If basking young lady down the pub about FAPE in hands, what they probably say, no one agrees.
If it's safe on not so, you might as well smoke anyway.
Now, what Jemmy needs is a Cochrane review. All the facts have been checked at least twice.
They find there's a lot that the experts agree on.
I'd give you a. Hi, I'm Nicola Linson.
And I'm Jamie Harmon Boyce. We're both researchers based at the University of Oxford, where we work with the Cochrane Tobacco Addiction Group.
Welcome to this edition of Let's Talk E-cigarettes. This podcast is a companion to a research project being carried out at the University of Oxford,
where every month we search the e-cigarettes literature to find new studies.
We then use these studies to update our Cochrane systematic review of e-cigarettes for smoking cessation.
This is called a living systematic review. In each episode of this podcast,
we start by going through the studies we found that month and then go into more detail about a particular study or topic related to e-cigarettes.
So for our in a nutshell, this month, we ran our searches on the 1st of April.
And we found one paper that was linked to a study already in the review and two new ongoing studies.
However, we didn't find any completely new and completed studies this month at all.
Excitingly, though, this month we publish an update to our review of e-cigarettes for smoking cessation.
And that's what we're going to talk to you about in more detail and also answer some listener questions in our next section.
This month, deep dive. So out at the end of April is an updated version of our Cochrane Review of electronic cigarettes for smoking cessation.
This update includes six new included studies added since our October 2020 version.
And if you've been listening to our podcasts since December, you will have heard about each of these studies and a little bit of detail.
So I'd encourage you to listen to previous episodes if you want to know more about them in terms of how these studies affected our overall review.
There aren't any really major changes when it comes to cessation.
We didn't find evidence that changes our current moderate certainty and our conclusions that nicotine containing e-cigarettes
help more people quit at six months or longer than e-cigarettes without nicotine or than nicotine replacement therapy.
And similarly, didn't find any evidence that changed our conclusions of uncertain evidence
around nicotine containing e-cigarettes compared to no intervention whatsoever.
But a reminder to people that that isn't necessarily reflecting the fact that
we don't think nicotine e-cigarettes would be beneficial in that context,
because we know that nicotine e-cigarettes, compared to nicotine replacement therapy, nicotine e-cigarettes appear to work better.
Same when we compare them to non nicotine cigarette. It's just that the quality of the evidence we have comparing nicotine e-cigarettes to no
intervention whatsoever or by the very nature of the way those studies are designed,
considered a little less certain. According to Cochrane's standards.
Really excitingly, I think the two things, at least that that I'm most excited about with this new update are,
first of all, that finally we have our first randomised controlled trial of a pod, a cigarette device included.
And for people who want to hear more about that study,
that is the study by Professor Kim Pulvers and colleagues which we covered in January's deep dive.
I've been working on this review since 2014, and pretty soon into it, we started calling for studies of pod devices.
So it was great to finally see one and be able to include it in our review. Also, previously,
all of our findings related to adverse effects and serious adverse effects were considered
low to very low certainty simply because we just didn't have very much evidence on them.
In this version, that's broadly the same, except for with one exception.
So in our group of studies, which compare nicotine e-cigarettes to non nicotine e-cigarettes,
we used to have low certainty, evidence that there didn't seem to be any difference in adverse effects.
And now we've had more evidence added in this update and essentially upgraded the certainty and that evidence.
So we now have moderate certainty, evidence of no difference in the number of people experiencing adverse effects in
those using nicotine e-cigarettes compared to those using non nicotine e-cigarettes.
So it really encourage you all to take a look at the review,
will have some updated briefing documents available to look at as well around our new findings.
And it's just really nice to be able to do this now as a living systematic review and mean that we can incorporate these studies as they come out.
But with that being said, I think we'll turn it over to you essentially and look at some of the questions you've submitted to us over this past month.
On Twitter, we asked for people to send in questions because we knew the new version of the
review was coming out and we were really impressed by all of the thoughtful,
helpful questions that came in. So Niccola is going to be summarising those.
I'm going to be doing my best to answer them somewhat succinctly.
And Nicola will also be chipping in to comment on what I've said and if there's anything I've forgotten or even possibly gotten wrong.
Thanks, Jamie. So it's a bit of a change of scene for Jamie. Usually the interviewer, she has become the interviewee.
So firstly, we have a number of questions or topics for discussion that came in about the real world relevance of our review.
So firstly, somebody asked if we could have bit of a discussion of the limitations of all cities, obscure science term definition.
