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

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  • Treece  On September 28, 2010 at 7:20 pm

    I’m sure I wasn’t the only who knew the results Eissenberg would get before he got them, least of all (I suspect, in my newly acquired, bordering-on-conspiracy-theorist state), Eissenberg himself.

    At this part of the game, I’d trust my life to a Philip Morris executive long before I’d hand it over to the likes of Tom Eissenberg. (Yeah, I’m that angry.)

    Anyway, here’s something extraordinary (and entirely anecdotal) about switching to an e-cigarette: lots and lots and lots of us (i.e., substantial anecdotal evidence) can no longer tolerate smoking a cigarette.

    I’ve been using an e-cigarette since March ’09. For about a year after, I’d have an occasional cigarette–maybe one a month. They tasted worse, and worse, and worse. The last time I tried one, I had to put it out after two drags. It tasted … vile.

    I smoked for 30+ years. Before I switched to an e-cigarette, I never imagined a time that I wouldn’t want to smoke. I said I wanted to quit, but I didn’t–not really. I wanted … to want to quit, but I was filled with dread about it, because I knew that if I quit, I’d feel deprived every day for the rest of my life.

    I write this (now) with the knowledge that vaping isn’t for every smoker, and that there are plenty of people who do, and will, prefer to smoke. I absolutely defend their right to make that choice, and I now hate the way smokers are treated far more than I ever did when I was one (my consciousness had yet to be raised … and it’s still rising, I think … and I’ve begun to wish it would stop, ow).

    Anyway, I genuinely prefer to vape. Key to this (and I’m not unique) are the variety of available flavors–including the “kid” ones. I love vaping “Maple Pancake,” even though I never eat pancakes with maple syrup. Go figure.

    I fear this will be the first thing the FDA will take away from us, as soon as its given the chance. They won’t take it away from me, because I know how to flavor my own e-liquid, but for smokers who may want to try vaping but haven’t yet, I fear this will be significantly detrimental.

    Almost universally, vapers start out thinking we want something that tastes/looks/feels as much like a traditional cigarette as possible, but at least for the e-cigarette forum members, this need is replaced, remarkably fast, by a love for different (i.e., less cigarette-like) devices–and the lovely, pleasurable flavors available.

    All by way of saying that a substantial number of us aren’t vaping to squeak through cravings for a cigarette–at all. To the contrary, we really and truly prefer to vape.

  • Elaine Keller  On September 29, 2010 at 9:09 am

    Here’s a novel idea. How about a study design where people who actually want to quit smoking are recruited and randomly assigned to 6 treatments:
    Nicotine patch used according to FDA-approved directions
    Nicotine patch used ad libitum
    Nicotine gum used according to FDA-approved directions
    Nicotine gum used ad libitum
    Snus used ad libitum
    E-cigarette used ad libitum

    Participants in each group are coached by folks who used the method to quit smoking and have been quit for more than one year. Coaching is provided on best use of the product to achieve results. Smoking status is verified once a month. Participants are free to stop using their assigned product at any time but continue to have their smoking status checked monthly.

    Additions? Corrections?

  • Paul  On September 29, 2010 at 9:23 am

    I would add a couple of more conditions: 1. a cold turkey group coached by cold turkey quitters and 2. smokers just left alone. You would need to see how many people just quit over the same period without any intervention at all.

    (Though not as an experiment but as a report on actual behavior, we already do have some comparison of smokeless tobacco and pharmaceutical products with st being more than twice as successful:

  • Elaine Keller  On October 1, 2010 at 11:56 am

    I thought that article looked familiar. I just checked and verified that I have it posted on the Journal Articles page of the CASAA web site:

    Can you tell that I am a big fan of both authors?

  • Paul Westphalen  On August 2, 2011 at 5:49 pm

    The statement by Eissenberg, “just last year came to similar conclusions re e-cigarettes, claiming they did not deliver enough nicotine to substitute for smoking” is false. I have mixed E-Liquid for over 2 years. If he is claiming that E-Cigarettes don’t deliver enough nicotine, I could provide him some E-Juice to prove him wrong. E-Cigarettes deliver nicotine just fine, in fact, since E-Cigarettes don’t contain carbon monoxide, they are much more satisfying than regular cigarettes. You get the nicotine without all the chemicals that make you feel terrible.


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