Research Ending Threatens Legislation

Cochrane lost its funding from the National Institute for Health and Care Research (NIHR), meaning that the monthly research living review will now end. This world-leading evidence update has been the UK’s go-to for the best overview of international ecig research evidence to inform and shape evidence-based policy making. Its loss means that future government decisions may not chime with what happens in the real world.

The need for a harm reduction approach
In 2022, Professor Caitlin Notley delivered her University of East Anglia Inaugural Lecture on Harm reduction: minimising the consequences of addictive behaviour.
Professor Notley explained the rationale behind harm reduction strategies: “We have harm reduction policies regulating behaviours that make everyday life safer. We have laws on wearing seat belts in cars, for example to make driving cars safer and within substance use.”
Having witnessed how harm reduction approaches helped during the Aids crisis in the 1980s, she knew that a similar strategy could be applied to smoking.

“Although many people manage to quit smoking most people relapse and this suggests in simple terms most quit attempts by smokers will fail and most will result in relapse,” Professor Notley warned.
Critically, disadvantaged groups harbour the greatest percentage of smokers – at least 78% of people experiencing homelessness are smokers compared to under 15% in the general population.
In addition, “you have a situation where between 75 and 90% of women that quit smoking for pregnancy relapse in the first year.”

It’s clear that vaping has so much to offer, not just in improving the health and lives of smokers – but of the health and lives of all of those who live with them. Since vaping became mainstream within the UK, the UK has relied on experts such as Professor Notley to tell them the facts about vaping, but this is now under threat.

The growth of misunderstanding
We have touched on this in previous articles, adult smokers and non-smokers are increasingly sceptical about vapes and vaping. A recently published study conducted by University College London researchers found that over half of the smokers in England now believe vaping is as or more harmful than smoking. The Cancer Research UK funded work interviewed almost 30,000 adult smokers between 2014 and 2023, allowing them to guage the changing opinions over time.
The team said: “The research team found that public perceptions of e-cigarettes had worsened considerably over the past decade, with an overall increase in the perceived harm of e-cigarettes since 2021, coinciding with a sharp rise in vaping among young people. In June 2023, 57% of respondents said they thought vaping was equally as harmful as smoking or more harmful, while only 27% thought e-cigarettes were less harmful.”

The emphasises the need for clear messages from the Government and health bodies – messages that would be informed by Cochrane’s work.

Because the NHS says vaping is safer
The NHS says: “Cigarettes release thousands of different chemicals when they burn. Many are poisonous and up to 70 cause cancer. They also cause other serious illnesses, including lung disease, heart disease and stroke. Most of the harmful chemicals in tobacco smoke, including tar and carbon monoxide, are not contained in vape aerosol.”
The health benefits are clear, the evidence to date has been compelling.

Cochrane’s closure is a huge loss
So, Cochrane UK closed its doors for the final time on Thursday 28th March 2024, due to the loss of its NIHR funding. Cochrane has been industriously labouring to review the research evidence about vaping, its impact on health, and the ability for vapes to help with quit attempts.
The hugely important thing about the papers Cochrane has produced is that they are all translated from science talk into plain English so the findings can be used by policy makers and legislators to create better procedures, practices and laws – but also to aid them and the media to communicate the good news to smokers who need clear, unequivocal messages.
In their words: “Cochrane Reviews are updated to reflect the findings of new evidence when it becomes available because the results of new studies can change the conclusions of a review. Cochrane Reviews are therefore valuable sources of information for those receiving and providing care, as well as for decision-makers and researchers.”

The final Electronic Cigarettes for Smoking Cessation: Cochrane Living Systematic Review has now been published. The team, made up from experts from the UK, Australia, New Zealand, and the US, were all “independent academics with no ties to the e-cigarette or tobacco industry” – guaranteeing their impartiality.
The findings are in line with previous reports:

·There is high certainty evidence that more people stop smoking for at least six months using nicotine e-cigarettes than using nicotine replacement therapy (NRT, such as patches, gum, or lozenges).

·There is moderate certainty evidence that more people stop smoking for at least six months using nicotine e-cigarettes than nicotine-free e-cigarettes.

Given the need to be cautious and mindful that other evidence may come to light in the future, “moderate certainty” is still very good evidence.

Other findings include:

·Using vapes to quit smoking may help more people than no support or behavioural support only

·Evidence is insufficient to determine if there is a difference between how many unwanted effects occur using vapes compared with other quit methods

·There is some evidence that unwanted effects from vaping are similar to unwanted effects when using nicotine gums, patches or sprays

·None of the studies they looked at show any serious side effects caused by vaping

·When people switched from smoking to vaping, a drop in toxin concentrations and biomarkers of harm were observed – similar to levels found in people who had completely quit smoking

·Over half of all people using a vape to quit smoking were still using their vape six months later, and the team believes this is why vaping works so well as a smoking substitute

Finally, “levels of other tobacco-associated toxicants were also significantly lower among people using e-cigarettes compared to people who continued smoking.”

The evidence in favour of electronic cigarettes is clear
Professor Notley’s belief in harm reduction for tobacco use has been shown to work in multiple research studies as covered by Cochrane. Vaping is safer, works better than NRT and is not linked to any serious side effects.
With the growth is mistrust of ecigs among smokers, it is troubling that Cochrane will not be able to deliver these updates in future – updates that would be vital in the formulation of new legislation by politicians as they seek to limit the use of vapes by underage users. Time will tell how this will impact the UK.