Smoker’s remedy

Smoking is injurious to health! A message that was echoing for quite some time. Some say they even used many remedies like nicotine gums to curb the urge to smoke. Alas! They have all failed. Although one such way recently has been researched by scientists that e-cigarettes can help not only curb smoking but also help one It has been one of the most pressing unanswered questions in public health: Do e-cigarettes actually help smokers quit? Now, the first, large rigorous assessment offers an unequivocal answer: yes.

A study published recently in the New England Journal of Medicine, found that e-cigarettes were nearly twice as effective as conventional nicotine replacement products, like patches and gum, for quitting smoking. The success rate was still low — 18 per cent among the e-cigarette group, compared to 9.9 percent among those using traditional nicotine replacement therapy — but many researchers who study tobacco and nicotine said it gave them the clear evidence they had been looking for.

The study was conducted in Britain and funded by the National Institute for Health Research and Cancer Research UK. For a year, it followed 886 smokers assigned randomly to use either-cigarettes or traditional nicotine replacement therapies. Both groups also participated in at least four weekly counseling sessions, an element regarded as critical for success.

“This is a seminal study,” said Dr Neal L. Benowitz, chief of clinical pharmacology at the University of California, San Francisco, and an expert in nicotine absorption and tobacco-related illnesses, who was not involved in the project. “It is so important to the field.”

Tobacco use causes nearly 6 million deaths worldwide each year, according to the Centers for Disease Control and Prevention. If tobacco use trends continue, the global death tally is projected to reach 8 million deaths annually by 2030.

E-cigarettes provide the nicotine smokers crave without the toxic tar and carcinogens that come from inhaling burning tobacco. But regulators in the United States, Britain and elsewhere have not approved them to be marketed as smoking cessation tools. They noted that 80 percent of the study participants who had quit by using e-cigarettes were still vaping at one year, while only nine percent of the nicotine replacement therapy group was still using nicotine products. That raised concerns, they wrote, about sustained nicotine addiction and the unknown health consequences of long-term e-cigarette use.

The editorial recommended that e-cigarettes be taken up when other cessation approaches, including behavioural counseling, have failed; that patients use the lowest dose of nicotine possible; that health care providers establish a clear timeline for e-cigarette use. The clinical trial took place from May 2015 to February 2018. Because the smokers were recruited at the clinics, they were already predisposed to quitting, a feather on the scale that could slightly have affected results. The participants were typically middle-aged, smoked between half a pack and a pack a day and had already tried quitting.

The people using nicotine replacement therapy could select from an array of products, including the patch, gum, lozenge and nasal spray. They were even encouraged to combine them; most did so, typically opting for the patch and an oral therapy.

Because self-reports of smoking abstinence are not considered reliable, researchers measured the quantities of carbon monoxide in the participants’ breath, a more precise validation. Dr. Maciej Goniewicz, a co-author of the British study who is now a pharmacologist at the Roswell Park Comprehensive Cancer Center in Buffalo, N.Y., said that the success of the e-cigarettes most likely reflects a combination of factors:“It’s about the method of delivery, the quantity of nicotine and the user’s behaviour,” he said. “E-cigarettes have the advantage that the user decides how and when to puff. Nicotine replacement therapy products have specific instructions, which are different for different products.”

Dr Benowitz noted that the higher quit rates and compliance among e-cigarette users could be additionally explained because those subjects expressed more satisfaction with the devices than did the other group with their products.

In their editorial, Dr. Borrelli and O’Connor pointed to other research on smoking cessation therapies: In one study nicotine-replacement therapy and the antidepressant buproprion (Wellbutrin) achieved slightly higher abstinence rates than did e-cigarettes in this latest trial. The prescription drug varenicline (Chantix) has performed even moderately better. Moreover, these products have been proven safe, they said.

Sunit Narula, general secretary, Infinite Achivers said, “We should refer to the studies like these and hence refer to both sides of a coin before arriving at any biased conclusion of blaming a new product like e cigarettes or ENDS, (Electronic Nicotine Delivery System) as only harmful without referring to any comparable studies across the globe. We should not make an Indian consumer deprived of a safer option available. We should leave it on to the consumer to choose a less harmful product.”