Jamie Hartmann-Boyce, author of a review of studies on electronic cigarettes, states that benefits occur in countries with many smokers
Jamie Hartmann-Boyce leads a systematic review of studies on electronic cigarettes in the Cochrane library, an information bank that is a reference in the world. For the researcher, the evidence that this type of device can be useful in the fight against smoking is clear in the 88 studies she analyzed.
“According to the criteria we use at Cochrane, the evidence clearly shows that nicotine e-cigarettes can help people quit smoking”, says the professor at the University of Massachusetts Amrest in an interview with Power360.
The use in treatments is based on the same principle as nicotine gum or patches, but with devices that reproduce the behavioral cues of traditional cigarette use.
Jamie says, however, that e-cigarettes also pose health problems. Although the known harms are lower than those of traditional cigarettes “that kill 1 in 2 smokers”, there is a risk of creating new dependents. Therefore, he states, it is necessary to evaluate the usefulness of this type of use according to the characteristics of each country.
“In a country where almost no one smokes, electronic cigarettes are unlikely to benefit the population. On the other hand, in a country where many people continue to smoke and die from tobacco, regulation rather than banning e-cigarettes may be considered.”, says the researcher, who is also director of the Department of Evidence-Based Medical Care at the University of Oxford.
Watch complete from the interview (20min6s):
Brazil has banned the sale of these devices since 2009. A Anvisa (National Health Surveillance Agency) confirmed the ban in 2022 and will keep a public consultation on this policy open until February.
Jamie says that the scientific evidence for the use of electronic cigarettes in tobacco control is strong, that replacing traditional cigarettes with electronic cigarettes brings harm reduction, but that each country's public policies in relation to regulation must take into account a series of factors .
The researcher states that, although the studies show what happens in a controlled scenario, there are other uses of electronic cigarettes in real life that must be considered when enacting regulations and shows concern about the increase in smoking in youth.
Read excerpts from the interview below:
BAN
“Smoking traditional cigarettes is incredibly harmful and deadly. E-cigarettes are not risk-free, but they are considerably less harmful. In a country where almost no one smokes, electronic cigarettes are unlikely to benefit the population. In a country where many people continue to smoke and many people continue to die from tobacco, this may be an area where regulation rather than banning e-cigarettes can be considered.”
“Taking into account all the people who die every day because of tobacco, knowing that many adults who smoke want to quit smoking and have not been able to do so successfully, it is possible to better understand why some people are pushing for electronic cigarettes are available.”
“On the other hand, if we're going to move forward and say 'yes, we're going to allow e-cigarettes on the market,' there are a number of really important things to consider. We need to think about the markets for which e-cigarettes may or may not be suitable and how to control messaging and access to these markets. Therefore, it is not just a question of whether or not a product is commercially available. It’s also about thinking, for example, about advertising and the placement of these products.”
ILLEGAL MARKET
“It is not up to me to say what Brazil or any government should or should not do in this area [da regulamentação]. Concerns about unregulated products [que estão no mercado ilegalmente] are legitimate. There have been a number of lung injuries that have occurred in the US in 2020 that have been linked to the use of vapes. They were found to be linked to an additive that was being put in e-cigarettes that were largely unregulated.”
ELECTRONIC CIGARETTES AND SMOKING
“We have very good evidence that nicotine e-cigarettes can help people who smoke to quit smoking. I lead a Cochrane review on this topic, along with a large team of colleagues, and every month we review all the studies looking at the role of nicotine e-cigarettes in helping people quit smoking. And there are some very good trials that show definitive data that for people who smoke, using an e-cigarette with nicotine can help them quit.”
“This is not a surprise. We know that nicotine gum and patches help people quit smoking. E-cigarettes are another way to deliver nicotine, but by mimicking some of the social, environmental and psychological cues that many people have difficulty letting go of when trying to quit smoking.”
PUBLIC POLICY
“Someone like the World Health Organization, as a policymaker for the entire world, doesn’t just consider what the evidence shows about individuals.”
