Who carried out the research?
The research was carried out by Professor Robert West along with a team made up from the University College of London, the Maastricht University Medical Centre in Holland and the National Centre for Smoking Cessation in London.
Professor West has been a vocal supporter of the use of e-cigarettes and has featured frequently in television, print and radio interviews.
How was the research paid for?
Salaries and direct funding came from the following sources:
• UK Society for the Study of Addiction
• Cancer Research UK
• The Department of Health
• Pfizer
• GlaxoSmithKline
• Johnson and Johnson
• McNeil
• Nabi
• Novartis
• Sanofi-Aventis
This funding is interesting for two reasons; all bar two of the sponsors are pharmaceutical companies with vested interests in Nicotine Replacement Therapy (NRT) products.
Secondly, no funding or influence came from any manufacturer of electronic cigarettes or e-liquid for up to three years prior to the release of this report.
How was the research carried out?
5,863 adults were consulted. Each adult had to be a smoker and have made at least one failed attempt to quit smoking in the year before they were studied.
• 8% had tried and failed using an e-cigarette
• 33% had tried and failed using NRT
• 59% had tried and failed by going without any nicotine substitute
What did the research find out?
- The highest success rate in stopping smoking was achieved by people using e-cigarettes.
- E-cigarettes are more successful than NRT and going without either regardless of the quantity, strength or length of time a smoker had been smoking.
What does the report reference?
1. That it is estimated that up to 6,000,000 die from preventable smoking-related diseases each year
1. That the diseases are directly linked to the contents of cigarette smoke and not the nicotine
1. E-cigarette vapour appears to reduce craving when used to replace smoking
1. That electronic cigarettes are substantially safer than cigarettes because they contain much smaller quantities of poisonous toxins
1. E-cigarettes have increased in popularity from 2% in 2010 to 30% in 2012 in the USA and that this is similar to the UK take-up rate
1. That effectiveness depends on the type of e-cigarette used, the way the e-cigarette is used and who chose to use them
1. Several studies including one long-term study consistently reported users claiming that e-cigarettes helped them to reduce or stop cigarette use
1. People who began studies as e-cigarette users were likely to remain using e-cigarettes
1. The Smoking Toolkit, by ASH UK, had been tracking e-cigarette use since 2009 and has discovered that using a combination of behaviour training and the use of varenicline was more successful than NRT
Who took part?
• A cross-section of households representing the population of the UK were surveyed on a monthly basis between 2009 and 2014.
How were they measured as non-smokers?
Subjects were asked:
“How long did your most recent serious quit attempt last before you went back to smoking?”
If they replied they were still not smoking they were classified as non-smokers.
- By being asked these questions in their home it has been proven by other scientific studies that people are most likely to give a truthful answer than when they are in groups and feel pressured into giving what they think is the correct answer rather than the truthful one.
- They were asked how often they felt the urge to smoke a cigarette
- They were asked how strong the urge was
- The answers were catagorised by age, sex and into two social groups
In conclusion
Because of the huge success of e-cigs in helping people to quit smoking, and that NRT offered little benefit over any other method of trying to quit, Professor West questions how far medicine regulation should be applied to an already successful and safer method.
Professor West also highlights that although the report does not look at the re-normalisation of smoking he notes that the growth in the use of e-cigarettes has happened since 2010 with a linked reduction in general smoking, which begs the conclusion they do not.
The Aftermath of the West Report on E Cigarettes
In the lead up to the release of the West Report above we have seen the ASH UK report confirm that there is no evidence of harm in the short to medium term, that e-cigarettes are far safer than cigarettes, that there is no evidence of children using them as a gateway into smoking and that plenty of evidence exists to the contrary.
Also, that e liquid flavours do not encourage children to vape and that as sales of e-cigarettes went up the sales of cigarettes fell.
In the issue of the magazine Addiction, prior to the one carrying the West Report, Nicolas Franchitto from the Poisons and Substance Abuse Treatment Centre in Toulouse wrote that French judges had decided to define e-cigarettes as tobacco products even though they may not contain any tobacco as they “look like cigarettes”. He added that the judges had ignored all scientific evidence and public health benefits and just focused on the commercial and financial aspects of e-cigarettes.
This, to those wondering how the UK government are going to treat the implementation of the Tobacco Products Directive, does not bode well.
The day of release
As well as the research, Addiction carried the article entitled “Electronic cigarettes: time for an accurate and evidence-based debate” by Hitchman, McNeill and Brose.
In it they stated
current research and commentaries on electronic cigarettes…vary widely in quality, accuracy and objectivity.
While these issues are not limited to the research community, we believe that researchers need to demonstrate better scholarship in this area.”
In other words, people are not being truthful or carrying out good science methodology.
They stated that e-cigarettes have to be in a category all of their own for reasons that cars are not the same as horse drawn carriages, that they do not contain tobacco and should not be lumped together with tobacco products and that in the absence of any reliable evidence they lead to smoking no further reference should be made to it without sound research data.
E-Cigarettes Can Help Smokers to Quit, New Research Shows
The BBC kept Professor West a busy man on the day as he went from studio to studio, across different channels, being asked the same questions and giving the same replies.
During his grilling on the Victoria Show on 5Live he repeated the mantra that any person attempting to quit smoking is 60% more likely to succeed if they use e-cigs than any other method.
Plus, given that there is an absence of evidence of harm and a wealth of evidence that they are substantially safer, that governments and health organisations should be supporting their use.
A number of people misinterpreted his comments, leading them to believe that he was proposing a medical prescription route for e-cigs because of the following quote:
“E-cigarettes could substantially improve public health because of their widespread appeal and the huge health gains associated with stopping smoking. However, we should also recognise that the strongest evidence remains for use of the NHS stop-smoking services. These almost triple a smoker’s odds of successfully quitting compared with going it alone or relying on over-the-counter products.”
Professor West clarified that he sees the best solution to be that NHS-funded stop smoking organisation accept that people use electronic cigarettes and offer them behavioural support rather than an insistence on adopting an NRT regime.
The Aftermath
Blogger and e-cigarette commentator Clive Bates pointed out;
“I am just sick of being told that medicine regulation guarantees the efficacy of these products and medicine regulation will make e-cigarettes better products, or that e-cigarettes need to be evaluated scientifically… blah blah… all of that has been done for NRT and what has it led to?“
There is a very interesting discussion on Clive Bates’ blog page regarding the report’s contents and the way forward.
The following morning both Louise Ross from Leicester’s Stop Smoking Service and Katherine Devlin of the electronic cigarette trade body ECITA were interviewed on Radio Leicester.
The host, Jonathan Lampon, pointed out that Louise has overseen the first and currently only service to accept e-cigs. She responded to the direct question as to whether they work with an emphatic “Yes, they do.”
Katherine Devlin agreed that further research studies will always be welcome but that it is so important other stop smoking campaigns adopt Louise’s approach. She accepted that NRT can work well when coupled with a behavioral approach (but fails without) but that it now needs to be done in tandem with e-cigs – the end goal being to save lives.
Ultimately the general consensus was that e-cigarettes end the ‘quit or die’ approach currently undertaken.
Sources
• http://onlinelibrary.wiley.com/enhanced/doi/10.1111/add.12550/
• http://www.bbc.co.uk/news/health-27485954
