Study by prohibitionists finds e-cigarettes reduce cigarette consumption 40% among first time users, but authors misrepresent findings
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Thread: Study by prohibitionists finds e-cigarettes reduce cigarette consumption 40% among first time users, but authors misrepresent findings

  1. #1
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    Default Study by prohibitionists finds e-cigarettes reduce cigarette consumption 40% among first time users, but authors misrepresent findings

    Study (presented as a poster at last week's SRNT conference) by e-cigarette prohibitionists finds 40% decline in mean daily cigarette consumption (from 14.7 to 8.8) among 43 first time e-cigarette users who weren't interested in quitting smoking, but authors falsely claim tobacco toxicant exposure WAS NOT lowered, that "e-cigs may provide no public health benefit", and that their findings support FDA regulation of e-cigarettes as Modified Risk Tobacco Products (which would first require FDA to approve a "deeming" regulation that could/would effective ban e-cigarette sales).
    http://www.srnt.org/conferences/2012...bstracts_H.pdf (POS3-107 on page 121)

    POS3-107
    E-CIGARETTE ABUSE LIABILITY: SUBJECTIVE, BEHAVIORAL, AND EXPOSURE
    EFFECTS OF SWITCHING
    Vaughan W. Rees*, Jonathan Noel, Ilan Behm, and Gregory N. Connolly, Center for
    Global Tobacco Control, Harvard School of Public Health

    BACKGROUND: Electronic cigarettes have been promoted as a safer alternative for
    delivering nicotine to smokers. However, the appeal of the e-cigarette (e-cig) may be
    limited compared with a conventional cigarette. Abuse liability of e-cig was assessed
    among daily smokers using a switching study design. METHODS: Participants (N=
    43; 35.4 yrs of age; 70% male) were regular smokers not contemplating quitting,
    and were naive to e-cig use. After a 72 hour baseline of usual brand of conventional
    cigarette use, subjects were switched for a further 11 days to a commercial e-cig
    product. Behavior was monitored throughout the study (smoking diary, phone interview)
    and follow-up lab sessions were conducted at Days 11 and 14. Puffing topography,
    smoking urges, nicotine withdrawal, sensory perceptions, and drug effect and liking
    were measured pre- and post-smoking. Exposure to nicotine was assessed via urinary
    cotinine pre- and post-switching. RESULTS: After 14 days, mean cigarettes smoked
    per day significantly decreased a relative 40.3% from 14.7 at baseline to 8.8 at Day
    14 (paired t-test, p<0.001). Subjects took larger (p=.045) and longer (p=.008) puffs
    with the e-cig compared with conventional. Cotinine geometric mean did not differ
    significantly from baseline to Day 14 (1535.9 ng/ml vs. 1391.7 ng/ml; p<.001). E-cig
    use reduced urges to smoke (p=.046) and withdrawal (p=.046). However, e-cig nicotine
    effect (p=.006) and liking (p<.001) were rated significantly lower than the conventional
    cigarette. CONCLUSIONS: E-cigarette use reduced smoking urges and withdrawal,
    but nicotine effect and liking measures suggested a less optimal e-cig nicotine reward.
    While conventional cigarette consumption decreased, complete switching did not occur,
    further suggesting limited consumer appeal. These data suggest that e-cigs have lower
    abuse liability compared with conventional cigarettes and are likely to be used dually
    with conventional cigarettes. The failure to lower exposure to tobacco toxicants, while
    maintaining nicotine dependence, suggests that e-cigs may provide no public health
    benefit. These findings support FDA regulation of e-cigarettes as Modified Risk Tobacco
    Products.
    National Cancer Institute grant # RO1-CA-125224.
    CORRESPONDING AUTHOR: Vaughan Rees, PhD, Harvard School of Public Health,
    Center for Global Tobacco Control, 677 Huntington Ave, Boston, MA 02115, United
    States, Phone: 617-496-1395, Email: [email protected]

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    The intro on the Method says it all.

