Dr. Foulds and colleagues developed a 10-question scale to assess nicotine dependence and administered it to a sample of 2,368 current electronic cigarette users. Subjects were asked to fill out the scale to assess the level of their addiction while smoking, and then again to assess the level of their current addiction using electronic cigarettes.

2. In contrast to what we reported above, the anti-smoking groups have not - I repeat, have not - criticized the researchers for failing to disclose their conflicts of interest. They did not argue that "section 5 of the form refers to any and all conflicts of interest, regardless of when they occurred," and that "these researchers are breaking not only the spirit, but also the letter of these policies." We apologize for having incorrectly insinuated that these anti-smoking groups are concerned about the scientific and ethical integrity of published tobacco control research.

From a public health perspective, the effectiveness of e-cigarettes for smoking cessation must be assessed by examining how effective the product is for smokers who are trying to quit. When you do that properly, this initial evidence suggests that you find out e-cigarettes are a viable smoking cessation aid for a subset of smokers.

The biggest problem with Stan's approach is that when you examine e-cigarette users who are not using the product to quit, you are introducing a huge sampling bias. For example, why might someone use e-cigarettes, but not to quit? Most likely, the majority of vapers who are using e-cigarettes for a purpose other than cessation are using e-cigarettes to cut down on the amount they smoke. They are likely to derive benefits from smoking reduction. However, they are almost assuredly not going to quit smoking because they are not trying to quit, nor do they have such a desire.

The Rest of the Story

What Stan does not reveal in his review article is that instead of estimating cessation rates among a cohort of smokers who made quit attempts using these products, the Vickerman study analyzed cessation rates of a large number of smokers who had previously tried to quit using e-cigarettes but failed, and then called a quitline because they had failed and wanted to try again. Then, they compared the quit rate among these smokers to that among smokers without such a history of a failed quit attempt using electronic cigarettes.

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