Almost two-thirds of Canada’s 4.2 million smokers are seriously considering quitting—and more and more of them are turning to e-cigarettes for help. A new, first-in-Canada study, led by McGill cardiologist Dr. Mark Eisenberg, is asking whether vaping really is the magic ticket to breathing free and easy.
A five-year, first-in-Canada study, led by McGill cardiologist Dr. Mark Eisenberg, is exploring whether vaping really is the magic ticket to finally breathing free and easy.

By James Martin

Although the holidays may seem like a distant memory, statistically speaking, most of us are still sticking with our New Year’s resolutions. (For now. Let’s not talk about how many of us last until July.) For many, that means quitting smoking — and they’re hoping that electronic cigarettes will help. According to the U.S. Centers for Disease Control and Prevention, nearly half of all American smokers have tried e-cigarettes to help them kick the habit. But Dr. Mark Eisenberg wants to know: Is vaping really the magic ticket to breathing free and easy?

Dr. Eisenberg is passionate about getting people to butt out. He gives a lot of smoking cessation talks — just last month, he spoke at the Jewish General Hospital, where he is staff cardiologist — and has noticed that, invariably, reformed smokers come up to him afterward to sing the praises of e-cigarettes, those increasingly popular handheld battery-operated vaporizers that mimic conventional cigarettes.

“This is just a first step," says Dr. Mark Eisenberg of his five-year study." But the fact is that smoking is still the single most reversible cause of mortality in Canada — so it’s an important first step.”
“This is just a first step,” says Dr. Mark Eisenberg of his five-year study.” But the fact is that smoking is still the single most reversible cause of mortality in Canada — so it’s an important first step.”

“They say, ‘I smoked for decades and I’ve tried everything — nicotine gum, patches, Zyban, Champix — and I couldn’t stop. Then I picked up an e-cigarette and I never smoked again,’” recalls Eisenberg, who is also a professor in McGill’s Faculty of Medicine and director of the Joint MD/PhD program. “Anecdotally, we have many, many cases like this.”

What doctors don’t have, however, is hard data to back it up. That’s why, this month Eisenberg will start a five-year clinical trial to look at how effective e-cigarettes are at aiding smoking cessation. It’s not just smokers and physicians who are interested in such clarity — so are lawmakers. Under Canada’s Food and Drug Act, e-cigarettes containing nicotine cannot be imported, advertised or sold without Health Canada’s approval; nicotine-free e-cigarettes are not restricted. Although Health Canada has yet to grant such approval, nicotine-loaded e-cigarettes are nevertheless widely and openly available in Canada.

The study, which is funded by the Canadian Institutes of Health Research (CIHR), will follow 486 outpatient smokers at 19 sites across Canada. The smokers will be randomized into three groups. One group will be given e-cigarettes that contain nicotine and counselling. The second group will receive e-cigarettes that do not contain nicotine, and counselling. The third group will only receive counselling. The researchers will supply the smokers with e-cigarettes for 12 weeks, and then follow up with them after six months and a year, observing whether they graduate to total non-smoking, continue with the e-cigarettes, or return to conventional cigarettes. Although some reformed smokers may fall off the wagon after a smoke-free year, Eisenberg clarifies that “statistically significant results at 12 months would still be important evidence” for the efficacy of e-cigarettes as a cessation aid. All 486 patients will not be enrolled simultaneously, with the study expected to roll out over the course of five years.

“The ultimate goal is to use the e-cigarette as a transitional tool in going from smoking conventional cigarettes to not smoking at all,” says Eisenberg. He notes that, at least in the early stages, e-cigarettes are about “transferring the addiction. You’re getting people onto something else that is giving them their nicotine, so they may never quit. E-cigarettes also provide other physical and social aspects because they feel like a cigarette; a pack-a-day smoker makes that hand-to-mouth motion more than 70,000 times a year, for example. That’s a difficult thing to break away from, and a nicotine patch doesn’t provide it.

“We have great hopes that e-cigarettes will be helpful for people trying to quit smoking,” he adds. “Even if they just switch to smoking e-cigarettes that would be better than continuing to smoke conventional cigarettes for decades. I’m not saying that e-cigarettes are safe, but they’re much safer than conventional cigarettes. They’re not going to give you lung cancer. They’re not going to give you heart disease. They’re not going to give you emphysema.

