Further up the Garden Path

Since I first wrote about the PATH (Population Assessment of Tobacco and Health) study (https://www.nicotinemonkey.com/up-the-garden-path-to-reduce-tobacco-related-death-and-disease/) how far along have our intrepid researchers got? They now proceed, we are informed, not in steps or stages, but in waves. We’re now at Waves 1 – 3 with a paper released in March 2020 by Saul Shiffman and Mark Sembower. These gentlemen work for an outfit called Pinney Associates which, at the time the analysis was conducted, provided consulting services to the R J Reynolds Tobacco Company and to Juul Labs, the maker of the nicotine delivery device that looks like a USB stick so popular with American school kids (https://www.nicotinemonkey.com/what-rhymes-with-juul/).

This study was on ‘Dependence on e-cigarettes and cigarettes in a cross-sectional study of US adults’ (https://doi.org/10.1111/add.15060).

Before we get into that, let’s refresh our memory of where the PATH is leading. It’s

a nationally representative survey of tobacco use with annual waves of data collection with a four-stage, stratified probability sample of noninstitutionalized, civilian US adults…

All clear?

The current paper presents a ‘Dependence scale items for current users of cigarettes or e-cigarettes.’ This is done with a rating scale of 1 to 5, where 1 means ‘Not true of me at all,’ to 5, which is defined as ‘Extremely true of me’.

Isn’t this absurd, or isn’t it? How can you have degrees of truth? Either something is true or it isn’t, so you only need two possible answers: true or false. Then, the items on which they attempt to assess the degree of dependence—there we go again: someone is either dependent on something or they’re not—are of the following kind (paraphrased slightly for readability):

  • I find myself reaching for cigarettes/e-cigarettes without thinking about it
  • I frequently crave cigarettes/e-cigarettes
  • My urges keep getting stronger if I don’t smoke cigarettes/use e-cigarettes
  • Cigarettes/e-cigarettes control me
  • My cigarette smoking/e-cigarette use is out of control
  • I would feel alone without my cigarettes/e-cigarettes

However one responds to these suggestions, what difference does it make? They all mean the same thing: nicotine addiction.

Not to worry. Messrs Shiffman and Sembower attempt to explain what they’re doing by setting out the ‘Background and aims’ of the study in the following wordy and repetitive statement:

Cigarette smoking often results in nicotine dependence. With use of electronic cigarettes as an alternative source of nicotine, it is important to assess dependence associated with e-cigarette use. This study assesses dependence among current and former adult e-cigarette users on cigarettes and e-cigarettes, compared with dependence on cigarettes.

The reason they think this is important is revealed in the paper’s conclusion:

…whether they were using one or both products, users were less dependent on e‐cigarettes than on traditional combusted cigarettes. These findings…suggest that e‐cigarettes may have less potential than conventional combusted cigarettes to produce dependence, suggesting that individuals who switch from smoking to e‐cigarettes may reduce their nicotine dependence as well as their health risks. This, in turn suggests that smokers who transition from cigarettes to e‐cigarettes may find it easier to subsequently transition off e‐cigarettes should they try to do so. Further research is needed…[Emphasis added.]

Thus we have a hypothetical conclusion based on a fallacious premise (degrees of addiction).

Let me try and put this in plain English.

People who smoke, repeatedly every day suck into their lungs poisonous cigarette fumes, often continuing for years, decades, or even the rest of their lives. They do this because they are addicted to the nicotine in cigarette smoke and thereby find themselves unable to quit. It is well-known and indisputable that this abnormal behaviour is hazardous to health and may have fatal consequences. E-cigarettes, on the other hand, are claimed to be safer than smoking but at present this is unproven. Since many smokers find quitting very difficult, there is a movement, particularly in the UK, to encourage smokers to change the way they obtain their nicotine from smoking to vaping (as e-cigarette use is commonly called). This is counsel of despair, implying ‘once a nicotine addict, always a nicotine addict.’

Nonetheless, if smokers could be prevailed upon to switch completely from smoking to vaping then they would, it is hoped, by dint of inhaling a nicotine aerosol hundreds of times every day (as many typically do) instead of cigarette smoke, this would be a boon for individual and public health.

What the PATH study seems to be driving at is that, if vaping could be shown to be ‘less addictive’ than smoking, then vapers would have an additional reason to turn to e-cigarettes because they may subsequently find it easier to get off e-cigarettes if they were to try to do so.

We don’t need more research. There is no good reason for anyone to use nicotine at all. In any case, no method can be devised to speed up the process of discovering what the effects will be using e-cigarettes for twenty or thirty years: we just have to wait—then we’ll know. But by then it may be too late: https://www.nicotinemonkey.com/vapers-lung-the-disease-that-will-never-be-i-hope/

Text © Gabriel Symonds

Gabriel Symonds

Dr Gabriel Symonds is a British doctor living in Japan who is interested in helping smokers quit. He has developed a unique simple method without nicotine, drugs, hypnosis or gimmicks that he has used successfully with hundreds of smokers. Further information can be found at www.nicotinemonkey.com

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