The Strongest Evidence Yet Says Vaping Beats Patches.

In late August, Cochrane published an updated review of nicotine vaping, using a phrase it rarely deploys. The evidence was high-certainty, it said, that nicotine vapes produce higher quit rates than patches and gum.

The choice of phrasing is far more notable than it might sound, because Cochrane is the most cautious name in evidence-based medicine. It is the organization that reviews everyone else's research for a living and usually concludes that the findings are encouraging but further study is required. For Cochrane to call anything high-certainty is actually quite remarkable. 

The review drew on 80 randomized controlled trials and almost 30,000 participants. Across all of it, the pattern held firm. Smokers using nicotine vapes quit at a rate of around eight to ten per hundred, while smokers using the patches and gums (that have been the official advice for forty years) managed just six.

A few percentage points sounds trivial until you apply it to America's 28 million smokers, where it works out to several hundred thousand people who quit on one method and would not have on the other. In most areas of medicine, a cheap and widely available product that beat the standard treatment by that margin would be in every doctor's office within the month. 

There is a caveat. Most of the trials only followed people for six months, so the long-term numbers are a little weaker, and that is a fair thing to hold against the review. By the same token, it is not a reason to shelve the best evidence anyone has, which is more or less what American policy has done with it.

American Silence

None of this is particularly new or disputed, but the trials have stacked up for years and keep pointing the same way, and American health advice has barely moved in response.

The FDA still does not recognize vaping as a way to quit smoking, and a smoker who asks a doctor for help in most of the country gets handed the same patch Cochrane has now rated the weaker option. The big health charities go further and actively advise against the thing the evidence favours. 

The current messaging dates from a decade ago, when there was a real panic about teenagers taking up vaping, and it has never been rewritten since. A smoker whose own doctor keeps nudging him away from vaping could be forgiven for assuming it must be dangerous (or at least pointless), and plenty have drawn exactly that conclusion and kept smoking. 

How Britain Played It

The National Health Service recommends vaping to smokers who want to quit and hands out starter kits in some parts of the country, which is probably what you might expect a health service to do with such emphatic evidence.

British smoking rates have fallen to among the lowest in Europe, and for the first time on record there are more vapers than smokers in the country. A smoker who takes the NHS advice usually ends up with a refillable device and a bottle of the regulated e-liquids UK retailers have sold for years, rather than a patch, which the evidence never rated quite as highly.

The breakthrough everyone keeps waiting for already happened and has been sitting in the Cochrane database for years. What it needed was someone in authority willing to read it and rewrite the advice, which Britain managed and America has not.

So Why the Deadlock?

The American vaping debate rumbles on well past the point where the facts stopped being in debate. Cochrane has said (as directly as it says anything) that nicotine vapes are the most effective quitting aid a smoker can buy. What remains unresolved is not the science but whether anyone with the authority to rewrite the official advice will get around to reading it.

A smoker who wants to quit has never had a stronger option than the vape, but in most of America the official advice still points him at the patch instead.