Why can"t scientists agree on e-cigarettes?

Earlier this year, Michael Gove claimed Britain’s had enough of experts. Now I don’t agree with Gove on much, but when it comes to e-cigarettes, he may have a point. We’re bombarded with stories about these products, but most just add to the confusion, with perceptions of vaping risks rising year on year. Just recently the Sun informed us that experts are saying “e-cigs are just as bad for your heart as smoking fags”, but read a couple lines down and you’ll find other experts reasserting the claim that e-cigarettes are 95% safer than tobacco. So which is it? Why can’t the scientists agree? And will they ever?

Cochrane is a global non-profit group that reviews all the evidence on healthcare interventions and summarises the findings so people making important decisions – you, your doctor, the people who write medical guidelines – can use unbiased information to make difficult choices without having to first read every study out there. This week, the latest Cochrane review of e-cigarettes was published. I’m its lead author. While our conclusions are limited because there aren’t many high quality studies available yet, overall the evidence suggests that (1) e-cigarettes with nicotine can help people quit smoking, (2) they don’t seem to have any serious side effects in the short- to mid- term (up to 2 years), and (3) in some cases, switching to them leads to changes in your blood and breath that are consistent with the changes you’d see in people who give up smoking altogether.

This is good news. But other systematic reviews and studies have drawn very different conclusions, and I’m going to try to shed some light why that is.

Can e-cigarettes help people quit?

Our Cochrane review (and others, like this one published in PloS One) suggest they can. But a review published in the Lancet Respiratory Medicine earlier this year, which received a lot of attention, suggests they actually make it harder. The reason for this difference is the types of studies the authors include.

Randomized controlled trials are the best way to see if a treatment works. As Ben Goldacre, author of Bad Science, explains, by randomly assigning people to one intervention or another and measuring the outcome in the same way across both groups, you can rule out alternative explanations for differences between groups. The reviews that find e-cigarettes help people quit smoking only include randomized controlled trials. The studies (like this one and this one) that find that e-cigarettes stop people from quitting aren’t randomized controlled trials – instead they survey smokers and ask if they are using e-cigarettes. Then, some months later, they ask the same people if they are still smoking. We don’t know if the results from these studies reflect the effect of vaping, or if something else about the vapers makes it harder for them to quit. For example, it might be reasonable to imagine they are more dependent smokers, which is why they vape as well as using regular cigarettes. This would make quitting harder.

Are they safe?

The issue here isn’t so much the study type, but the way you ask the question. By ‘safe,’ do you mean completely without risk? No, they’re not – not much is. We’ve seen stories about people catching fire and puppies with nicotine poisoning. Plus, in general, it’s not a great idea to inhale chemicals into your lungs if you can avoid it. Experts basically agree on that – I’ve yet to come across a tobacco researcher or policy maker who would recommend you start using e-cigarettes if you aren’t already a smoker.

The crucial question here is – safe compared to what? Cigarettes are uniquely deadly. They kill one in two people who use them regularly. So, if you’re asking whether e-cigarettes are safer than regular cigarettes, most experts would, after briefly hesitating, lean on the side of yes. The hesitation is there because e-cigarettes are new to the scene. We don’t know their long-term safety profile, so we have to look for clues elsewhere – for example, studies that measure side effects of short-term use (results from these are promising) and studies about how e-cigarettes affect your blood, lungs and heart. Interpreting these measures is complicated. For example, a recent study found that vaping affects the same blood vessel in your heart as smoking regular cigarettes. This isn’t necessarily surprising – we know nicotine, the active agent in both, affects this vessel. We also know that nicotine isn’t responsible for the harms associated with smoking. So how to interpret these results? The gamut of expert reactions ran from “[e-cigarettes are] far more dangerous than people realise” to “vaping carries a fraction of the risk of smoking.” When it comes to long-term safety, experts are making their best guesses in the absence of solid data, and that’s where room for disagreement creeps in.

So what’s next?

The good news is there’s lots of research going on – finally. The most recent update of the Cochrane review found 26 studies in the pipeline that will help answer questions about the safety and effect of using e-cigarettes to quit smoking. The more studies we have looking at a question, the more certain we can be about the answer. The irony is that until we have the answer, narrow interpretations of the results of individual studies risk doing further harm, undermining public confidence in science and possibly discouraging quit attempts. Fundamentally, tobacco researchers on both sides of the argument want the same thing – to reduce death and disease. We’re in the same boat. If you’re reading this as a member of the public, please don’t be put off by the conflicting headlines – we all agree cigarettes are bad for you, most of us agree vaping is probably much safer than smoking regular cigarettes, and if you’re a smoker we all really want our research to help you to quit. Don’t let us get in the way.

Jamie Hartmann-Boyce is an author and editor of the Cochrane Tobacco Addiction group, based at the Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK. She works as part of the Health Behaviours team, reviewing the most recent evidence to help people stop smoking and manage their weight. You can find her on twitter at @jhb19. Her words stated and expressed in this blog are entirely personal, and do not represent any official views or opinions of Cochrane.