“They think about what this means for an entire population. Do the potential benefits of this [do uso do cigarro eletrônico para deixar o tabagismo] at population level do they outweigh the disadvantages? When you think about disadvantages, one of the big disadvantages is the increase in the use of vapes by young people, especially young people who would not use any nicotine products.”
“The studies we looked at are of people who are given e-cigarettes with nicotine and are encouraged to use them to quit smoking. This may be very different from the effect of someone purchasing an illicit product that may or may not contain nicotine, may or may not be safe, and may or may not be encouraging you to quit smoking.”
ELECTRONIC CIGARETTES AMONG YOUNG PEOPLE
“It certainly appears that a portion of young people who use nicotine e-cigarettes are people who we would not otherwise expect to smoke regular cigarettes. One of the public health community’s biggest concerns is whether the use of vapes is causing more young people to start smoking.”
“We know that e-cigarettes with nicotine are not without harm, but we know that smoking regular cigarettes is very, very harmful. So we definitely don't want anything that would lead young people who wouldn't smoke regular cigarettes to start smoking. The evidence on this is difficult to interpret. What we can clearly see is that young people who vape are more likely to go on to smoke [cigarros tradicionais] than their non-vape peers. But there is controversy as to whether one of these behaviors is, in fact, causing the other.”
“We can look at a country like the US where we have had a lot of young people using e-cigarettes over the years. If devices are driving more young people to smoke, we would have started to see an increase in youth smoking by now. But what we see in general is more indicative of the opposite. So the evidence is starting to suggest that, at a population level, vaping may be replacing tobacco in younger populations, but we also know that there are populations that would not have smoked and that have switched to using vapes.”
REGULATION AS REMEDY
“In an ideal world, having a nicotine e-cigarette available with a prescription would be great. It would encourage healthcare professionals to talk about the issue with their patients.”
“I think another thing to take into account is that, when it comes to access to medicines and treatments, it depends on the healthcare system in each country, but this can be difficult. So if we require revenue in a country where many low-income people don't have access to health care, that's going to create some problems.”
“In the meantime, they could go to a corner store and buy a cigarette without any problems. We have to think about how to encourage people to stop engaging in the most harmful behavior on the spectrum, which is smoking combustible tobacco, and provide less harmful alternatives. There are a number of policy options and different countries will choose different options based on their populations and the various regulations that are already in place.”
DAMAGE REDUCTION
“The evidence we have shows that in people who smoke, switching to nicotine e-cigarettes, and in particular when they switch completely from smoking combustible tobacco and using only nicotine e-cigarettes, reduces levels of many of the harmful things that happen in the body.”
“There is good evidence to suggest that, although not risk-free, e-cigarettes are considerably less harmful than smoking. This is not to say that e-cigarettes are safe. Traditional cigarettes, when used according to the manufacturer's intention, kill one in every two users in the long term. Here we compare it with a product [o cigarro eletrônico] which is not without risk, but it is safer than that.”
“An e-cigarette that is strictly regulated, that has been tested for use as something people can use to reduce harm, where the ingredients have been tested and guaranteed, is likely to be much less harmful than smoking. [cigarro tradicional]”.
NEED FOR MORE STUDIES
“We certainly need more studies on the safety and health effects of e-cigarettes. We need long-term studies, on people who have been using vapes for a long time. And traditionally, that’s been a difficult thing to do.”
“But now we have people who use vapes who have never smoked [cigarros tradicionais]. Therefore, it will be very useful to analyze the long-term health outcomes of this population. And because of all these unknowns, I'm not aware of anyone who suggests, and I certainly wouldn't suggest, that someone who doesn't smoke use an electronic cigarette. It is unlikely that this will do any good.”
“However, for people who smoke, who are struggling to quit, the evidence shows that e-cigarettes or nicotine are a viable option to help them wean themselves from the more harmful product.”
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