CASAA Warns Consumers: Electronic Cigarette Study Misleading

The Consumer Advocates for Smoke-free Alternatives Association (CASAA) ¹ is warning tobacco smokers, who are considering switching to electronic cigarettes, not to put too much weight in a recent study funded by the National Cancer Institute. ²

"While we agree that electronic cigarettes need to be regulated for quality control and advertising claims, thousands of CASAA members and hundreds of thousands of users worldwide, would have to disagree that the devices can be called ineffective," said CASAA Chairman, Michal Douglas. "The study is misleading and could cause smokers to continue smoking tobacco, rather than trying electronic cigarettes, which have been shown to be without the high levels of toxins and carcinogens found in tobacco smoke. We also caution legislators and lawmakers to wait for supporting studies before going after electronic cigarette retailers and manufacturers based on misleading evidence."

The study was done by Dr. Thomas Eissenberg, a Virginia Commonwealth University researcher and was recently published in the February 2010 Online First issue of the Tobacco Control journal.³ Researchers tested 16 participants over four sessions, in which they smoked their preferred brand of cigarettes, puffed an unlit cigarette, or tried one of two different brands of electronic cigarettes. The participants were required to be new to electronic cigarettes and were not trained in electronic cigarette technique. The two brands tested were labeled as "16mg" of nicotine and "high strength."

Electronic cigarette cartridges and liquids are generally available in strengths ranging from 0mg to 36mg of nicotine. The devices consist of a battery, heating element and nicotine liquid cartridge. The nicotine is diluted in a flavored solution of propelyne or vegetable glycol. When the user "puffs" on the device, the heating element vaporizes the liquid, delivering nicotine and a "smoking-like" experience. The devices are typically marketed as a smoking alternative, rather than a smoking cessation device. The study was conducted to determine the efficacy of electronic cigarette nicotine delivery compared to tobacco smoking.

"The study appears to contain some flaws," said CASAA medical director, Theresa Whitt, M.D. "Neither test subjects nor the researchers had ever used the devices before, thus were not aware of the differences between using an electronic cigarette versus a tobacco cigarette. There is a learning curve to using these devices and I believe that a lack of experience may explain the results of this study."

"The study had novice participants take 10 "puffs" on a new, medium-low strength cartridge," said Dr. Whitt. "First of all, new users generally take shallow, ineffective puffs and before they learn that they must inhale longer and deeper. Because vapor does not deliver nicotine in the same manner smoke does, experienced users have learned inhaling techniques to increase efficacy."

"Secondly, new atomizers are treated to keep the wick moist until it is used and it can take 10-20 "puffs" before the nicotine liquid even reaches the heating element. Experienced owners know to take a number of puffs on the device, without inhaling, until the flavor of the nicotine liquid appears ."

"Finally, devices containing an automatic switch, which is activated when the user inhales through the electronic cigarette, need a technique called a "primer puff." This short puff, prior to inhaling, helps heat up the element to vaporize the liquid. Without knowing how to do a primer puff or how to inhale properly, the test subjects easily may have been inhaling little more than air, leading to little or no nicotine adsorption," concluded Dr.Whitt.

"The data collected in this study could still be very valuable," added Douglas. "If all electronic cigarettes truly lack the the ability to deliver an effective amount of nicotine, yet hundreds of thousands of consumers still find them as an effective substitute to smoking tobacco, it could mean that the right kind of placebo will help people quit tobacco smoking. Nicotine replacement therapy, such as nicotine gums and patches, have a dismal 7% success rate. So, we must not jump to the conclusion that electronic cigarettes are not effective as smoking alternatives, simply because they don't deliver the same dose of nicotine."

"Nor must we assume that the experiences of just 16 novice electronic cigarette test subjects genuinely reflects the real-life results of experienced consumers," Douglas continued. "There are too many questions and variables for this study to be considered conclusive. We don't want people to continue inhaling toxic cigarette smoke, just because Virginia Commonwealth University is telling smokers that their tobacco cigarettes are more effective at delivering nicotine⁴, essentially implying that smokers may as well not bother trying electronic cigarettes. That is both misleading and irresponsible. Smokers need to have effective and affordable alternatives available to them - too many lives are at stake to take this study at face value. More research must be done," Douglas stated.

1. http://cassa.org
2. http://www.cancer.gov
3. http://tobaccocontrol.bmj.com/content/19/1/87.extract
4. http://www.news.vcu.edu/news/Study_reveals_a_need_to_evaluate_and_regulate_electronic_cigarettes