Why can"t scientists agree on e-cigarettes?

Benefit Experts Agree With Obama That ACA Has Sufficient Enrolled

Well being advantages consultants agree with President Obama’s assessment this week that adequate Americans have signed up to personal overall health strategies beneath the Inexpensive Care Act that it will perform even though there could be up to two million fewer Americans covered than the White Home had hoped.

“We would agree with the president, but it is really on a state-by-state basis,” explained Bryce Williams, managing director of rewards consultancy Towers Watson’s exchange answers segment. “We really do not even appear at the national enrollments. You don’t need to get to six to seven million nationally.”

The Obama administration earlier this week mentioned 4.2 million people picked strategies on both federal or state exchanges throughout the 5-month signup period through February with less than a month to go for folks to select a plan with subsidized well being advantages under the law.

On Friday, Obama informed WebMD in a video linked right here that he’s assured there’s enough individuals signing up for wellness insurance on the state and federal marketplaces that the law’s “going to function.”

“The simple principle of insurance is pretty straightforward:  the far more you can spread the risk with more men and women, the better deal you are going to get,” Obama mentioned in the WebMD interview.  “Now the pool is previously massive enough.  The variety of men and women who’ve signed up is currently big sufficient that  I am confident that the plan will be steady.”

Official photographic portrait of US President Barack Obama (born four August 1961 assumed office twenty January 2009) (Photograph credit: Wikipedia)

But Obama explained the essential will be the demographic makeup of the threat pool, which requirements younger people signed up to balance the claims that will be filed by older Americans who have a tendency to have more well being care requirements and will for that reason expense the system much more.

Overall health positive aspects consultants mentioned there is explanation to be concerned about whether or not ample younger Americans have signed up due to the internet site concerns early on that might have hurt enrollment.

In addition, slow signups in particular states that have continued to have much more technical problems, this kind of as Oregon, could set off wellness ideas to sustain better losses and consider pulling out of the program, benefits consultants explained.

“From an actuarial perspective, the truth that the rollout was poor harm preliminary enrollment, and the recent extension of the transitional policies by way of October 2016 may likely hold a lot of out of the single danger pool, at least for the quick term,”  said Tammy Tomczyk, principal and consulting actuary with Oliver Wyman Consulting Actuaries.

So far, however, wellness insurance coverage businesses have said the enrollment is trending younger and there have been number of surprises that would demand them to pull out of the program.

Americans can nonetheless enroll by way of the end of this month for coverage in 2014. Underneath the law, millions of Americans can get a subsidy of up to $ 5,000 to purchase an array of well being plan alternatives that consist of individuals sold by Blue Cross and Blue Shield strategies, Aetna (AET), Cigna (CI), Humana (HUM), UnitedHealth Group (UNH), based on the state.

Despite the technical troubles that dogged the healthcare.gov web site and prevented millions of Americans from signing up in October and a lot of November, positive aspects consultants mentioned they often expected the enrollment to be slow.

“Six or 7 million individuals doesn’t sound like significantly in a population of 300 million, but when you take into account that the majority of Americans gets their well being insurance through employers, and yet another big chunk is covered by government plans like Medicare, Medicaid, and Tricare, you are left with twelve million covered in the Personal industry and about 48 million uninsured pre-ACA,” said Helen Leis, spouse in the well being and lifestyle sciences practice group at Oliver Wyman, “Six or seven million of that is very good uptake right after significantly less than six months. We count on to see about 22 million lives on the public exchanges by 2018.”

Benefit Experts Agree With Obama That ACA Has Sufficient Enrolled

Smoking ban in cars when driving with young children: do you agree?

Smoking in vehicles exposes young children to notably “substantial amounts of tobacco smoke” say health professionals in a letter to MPs. Photograph: Alamy

MPs will vote Monday on no matter whether to back a ban on smoking in autos when young children are current. Divisions in Tory and Liberal Democrat ranks indicate Labour help is most likely to carry the ban by way of the Commons.

If the Commons backs the amendment to the Youngsters and Families Bill, the Well being Secretary will have the power to bring in a ban in England, empowering the government to make it a criminal offence for drivers to fail to avert smoking in their autos when youngsters are existing.

Final week, much more than 700 well being specialists wrote an open letter to MPs urging them to back the measure.

The shadow public wellness minister, Luciana Berger, explained 300,000 GP appointments every yr consequence from kids suffering from the results of secondhand smoke, like these who have had to endure passive smoking in the back of a vehicle.

The letter writes that smoking in automobiles exposes youngsters to specifically “higher quantities of tobacco smoke” and there is now a consensus that kids must be protected from this kind of pointless hazards

Bans on smoking in autos carrying kids presently exist in countries which includes Australia, Canada, South Africa and the US.

What do you believe? Should it be a criminal offence to avert smoking in your automobile when kids are existing? Do you consider the law has any possibility of getting enforced? Vote and share your view in the comment thread under

Smoking ban in cars when driving with young children: do you agree?