Researchers say not enough nicotine in alternative products

In the latest volume of Tobacco Control, among the many new strategies proposed by self described endgame visionaries, those who are skirting ever so closer to prohibition but dressing it up in more flattering wear, is a new paper evaluating various smokeless products as cessation aids. (Regarding the same volume, make sure to read Carl Phillips’s deconstruction of Ann Gilmore and company’s proposal for a price cap on cigarettes to address market shortcomings.)

In Evaluating the acute effects of oral, non-combustible potential reduced exposure products marketed to smokers, authors Cobb, Weaver, and Eissenberg tested two types of snus, a nicotine lozenge, a dissolvable tobacco product, low nicotine cigarettes, sham cigarettes, and the smokers’ preferred brand for short term effects to see if there were indications one way or the other that these might be effective for quitting smoking. Their question really was: do these products deliver enough nicotine to adequately substitute for smoking.

The stated results were: “Non-combustible products delivered less nicotine than own brand cigarettes, did not expose smokers to CO and failed to suppress tobacco abstinence symptoms as effectively as combustible products”. The conclusion was: “While decreased toxicant exposure is a potential indicator of harm reduction potential, a failure to suppress abstinence symptoms suggests that currently marketed non-combustible PREPs may not be a viable harm reduction strategy for US smokers”.

Curiously enough the third author, Eissenberg, just last year came to similar conclusions re e-cigarettes, claiming they did not deliver enough nicotine to substitute for smoking. That study was pilloried for bad design due to the researchers not being aware of critical differences between smoking and vaping but that is beside the point here.

The big picture issue is that the reactions and biological measures taken from smokers under laboratory conditions are being presented without taking into account the fact that in the real world smokers are switching successfully and long term to e-cigarettes and smokeless tobacco. They are finding them satisfying enough to switch, and satisfying enough to stay. (Maybe they just haven’t yet heard they don’t work and with this report will reconsider their foolish decision.)

First of all, that any viable substitute would not be as perfectly satisfying as the entrenched long familiar personal brand is one of those Simpsonian (as in Homer) observations. It is both obvious and not that important. Secondly and related to that, people smoke and switch to other products for a multitude of reasons, strength of nicotine delivery being only one of those reasons, and if it is important it is still mitigated by concerns of health, desire for other aspects of smoking, and various social pressures.

It is no different than if you decide to change you eating habits for the better. If you have the motivation, though taste and convenience are still important, they do not have to be perfectly matched for you to consider switching for better nutrition or health.

I don’t want to read too much into these studies but I am tempted to say that Eissenberg seems to creating evidence that could be misused to support policy changes that could favor removing harm reduced alternatives.

Overall, and while I am pretty sure they would not actually endorse such a move, these authors are implying that these products need to deliver more nicotine to be more competitive with smoking. In this same volume is a proposal to lower nicotine levels in cigarettes so there might be an interesting race within Tobacco Control to (on the basis of these papers and not the real world) get rid of these substandard nicotine delivery vehicles before they more effectively match the levels of lower nicotine cigarettes.

Forgot to add this on the original post: There is much more to be written about the actual methods of this, and will be. What is most glaring however is that conclusions are being drawn about quitting/switching on the basis of a single day/first exposure to a new product. Most switching takes place over time and the first exposure to anything (even Seinfeld) does not adequately predict future satisfaction.

-Paul L. Bergen