“But what we’re really hoping for is that e-cigarettes lead people to not smoking altogether.”

(This particular study, Eisenberg notes, is not designed to investigate safety concerns, such as whether e-cigarette vapour contains trace elements of harmful substances. Other than their smoking habits, the trial’s participants are healthy, he explains, “so the chances that they’d have adverse effects over a short time like the course of one year are quite low.” The researchers will, however, track whether the smokers are hospitalized for any cardiopulmonary issues. They will also gather data about benign side effects, such as throat irritation.)

E-cigarettes are already big business, ringing up an estimated $500-plus million in sales in the U.S. alone — and that’s without being able to make any claims about helping smokers kick their habits. Eisenberg says that the e-cigarette industry itself isn’t clamouring to make such claims: “They don’t want to be regulated by the Food and Drug Administration [in the U.S.] and Health Canada, so they don’t want to support clinical trials,” he says. “And they don’t need to: Smokers are voting with their feet by buying e-cigarettes to help them quit smoking.” Governments, however, want more than anecdotal evidence.

“This study alone would not be enough for Health Canada to allow companies to market e-cigarettes as smoking cessation aids,” explains Eisenberg. “That said, if this trial shows that there is a substantial reduction in smoking traditional cigarettes, then Health Canada will have to rethink their policy.

“This is just a first step. Then we would need multiple big trials in multiple populations. We would need to use tapering [of nicotine levels] studies, and we would need to use interventions that are longer than 12 weeks. But the fact is that smoking is still the single most reversible cause of mortality in Canada — so it’s an important first step.”



Comments on “E-quitting”

  • Avatar

    I wanna know what type of vape he’s going to supply as that is one of the key reasons why ppl quit. If they use the crap ones they have at the corner stores the end results may not be satisfying. We should be contacting this dr and ask for details.

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    James Sweda

    Well before all the government officials jumped the gun , these studies should of been done . This is one of the biggest reasons a lot of people lost faith in there own government and health officials.

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    I agree with Richard, the “cig-a-like” type of vaping devices are not very effective. I used those about two years ago and was not satisfied with them and did not quit at the time. In September 2015 I bought a real personal vaporizer (mod and tank) and have not had a single cigarette since. The instruction and guidance provided by my local vape shop is what I needed to succeed.

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    Hopefully this doctor takes the time to speak to an actual vape shop or long time vaper and pick the right devices to start with. I started with a cigalike and it failed but once I got a pen type and the right juice I was off to the races and have never taken even a drag of a cigarette since. Its been more than 3 years and I smoked 3 packs a day, so if I can do it anyone can.

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    “Under Canada’s Food and Drug Act, e-cigarettes containing nicotine cannot be imported, advertised or sold without Health Canada’s approval”
    Wrong. In 2009, Health Canada made a suggestion that people not use e-cigarettes, but there is no federal law in Canada which states that they cannot be imported, advertised, or sold without Health Canada approval.

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    Any time Health Canada or a lot of researchers talk about vaping, they always call it a smoking cessation tool…..but it is really up to the person trying it. I use it as a harm reduction tool as I am not willing to give up the health benefits of nicotine. In Canada, I have never seen a vape shop sell vape gear as a smoking cessation aid. It seems only public health, doctors and Health Canada want to pigeon hole vaping into a medical device or prescription…..and that is simply the worst idea ever. I also agree with other comments made here that I would be curious to know whether the study would use useless cig-a-likes or real vaping gear from a vape shop. Using the real devices would be the only way to do this study properly. I have been vaping for 7 years now….with nicotine after using tobacco for 43 years….a pack & a half a day. Vaping was what took me off the tobacco merry-go-round. I’ve never “fallen off the wagon” in all that time. The smell of tobacco now actually makes me feel ill.

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    I smoked 2 packs a day for 41 years. Tried many stop smoking products with zero success. The day I bought my e cigarette was the last day I smoked a real cigarette. That was 2 years & 5 months ago.

