Do Zero Nicotine E-Cigs Really Count As Placebos?
A recent study comparing 13-week quit rates among smokers using electronic cigarettes and nicotine patches raises an interesting question. The study was interesting on its own as electronic cigarettes showed a higher (though not statistically significant) capacity to help smokers quit smoking.
However, the study did something that a few others have done seemingly without hesitation. It gave zero nicotine electronic cigarettes to smokers and qualified them as a “placebo” group. This carries with it a few questions that researchers may need to ask before they continue doing this.
By the strictest definition, a placebo is a harmless and medically ineffectual pill, medicine, or procedure. It’s often used to compare the psychological tendency to exhibit an effect without the physiological part of the equation. In the case of this study, nicotine is assumed to be the constituent that causes e-cig users to quit smoking. So a group is given an electronic cigarette without nicotine to see what percentage would have quit using a “harmless and medically ineffectual” e-cig.
In this case, placebo seems like a bit of a misnomer. If nothing else, it makes a logical leap that many researchers may not be ready to make: that electronic cigarettes absent nicotine are medically ineffectual and harmless. Even electronic cigarettes absent nicotine are believed to have some effect on the user. This isn’t the same as comparing a nicotine patch to a disguised bandaid.
First, electronic cigarette opponents still like to berate e-cigs for containing propylene glycol. They say that the effects of prolonged propylene glycol (PG) exposure — especially when inhaled — are unknown. Most reasonable researchers find this to be a rather silly argument as PG has been used as a base in countless products for decades with almost no ill-effects aside from a few allergic reactions. Still, this means that the jury is out on the “harmlessness” of zero nicotine electronic cigarettes. This makes it hard to justify them as a placebo, strictly speaking.
Second, electronic cigarettes (again, even without nicotine) represent a complex replacement therapy for smoking individuals. One can hardly compare the existence and non-existence of nicotine to quit rates and think that tells a complete story. E-cigs offer the hand-to-mouth motion, the inhalation ritual, and the social aspects of smoking as well as a variety of flavors. All of these may contribute to a successful quitting therapy having nothing to do with the replacement of nicotine. Again, this can hardly be considered a placebo in the strictest sense.
This isn’t meant to deride the research efforts contributing to our overall understanding of electronic cigarettes. The main point is to say that electronic cigarettes are not a simple thing to study (even if chemically they are). It isn’t enough to slap them into the hands of some smokers and track their quitting rate over a few weeks.
Tobacco cigarettes have been studied for decades upon decades. It will take time to work out all the essentials — like whether electronic cigarette use poses any long-term serious risk (so far, it looks like they don’t pose much). Still, many researchers say that because of the relative complexity of tobacco cigarettes and simplicity of e-cigs, we already know more about the later than the former.