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Reading of the Week: Do E-Cigarettes Help with Smoking Cessation? The New NEJM Paper

From the Editor

Last week, I spoke to a patient who wanted passes off the ward so that he could smoke. When I suggested that we could help him reduce his nicotine use – and maybe even help him quit – he responded: “I’ve been smoking for 40 years. I’ll never quit.”

As much as the comment is disappointing, it is all too familiar. Nicotine is highly addictive, and it’s very challenging for our patients to quit.

What then to make of e-cigarettes? While they have been marketed well for smoking cessation, the evidence to date has been lacking. Do they offer a pathway to ending nicotine use? Or are e-cigarettes another type of nicotine product – addictive and ultimately unhelpful?

This week, we look at a paper just published in The New England Journal of Medicine. Queen Mary University of London’s Peter Hajek and his co-authors report on a “pragmatic, multicenter, individually randomized, controlled trial” comparing e-cigarettes to nicotine replacement therapy (NRT). It’s the first adequately powered study on this topic. And this Very Big Paper comes with a Very Big Result: e-cigarettes offered a strong advantage over NRTs.

e-cigGreat ad, great product?

In this week’s Reading, we look at the Hayek et al. paper and consider e-cigarettes.

Have thoughts on the Readings of the Week? Please take this 15-question survey to make the Readings better: https://www.surveymonkey.com/r/GP5XXMB.

DG

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Reading of the Week: Smoking, Cognitive Performance, & Mental Illness: Quitting Matters – the New AJP Study

From the Editor

I don’t quite know when the shift occurred, but somewhere between the zeal of residency and the busyness of life as an attending physician, I stopped documenting nicotine use disorder. Indeed, working with severely ill patients, it was a given that they did smoke, and thus hardly worth mentioning. (Studies suggest that smoking is thrice as prevalent among those with schizophrenia compared to the general population.)

For many of our patients, tobacco use is a deadly problem – a major reason why people with severe, persistent mental illness have a life expectancy much shorter than ours.

This week, we consider a new paper from The American Journal of Psychiatry. The University of Academisch Medisch Centrum Universiteit van Amsterdam’s Dr. Jentien M. Vermeulen and her co-authors consider smoking in those with psychosis, their families and a control group, studying the impact on smoking on cognition – and also the impact of smoking cessation on cognition. Though work has been done in this area, the Vermenulen et al. paper is strong: they consider two comparison groups and follow people for six years. Spoiler alert: smoking cessation improved cognition in people with psychosis.

1304701062nosmokingButt out, think better?

In this Reading, we consider the paper, as well as the editorial by the University of Miami’s Philip D. Harvey, who raises some good points about what is – and isn’t – in the data.

We close the Reading with a couple of housekeeping items, including my new podcast (which may be of interest to Ontario doctors).

DG

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Reading of the Week: Smoking Cessation & Incentives – the NEJM Paper

From the Editor

“So to put it simply, forcing people to choose is not always wise, and remaining neutral is not always possible.” University of Chicago economist Richard H. Thaler and Harvard Law School Professor Cass R. Sunstein write this comment in their widely-read book Nudge: Improving Decisions about Health, Wealth and Happiness. They argue that people could be nudged in a certain direction, improving outcomes. Among the book’s fans: former UK Prime Minister David Cameron and former US President Barack Obama.

Thaler and Sunstein write about shaping basic decisions, like encouraging people to choose among their company’s pension plans. Retirement planning can significantly help people with their finances in their twilight years. But what about substance use? The stakes seem higher: smoking cessation can prevent major health problems long before retirement.

This week, we look at a new paper by University of Pennsylvania Perelman School of Medicine’s Dr. Scott D. Halpern and his co-authors. Published in The New England Journal of Medicine, they consider smoking cessation and find “financial incentives added to free cessation aids resulted in a higher rate of sustained smoking abstinence than free cessation aids alone…”

file-20170804-6503-18ujgw6Nudging people to butt out?

In this week’s Reading, we consider the paper and its implications. (There is, however, no financial incentive offered here.)

DG

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Reading of the Week: NEJM and Smoking Cessation

More than 50 years after the release of the first Surgeon General’s report on the harmful effects of smoking, national policies, behavioral programs, and pharmacologic approaches have helped reduce smoking rates in the United States. However, the need for new approaches is clear because smoking remains the leading cause of preventable illness and death.

So begins a big paper from The New England Journal with a simple aim: getting people to butt out. It raises two important questions: If we are serious about promoting smoking cessation, are we willing to put ‘our money where our mouth is’ – literally? And how could we do this?

“Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation” by Dr. Scott D. Halpern et al. is this week’s Reading; it has just been published.

Though other papers have been written on this topic, the Halpern et al. paper is clever and interesting – and the results are surprising.

And, don’t tell the editors of The New England Journal of Medicine: the results are also disappointing. Continue reading