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E-cigarettes more effective than nicotine replacement to help smokers quit, study finds

Findings stir debate over regulation of e-cigarettes.

A customer exhales vapor from an e-cigarette at a New York store. (Frank Franklin II/AP)

E-cigarettes are almost twice as effective at helping smokers quit as nicotine replacement therapies such as lozenges and patches, according to a new study that immediately stoked the debate over whether e-cigarettes are an important smoking-cessation tool or a health menace.

The study, published online Wednesday by the New England Journal of Medicine, is the first randomized trial to test the effectiveness of modern e-cigarettes vs. nicotine-replacement products, said Peter Hajek, a psychologist at Queen Mary University of London, who led the trial. The researchers found that 18 percent of the e-cigarette users were smoke-free after a year, compared with 9.9 percent of those in the nicotine-replacement group. The participants also received behavioral support to stop smoking.

For years, physicians have been reluctant to recommend e-cigarettes for smoking cessation because of a lack of clinical trial data, Hajek said. “This is now likely to change,” he added in a statement.

But two editorials in the same publication threw some cold water on the trial’s results. One editorial, by Boston University researchers, said e-cigarettes should be used only when Food and Drug Administration-approved treatments do not work. Those approved therapies, as well as drugs such as bupropion, have higher effectiveness rates than the new study suggested, and much more is known about their side effects, said Belinda Borrelli, a Boston University researcher who co-wrote the editorial.

She noted e-cigarettes pose some serious risks, including potential harm to the lungs caused by flavorings — as well as the possibility that some people will end up using both regular cigarettes and the electronic versions.

The other editorial called on the FDA to immediately ban all flavored e-cigarettes, saying such flavors are responsible for a huge increase in teen vaping. “We fear that the creation of a generation of nicotine-addicted teenagers will lead to a resurgence in the use of combustible tobacco in the decades to come,” said lead author Jeffrey Drazen, editor in chief of NEJM. Such a ban would go far beyond FDA’s plans to sharply restrict sales of flavored e-cigarette products, other than mint and menthol.

David Abrams, professor of social and behavioral sciences at New York University who is a strong supporter of e-cigarettes, said the editorial calling for a ban “misses the boat.” He noted the new British study provides “very strong evidence” e-cigarettes “can help you quit, as good or better than nicotine-replacement therapy” over the long term. “Anybody who smokes should be switching to e-cigarettes now.”

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