Ecig research floundering to understand what vapers already know

By Paul Bergen from


A recent study by Jean-Francois Etter and Chris Bullen, Saliva cotinine levels in users of electronic cigarettes, concludes that vapers ingest about the same amount of nicotine as smokers. Since it is often difficult to mimic the real world, Etter and Bullen used cotinine levels to compare nicotine acquisitions. Vapers were asked to chew on a small cotton roll less than 30 minutes after vaping, place these saliva samples in a vial, and mail them in.

We conclude that cotinine levels in ENDS [electronic nicotine delivery systems] users were similar to levels observed, in previous reports, in smokers and higher than levels usually observed in NRT users. This finding has important implications for ENDS use by smokers who want to quit, for future research, and for the regulation of these products.

Forgiving the fellows for the use of the anti-tobacco folks’ term ENDS (maybe they are trying to make you think of butts or imply death), this comment makes sense about the implications in that if smokers know that there is better nicotine delivery in vaping than in using NRTs, then they know which alternative is most likely to result in cessation. And, of course, it is always good to know more than less about these things.


There is an implication that this will somehow prove to vapers that vaping is a good way to quit smoking. It is quite funny because if there is anything vapers know, and knew quite some time ago, vaping is one of the best ways of getting off tobacco cigarettes.

There is often this disconnect between research and real world experience. Research beats anecdotal easily but when it comes to behaviors in which millions of people are engaged in, the real world manifestation can tell you more than any lab tests as to what is actually going on at the user level.

That vaping delivers adequate nicotine certainly contributes to its success as an alternative but so does the fact that it mimics smoking. There are quite a few ex-smokers who are happily vaping away on nicotine-free versions. What that tells us is that while nicotine levels might make a difference for some (and possibly for most) users, for others it is something else.

Many vapers have successfully switched from smoking. They knew within puffs that this was a reasonable substitute and a research article residing behind a pay wall is not going to alter their experience one way or the other.

My criticism is not so different from when I wrote about research which had argued that there was not enough nicotine in alternative products to satisfy smokers (see here). Whether the research finds too little or too much nicotine in these products, and whatever conclusions they draw about suitability, the real evidence lies in the growing population of ex-smoking vapers.

If it did not work, they would not exist.

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16 thoughts on “Ecig research floundering to understand what vapers already know

  1. It is easy to understand that most of the so-called “ENDS” research that is published is “influenced” by Big Pharma one way or another. No surprise if the conclusions are biaised…

    For those who read french (or use some translation facilities), here is another viewpoint :
    La cigarette électronique menace le business des anti-tabac, sérieusement

  2. Thanks, Randall. I have read the translated version here, which is not perfect but gets the gist across: – I think you make some really valid points.

    Etter has told me in the past that he is now independent of the pharmaceutical industry (see I’d be interested to see his reaction to your post.

    Suggestion – would you consider adding a translation link so more people could read the content of your blog?

  3. Hello,

    I am the author of the Eur Respir Jnl paper showing that some e-cig users can obtain large amounts of nicotine from e-cigs. I am completely independent from pharmaceutical or tobacco industries. Best wishes.

  4. The reason they are “floundering” is 2-fold. As Randall pointed out, most of them have or had connections to Big Pharma’s smoking cessation industry, which has solely been focused on nicotine cessation for the past 30-some years. They just cannot get past the nicotine and that being the only reason why smokers smoke. Smoking is all about the addiction to nicotine for them, which is why so many have turned into ANTZ.

    They are also floundering under the assumption that all smokers WANT to quit smoking. They don’t understand the difference between “wanting to” and “knowing one should” in their surveys of smokers. Hence why many ANTZ see the effective nicotine delivery of e-cigarettes as counteractive to their belief that all smokers want to be free from nicotine addiction and nicotine abstinence is the only answer.

    I wrote a similarly themed blog post back in February:

    Funny how it took researchers two separate studies and several months to come to the same conclusions. And it is inconceivable to me that their first test subjects were not those who have successfully quit smoking using e-cigarettes, but those who had never even used e-cigarettes. If someone has claimed to have found the cure for cancer, would you first look for proof in those patients who still haven’t tried the treatment or those currently using the treatment who claim to have been cured by it?

    Most “studies” of e-cigarettes seem less intent on discovering the why and how they work for so many and more focused on finding evidence to support using NRTs instead. One has to ask why that is and once one sees the funding behind the studies and considers the ANTZ beliefs about smokers and nicotine, the answers are pretty obvious. They are clueless about smokers and why they smoke, so they know even less about vapers and why they vape.

