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Reply to: “Nicotine or tobacco abstinence?”

Reiner Hanewinkel, Kathrin Niederberger, Anya Pedersen, Jennifer B. Unger, Artur Galimov
European Respiratory Review 2022 31: 220158; DOI: 10.1183/16000617.0158-2022
Reiner Hanewinkel
1Institute of Therapy and Health Research, IFT-Nord, Kiel, Germany
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  • For correspondence: hanewinkel@ift-nord.de
Kathrin Niederberger
2Clinical Psychology and Psychotherapy, Dept of Psychology, Kiel University, Kiel, Germany
3Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
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Anya Pedersen
2Clinical Psychology and Psychotherapy, Dept of Psychology, Kiel University, Kiel, Germany
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Jennifer B. Unger
4Institute for Health Promotion and Disease Prevention Research, Dept of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Artur Galimov
4Institute for Health Promotion and Disease Prevention Research, Dept of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Abstract

The true impact of vaping on health will manifest over the coming decades, but the evidence to date on the deleterious effects of e-cigarettes on health justifies the recommendation to abstain from the consumption of inhaled nicotine and other products https://bit.ly/3Dn4riC

Reply to R.L. Murray and co-workers:

9 years ago, in July 2013, a group of 12 experts, many who had previously expressed support for e-cigarettes, rated the relative harm of 12 nicotine-containing products by using 14 criteria addressing harms to the users and others [1]. The group concluded e-cigarettes were substantially less harmful than combustible cigarettes. The popular media have taken up these results and promoted e-cigarettes as “95% less risky” or “95% less harmful” than combustible cigarettes. However, the authors acknowledged, “a limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria” [1].

Despite this lack of “hard” evidence, Public Health England endorsed and publicised the “95% less harmful” assertion in 2015 [2]. Researchers clearly pointed out the “invalidity” of this estimate [3], and tried to explain the “English exceptionalism” on e-cigarettes [4]. Even so, R.L. Murray and colleagues used the “95% less harmful” assertion as the main argument in their response to our paper [5].

Since 2013, research on e-cigarettes has rapidly accumulated. Today, there is substantial evidence that using e-cigarettes is harmful to cardiovascular [6] and respiratory health [7]. Indeed, in 2019, an editorial in the Lancet stated that “no solid evidence base” underpins the marketing claims that e-cigarettes are healthier than cigarettes or that they can support quitting [8].

Unproven claims that e-cigarettes are useful harm-reduction tools are further undermined by their high uptake among young people, and the elevated risk of switching from e-cigarettes to combustible cigarettes. Results of the latest meta-analysis of 25 cohort studies confirm this concern, by showing that ever users of e-cigarettes at a young age had over three times the risk of ever cigarette use later on [9].

Discussions regarding the potential harms of e-cigarettes remind us of scientific debates about the health effects of cigarette use in the 1940s and 1950s. Smoking tobacco was apparently not even suspected as a cause of lung tumours, which were very infrequent at that time, until the final decade of the 19th century. It took us half a century to establish cigarette smoking as the leading cause of lung cancer. The true impact of vaping on health will manifest over the coming decades, but the evidence to date on the deleterious effects of e-cigarettes on health justifies the recommendation to abstain from the consumption of inhaled nicotine and other products. This recommendation is endorsed by a substantial number of international societies, including the Forum of International Respiratory Societies [10, 11], the European Academy of Paediatrics [12], and the American Cancer Society [13].

Footnotes

  • Provenance: Invited article, peer reviewed.

  • Conflict of interest: R. Hanewinkel reports the following relationships outside the submitted work: grants received from the German Ministries of Health and Research, German Cancer Aid and German Health Insurances. A. Galimov reports the following relationships outside the submitted work: grant received from NCI/FDA Grant #U54CA180905 (PIs: Mary Ann Pentz and Adam Leventhal). J.B. Unger reports the following relationships outside the submitted work: grant received from NIH. The remaining authors have nothing to disclose.

  • Support statement: A. Galimov and J.B. Unger are partially supported by the National Cancer Institute and the FDA Center for Tobacco Products (CTP) Award (NCI/FDA Grant #U54CA180905). NCI or the FDA had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Received August 14, 2022.
  • Accepted August 23, 2022.
  • Copyright ©The authors 2022
http://creativecommons.org/licenses/by-nc/4.0/

This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions{at}ersnet.org

References

  1. ↵
    1. Nutt DJ,
    2. Phillips LD,
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    Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res 2014; 20: 218–225. doi:10.1159/000360220
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    1. McNeill A,
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    E-cigarettes: an evidence update. A report commissioned by Public Health England. London, Public Health England, 2015. https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update
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    1. Eissenberg T,
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    Invalidity of an oft-cited estimate of the relative harms of electronic cigarettes. Am J Public Health 2020; 110: 161–162. doi:10.2105/AJPH.2019.305424
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    . Evidence and e-cigarettes: explaining English exceptionalism. Am J Public Health 2019; 109: 965–966. doi:10.2105/AJPH.2019.305132
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    1. Hanewinkel R,
    2. Niederberger K,
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    E-cigarettes and nicotine abstinence: a meta-analysis of randomised controlled trials. Eur Respir Rev 2022; 31: 210215. doi:10.1183/16000617.0215-2021
    OpenUrlAbstract/FREE Full Text
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    . Impact of vaping on respiratory health. BMJ 2022; 378: e065997. doi:10.1136/bmj-2021-065997
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    1. The Lancet
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    1. Yoong SL,
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    1. American Cancer Society
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Reply to: “Nicotine or tobacco abstinence?”
Reiner Hanewinkel, Kathrin Niederberger, Anya Pedersen, Jennifer B. Unger, Artur Galimov
European Respiratory Review Dec 2022, 31 (166) 220158; DOI: 10.1183/16000617.0158-2022

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Reply to: “Nicotine or tobacco abstinence?”
Reiner Hanewinkel, Kathrin Niederberger, Anya Pedersen, Jennifer B. Unger, Artur Galimov
European Respiratory Review Dec 2022, 31 (166) 220158; DOI: 10.1183/16000617.0158-2022
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