The U.S.
Preventive Services Task Force (USPSTF) released its updated recommendations
for smoking cessation (
here), and the outcome
is utterly unsurprising and unacceptable: “the current evidence is insufficient
to assess the balance of benefits and harms of e-cigarettes for tobacco
cessation in adults.”

The
task force claims that “Recommendations made by the USPSTF are independent of
the U.S. government. They should not be construed as an official position of
the Agency for Healthcare Research and Quality or the U.S. Department of Health
and Human Services.”

In
fact, the recommendations are in lock-step with the policies of all other
federal agencies.

The only
“evidence” the task force deemed acceptable consisted of five randomized
clinical trials (RCTs), and it briefly acknowledged that two showed
success.  However, the report prominently
notes that all trials were conducted outside the U.S., used e-cigarettes that
were not available here, and “continued e-cigarette use rang[ed] from 38% to
80%. One study reported that 26.9% of all study participants were using
e-cigarettes at 1 year.”

U.S.
authorities are obsessed with the idea that only clinical trials can provide
valid evidence that smokers can switch (here).  They are also excessively worried about
continued use of e-cigarettes after smokers step away from the fire, which
plays into their insistence that smoking cessation requires tobacco and
nicotine abstinence.

The
task force exposes its bias when discussing the “harms” of e-cigarettes, introducing
four additional RCTs.  The worst symptoms
reported were not serious: “coughing, nausea, throat irritation, and sleep
disruption.”

In
keeping with federal agency practice, this report cites e-cigarette or vaping
product use-associated lung injury (EVALI), even though this pseudo-epidemic was
linked conclusively to illicit marijuana products.  The task force does mention the real culprit
– vitamin E acetate – but asserts disingenuously that we don’t know if nicotine
e-cigarettes were involved.  They were
not.

It
is striking that the task force describes with conviction minor adverse effects
of safer tobacco products, but feigns uncertainty about any positive effects, such
as helping smokers quit or having no association with EVALI.  At least they put one honest statement at the
top of their report: “480,000 deaths annually are attributed to cigarette smoking.”

The
report closes with lists of “research needs.” 
For e-cigarettes, this involves finding more evidence for anything
negative.  For cessation, “[s]tudies must
be well-designed RCTs.”  No matter how
much evidence is found in government surveys (here and here), it won’t count.  Unsurprisingly, we need to know about “smoking
relapse rates in adults who have used e-cigarettes for smoking cessation.”  Did the task force ever call for similar
research for “FDA-approved methods”? 

Finally
and most importantly, “More research is needed on understanding how to help
adults quit e-cigarettes.”  For the task
force, no other outcome, even for products that are vastly safer than
cigarettes, is valid.

 



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