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    The problem with blanket studies like this is that not one device will work the same for everyone, typically when a smoker wants to give vaping a shot they need to find a device and flavors that suits them, this is of utmost importance when it comes to success rates and one of the major advantages the unrestricted market has now.
    I can’t quite remember the number but on average I believe the number of devices purchased/tried was 3 before they found one that was suitable for them, some flavors may sound tasty but aren’t actually ideal to use all day, personally I prefer fruit flavors in the morning/afternoon but at night I’ll use desert flavors, having just one flavor isn’t ideal as well, a persons taste buds can become immune/mute to more subtle flavors if used extensively.
    I would suggest having 3 different devices and allow the person to upgrade if they feel the need. (I under no circumstances recommend cigalikes the ones that look like cigarettes although they work for some they have been proven to have sub par performance)….
    Simple Ego/Evod 1.6ml tank setup (1.6 ohm to 2.4 ohm coil choice)
    A mid range Variable Wattage with a 30 watt maximum variable wattage device (1 ohm to 1.5 ohm coils)
    A more advanced device Variable Wattage/Temperature Control device with a 75 watt maximum (0.5 ohm – 1.2 ohm in wattage mode and various resistances for Temperature mode).
    If you would like recommendations for actual devices contact me via my supplied email or facebook link.

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    Lyne Lépine

    me and my husband have been off the cigarettes for 28 months and stopped with the e cigarettes and tried all the other stuff to quit out there.I say is the best thing so far to quik smoking.The big problem with the e-cigarette is the governement are not making money off it and pharmaceutical companies are not also, their patches-gum-anti depressive are not selling big businesss for them.They are with the governement it all about MONEY they don’t care about your health.Governement are bought by pharmaceutical company to put the eliminate the e- cigarette. Thats why the e-cigarette is now considered in the same category as the tobacco industry

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    Cliff Chandler

    I started smoking at 13 by the time i hit 34 i could barely breathe. I drive truck,just cranking a dolly handle winded me. One night at the truck stop i woke up choking , i could not get a breath into me scared me senseless , waited about an hour till i was comfortable driving myself about 4 blocks down to the walk in clinic, the nurces were shocked i drove there. It was clear i needed serious help. I was diagnosed with C.O.P.D. at 34 yrs old youngest she had ever seen . i was on 3 inhalers pills and steriods to force my lungs to work. She said she could not recommend it but to buy a vaporizer. I did that day. It was a huge wake up call for me. She said at my age it can be possible to recover from the damage. Its been 6 mos. My lung function has improved. My blood pressure dropped back below 140. I can breath deep and full and i only need the 1 inhalor now. I used the vaporizer non stop when i first got it but find myself using it less nowadays. I thought i would die with a cigarette in my hand. Giving that up i thought was physically impossable, but with use of the e-cig seems possible now. Really tired of hearing people bash the use. I sleep better as well. When i wake i dont frel dead like a zombie all day. I have energy. I can hit the treadmill for over an hr every day……..a long way for a guy who could barley crank a tlr dolly. I hope your reasearch sheads light on some of the positive things this does for people instead of all the factless garbage you hear. Only a smoker who switches to an e cig will understand how much better they feel. Should be classified as a health wellness device and never looked at in the same light as smoking.

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    FFS!!!! Once again someone in the “heath” profession is calling VAPING smoking!!! You can’t SMOKE an e-cig in any shape, way or form.
    Ok, rant over. However, on a serious note or two:-
    As others have pointed out, the choice of vaping devices and juice is vast, and finding the right kit & juice FOR THE INDIVIDUAL is a key success factor. Also, tank systems have already been studied and shown to be more effective than cig-a-likes for people quitting tobacco altogether (can’t find the link to the study at the moment, but it is out there from mid-2015)
    If, as I suspect, the subjects are given cig-a-likes, with too low a nic level and a chronic lack of variety of flavours and no-one quits, I can see the skewed study headlines now….
    Why not recruit some of the non-smoking vaping anecdotes (i.e. vapers!!!) to help out the study subjects with advice and support for proper kit, a far wider range of juice, and yes, technical support to help them vape better, THEN see what the study concludes….
    oh, I’m a 3.5-year tobacco-free vaping anecdote from Wales, so your doc would probably still class me as a “smoker” (sic)

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    I welcome the study if its aim is to demonstrate to governments, health practitioners, and smokers that vaping provides a safer and more satisfying alternative to smoking. I won’t repeat the wise advice given in previous comments except to advise the doctor to make sure that the counselling is provided by staff in dedicated vape shops. Most vapers don’t need much encouragement once they’ve started, but they do need practical information about how to use and maintain the devices. Above all, don’t hand out the cheap cig-a-likes! That will prove nothing.