    "Participants (N=43; 35.4 yrs of age; 70% male) were regular smokers not contemplating quitting,
    and were naive to e-cig use."

    New people who aren't interested in stopping/switching. That there was still a 40% reduction in smoking is pretty amazing.

    "Hey, guy, you don't want to stop smoking, but mind trying a Schnoo ecig for a couple weeks? It's fine to smoke, too, just tell us what you feel like using. Oh, yeah, it's likely a pretty cruddy ecig, and, well, we aren't even sure how you should use it, don't know about how to inhale, or drink extra water, or..., but press on and let us know what happens."
    Pay It Forward Learn to laugh at yourself -- why let everyone else have all the fun :)
    http://www.e-cigarette-forum.com/forum/diy-e-liquid/

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    I sent the following e-mail to Vaughan Rees.


    Hi Vaughan,

    I noticed your poster presentation for the SRNT conference and found it extremely inconsistent.
    http://www.srnt.org/conferences/2012...bstracts_H.pdf (POS3-107 on page 121 and printed below)

    Please explain how a 40% decline in mean daily cigarette consumption (from 14.7 to 8.8) did NOT lower tobacco toxicant exposure for the 43 first time e-cigarette users in your study. In fact, a 40% decline in cigarette consumption is about a 40% decline in tobacco toxicant exposure (since the smoke is the toxicant).

    Also, please explain how did you conclude that a 40% decline in mean daily cigarette consumption "may provide no public health benefit". Do you similarly believe that a 40% increase in daily cigarette consumption would benefit public health?

    Finally, please explain how your study's findings support FDA regulation of e-cigarettes as Modified Risk Tobacco Products (since MRTP applications can only be submitted by manufacturers of cigarettes, cigarette tobacco, RYO and smokeless tobacco, and since FDA would first need to promulgate a "deeming" regulation to apply Chapter IX provisions of the FSPTCA to e-cigarettes before any e-cigarette company could even submit a MRTP application, and since the promulgation of a "deeming" regulation for e-cigarettes could/would protect cigarette markets and harm public health by bannign most e-cigarette sales and otherwise decimating the e-cigarette industry).

    In fact, none of your study's findings support any regulation(s) for e-cigarettes. Rather, your study found that e-cigarettes could sharply reduce cigarette consumption among first time users, and that e-cigarettes could potentially save tens of millions of lives if smokers were truthfully informed that e-cigarettes are far less hazardous alternatives to cigarettes and if e-cigarettes remain inexpensive, legal and easily accessible.

    Bill Godshall
    Executive Director
    Smokefree Pennsylvania
    1926 Monongahela Avenue
    Pittsburgh, PA 15218
    412-351-5880
    [email protected]

    POS3-107
    E-CIGARETTE ABUSE LIABILITY: SUBJECTIVE, BEHAVIORAL, AND EXPOSURE
    EFFECTS OF SWITCHING
    Vaughan W. Rees*, Jonathan Noel, Ilan Behm, and Gregory N. Connolly, Center for
    Global Tobacco Control, Harvard School of Public Health