Our S.T. is shorthand for randomised controlled trial. Nice defines this as a study in which a number of similar people are randomly assigned
to two or more groups to test a specific drug treatment or other intervention.
One group, the experimental group, has the intervention and tested the other.
The comparison or control group as an alternative intervention, a dummy intervention, placebo or no intervention at all.
The groups are followed up to see how effective the experimental intervention was. Outcomes are measured at specific times.
And any difference in response between the groups is assessed statistically. This method is also used to reduce bias.
Somebody asked if we could have a bit of a discussion of the limitations of all sweetie's in assessing diffusion of innovation.
Uptake is driven by product appeal and consumer choice or preferences and factors like price branding,
the wider environment, including positive and negative communications.
And they also mention accidental. So that that's a great question.
And there's a lot to unpack there. And I think it's certainly something we should all be considering.
You know, when we think about randomised controlled trials, for many reasons,
they're considered kind of the best way to test whether or not a treatment works.
But, of course, there are lots of limitations around that as well,
especially when we're evaluating something like e-cigarettes, which has so many behavioural,
cultural, societal, psychological drivers involved, which are adding so much added complexity as to how an intervention might work.
So I think it's really tricky. And basically what I'd say is that, of course, we can't just rely on evidence from randomised controlled trials.
And I think that's the case for e-cigarettes, but it's also the case for,
you know, any public health interventions certainly that you might think about.
And what we view our job as an Cochrane is following is Cocklin Standards and doing these rigorous reviews
of the evidence which look at interventions delivered in the way they're delivered and trials essentially.
And those trials are sometimes more or less representative of real life.
But what we'd hope is being done in the policymaking context is that indeed,
from conversations with policymakers, I think a lot of the time is is a triangulation of data.
So they're looking at data from our Cochrane Review of e-cigarettes,
but also what we would hope they were doing was looking at population data on smoking.
Update on smoking cessation,
on how this might vary across groups in the community to really think about the impacts of interventions both in these tightly controlled setting.
And in what people might refer to as the real world and tying into that that
last point from that question on accidental quitter's is a really good point.
I think what that refers to is this phenomenon that we know about anecdotally.
I don't think it's been studied all that much, though.
Hopefully more is going on in this area about people who smoke, who don't have any intentions to quit smoking.
They start using e-cigarettes and all of a sudden they find themselves not smoking anymore.
And essentially and that way they quit. They've quit smoking. But by accident, they didn't set out on any intervention designed to achieve that.
And and that's the kind of information that's really difficult to capture in a randomised controlled trial.
We do have studies that are designed specifically. They say they're only recruiting people who smoke, who don't want to quit smoking.
But even then, clearly, the e-cigarettes are being provided in a context that's been supportive of
cutting down how much people smoke and ultimately quitting smoking altogether.
And so, again, that's just a really good point out why randomised controlled trials, though, are really important.
Piece of the picture are not the entire picture. And of course, when decisions are being made by policymakers, by people who smoke,
by health care providers, we would hope that that a broad array of evidence is taken into account.
Thanks, Jamie. These are some really good points.
And I think it also relates to another point somebody made when they were talking about why the relative risk perception
of combustible cigarettes and electronic cigarettes aren't usually taken into account when measuring efficacy.
So I think he's kind of already covered that next question.
So I'll move on to another question we have, which again, is is related to that real world relevance,
but specifically mentions two of these studies that we've got included in the review.
So this person says hi. Some clinical studies, for example, Higher Kartal proposed various vape products,
as in what people would get in real life, while others imposed unique products, taste or nicotine levels.
For example, this study by Eisenberg. Could you think a little bit about the realism of study results on the important property of FAPE adjustability?
I think that's another excellent question.
And my personal feeling on this, I suppose, is that actually you probably need studies of both types because they serve different purposes.
And I think there's a spectrum of how representative studies are of real life context,
but also real have context must may vary depending on country and the situation someone's in.
So I think these studies like like Kayak's, which look at proposing various different products and people can choose what suits them best.
I think there's there's a real argument for that being what is currently most representative of real life.
Right. Where you could you could walk into a vape shop and and pick what you wanted to best, suit your needs and tastes.
But also, if we think about how e-cigarettes could be used and, for example,
the possibility of them being prescribed to help smokers quit than actually in that case,
probably there's gonna be a lot more limited choice within the space of what can be prescribed,
because we know getting anything licenced for prescription is a challenge in and goes through a lot of different steps.
