Advertisement
Mayo Clinic Proceedings Home

Electronic Cigarettes Are Efficacious

      To the Editor:
      Regarding the pair of smoking cessation articles published in the October 2014 issue of Mayo Clinic Proceedings, neither the original article
      • Kotz D.
      • Brown J.
      • West R.
      Prospective cohort study of the effectiveness of smoking cessation treatments used in the “real world.”.
      nor the accompanying editorial
      • Hays J.T.
      Helping smokers quit in the “real world”.
      addressed the utility of electronic cigarettes, thereby invalidating all conclusions therein…except for emphasizing the generic importance of translational research.
      Specifically, the methodology employed in the article and the analysis thereof in the editorial eschewed any citation of “vapes,” which have quickly justified having earned a solid position in the antitobacco armamentarium; consider one conservatively phrased commentary:E-cigarettes, with or without nicotine, were modestly effective at helping smokers to quit, with similar achievement of abstinence as with nicotine patches, and few adverse events. Uncertainty exists about the place of e-cigarettes in tobacco control, and more research is urgently needed to clearly establish their overall benefits and harms at both individual and population levels.
      • Bullen C.
      • Howe C.
      • Laugesen M.
      • et al.
      Electronic cigarettes for smoking cessation: a randomised controlled trial.
      Indubitably, use of electronic cigarettes reduces the risk of serious illness caused by inhalation of tobacco smoke, as documented in hundreds of articles compiled by one of the authors of this letter (W. T. G., Executive Director of Smokefree Pennsylvania).

      Godshall B. THR Updates. E-Cigarette Politics website. http://www.ecigarette-politics.com/bill-godshall-thr-updates.html. Published June 11, 2013. Updated March 14, 2014. Accessed October 17, 2014.

      Indeed, the only quasi-justifiable—albeit unproven—concern is whether they could become gateways for adolescents and others to become smokers. Thus, a reasonable area of study would be whether—just as pharmacological and counseling initiatives can yield multiplicatively beneficial effects—the combination of using electronic cigarettes with other approaches could yield outcomes superior to all other reported interventions.
      Another component of this challenge is reflected in the fact that only 4.8% of patients received the most effective therapy in the study by Kotz et al
      • Kotz D.
      • Brown J.
      • West R.
      Prospective cohort study of the effectiveness of smoking cessation treatments used in the “real world.”.
      ; noting the capacity of “markets” to allow consumers to choose what is most desired (in England, regardless of whether the government sponsors specialized clinics), analysis of further interventions could easily conclude that patients could successfully “kick the habit” by choosing to follow a self-motivated pursuit of electronic cigarettes, a novel modality that—absent governmental interference—could continue to burgeon in popularity.
      Regardless of what intervention is chosen, Hays properly advocated that it be conducted under the aegis of a support system (physician, physician extender, and/or clinic); this is how plans can be effectively reformulated. For example, improper use often leads to ineffectiveness of nicotine gum; when smokers keep chewing after the addiction urge has passed, they may experience nausea and/or headaches from nicotine overdose (as this neurotransmitter continues to be released from the resin following mastication). Similarly, the efficacy of nicotine patches may be dose related.
      Some may perceive the electronic cigarette omission merely as a benign procedural oversight; yet, electronic cigarette advocates often encounter ill-advised, real-world political implications of such unjustified glitches. For example, despite our well-documented and unrefuted testimonies,

      Sklaroff RB, Godshall WT. Testimony to the Philadelphia City Council Public Health and Human Services Committee opposing bills No 140095 & 140096, March 13, 2014. Scrbd Inc website. http://www.scribd.com/doc/212166693/e-cigs?post_id=1448468906_10203439945106486#_=_. Accessed October 28, 2014.

      Philadelphia passed 2 ordinances that essentially equated using vapes with tobacco smoking.
      Consider the stridency of a conclusion drawn from another smoking cessation study: “Unsubstantiated overt and implied claims that alternative tobacco products [such as electronic cigarettes] aid smoking cessation should be prohibited.”
      • Popova L.
      • Ling P.M.
      Alternative tobacco product use and smoking cessation: a national study.
      Such crass attempts to suppress colloquy are antithetical to the tenets of the scientific discourse; condemnation thereof corroborates the recommendation—shared with the authors of both of these Mayo Clinic Proceedings articles—that further, intelligent, “efficacious” research be aggressively pursued…wherever it may lead.

      References

        • Kotz D.
        • Brown J.
        • West R.
        Prospective cohort study of the effectiveness of smoking cessation treatments used in the “real world.”.
        Mayo Clin Proc. 2014; 89: 1360-1367
        • Hays J.T.
        Helping smokers quit in the “real world”.
        Mayo Clin Proc. 2014; 89 ([editorial]): 1328-1330
        • Bullen C.
        • Howe C.
        • Laugesen M.
        • et al.
        Electronic cigarettes for smoking cessation: a randomised controlled trial.
        Lancet. 2013; 382: 1629-1637
      1. Godshall B. THR Updates. E-Cigarette Politics website. http://www.ecigarette-politics.com/bill-godshall-thr-updates.html. Published June 11, 2013. Updated March 14, 2014. Accessed October 17, 2014.

      2. Sklaroff RB, Godshall WT. Testimony to the Philadelphia City Council Public Health and Human Services Committee opposing bills No 140095 & 140096, March 13, 2014. Scrbd Inc website. http://www.scribd.com/doc/212166693/e-cigs?post_id=1448468906_10203439945106486#_=_. Accessed October 28, 2014.

        • Popova L.
        • Ling P.M.
        Alternative tobacco product use and smoking cessation: a national study.
        Am J Public Health. 2013; 103: 923-930

      Linked Article