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    “One group will be given e-cigarettes that contain nicotine and counselling.” As others have said, cig-alikes aren’t likely to work. Picking the right combination of hardware, e-liquid strength, viscosity and flavors is a highly individual thing and the number of possible combinations is virtually infinite. Some experimentation is required. In the likely event that the people doing the counselling aren’t well versed in e-cigarettes and how to use them, the study’s results won’t mirror reality. The subjects of the study would be better off getting their counselling at ECF.

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    Here’s an article I wrote for the local paper I worked for. I’ve been tobacco free for 2 and a half years now and still vape with no regrets.
    Hi, my name is Doug, I smoked cigarettes for 36 years until July 1, 2013. I am also a freelance sports photographer for The Paper and have been doing so for the past 5+ years. The last part is relevant to my decision to quit smoking. Chasing up and down a football field or a soccer field is a pretty decent workout at times and over time since I started at The Paper I realized I was losing lung capacity and would tire quickly and would need to stop frequently to catch my breath. If I wanted to continue to pursue my passion for sports photography I had to do something. Not to forget that I want to be around longer so I can enjoy watching my grandchildren grow up and grow old with my wife of 30 years.
    Flash back to 14 months ago and a two and a half pack a day habit. Yes, that’s a lot but I drive in my job and have for 25 years so the habit of smoking while driving had become engrained in my daily routine. We had a new employee at my 9-5 job as a grocery merchandiser and he had what we all called a “magic wand” so we called him our Harry Potter. Over the course of a week we spoke frequently about his nicotine stick and I became more intrigued by the option of an E-Cig and began to do research on all the available varieties and styles and the “e-juice” that is vaporized that delivers the nicotine to your body. There are only 4 ingredients in the juice, Propylene glycol, vegetable glycerin, flavorings and nicotine. Nothing more and all FDA approved ingredients. I also found out that Nicotine makes your bodys metabolism higher which explains why a lot of people that stop cold turkey complain about gaining weight which I haven’t experienced.
    I was planning on having this written at my 1 year anniversary of being tobacco free but I wanted a benchmark moment to truly know that what I was doing was truly helping me and that moment came at the first UGA football game this year. The walk from my tailgate location to the stadium was the perfect test for this. The past couple of years my walk into the stadium had become a true burden on my body and more so my lungs. This will seem shocking to anyone who doesn’t smoke but the walk was about one third of a mile. Not a far distance to walk but it was half uphill and half downhill for the rest. In years past I would have to take two breaks during this trek to catch my breath just to make it into Sanford Stadium. This year, well, this year was different. I was able to make it through the entire walk and never had to stop to catch my breath once going into the game or leaving! I felt accomplished and that I had a new lease on life and my switch to vaping was a success.
    With this knowledge of where I was before starting on my E-Cigarette and where I am now, I know that what I am doing is much better for my body and health than tobacco ever was. If you are debating on trying an electronic cigarette over tobacco I hope my story of success will help push you in that direction. If you are planning on making the switch you will need to remember 5 important things about E-Cigarettes.
    1. You will experience throat irritation for the first few weeks. For long time smokers it might be hard to remember the throat irritation that was associated with tobacco cigarettes when you first started. Your throat became used to the smoke after a while and the irritation went away. The same is true for E-Cigarettes and the vapor, your throat has to become accustomed to it.
    2. There is maintenance involved with the more professional types. There are coil units inside that are charged by the battery to create the vapor. After use they can build up a burnt amount of the juice on them causing them to become less effective. This is due to the sweeteners used in the juices flavorings crystallizing on the wicks. This will also affect the flavor and cause it to taste bad. They cost around $3.00 a piece and should be changed at least once a week.
    3. This is probably the most important thing that will happen and it’s just a matter of conditioning. You will have the urge to have a cigarette between your fingers. This is nothing more than a Pavlov’s Dog effect. Your brain and body work in unison. When your body wants more nicotine it tells your brain and for years your brain has associated this craving to having a cigarette between your fingers. You will need to retrain your brain to associate your new E-Cigarette with that craving. When you get that urge just pick it up and feed your body what it wants. After a few days your brain will get it down.
    4. Always have spare batteries. Nothing will stop your progress dead in it’s tracks than having a dead battery and no spare to connect to it and falling back into tobacco.
    5. And last but certainly not least, KEEP ALL E-JUICE OUT OF REACH FROM CHILDREN! You can overdose on nicotine and it can kill so be a smart vaper and protect your children and others children by keeping it out of reach!
    Electronic cigarette shops are popping up in most communities due to the overwhelming popularity of it. Talk with the people in these shops about how much you smoke daily and they can come up with the correct percentage of nicotine to put in your juice to keep you on track. A couple of local shops I frequent are Mad Vapes in Buford and Blazzin Vapes in Elberton. Both of these shops provide a Flavor Bar where you can try their E-Juices and choose a flavor for you and yes, they even have menthol. There may be other locations near you so check online or the yellow pages.
    Now for the financial kicker, once you make the initial investment on your equipment it should cost you no more than $10 a week to vape! My vaping this past year has saved me at least $5,200! Better health and better financial situation! Not to forget your car, house and clothes will no longer smell of cigarettes!
    I use the professional style of electronic cigarette with a refillable tank and rechargeable batteries and not the ones that look like real tobacco cigarettes. While it can be slightly more cumbersome than the cigarette style the ability to choose your flavors and control your voltage input and not have to throw them away makes them much better in my opinion. You can also use a lanyard and wear it around your neck for convenience and just tuck it inside your shirt while not in use. For 2 batteries, a charger, a tank or two and some e-juice your initial investment should run you around $100-$150 which is about average for a 2 pack a day smoker to get you started in vaping. Good luck on kicking tobacco and gaining better health and more wealth if you choose to start vaping!