And so in that case, maybe having these studies which test a specific product are also really quite useful and informative.
So I'm not necessarily sure that one is better than the other, but I think we definitely need both.
You know, if we just had all of these studies testing only one type of a cigarette with only one strength or only one taste,
that wouldn't serve us particularly well. But similarly, of all the studies we had just said, users could pick whichever one they wanted.
It might make it more difficult for us to even be able to say, OK, this type of device looks more effective than this type of device.
So I think having both is really useful and it's a good thing that we have both in the review.
All right. Thank you, Jamie. So kind of moving on slightly now.
Some more questions that we got, talking more about the methods of the review that we've used in coming up with our evidence.
So we have a question that relates to risk of bias.
And somebody has mentioned that, unfortunately,
some professionals use the call for more studies with low risk of bias as a means of discrediting the evidence base to date.
Yeah, that's another important point. Cochrane Reviews are considered.
Goldfeder We follow a very kind of such transparent and rigorous set of guidelines for assessing risk of bias within studies.
And that means that we tend to be very critical. You know, part of part of systematic reviews is critical appraisal.
Say, okay, where where could this study go wrong? Is there any reason why we might not trust these results?
And one of the challenges in our review of e-cigarettes for smoking cessation,
and it's simply just a methodologically, is that we include different study types.
So when you compare an uncontrolled study to a randomised controlled trial, that uncontrolled study is always going to show up.
As being higher risk of bias, and that means that because in our review,
where we do include uncontrolled size, we have quite a few which are showing up as high risk of bias.
And we do make calls for more studies are at low risk of bias.
I think the important point to make is that the studies that contribute to our main analysis, we do consider for the most part to be low risk of bias.
And we also test whether our results are sensitive to the inclusion of studies at high risk.
So that means if we have four studies looking at something and one of them is high risk of bias,
we'll take that study out and see what only the studies that we judged to be kind of the lowest risk of bias,
the highest trustworthiness, what they say.
So actually, even though we have a case where we have a lot of studies with high risk of bias,
I'd say still the major threat to certainty in our review and the reason why
we can't say things with more certainty is just a lack of studies overall,
not a lack of low risk of bias studies. So when we call for more studies, we want them to look into more things.
We want them to look into different sorts of devices. And of course, we also want them to be conducted to minimise any potential risk of bias.
But that shouldn't necessarily be taken as discrediting the evidence base.
There's some really good points that. Amy, thank you. So another point someone's raised, which I think is a really important point.
To be able to talk around is someone said that they'd like us to please in our review sake as unsustainable, sustained cessation.
So they define that as more than one year.
Could you give us a little bit of background on on the cessation at home?
Cessation basically means the number of people who's quit smoking and how we assess that in our
review and how that's relevant to people either quitting in the long term or in the short term.
Yeah, absolutely. So we only look at cessation or quitting smoking at six months or longer and we use the longest follow up time point.
So if a study reported at six months, one year, two years, for example, we'd use that two year time point.
And the reason why we look at six months or longer is because we know in the shorter term those quitting rates can be really variable.
But we do have some evidence that over the longer, longer term, you know,
if you look at six months versus one year versus two years, typically a few people will have relapse to smoking.
But the outcome that we look at in our reviews isn't the absolute number of people who quit.
It's the difference that in e-cigarettes makes to that number. So it's the relative difference.
So basically comparing people using an e-cigarettes to people not using any cigarette or using any cigarette without nicotine.
And what other studies have shown is that this comparison is pretty stable.
So over the course of six months, one year, two years, the difference between groups will remain broadly similar.
But this is something once we have more studies, we can investigate in more detail as well.
And apologies if you can hear some thrashing about. My dog has just come in from a walk and is wagging his tail vigorously.
Great. Great for the dog and great. See.
So then somebody else has kind of got a question, I suppose relates to that risk of bias.
Question from earlier asking us how Tresh studies on vaping are detected and how we might assess wrong or not conclusive methodologies.
Yeah, that's a great question. So I think, you know, in our review specifically,
we use that risk of bias still that I talked about to critically assess each of the studies against a number of domains.
But, of course, already within our review. And as I kind of mentioned earlier, in the context of real world,
we are restricting to only a certain type of studies or types of studies within this space.
So there are a lot of studies outside of that space which may well,
some of them might be conducted beautifully and really trustworthy and others might not be.
And what I suppose this question isn't isn't just related to vaping.
