James, I agree with your first choice of Chantix - I have had good success with using it with many inveterate smokers who were motivated to quick.  As yiu may know we don't have Cystine available in the US because it lacks FDA approval.

The NEJM  article on Cystine in smoking cessation demonstrated superiority to placebo but a rate of 8.2% of sustained abstinence.  THis seems lower than the Chantix rates of sustained abstinence in the trials and clincial practice.  Is this your experience?

Thanks for posting

sb

Hello Dr. Billazarian: 

Your presentation listed two references, both of which would be classified as commentary or opinion pieces. But the content of your presentation shows that you have given more weight to the "Promise or Peril" piece. The results of over a dozen clinical studies on the use of e-cigarettes have been published or presented at conferences such as the Society for Research on Tobacco and Nicotine (SRNT), European Respiratory Society (ERS) and European Society of Cardiology (ESC). In addition, many researchers and laboratories have tested e-cigarette liquid and vapor and have done a better job of telling the whole truth about their results than the FDA. You have my email address. Drop me a note and I will be happy to send you a copy of CASAA's document, Electronic Cigarette Research, that lists these articles as well as additional opinion/commentary articles and population surveys of e-cigarette consumers.

On Slide 7 the title "Alleged benefits of e-cigarettes" has the word "alleged" underlined for emphasis. Why? Were you trying to convey the impression that all of the points listed are untrue? It only takes common sense to verify the truth of the first four points. The fourth point is half true. E-cigarettes can deliver nicotine effectively, but several studies show that e-cigarettes do not deliver nicotine more rapidly. Part of your last point has been verified by several researchers, as well as by all of the population surveys: the products significantly reduce craving and number of cigarettes smoked; however they don't do it at a level similar to nicotine-replacement products. They work much, much better. People who tried to quit over 10 times and kept relapsing have been able to finally escape from inhaling tar, CO, numerous toxins, and large particulates along with their nicotine by switching to an e-cigarette.

Slide #8 illustrates how heavily you relied on the "Promise or Peril" opinion piece as your source. For example, the FDA did not find any carcinogens in quantities that exceed the levels in approved NRT products. In fact, extensive testing of vapor has found only a handful of potential toxins in quantities less than 1% of OSHA Permissible Exposure Level. Your drinking water probably has higher numbers and levels of toxins. There is absolutely no evidence that particles of vapor have the same effect as second-hand smoke. As for evidence of a cessation strategy, the published population studies show that 40 to 70% of users have quit smoking. But pay particular attention to the clinical trials conducted by Dr. Riccardo Polosa. He's shown that these products can induce quitting in smokers who had no intention of doing so. Finally, there's a growing body of harm-reduction evidence, including the presentation at the ESC conference by Dr. Konstantinos Farsalinas, and covered by MedScape.

Who am I? Just a 66 year old woman who smoked for 45 years and gave up on giving up over 20 years ago after I became abstinent from nicotine and waited over 6 months for my attention deficits and memory impairments to go away. They didn't. E-cigarettes allowed me to finally stop smoking without having to sacrifice my cognitive health. I've been smoke-free for over 3 years now; and despite continued use of an e-cigarette, I have seen significant improvement in my lung health and markers of CV health (lower cholesterol and lower BP). 

I am an unpaid volunteer for a non-profit organization formed by former smokers who became free from smoke by switching to e-cigarettes and/or smoke-free tobacco products:  The Consumer Advocates for Smoke-free Alternatives Association (CASAA.org). I look forward to corresponding with you.

--Elaine Keller