Unsafe Lifestyle Product

Letters to the Editor The Effectiveness of E-Cigarettes for Smoking Cessation A Comparison With Nicotine Replacement Therapy and No Use of Evidence-Based Cessation Aids in the German Population by Prof. Dr. Daniel Kotz, PhD MSc MPH, Sarah Jackson, PhD, Prof. Jamie Brown, PhD, and PD Dr. rer. nat. Sabrina Kastaun, Dipl.-Psych. in issue 17/2022

High hopes were placed on e-cigarettes as a smoking cessation aid. A recently published Cochrane review identified four randomized controlled trials that compared the effectiveness of e-cigarettes with that of nicotine replacement therapy. Only one single study, which has not been replicated to date, indicates superiority for e-cigarettes as regards tobacco abstinence (1). A new meta-analysis, that in addition to tobacco abstinence studied freedom from nicotine as a primary endpoint in randomized controlled trials, showed that only 3–4 in every 100 smokers completely ceased nicotine consumption by means of e-cigarettes—significantly fewer than the 7 smokers in the nicotine replacement group (2). The observational study by Kotz et al. confirms this finding if the reported results are considered accordingly (3).

Of those persons who attempted to stop smoking more than 6 months ago, 15.6% of the e-cigarette group (17 out of 109) and 13.8% of the nicotine replacement group (12 out of 87) had stopped smoking tobacco (not significant). Only 5.5% of the e-cigarette group (6 out of 109) completely abstained from tobacco. By comparison, 19.3% of smokers in the e-cigarette group started using tobacco simultaneously (21 out of 109). This simultaneous consumption of tobacco and e-cigarettes is classed as a particular health hazard (4). The ethical question arises of why doctors should recommend their patients an unsafe, in many cases an addiction-prolonging and health-harming lifestyle product when simultaneously, safe, evidence based medical products/preparations are available.

DOI: 10.3238/arztebl.m2022.0264

Prof. Dr. phil. Reiner Hanewinkel

Institut für Therapie- und Gesundheitsforschung, IFT-Nord gGmbH, Kiel

Conflict of interest statement

Prof. Hanewinkel is the deputy chair of the Aktionsbündnis Nichtrauchen e. V. (ABNR, the Action Alliance for Non-smoking).

References

1. Hartmann-Boyce J, McRobbie H, Butler AR, et al.: Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2021; 9: CD010216

2. Hanewinkel R, Niederberger K, Pedersen A, Unger JB, Galimov A: E-cigarettes and nicotine abstinence: a meta-analysis of randomised controlled trials. Eur Respir Rev 2022; 31: 210215

3. Kotz D, Jackson S, Brown J, Kastaun S: The effectiveness of e-cigarettes for smoking cessation—a comparison with nicotine replacement therapy and no use of evidence-based cessation aids in the German population. Dtsch Arztebl Int 2022; 119: 297–301

4. Neczypor EW, Mears MJ, Ghosh A, et al.: E-cigarettes and cardiopulmonary health: review for clinicians. Circulation 2022; 145: 219–32