This is Jgitchell's Typepad Profile.
Join Typepad and start following Jgitchell's activity
Join Now!
Already a member? Sign In
Jgitchell
Recent Activity
I know that I'm a bit like a dog with a bone on this stuff, Bill, but with that confession stated, have you seen these two recent pieces in Addiction? I found the commentary provocative and the review paper essentially renders null and void the Kalkhoran & Glantz 2016 citation you used to support your "evidence is mixed" conclusion. Do you agree? If not, why not? And if yes, would you consider changing anything in your initial post? Weier M. Moving beyond vaping as a cessation-only practice - http://onlinelibrary.wiley.com/doi/10.1111/add.14095/full Villanti et al. How do we determine the impact of e-cigarettes on cigarette smoking cessation or reduction? Review and recommendations for answering the research question with scientific rigor - http://onlinelibrary.wiley.com/doi/10.1111/add.14020/abstract Disclosures: My employer, PinneyAssociates, provides consulting services on tobacco harm minimization (including nicotine replacement therapy and vapor products) to Niconovum USA, RJ Reynolds Vapor Company, and RAI Services Company, all subsidiaries of Reynolds American Inc. In the past three years, PinneyAssociates has consulted to NJOY on electronic cigarettes. I also own an interest in intellectual property for a novel nicotine medication.
Bill - I hope you'll indulge a few more thoughts from me as they hit me after reading your reply to my post. First, I'm not sure I understand your point as to how our "readings" of Cochrane differ. I quoted the authors' conclusions, not an interpretation of their review. So is your point that their acknowledged uncertainty is so great, even though the available RCT-evidence points towards the products helping, that you just won't accept their conclusion? Second, there are other supporting arguments of the potential utility of these products* for helping people quit. The fact that they deliver nicotine to the blood and in much the same if not higher levels as NRT products (https://www.ncbi.nlm.nih.gov/pubmed/28070620) would seem to move your Bayesian priors towards assuming that they would help (given the evidence base supporting NRT for cessation; http://www.cochrane.org/CD000146/TOBACCO_can-nicotine-replacement-therapy-nrt-help-people-quit-smoking. NB: This is not an original argument from me. Deborah Arnott expressed this most clearly at the US E-Cig Summit in May and I bet it is spelled out in the RCP2016 or somewhere else but I haven't bothered to track it down). Population-level analyses that don't have all/most of the limitations of the studies cited by Kalkhoran and Glantz in their review are consistent with the products increasing cessation (eg https://www.ncbi.nlm.nih.gov/pubmed/24846453, https://www.ncbi.nlm.nih.gov/pubmed/25301815, https://www.ncbi.nlm.nih.gov/pubmed/28747333, https://www.ncbi.nlm.nih.gov/pubmed/28802179, https://www.ncbi.nlm.nih.gov/pubmed/29059341, and much more feeble (driven by its first author's limitations...) and not as directly related, but I can't resist the self-promotion: https://www.ncbi.nlm.nih.gov/pubmed/27933678). Do you view this evidence as informing the coach's question? I look forward to your further thoughts, Bill. Thank you. *It is fair and important to acknowledge that the wide variety of products and liquids has an array of impacts--it offers lots of choices to consumers, but it also means that it is much tougher to generalize to "e-cigarettes" as one might to "nicotine gum". Disclosures: My employer, PinneyAssociates, provides consulting services on tobacco harm minimization (including nicotine replacement therapy and vapor products) to Niconovum USA, RJ Reynolds Vapor Company, and RAI Services Company, all subsidiaries of Reynolds American Inc. In the past three years, PinneyAssociates has consulted to NJOY on electronic cigarettes. I also own an interest in intellectual property for a novel nicotine medication.
Thank you for this posting, Bill. You are certainly grappling with tough questions where the evolution of evidence, and its application to practice, is subject to an array of interpretations. I'm not sure, however, how to reconcile your characterization of the conclusions of the Cochrane Review ("The evidence doesn’t support using electronic cigarettes to quit smoking (Hartmann-Boyce et al., 2016)") with their actual conclusions: "Authors' conclusions: There is evidence from two trials that ECs help smokers to stop smoking in the long term compared with placebo ECs. However, the small number of trials, low event rates and wide confidence intervals around the estimates mean that our confidence in the result is rated 'low' by GRADE standards. The lack of difference between the effect of ECs compared with nicotine patches found in one trial is uncertain for similar reasons. None of the included studies (short- to mid-term, up to two years) detected serious adverse events considered possibly related to EC use. The most commonly reported adverse effects were irritation of the mouth and throat. The long-term safety of ECs is unknown. In this update, we found a further 15 ongoing RCTs which appear eligible for this review." (http://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-are-they-safe-use-purpose) Certainly Cochrane's conclusions are guarded and qualified, but in my mind, they certainly lean towards recommending ecigs for smoking cessation. And it is obviously not answerable, but I wonder how the coach might have pursued his quit attempt if you had provided him with this link from the UK National Health Service? https://www.nhs.uk/smokefree/help-and-advice/e-cigarettes Disclosures: My employer, PinneyAssociates, provides consulting services on tobacco harm minimization (including nicotine replacement therapy and vapor products) to Niconovum USA, RJ Reynolds Vapor Company, and RAI Services Company, all subsidiaries of Reynolds American Inc. In the past three years, PinneyAssociates has consulted to NJOY on electronic cigarettes. I also own an interest in intellectual property for a novel nicotine medication.
Jgitchell is now following The Typepad Team
Nov 20, 2017