This is about science generally is unfortunately,
we know that despite all of the cheques and balances that have been tried to be put in place around peer review registry and protocols in advance,
et cetera,
we still get a case where a lot of studies come through which might not necessarily be using the best methodologies to answer the questions at hand.
And all we can do, I suppose, as readers, as people who consume evidence in that way, is look at it and really think critically about it.
Do I trust these outcomes? What could be going wrong here? What are the interests of the people writing this?
Do they have any financial reason to hope that they find something so really challenging?
And one of things we hope we're doing with this podcast is talking a little bit more about e-cigarettes,
evidence generally and where some of the weaknesses might be and where some of the stronger points might be.
But it's it's a continual learning process. For everyone, including us as researchers and and even as scientists,
we can go in with the best intentions and still find that what we've done might be subject to some sort of bias.
And we have to be aware of that. And so whenever we write, we always include a section in our discussion on limitations and places where people should
be aware that it might not necessarily represent a conclusive answer to the question at hand.
Right. Thanks, Jamie.
So on next set of questions, relate to some topic areas that are kind of around the periphery of wall our review looks at at the moment.
And the first one of these is thinking about flavours.
So different is cigarette vapour flavours. So this person says flavour bans are being taken up by a number of governments throughout the world.
How about a review of the roles at non tobacco flavours, play in product acceptability and successful quit rates?
Such a good question. And in an ideal world, within our review, we'd have sections of studies comparing different flavours directly.
We don't have those studies yet. We hope they'll come out in due course.
And probably if we were to do a review now that was looking at the role of flavours,
we'd have to look at a much wider range of study type study lengths and outcomes
in order to find enough literature to make it worthwhile to do a review. But it is something that we're keeping an eye on.
And we're really hoping that as new studies come out and as maybe we become more
confident in the role of nicotine containing e-cigarettes for smoking cessation,
we can look at some more questions about optimising their use and flavour,
being, of course, one of those as might be device type of nicotine strength and also the other
support provided to someone when they're trying to stop smoking with a cigarette.
Great. Thank you, Jamie. It's a really interesting topic.
And as Jamie says, it's not something that we would exclude from our review, in fact, to these type of studies would definitely be included.
Say, for example, if if there was a study looking at tobacco flavour e-cigarettes, this is a fruit flavour,
a cigarette, that would be something that we could include in our review and potentially draw conclusions on.
But it's just that these studies don't exist yet. They also meet all of their eligibility criteria and therefore we don't have them in the review.
So the next question on a kind of slightly different topic is, well, somebody said to us, let's talk about Second-Hand Vapour.
So obviously, that's something that's not in the review as it stands.
Can you cheque around that a little bit, Jamie? Oh, yes. I would love to talk about Second-Hand Vapour.
And in fact, listening to that question and thinking about it now,
it's making me think I wonder if that would be a good topic for a podcast at some point,
if we could find some most of expertise in the area and get them on and talk to them about it,
because they're probably there are people who study this more than I do. I think second home vapour is incredibly important to understand more about.
And we're getting there, you know, there there are more and more studies, more and more reports talking about this.
And I think what we have so far broadly suggests that the harms from Second-Hand Vapour
are considerably less than any harms from Second-Hand combustible tobacco smoke.
But I think this is just such a critical area to focus on because we know that so much of the success
of some of the tobacco control movement in the past has been around this issue of Second-Hand,
combustible tobacco smoke and its impact on young people. And, you know, I completely support that.
And I think somehow we've stopped talking about it in terms of vaping it.
It almost seems like it's not as much of a question. And of course, we need to know if Second-Hand Vapour has harms to bystanders.
But we also need to know in people who switch from smoking to vaping what the impacts are on the people around them.
So what are the impacts on the kids at home whose parents have switched from smoking to vaping?
Is it having a comparable impact on on that child's asthma control?
What's happening in terms of things like Rath's of Sudden Infant Death Syndrome,
which we know is is increased from Second-Hand, combustible tobacco smoke.
So I think there's a whole field of research here,
which is so conceptually important and practically important to the people who smoke, to the people around them, to policymakers.
So I hope that we can see more on this. And and in fact, maybe if we can find someone who's willing to talk to us about it,
possibly do a podcast episode focussed on those kids, I personally would love to know more.
I just know from reading around the topic as opposed to directly doing any research on it.
Thanks, Jamie.
And I agree there's definitely some things coming up there that have been really good to have an expert on to talk to us about in the podcasts.
