A debate has been raging around the health implications of novel nicotine products, with public health proponents maintaining that vaping or intake of any of the new nicotine products was as equally harmful to human health as combustible cigarettes. The major take-home message from the 6th Summit on Tobacco Harm Reduction (THR) in Athens Greece, was that the resistance to harm reduction is increasing as penetration of alternatives to tobacco novel products grows. Nicotine is burdened with combustible cigarette smoking hazards.
World Health Organisation (WHO) data shows that no less than 8 Million people die globally from the effects of smoking combustible cigarettes. Policies hostile to THR―yet not evidence-based―have been reported on many occasions; although harm reduction is for the benefit of consumers and patients, and is one of the agreements in Article 1 of the WHO Framework Convention on Tobacco Control (FCTC) signed by 168 Parties, it is not respected.
While the lack of sufficient data has been singled out as one of the leading gaps with regard to the acceptance and uptake of novel nicotine products, the Umbrella Review methodology has proven to produce more reliable and authentic data regarding the health implications of e-cigarettes and heated tobacco.
Leading Tobacco Harm Reduction (THR) researcher, Rene O’Leary said during a panel session on the Health effects of e-cigarettes and heated tobacco products that data from systematic reviews conducted over the past 12 months shows impressive smoking cessation levels amongst those who had switched to e-cigarettes and heat-not-burn products.
“We started our systematic review on Electronic Nicotine Delivery Systems (ENDS) and Cessation retrievals. We started with one in 2021 and we went right up to August this year. Looking at the five systemic reviews we conducted and synthesizing them together, what does this say to us about cessation and e-cigarettes? There are two areas that we are looking at. One is the quit rates and the other one is comparative effectiveness. There is a good primary evidence base,” said O’Leary.
21 Randomised Control Trials were looked at in these five systematic reviews and one of the systematic reviews looked at 18 longitudinal cohort studies.
“So what kind of quit rates did we find in these five studies? At the high end, we found 44 percent of people at six months, who switched to e-cigarettes had actually quit cigarettes. At the low end, it was down to 14 percent at 12 months but that was among a group of which had no intention to quit. The general rate of quit rate success is about 10 percent. It’s heart-breaking. That is why we need harm reduction because even those who try can’t seem to quit.”
She added that on the other side, the cohort made an analysis and didn’t find any difference in the quit ratio between the groups. There was no improvement, but very important to remember is that there was no detriment.
She added that they have now set up a new form of methodology called Umbrella Reviews where they take the umbrella approach to all the research that is at their disposal and look at it together.
A comparative analysis of the effectiveness of ENDS and Randomized Control Trials (RCT) data shows that Nicotine ENDS were a more effective smoking cessation tool.
“When we look at Nicotine ENDS versus behavioural/no support, we find that ENDS were 161 percent more effective than having no treatment or simply behavioural treatment. That is nearly double what we do even at the lowest end of the statistical comparison, it's still 44 percent more effective to be using ENDS to quit than not having any support or just a behavioural support.”
Another area that has been of great concern is the Nicotine Replacement Therapies (NRTs). Two systematic reviews found that ENDS were 65 percent more effective than any NRT in helping smokers to quit. Even at the low end of the scale, that is a 21 percent improvement in effectiveness. One of the reviews showed no significant difference in effectiveness. Another systematic review on ENDS versus any form of treatment found that ENDS were 55 percent more effective than any form of treatment.
Meanwhile, presenting on cigarette smoke and reduced-risk products as modifying factors in Non-Alcoholic Fatty liver Disease progression, Professor Giovanni Li Volti said there was no link between novel nicotine products and liver disease.
“It is well known and established that smoking cigarettes promotes drug resistance and the expansion of the Cancer Stem Cell-like population. There is a recently retracted paper about the harmful effects of e-cigarettes and the liver. The paper was retracted by the journal because it was not conducted properly.
“Turning to other less harmful conditions such as Non-Alcoholic Fatty Liver Disease and liver diseases in general, it is a very common disease and for instance, a survey on adolescent participants in the NHANES observed that ALT, a surrogate marker of Non-Alcoholic Liver Disease in the absence of causes of liver disease is present in the 0.8 percent of the United States adolescents aged 12 to 19 years. This means that the disease may already be present when people start to smoke or even start using e-cigarettes, tobacco heated products or combustible cigarettes,” said Professor Li Volti.
Non-Alcoholic Fatty Liver Disease is a Clinical Pathologic syndrome encompassing a wide range of fatty liver diseases in the absence of significant alcohol intake (two drinks or fewer daily) and other common causes of steatosis. There are several grades to Non-Alcoholic Liver Diseases that may get complicated and become more severe. ENDS