    BACKGROUND: Electronic cigarettes have been promoted as a safer alternative for
    delivering nicotine to smokers. However, the appeal of the e-cigarette (e-cig) may be
    limited compared with a conventional cigarette. Abuse liability of e-cig was assessed
    among daily smokers using a switching study design. METHODS: Participants (N=
    43; 35.4 yrs of age; 70% male) were regular smokers not contemplating quitting,
    and were naive to e-cig use. After a 72 hour baseline of usual brand of conventional
    cigarette use, subjects were switched for a further 11 days to a commercial e-cig
    product. Behavior was monitored throughout the study (smoking diary, phone interview)
    and follow-up lab sessions were conducted at Days 11 and 14. Puffing topography,
    smoking urges, nicotine withdrawal, sensory perceptions, and drug effect and liking
    were measured pre- and post-smoking. Exposure to nicotine was assessed via urinary
    cotinine pre- and post-switching. RESULTS: After 14 days, mean cigarettes smoked
    per day significantly decreased a relative 40.3% from 14.7 at baseline to 8.8 at Day
    14 (paired t-test, p<0.001). Subjects took larger (p=.045) and longer (p=.008) puffs
    with the e-cig compared with conventional. Cotinine geometric mean did not differ
    significantly from baseline to Day 14 (1535.9 ng/ml vs. 1391.7 ng/ml; p<.001). E-cig
    use reduced urges to smoke (p=.046) and withdrawal (p=.046). However, e-cig nicotine
    effect (p=.006) and liking (p<.001) were rated significantly lower than the conventional
    cigarette. CONCLUSIONS: E-cigarette use reduced smoking urges and withdrawal,
    but nicotine effect and liking measures suggested a less optimal e-cig nicotine reward.
    While conventional cigarette consumption decreased, complete switching did not occur,
    further suggesting limited consumer appeal. These data suggest that e-cigs have lower
    abuse liability compared with conventional cigarettes and are likely to be used dually
    with conventional cigarettes. The failure to lower exposure to tobacco toxicants, while
    maintaining nicotine dependence, suggests that e-cigs may provide no public health
    benefit. These findings support FDA regulation of e-cigarettes as Modified Risk Tobacco
    Products.
    National Cancer Institute grant # RO1-CA-125224.
    CORRESPONDING AUTHOR: Vaughan Rees, PhD, Harvard School of Public Health,
    Center for Global Tobacco Control, 677 Huntington Ave, Boston, MA 02115, United
    States, Phone: 617-496-1395, Email: [email protected]

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    It seems their trying to say, That being slap up the side of your head with and open hand
    Is the same as being hit with a two by four. I would love to demonstrate the differences to them
    I think you would have to use the two by four first just to get their attention.
    Last edited by VapApe; 03-28-2012 at 11:16 PM.
    I feel a bout of Civil disobedience coming on

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    What their saying is if it doesn't lead to total cessation then, on the principal that their is no safe amount of tobacco, then it is a failure and of no benefit.
    Once you set the complete removal of any and all tobacco products as your goal, then only that which could, might, maybe, lead to that end is acceptable.
    It's stops being about what works to reduce and becomes about what will lead to elimination.

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    Quote Originally Posted by tommy2bad View Post
    It's stops being about what works to reduce and becomes about what will lead to elimination.

    When you are completely full of "it", elimination does seem to become the priority.
    Vocalek, JC Okie, TomCatt and 2 others like this.

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    Vaughan Rees sent me the following reply.

    Dear Bill,
    Great questions. I have provided responses to your questions below. Please note that the study has not been peer-reviewed and published and that this conference presentation should be considered a preliminary finding until the manuscript is finalized. Also, some further data on exposure were obtained after the abstract was submitted back around September 2011. Consequently, some of the statements made in that abstract have been revised for the poster actually presented.

    Regards,
    Vaughan

    Vaughan Rees, PhD
    Center for Global Tobacco Control
    Dept. Society, Human Development and Health
    Harvard School of Public Health
    Landmark Building, Level 3 East
    677 Huntington Ave
    Boston, MA 02115
    Ph. 617-496-1395


    >>> "Bill Godshall" <[email protected]> 3/28/2012 2:03 PM >>>

    Hi Vaughan,

    I noticed your poster presentation for the SRNT conference and found it extremely inconsistent.
    http://www.srnt.org/conferences/2012...bstracts_H.pdf (POS3-107 on page 121 and printed below)

    Please explain how a 40% decline in mean daily cigarette consumption (from 14.7 to 8.8) did NOT lower tobacco toxicant exposure for the 43 first time e-cigarette users in your study. In fact, a 40% decline in cigarette consumption is about a 40% decline in tobacco toxicant exposure (since the smoke is the toxicant).
    There was a significant decrease in NNAL, indicating that NNK exposure was decreased. Cotinine was not significantly decreased, suggesting that the e-cig maintained users' nicotine requirement while cigarette consumption reduced.
    The decrease in NNAL is certainly a positive step, but likely falls far short of providing substantial reduction in health risk. This question requires further evidence to be established.

