In a multi-center trial of almost 900 smokers(1), e-cigarettes were shown to be twice as effective as pharmaceutical "gold standard" approaches like gums, lozenges, and patches.

After one year, nearly 20 percent were still off cigarettes, which is in line with U.S. survey results. Gums and patches are only around 10 percent effective and have been criticized by smokers for being a top down approach to cessation and harm reduction; pharmaceutical giants collaborating with government to force a product onto the market to displace tobacco giants. E-cigarettes were instead a free market approach that received a groundswell of support, and achieved success, because they mimic more of the social aspects of addiction while getting rid of the harmful toxins in cigarette smoke.

But anecdotal evidence is not convincing, that it is used by both sides. Teens are rebellious, and if one even claimed to have tried an e-cigarettes on a survey, they were considered addicted by the U.S. Centers for Disease Control and Prevention. Based on claims alone, some health professionals were resistant to recommending them even for the 90 percent of smokers who did not respond to other nicotine replacement products. 

That makes no sense at all.

But 'more evidence is needed' is a standard rejoinder for people who will never be convinced their belief system is wrong. Still, more evidence is what the National Institute for Health Research and Cancer Research UK sought to provide, and it has arrived. Survey results related to the success rates of both ended up being accurate, found the trial; only 9.9 percent of people using pharmaceutical products to quit smoking were smoke free after a year.

Abstinence rates were higher in the e-cigarette arm at all time points

As expected, most of the participants were middle-aged, e-cigarettes and consumer awareness campaigns have already killed smoking among younger people. And 40 percent were poor, which shows the bigger government approach of piling on more taxes has limited effectiveness.

Among abstainers, e-cigarette participants were more likely (79.8 percent) to still use them at 52 weeks than gum and patch nicotine replacement participants (9.1 percent) which is good enough for the "quit or die" contingent (and American pharmaceutical nicotine activists like Prof. Stan Glantz of UC San Francisco) to criticize the result. Nicotine is addictive, just like caffeine, and New England Journal of Medicine published an immediate rebuttal along with the study. "While e-cigarettes are 'safer' than traditional cigarettes, they are not without risks," said Belinda Borrelli, PhD, professor of Health Policy  &  Health Services Research at Boston University's School of Dental Medicine, who co-authored the op-ed refuting the data.

But so what? Nothing is without risk. We don't lower the speed limit for cars to 5 MPH or ban bicycles because they carry risk of accidents. Nothing is as risky as cigarettes, it is the world's leading killer among lifestyle diseases, and increases risks for just about everything. Yes, nicotine is a chemical, but it's time to stop using chemical as a dirty word. And kids engage in fads. Juul is wildly popular in its space, including among young people, and the U.S. government is focused on that company but it is .002 of what the cigarette market is. It is impossible to fathom the health savings if the cigarette market suddenly switched to nicotine and we got rid of the actual toxic chemicals in cigarettes.

There are confounders, of course. The study tried to recruit only participants with no preexisting product preference but there is no e-cigarette product equivalent of a sugar pill, so product allocation could not be blinded.  If someone said one thing on a survey but was biased for or against one of the products is impossible to know.

What is possible to know. For any scholars to defy trial results and argue that e-cigarettes should only be recommended if Chantix fails sounds they are putting their ideology ahead of public health.

(1) At UK National Health Service stop smoking services in Tower Hamlets, City of London, Leicester and East Sussex. In total 886 and were randomized to receive either an e-cigarette starter pack with e-liquid or could choose a nicotine replacement treatment (gum, patch, lozenges, etc. or a combination) for three months. All got behavioral support and were checked for carbon monoxide in breath.