So the next one also is something that I do know a great deal about.
We'll see. We'll see what Jamie knows. And I'm also hoping that I'm gonna be able to pronounce this.
So apologies in advance. I haven't pronounced it correctly, but the next topic someone's asked is just.
Maybe having a chat around is the elimination of opening glycol and glycerine from the body and using e-cigarettes.
So that specific question around the elimination of problem glycol glycerine from the body isn't something that we look at in our review.
But again, is really interesting and I know is something that is being investigated.
And so it could be that at some point, again, in this podcast,
we we bring on an expert who's looking at these more lab based studies to look into this and a bit more detail.
Great. And and so finally, in these kind of related topic areas, somebody has asked us a bit about young vaping across the world.
And obviously, again, that's not something that we're covering in this particular review.
But I know you probably have some thoughts on that. Yeah, well, the main thought,
I have a life that I'm delighted to say that we have now received funding from Cancer
Research UK to start up a new Cochrane Review looking at the impact of e-cigarettes,
availability and use on young people, particularly on young people's smoking behaviour.
So it's something where we know there's there's a lot of conflicting statements out there from guideline developers,
from scientists about the role that vaping plays in young people and particularly in terms of cigarette initiation.
And so that's something that that in the next couple of years we'll be paying a lot of attention to.
And I'm sure we'll be talking about a bit more on this podcast as we get more into it as time goes on.
All right. Said that on next. Lot of questions all relating really to our systematic living, systematic review process.
Should I say so? Somebody is asked is what is the cycle for regular future reviews?
Yes. So basically within the Libyan systematic review process, what we do is we search for new evidence every month,
but we only update the review when we find sufficient information from the searches that we think the update would be meaningful.
And so this time around, we incorporated evidence from searching over a number of months.
And basically what triggered us to update is that we had evidence that strengthened the fact,
the certainty of our conclusion of no difference between nicotine and non nicotine e-cigarettes and the number of people experiencing adverse events.
And also, we had our first study of pot devices. So we felt like it was really important for people looking at the review to know that new evidence.
And so we can't say exactly when the next review will come because it will depend on what studies we find.
But we certainly have already found some new studies from last month that we will incorporate in a future version.
So I would anticipate, but wouldn't promise that we'll have another one out probably towards the end of this year.
Right.
And it's really exciting that to see these reviews coming out quicker so that we can inform you all of this new evidence as it becomes available.
Exactly. So that same person is also asked, can the impact of this view be broadened?
Given the data doesn't lend broadly?
And so they're saying, you know, it might not be included in all kind of international's smoking cessation guidance?
Yeah. That's a really good question. Actually, I have the list of questions in front of me.
TUDA touches on a few others.
So one question about Cochrane, Taiwan translating the systematic review and another comment on the new German cessation guideline,
which doesn't mention the October review. So these are all about impact.
And I think one of the things we're trying to do with this podcast,
but also in a lot of other activities around ours, are just disseminate our findings.
You know, our job in Cochrane is not to tell anyone what to do.
It's not to make recommendations. It's just to say this is what the evidence shows.
And an area like e-cigarettes where the evidence is evolving so rapidly,
it's really important that people do have the most UP-TO-DATE evidence to hand.
And so we'd proactively work with guideline developers, with clinicians, and, of course,
are trying to access and talk to people who smoke as well about the evidence we have on e-cigarettes.
One of the issues which I am kind of completely, I suppose, understanding of when it comes to guideline development and sorry, that's my doorbell.
So we're going to have a momentary pause one second. So sorry about that.
That was the doorbell, the joys of working from home. We've had the dog. You've had the doorbell.
The dog was also very excited about the doorbell.
But what I was in the midst of saying was that one of the things I'm most sympathetic to with guideline
developers is that they often follow a process that began in that similar to ours in Cochrane,
where we search for new evidence. But then the time between searching for that new evidence and the guideline coming out can be quite long.
So it's quite possible that, for example, in the German guidelines, which have been referred to at the time, they search for new evidence.
October 2020, Cochrane Review wasn't out there yet and that that's a problem for our views.
That's why we've moved to a live in systematic review for our Cochrane Review of e-cigarettes.
And actually some guideline developers are now looking at living guidelines for certain topics.
I think probably the. Covered pandemic has made this more relevant than ever.
So, yeah, just to say we are trying to stay on top of this and trying to update our reviews and make clear that that updated information is available.
