"E-cigarettes might help women who are pregnant to stop smoking." Shockingly, that's the conclusion of a new study that found that 93.2% of 569 UK women who were provided refillable e-cigarettes 3-4 months into their pregnancy were still smoking at the end of their pregnancy.

Published in the May 2022 edition of Nature Medicine, what were the study's 18 authors smoking?

Entitled "Electronic cigarettes versus nicotine patches for smoking cessation in pregnancy: a randomized controlled trial," the nicotine patch's unadjusted smoking relapse rate was even worse. There, 95.6% of 571 patch users were still smoking at pregnancy's end.

With nearly all women failing to quit, wouldn't a more accurate conclusion have been, "Our study found that it is highly unlikely that e-cigarettes or nicotine patches will help pregnant smokers stop smoking"?

The burning question is, why would the study's 18 researchers/authors conclude otherwise?

They did so because they put on blinders as to the study's disastrous smoking cessation rates while focusing instead on the e-cigarette's microscopic victory over the patch.

The authors ignore two important points. Upon learning they were pregnant, delayed smoking cessation until enrolled in the clinical trial and randomized to either the patch or e-cigarettes granted women license to smoke.

Also, as with the recovering alcoholic taking a sip, unsupported nicotine weaning schemes are generally longer, more challenging, and less effective than abrupt nicotine cessation.

As for using e-cigarettes to stop smoking, even the winners are losers. They're still hooked. Also, more end up dual users of both cigarettes and e-cigs than actually quit smoking. With two studies finding that most e-cig users want to quit vaping, what's the cure for the cure?

The authors are dismissive of the fact that congenital abnormalities among babies of e-cigarette users were 41 percent higher, with birth defects occurring in 25 babies (4.6% of e-cig users) compared to nicotine patch users where 15 babies (2.7%) were born with abnormalities.

"The difference between the study arms was not significant," the authors wrote. And the "findings do not suggest that e-cigarette use in pregnancy poses larger risks than use of NRT..."

How is a 41% greater birth defects rate not significant while the 48% difference between the 6.8% of e-cig users who quit smoking and the adjusted 3.6% patch user rate was significant enough to fully support the study abstract's conclusion?

The nicotine patch group sounded alarms too. Patch users experienced more neonatal deaths than e-cig users (3 vs. 2), more post-neonatal deaths (3 vs. 0), a higher pre-term birth rate (11.5% vs. 8.4%), with lower birth weights (14.8% vs. 9.6%).

Varying risks may be explained by the fact that the transdermal patch delivers more nicotine to the fetus than smoking does.

As Duke nicotine toxicology Professor Slotkin has noted, studies have found that the brains of fetal mice contain up to 2.5 times higher nicotine concentrations than found in the mother's blood when on a slow continuous nicotine feed, as is the case with the nicotine patch.

Might higher e-cig birth defect rates be explained by the fact that inhaling e-cigarette vapor introduces substantially more chemicals into the bloodstream than a nicotine patch, including flavorings? Frankly, we don't yet know.

One of the few "near-risk-ties" between the e-cig and patch was in the number of women with adverse birth outcomes, which occurred with 112 or 20.5% of e-cigarette users and 118 or 21.7% of patch users.

All 18 of the study's authors know that nicotine is a potent natural insecticide and that synthetic nicotine products called neonicotinoids are the leading farm pesticide worldwide.

In conducting nicotine experiments on pregnant humans the authors effectively ignored scores of animal studies finding that nicotine during pregnancy causes what the authors term "serious detrimental effects."

As reviewers, three of the study's authors, including the lead author, were involved in producing a 2005 UK guidance advocating NRT use by pregnant smokers.

There, while admitting that there is insufficient evidence of pregnancy NRT effectiveness but "overwhelming evidence for effectiveness generally," it was noted that while nicotine "may ... contribute to some of the damage to the fetus caused by smoking ... this contribution is likely to be small and there is no doubt at all that NRT use is much safer than smoking."

Nicotine harm risks are "likely" to be relatively small? Neither this new study nor the 2005 Guidance specifically discuss any potential fetal nicotine harm.

To name just a few, recent animal studies have linked pregnancy nicotine to congenital heart defects (2022), brain damage with impaired memory, learning and motor coordination (2020), ADHD-like behaviors, such as hyperactivity, anxiety and compulsive-like behaviors (2020), and sudden infant death syndrome (2017).

So it's head-scratching when the new study's authors note that "Given the questions that remain about the potential risks of nicotine in pregnancy, stopping smoking without nicotine-containing aids is preferable to switching to such products."

Preferable?

Knowing that pregnancy nicotine use is super risky, knowing that nearly all population-level findings suggest that OTC NRT is ineffective and that the vast majority of UK smokers who successfully arrest their dependence upon nicotine do so cold turkey, why aren't these 18 researchers super driven to investigate, discover and share the "preferable" keys to successful abrupt nicotine cessation?

There are a number of reasons. Peer pressure isn't just about teen smoking and extremism doesn't just occur with religion or politics. Three decades of pharma-driven group-think has taken a toll.

Also, there's no money in free quitting. And it's contrary to pharma's financial interests. Researchers know that should they find smart turkey effective and science-based that they will never again be a recipient of pharma funding or consulting fees.

It isn't easy openly admitting that you were mistaken all those years about OTC replacement nicotine being highly effective. It's less painful to advocate vaped nicotine as you try hard to ignore the likelihood that more than 200 placebo-controlled NRT trials were not blind or science-based as claimed.

While knowing that smokers wanting to quit cold turkey (most spontaneously) almost never wait and join clinical trials dangling free NRT or refillable e-cigarette devices as study recruiting bait, it's simpler to pretend that they do.

So, what is the key to successful cold turkey quitting? If any of these 18 researchers know the answer, they certainly haven't shared it.

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