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Doubt cast over the effectiveness of e-cigarettes for stopping smoking

A group of 16 American experts claims that there is no evidence that electronic cigarettes can be recommended as a way to quit smoking.

Tobacco kills half of those who smoke it, and accounts for almost 6 million deaths per year worldwide.  Anything goes when it comes to quitting: nicotine substitutes (patches, gum, tablets, inhalers), drugs, behavioral and cognitive thearapy, or even alternative medicine.  ”But what about e-cigarettes?” you might ask.  The 16 experts on the US Preventive Service Task Force, an American group working on prevention in public health, will tell you that there isn’t enough evidence to show that these devices are effective for stopping smoking.

American Guidelines

The experts came to this conclusion after analysing the results of over fifty studies about the effectiveness of the various methods for smoking cessation.  They published their synthesis a few days ago as a set of recommendations for health professionals.  In it the scientists stress the lack of proof concerning the effects of e-cigarettes and do not recommend their use.

“There are hundreds of studies on the subject, but only 3 are randomized, and therefore the most reliable.” explained Jean-François Etter, a professor of Public Health at the University of Geneva.  ”In a randomized study patients are randomly assigned to one of two identical groups, and in just one of them electronic cigarettes are used.  This allows us to prove causality between e-cigarette smoking and cessation.”

In their view, only two methods are effective for curing addiction to smoking.  The first is medication, using varenicline (commercially sold as Chantix or Champix), buproprion (an antidepressant called Zyban) or nicotine substitutes.  The second is cognitive and behavioral therapy, whch is recommended in particular for pregnant women as a way to avoid the possible side effects of medication on foetal development.

In France

The French tobacco addiction prevention service (Office français de prévention du tabagisme, or OFT) has noted that the commercial success of e-cigarettes coincides with a fall in cigarette sales (-7.6% at the end of 2013) and a reduction in the use of traditional methods of giving up.  In a statement published last year the OFT states that “e-cigarettes are a lot less harmful than traditional cigarettes” and that “replacing tobacco smoking with e-cigarettes can reduce health risks”.  Since 2014 the national health authority has also been recommending to doctors not to discourage the use of e-cigarettes for people who wish to give up smoking.

Despite the prudence of the authorities, the e-cigarette is viewed by many smokers as an alternative to tobacco.  A study of 15000 people carried out in 2014 by the national institute for health prevention and education showed that more than 80% of vapers said that e-cigarettes had enabled them to reduce their tobacco consumption, on average by 9 cigarettes each day.

Retinal Implants Bring Hope to the Blind

Retinal implants could allow the blind to partially recover their sight.  At the Vision Institute in Paris, two blind men explained how their artificial retinas work to health minister Marisol Touraine.

Suffering from pigmentary retinopathy, a hereditary disease causing progressive loss of vision, Jean, 72, and Claude, 60 wear a prosthetic device designed to partially restore their sight. Such medical progress could concern thousands of French people who suffer from the disease.

Since his retina operation two years ago, Jean still remembers the first time he wore his glasses. “It was phenomenal.  I hadn’t seen in 20 years, and suddenly there was all of this.  I said (to the doctors) “it was like fireworks”.  Those fireworks were the flashes that enabled him to see shapes, movement and contrast.

At the age of eighteen Jean was diagnosed with a congenital disease. “I was told ‘At the age of 50 or 60 you might become blind’.”  On public transport, he used to bump into people because they were not in his field of view, he told us.  At work, he went from one manual job to another, and admits to having hidden his problem for a long time, afraid he would be fired.  At 51 he lost his sight completely.  It was around the age of 18 that Claude, who lives in Avignon, started to have blurred vision. Glasses managed to correct what he thought was simply myopia, but now illness has caught up with him.

“When I was offered artificial retinas, I said yes right away” said Claude emphatically .  “It was a gift from above” added his son Julien.  “I hope to recover some of my vision, gain more independence and watch TV”, said this retired farmer whose brothers are also affected by pigmentary retinopathy.  Only five months after the surgery, it is however too early to perceive any possible changes.

Jean assures us he is able to go walking with his wife, often avoiding obstacles all by himself.  He has also succeeded in estimating a person’s height or even spotting a match on the table and grasping it. “It has changed my life a little,” he told us.

Artificial retinas from 50 to 60 pixels

To perceive visual information the patient wears a pair of goggles equipped with a miniature camera and a portable electronic device which relays the visual data to the eye implant. The latter, grafted to the retina transforms visual information into electrical stimulations which are sent to the brain, Serge Picaud, director of research at the Vision Institute, told us.  The patient can perceive at best 50 to 60 pixels in black, white or grey.  This will help him to have a better sense of direction but he won’t see colors, he explained.

To improve their vision, the patients are subjected to rehabilitation exercises: recognizing numbers, letters, or objects of different sizes, or shades of grey.  The aim is to stimulate memory because these prostheses are intended for people who were previously able to see.  The long term objective is to help patients become independent again, to be able to recognize faces, and then read complex texts,” explained Serge Picaud.

Currently, fewer than 10 people have a retinal implant in France, including Jean and Claude, for whom the intervention was fully reimbursed by social security.  Between 20000 and 40000 people suffer from pigmentary retinopathy in France.