But there may be valid reasons why it's not being used as quickly as we'd hope it might be.
And we do do our best to engage with guideline developers.
We do try to be proactive in that where we can be.
Obviously, it's hard for us to keep on top of things internationally, and it's always useful for us if guideline developers reach out to us.
We don't always know what's going on everywhere.
And in fact, Jamie has spoken to a number of different policy makers and even governments about all our review.
So be reassured that it is getting out there. But it is hard to cover all of those bases.
Isn't it, Jamie? Yeah, absolutely. And I suppose it's worth mentioning that Cochran do also make a lot of effort to translate,
ah, plain language summaries into lots of different languages. So say the question about translating into Mandarin, for example.
I'm not a hundred percent sure if the plain language summary for our 2020 review has been translated into Mandarin as yet.
But definitely there are a lot of translation efforts going on and a lot of plain
language summaries of all group are translated into a lot of different languages.
So it's, again, something that Cockram tried really hard on.
So our final question. In fact, our final question in this section.
But our final question overall basically asks you to speak to Jamie.
The fact that Cochrane's rigorous evidence reviews are the global gold standard for all fields of public health except tobacco control.
I suppose it's important to say that that's an opinion and would be interesting to to hear what you think about that, Jamie.
They all say say perhaps this say something about where tobacco control is today and evidence that doesn't fit dogma is simply rejected out of hand.
I, I would love to have kind of a long conversation about that, I suppose.
I think there's a lot of context that comes into this statement.
You know, personally, I think a lot of tobacco control has looked at Cochrane's evidence reviews.
We know that they're used extensively in national and international guidelines.
And this includes lots of guidelines on different tobacco control interventions,
including, you know, the Cochrane Review of Nicotine Replacement Therapy, for example,
was was cited as one of the central documents behind the World Health Organisation's
decision to list nicotine replacement therapy as a globally essential medicine.
So I think we do have a role on tobacco control and and we are listened to.
But I think where this question comes from is in within the context of e-cigarettes.
And there I think there is a huge amount of variation country by country at the moment around e-cigarettes,
legislation, conversations, policies, and I suppose.
What we need to think about, not just in tobacco control,
but across all of science is being open to evidence and being open to the fact that evidence might change.
Methods might change. Situations might change. And I think we need nuance when we are looking at evidence and also considering societal contexts.
And if the evidence doesn't fit our context. That doesn't necessarily mean the context is wrong or the evidence is wrong.
But it does mean there's a disconnect that needs actual thought. We need to be transparent about it.
We need to be clear on why we think the evidence might not suit our needs as opposed to simply not addressing that evidence.
And when we set out to do our Cochrane reviews, we really genuinely try to be agnostic about every hour of every intervention we're looking at.
So when I set out to do our e-cigarettes review, if this evidence had found that e-cigarettes didn't work at all,
didn't help anyone, quit smoking, I would have been very confident in saying that.
Just as I'm very confident say now that we do have evidence, growing update on update about a promising roll of e-cigarettes for smoking cessation.
So I think for us in Cochrane, it's really easy for us to stick with the evidence for those making policies.
They're considering so many different elements.
And I suppose all we can ask is that the evidence is fairly considered, transparently considered and openly discussed.
Thanks, Jamie. And I think it's important to remember and also gives me the opportunity to give
a shameless plug that this electronic cigarettes review isn't the only review.
There are groups that Cochran's Bacco addiction group put out.
We have a range of reviews looking at different treatments for tobacco addiction, ways of preventing tobacco addiction and on various of topics.
So, you know, our evidence gets out there on a wide range of topics within tobacco control.
And if you're interested in that wider area, then please cheque out all the reviews as well.
So that's it from us this month. Thanks so much for listening. Do cheque out our new review, which is out at the end of April.
Thanks again. Please subscribe on iTunes or Spotify and stay tuned for our next episode.
This is me. Yeah. But some mention the findings we have can tell us what happened, Lungu.
Even though we know Maybin is safer than smoking weed, still buying cars.
Switching to. Thank you to Jonathan Livingston Banks for running searches to Elsa Butler for producing this podcast.
And to all of you for tuning in.
Music is written with Johnny Berliner and I and performed by Johnny are live in systematic reviews supported by funding from Cancer Research UK.
The Cochrane Tobacco Addiction Group also receives core infrastructure funding from the National Institutes for Health Research.
The views expressed in this podcast are those of Nicola and I and do not represent those of the funders.