במאמר אורח זה מתייחס ד''ר איאן פירון, חוקר עצמאי , להודעת האיגוד האירופאי לנשימה , המביעה התנגדות לגישה הרואה בסיגריות אלקטרוניות ככלי עזר לגמילה מעישון.
במאמרו טוען פירון כי לאמצעי הגמילה מעישון הקיימים כיום בשוק יש אפקטיביות מוגבלת והממצאים המחקרים מראים כי שימוש בסיגריות אלקטרוניות כאמצעי לגמילה הדגים יעילות כפולה. לכן , לדעתו, גם אם מניחים שקיימים ככל הנראה גם סיכונים בריאותיים בשימוש בסיגריות אלקטרוניות, די ברור שאלה פחותים באופן מאוד משמעותי מהסיכונים מעישון סיגריות בעירות, ולכן יש לדעתו מקום לראות בהם, עבור אנשים שאינם מצליחים להיגמל באמצעים אחרים, פתרון סביר.
I write to comment on your recent coverage of the European Respiratory Society Position Paper on Tobacco Harm Reduction1, and to draw attention to some major omissions of evidence concerning the role of e-cigarettes in helping smokers cease the habit that has a 50% chance of making them die young.
The position paper2 does make some correct assertions. Of course, the majority of smokers are aware of the dangers associated with the habit they are addicted to and want to quit smoking. The reality though is that most smokers find it very difficult to do so. For example, a Canadian study published in 2016 suggested that smokers may make as many as 30 attempts to quit smoking before being able to do so3. In light of this, the US FDA recently ran an education campaign to highlight to smokers that quitting may take many attempts, and that ‘Every Try Counts’4. Clearly, stopping smoking is very difficult and smokers need the very best support they can obtain to help them do so.
So, what is the best support possible? Current estimates of the efficacy of traditional stop-smoking interventions range from 2% for physician advice, to 15% for the partial nicotine receptor agonist varenicline (Champix/Chantix)5. However, when compared side-by-side in a randomised controlled trial, e-cigarettes were twice as effective as varenicline in helping smokers quit6 when either form of support was combined with behavioural therapy. It is concerning that this paper was not cited in the European Respiratory Society Position Paper, given its publication almost 4 months ago. Such findings are supported by recently-published survey data which suggest the strong efficacy of e-cigarettes in helping people quit smoking7.
The position paper seems to base its concerns on the notion that the tobacco industry is largely responsible for the marketing of e-cigarettes, and that these large, multinational corporations have a hidden agenda to maintain current smoking rates and to encourage new users of nicotine-containing products. This assertion however does not appear to be true. In many countries globally, the e-cigarette market is dominated by small companies and the cigarette manufacturers’ products have, at best, high single-digit market shares. The e‑cigarette industry therefore is based not on large companies, but small manufacturers who are dedicated to helping people abstain from their deadly habit.
It is unlikely that e-cigarettes are completely safe and risk-free. However, given the lack of the toxic chemicals in e-cigarette vapour that are found in cigarette smoke and that are responsible for death and disease, their use is clearly less harmful than cigarette smoking. And of course, they have a proven greater ability to help people quit smoking than current licensed medications.
The European Respiratory Society appears to be taking the precautionary principle a step too far. We know the long-term effects of cigarettes smoking; smokers develop disease and die young due to their inhaling toxic chemicals. By delivering nicotine without these chemicals, e-cigarettes clearly offer smokers a much safer alternative. Should the European Respiratory Society therefore be recommending an efficacious treatment for an indication that sees millions of people visit its members each year in hospitals and surgeries? And by making such strong public statements denouncing e-cigarettes, is it not indirectly causing the very death and disability its mission is to prevent?
The most worrying aspect of the European Respiratory Society position is the words of its President, Professor Tobias Welte8, who clearly is misrepresenting the available evidence by stating “there is very little evidence to support the claims that e-cigarettes are helping smokers to quit conventional cigarettes for good”. Professor Welte further states that “we must not give up on smokers”. Unfortunately, by recommending that his members do not suggest to their patients the most efficacious option to help them quit smoking, he already has.
Dr. Ian M. Fearon
Independent Scientific Consultant
Disclosure: whatIF? Consulting Limited provides clinical study, regulatory affairs and general scientific consultancy to manufacturers of nicotine and tobacco products. The views expressed in this letter are those of Dr. Ian M. Fearon. No other party has contributed to this letter or reviewed its contents.
1. http://www.e-med.co.il/emed/new/usersite/content.asp?CatID=1&ContentID=754205
2. https://ers.app.box.com/v/ERSTCC-Harm-Reduction-Position
3. Chaiton M, Diemert L, Cohen JE, Bondy SJ, Selby P, Philipneri A, Schwartz R. Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers. BMJ Open, 2016;6(6):e011045
4. https://www.fda.gov/news-events/press-announcements/fda-launches-public-education-campaign-encourage-adult-smokers-trying-quit-cigarettes
5. West R, Raw M, McNeill A, Stead L, Aveyard P, Bitton J, Stapleton J, McRobbie H, Pokhrel S, Lester-George A, Borland R. Health-care interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. Addiction, 2015;110(9):1388-403.
6. Hajek P, et al. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. New England Journal of Medicine, 2019. doi: 10.1056/NEJMoa1808779
.7. https://onlinelibrary.wiley.com/doi/pdf/10.1111/add.14656
8. https://www.eurekalert.org/pub_releases/2019-05/elf-eah052819.php