  5. I think there is beginning to be a change. Paul Bergen, who wrote this post, certainly understands the pleasure smoking/vaping gives (see Vaping, it’s all about pleasure) and Polosa told us that he deliberately chose hardened smokers who had no desire to quit to test the e-cigarette on (although that may have been more to avoid bias).

    Would it be worth speaking to the researchers directly with your concerns. Carl Phillips, Etter and Siegel as well as other researchers are usually very accessible and ready to listen.

  6. I find it confusing that the title of that article Randall provided is “The electronic cigarette is threatening the business of tobacco, seriously” yet the article seems to (rightly) argue that it’s the pharmaceutical and smoking cessation (medical, advocate) industries (not Big Tobacco) that are most threatened by e-cigarettes. Was that just lost in the translation?

  7. > Kristin Noll Marsh & Admin

    Unfortunately, the _automatic_ translation of the title is incorrect. One should read : “The electronic cigarette is threatening the anti-tobacco business, seriously”.

    Regarding Mr M. Etter’s alleged “independance”, everyone might be able to make up one’s mind listening to his interview at Swiss TV TSR on october 11, 2011 (video in french) :

    Sales pitch : “Il y a plusieurs médicaments maintenant qui sont efficaces pour arrêter de fumer, il faut utiliser ça. …] On ne peut pas recommander aux gens d’utiliser ce produit-là.” (There are several pharmaceutical products that are effective to quit smoking. Smokers have to use them. Ecig cannot be recommended.)

  8. I am a bit behind on my reading and thus late to these comments (though I will increase the chance that this is seen by making this, and the comments, the “must read” in our next, overdue, suggested reading). I definitely agree with the sentiments, both Paul’s here and Kristin’s from February (Kristin, FYI I drafted an essay in response to yours but never quite finalized what I wanted to say, so never published it).

    In fairness to JF Etter, I think it would be best to count him as one of those rare scientists who we read the archetype about in grade school (and who really exist in other fields, just no so much public health): I believed that he hypothesized that good and honest, albeit not necessarily real-worldly, research would demonstrate that what users already knew was right and that the junk science form the ANTZ was wrong, and set out to test that.

    Personally, I am of the same view as Paul and Kristin and others, that real-world evidence trumps contrived experiments in several ways. Still, there is no harm in doing the contrived research properly and demonstrating that it shows the same thing that the real-world evidence showed. Indeed, given that there are so many people out there who do not understand science, and who have been erroneously taught that artificial experiments that are written about in journals are more informative than better sources of information, there is great value in something like Etter’s study, as a way to cancel out the political junk from Eisenberg, Hatsukami, etc.

  9. Thanks for your comment, Carl.

    I’d like your opinion on this – should we really be using the term Antz? I don’t know if I always succeed, but on this blog I aim to write as simply as possible in order to try and reach as many people as possible. (Plus, I like simple writing.)

    As a result I try to limit the use of terminology. The term Antz is known only to a few people. By using this term or others like it, aren’t we making it more difficult for readers outside a select group of tobacco harm reduction enthusiasts to understand us?

  10. I think most people who are involved or will read these stories in the vaping/anti/smoking/everything world probably know we are referring to those who object to anything that might reduce harm to smokers as ANTZ or ANTI’s which most read as ANTZ right? I don’t find it to be a “rude” term when talking about folks who really don’t want you to have any choice in what you use except for the product they deem appropriate.
    They want to regulate you as the FDA would some new drug and don’t want you to have a choice therefore the ANTZ nickname is fitting.

  11. I don’t find it rude because I have been following the debate for some time, and have little respect for most antis today. However, some one who doesn’t have the same understanding might be put off by the term. I am open to correction here 😉 but also thinking back to what Goerlitz said in his interview about how we should be presenting ourselves to the media and the general public.

  12. James,
    Re “ANTZ”, it would certainly be a reasonable decision by an editor (i.e., you) to disallow that term because it is not universally recognized, but in short essays it is awkward to define it every time. But then the problem is what term to use. Five years ago, most people would incorrectly refer to that faction as “public health” (and some still do), producing absurd constructions like “the public health people are opposed to harm reduction”. In response to that, I coined “anti-tobacco extremists”, which is mostly self-explanatory. That has been adopted and used in various “serious” publications by THRo, Rodu, Godshall, etc., so I think it qualifies as accepted jargon.

    That said, I quite like “ANTZ”, and we have been using it in our suggested reading and other informal publications since Kristin coined it. It is a bit more flexible than “extremists” because it does not imply that someone necessarily supports the most extreme beliefs (and similarly it is better than “prohibitionist” or the like because they have specific meanings). Also, I happen to like the subtle hint of diminution and ridicule that it conveys, because I think that a bit of ridicule is the proper response to thoughtless zealots who are a threat to social justice and people’s welfare.

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