigs had been offered to me long ago-I could have been a non smoker for a lot longer than I have!!!!

    *****The really sad thing to me is that our government knew about these & (out of whatever fears) did not offer them! That means that because of their fears lots and lots of people have & will continue to lose their lives because of tobacco use!*****

    (((We purchased our ecigs on July 2 of this year & haven’t had a cigarette since!!!! That just tells me that:
    1. They simply modified the study to suit their own missives.
    2: They did NOT do a study of a wide enough group of persons.
    3: They want ecigs to go away.
    I could go on & on-but I will stop with those three!)))

    Teresa

  • hilary 09/29/2014

    their knocking it because they view it as “smoking”. and the FDA hasnt gotten control of it either. their just mad.

  • Jason 11/22/2014

    The results are that I have not bought a pack cigarettes for 5 years other than for someone else and I do still Smoke almost every day but only one or two and I bum those.. I’m not a hater on people’s that smoke just hate the smell n my house or on my clothing. Really just where I can’t get away from it.. Lol c but it’s definitely saved my health it has done bad things to my bank account lol

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