Electronic Nicotine Delivery Devices: ineffective nicotine delivery and craving suppression after acute administration
Thomas Eissenburg Study
The summary here is based on Thomas's article which was published in the BMJ Tobacco Control Journal (subcription required.)
Thomas' Eissenburg's study looked at the effectiveness of electronic cigarettes in delivering nicotine, its effect on the heart rate and in reducing cigarette cravings and compared those effects to to those of cigarettes.
The effectiveness of the electronic cigarette was tested by giving 10 smokers an electronic cigarette and allowing each smoker 10 puffs on the e-cigarette, with the nicotine content being measured via blood tests as well as by other "subjective" tests.
Results
The study found that electronic cigarettes did not deliver nicotine:
"Relative to a tobacco cigarette, 10 puffs from either of those nicotine delivery devices (E-cigarettes) with a 16 mg nicotine cartidge delivered little to no nicotine and supressed craving less effectively."
Or, in Thomas' own words:
Conclusion
Thomas concluded that as a result the device needed to be "evaluated, regulated, labelled and packaged in a manner conistent with cartidge content and product effect."
Errors
During the discussion of the electronic cigarette forum it was pointed out that there was in fact no 16mg nicotine NCIG cartridge, one of the catridges Thomas Eissenburg claimed to have tested. Thomas later wrote to the BMJ stating that this was an error and that he had in fact tested an 18 mg NCIG cartridge.
Conflict
The study conflicted with other studies on the effectiveness of the electronic cigarette carried out in New Zealand. This study found that 16 mg cartridges were effective in reducing nicotine cravings , and that despite delivering a smaller amount of nicotine was effective in treating nicotine cravings. The conflict was not noted in the article.
When the study was criticised in the electronic cigarette forum, the author tested another electronic cigarette on himself, and in a post on the forum agreed that it raised the level of nicotine in his blood.
Placebo Effect
The research raised the question: Why, if electronic cigarettes were not delivering nicotine, were smokers able to switch to the electronic cigarette while competing nicotine cessation aids only delivered a 5% success rate over the long term?
One answer discussed on the Tobacco Analysis blog is that nicotine cessation products do not treat the stimuli associated with smoking. Research has shown that smoking stimuli alone can be used to treat nicotine addiction, with one study concluding:
"These results indicate that, while some tobacco abstinence symptoms may be suppressed with nicotine, suppressing others may also require strategies that address the absence of smoking-related stimuli." (Source: Tobacco abstinence symptom suppression: the role played by the smoking-related stimuli that are delivered by denicotinized cigarettes.)
Reaction
Professor Michael Siegel argued on the Tobacco Analysis Blog:
"...if this research is accurate (and generalizable), then electronic cigarettes may not only be a safer alternative to smoking, they might actually be a safe alternative." (Source: Tobacco Analysis Blog.)
User reaction, on the other hand, has been one of indignation, with many users of the electronic cigarette refusing to accpet the findings. Others pointed out that they were having no problem replacing cigarettes with the electronic cigarettes judged to be so ineffectual:
"On a personal note, I've been smoking for 12 years and using electronic cigarettes has given me real hope of quitting. I tried cold turkey and the gum numerous times and just went back to smoking. With this product I can simulate the act of smoking (a substantial part of the addiction) and yet avoid ~4000 chemicals found in tobacco cigarettes. I have not had a cigarette since I started using one."
(E Cigarette Forum)