From: Bareham David (LCHS)
Sent: 07 July 2016
Subject: Op-Ed Response to “Shoddy Research on E-cigarettes Harms Public Health ” by Lindsay Stroud: Muddle-Headedness on Electronic Cigarettes.
Importance: High
To the Editor,
The recent Inside Sources piece by Lindsay Stroud on E-Cigarettes lacks sound insight into this issue, and the science related. For example, it is highlighted that Ann McNeill argued, regarding the cited Pediatrics piece that:
“Ann McNeill, a professor of Tobacco Addiction at King’s College London, says the study erred by examining teens who had just “tried” e-cigarettes, rather than studying consumers who use the product frequently”
Lindsay Stroud appears unaware that McNeill and colleagues have previously stated, with regard to adolescent nicotine dependence, that:
“There does not appear to be a minimum nicotine dose or duration of use as a prerequisite for symptoms to appear.”
McNeill’s previous work and subsequent opinion appears to justify the utilisation of “ever use” in the Pediatrics paper. It further appears, therefore, that at certain times, it suits Professor McNeill to minimise the risks of very low level exposures to nicotine, but at others, to highlight and magnify them. This somewhat “schizophrenic” relationship with nicotine likely emanates from the Professor’s long-standing affinity to the theory of “Tobacco Harm Reduction”, and a tendency to therefore believe that “all-things e-cigarette” can and will only lead to good, and to oppose the application of Precautionary Principle. These cognitive biases appear to have transitioned to some “muddle-headedness” related to nicotine.
Lindsay Stroud also states: “One of the criticisms of the study is the small sample size. The study relied on only 300 students who identified themselves as “nonsmokers.”
If one is familiar with the evidence base for electronic cigarettes and smoking cessation, then it is widely accepted that the “highest quality” data available currently is the randomized controlled trial by Bullen et al, where the sample size of the experimental group was only: 289. Of these, only 21 were tobacco abstinent at 6 months. These authors themselves state with regard to the scientific robustness of their research:
“Achievement of abstinence was substantially lower than we anticipated for the power calculation, thus we had insufficient statistical power to conclude superiority of nicotine e-cigarettes to patches or to placebo e-cigarettes.”
Therefore, it would certainly be “shoddy” – the descriptor used by Stroud – to read too much, currently at least, into the efficacy of e-cigarettes in assisting adult smokers to quit tobacco on such profoundly weak evidence. It is certainly worth the reader knowing, moreover, that participants in the patches group had to collect a voucher from a chemist before they could obtain their medication: a potentially significant confounder that may have reduced the efficacy data found here.
It is troublesome, moreover, that while Peter Hajek, who is cited in the Inside Sources piece as suggesting that the rate of decline in numbers of children smoking tobacco has never been as great subsequent to E-cigarettes becoming popular on the market, Action on Smoking and Health data for the U.K. demonstrates this to be an erroneous conclusion. The percentage of 15 year old boys and girls regularly smoking tobacco fell from 20% in 2006 to 12% in 2010: before the surge in “interest” in E-Cigarettes.
Stroud also promotes: “the fact these products that are 95% less harmful . . . than normal cigarettes.” This presumption, based on weak methodology and virtually no bioassay data, has very recently been challenged by toxicologists in New Zealand, who argue that long term users of e-cigarettes expose, potentially, to “a substantial level of exposure” of toxicants and subsequent disease, although less than for cigarettes. Other expert toxicologists, Robert Combes and Michael Balls, have therefore argued that the “95% safer” figure, based on current scientific data, is “reckless” to promote.
It is very early days indeed for anyone claiming to advocate an “evidence-based approach” on e-cigarettes to be making sweeping judgements about them: that really would be “shoddy”.
Yours sincerely
David Bareham.
David W Bareham BSc Hons (Physiotherapy) MSc (Pain Management).
Specialist Respiratory Physiotherapist
Lincolnshire Community Health Services NHS Trust
Locality Office
Louth County Hospital
Louth