Fact-check #02
“No evidence” versus Cochrane
In December 2023, Anvisa stated that e-cigarettes do not help people quit smoking. A year earlier, the field’s most authoritative review had already concluded the opposite, with high certainty. It was dismissed in a single sentence.
What they said
Anvisa, Vote 459/2023
Board of Directors, 4 Dec 2023, summarising the regulatory impact assessment
“[Electronic smoking devices] show no evidence indicating them as products that can be used for smoking cessation.”
GGTAB, Anvisa’s technical unit
Presentation to the Board of Directors, 1 Dec 2023
“No type of [e-cigarette] is useful for smoking cessation or treatment.”
Quotes from Brazilian documents are free translations from Portuguese.
How Cochrane was dismissed
Anvisa knew the review. And chose another.
Describing UK policy, the vote acknowledges that it is based on Cochrane, and adds:
“[…] based on evidence from health services and on the Cochrane Collaboration review […], I would like to highlight, even though there is no conclusive evidence on this in the scientific community.”
The vote then adopts a review prepared for the Irish government that saw “no clear differences” between vaping and nicotine replacement. Not a single line explains why that review should outweigh Cochrane.
What the source says
Cochrane
Living systematic review, November 2025 update
With high certainty, nicotine vapes help more people quit smoking than patches and gum.
104 studies, 30,366 participants. Risk ratio of 1.55 (95% CI 1.28 to 1.88) against nicotine replacement. No clear difference in adverse events.
Out of every 100 people trying to quit
The order of events
Nov 2022
Cochrane rates as high certainty the evidence that vapes help more than nicotine replacement.
Dec 2023
Anvisa states the products “show no evidence” for quitting and keeps the ban.
2024
Smoking in Brazil rises from 9.3% to 11.6%, the first increase since 2007.
Nov 2025
A new Cochrane update, with 104 studies, keeps the high-certainty rating.
Why this matters
Anvisa does not have to agree with Cochrane. But dismissing the field’s most authoritative review in one sentence, with no counter-analysis, is not regulatory science.
The people who pay are smokers who have already tried patches and gum and couldn’t quit. The tool that works best for them was declared not to exist.
What we are not saying
We are not saying vaping is harmless, or that it works for everyone. Cochrane itself notes that long-term effects remain uncertain. We are saying that the evidence that it helps people quit exists, is high-certainty, and was ignored.
Sources
Cochrane — Electronic cigarettes for smoking cessation, CEBM/Oxford briefing (November 2025 update) University of Oxford — Latest Cochrane review finds high certainty evidence nicotine e-cigarettes are more effective than traditional NRT (17 Nov 2022)Anvisa — Vote 459/2023, case 25351.911221/2019-74 (in Portuguese)
Anvisa/GGTAB — Regulatory process for electronic smoking devices, presentation at the 19th Public Ordinary Meeting (1 Dec 2023, in Portuguese)
Brazilian Ministry of Health, Vigitel 2024, via Futuro da Saúde (Jun 2025, in Portuguese)