    Also, please explain how did you conclude that a 40% decline in mean daily cigarette consumption "may provide no public health benefit". Do you similarly believe that a 40% increase in daily cigarette consumption would benefit public health?
    The concern is that reduction in smoking will not eliminate risk and may delay cessation among some smokers.

    Finally, please explain how your study's findings support FDA regulation of e-cigarettes as Modified Risk Tobacco Products (since MRTP applications can only be submitted by manufacturers of cigarettes, cigarette tobacco, RYO and smokeless tobacco, and since FDA would first need to promulgate a "deeming" regulation to apply Chapter IX provisions of the FSPTCA to e-cigarettes before any e-cigarette company could even submit a MRTP application, and since the promulgation of a "deeming" regulation for e-cigarettes could/would protect cigarette markets and harm public health by bannign most e-cigarette sales and otherwise decimating the e-cigarette industry).
    The poster presented at the meeting (in contrast with the earlier abstract) concludes:
    "Smokers reported generally unfavorable responses to e-cigarette use, including e-cigarette effect and liking, lower perceptions of product sensory appeal, and withdrawal reduction. However, smokers replaced 40% of their conventional cigarette consumption with e-cigarette use, and maintained cotinine levels, while reducing urinary NNAL. E-cigarettes may promote dual use rather than complete switching, and the influence of dual e-cig/conventional product use on individual risk requires further investigation."

    This evidence may contribute to the science base for FDA regulation, which may require a "deeming" regulation as you have stated.


    In fact, none of your study's findings support any regulation(s) for e-cigarettes. Rather, your study found that e-cigarettes could sharply reduce cigarette consumption among first time users, and that e-cigarettes could potentially save tens of millions of lives if smokers were truthfully informed that e-cigarettes are far less hazardous alternatives to cigarettes and if e-cigarettes remain inexpensive, legal and easily accessible.
    I don't think those conclusions can be made from this study

    Bill Godshall
    Executive Director
    Smokefree Pennsylvania
    1926 Monongahela Avenue
    Pittsburgh, PA 15218
    412-351-5880
    [email protected]

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    It seems that Dr. Rees has forgotten that this study specifically looked at smokers who were NOT willing to quit. The evidence shows that despite their unwillingness to quit, and without anything in the study encouraging these smokers to quit or cut down, they smoked 40% few cigarettes. How exactly does smoking fewer cigarettes make someone who is otherwise unwilling to quit...less willing to quit?? Are they worried that the people who weren't too excited about needing to quit, might not be willing to shut up about how they can temporarily or permanently avoid the perils of smoking without the need for psychiatric help? Come to think of it, yes, that's probably it.
    Last edited by Thulium; 03-28-2012 at 11:31 PM.
    TomCatt likes this.

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    Perhaps they should find smokers who are wanting to quit, and give them an eGo or other quality PV to use.

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    Quote Originally Posted by bruiser View Post
    Perhaps they should find smokers who are wanting to quit, and give them an eGo or other quality PV to use.
    You know, to tell you the truth, I don't think I've ever seen a study like that. Great idea.

    Also, would like to see (in smokers that want to quit: a 3 arm study):
    1. 1 arm being nicotine gum or patch.
    2. Second arm is e cigs (& a good version not a gas station one).
    3. placebo.

    I'd like to see it for whatever the length of time they say the average person stays off cigarettes using the FDA approved nicotine replacement strategy.
    Last edited by Penner; 03-29-2012 at 02:29 AM.

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