  • Avatar

    BAH. Another huge waste of money. An actual study on how healty or harmful using the ecig is. QUITTING OR NOT. You’re just part of the huge group of imbeciles shooting around the real question, helping ignorance, indecision, propaganda, and the tobacco lobbyists…

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    Little Scott

    How would you benefit form that knowledge? Seems like the conditions will make unrealistic results. The research needed is whether or not it’s better for the lungs then cigarettes.

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    Tom thompson

    I gave up the ashes about 6 months ago, I have smoked one or two cigs since then and everytime which was only twice it was yuck I did I do that and vamped right away to get that nasty ash taste out of my mouth, now if the doc actually did a study on vapers he would find out 90% of the time vapers are not going to go back to the nasty ashes however if he does those stupid electronic ones they sell at convince stores he will get a differnt aspect, I know when I did those they never wanted me to give ashes up they were just more convient however actual vaping makes me stay away from those nasty ash circigertes. Ash free and not going back

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    I’d be surprised if there’s much difference between the “e-cigs and counselling” group and the “e-cig only” group.
    I took up e-cigs two years ago, only to cut back on the more social smoke (pubs etc), but within 2 months had completely switched to vaping.
    Since then, about a third of my friends who smoke have either completely switched as well, or are partially transitioned. It’s by far the most effective method out there, and the tastiest.

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    “Vaping was what took me off the tobacco merry-go-round. I’ve never “fallen off the wagon” in all that time. The smell of tobacco now actually makes me feel ill.”
    I totally agree, I smoked about a pack a day, then tried vaping as a referral from a friend. “Here give this a try.”
    He loaned me his iStick 20W with enough juice for my 2 week hitch. That was almost 6 month ago now.
    But (here it is) my wife despises that I vape. “What sort of message are you sending our kids?” And the “What about what the other parents think?” I personally don’t care what other people think, and my two oldest kids think it is GREAT that I have stopped smoking.
    I also try to explain to my beautiful counterpart, the costs saving that we have enjoyed since I started to vape. Instead of 2 cartons of smokes a month, I spend on average I would say $50 for juice and coils. But it is her opinion and I can only try to change it.

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    Et bien que certains vous rétorquent que ce n’est pas un moyen de sevrage tabagique, j’ai arrêté totalement le tabac (25/30 cigarettes/jour) grâce à la cigarette electronique, alors que les méthodes officielles (patchs, gommes, etc.) ont échoué.

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