Unhappy with paper by Dr. Farsalinos

[Alien Traveler]

I am starting a parallel thread about paper by Dr. Farsalinos Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices : Scientific Reports : Nature Publishing Group

I am pleased to see published test results (not too much was done to date in this field). I am very unhappy with conclusions authors made from these results.

They observed that nicotine level in blood samples of vapers (of 18 mg nicotine juice) reached nicotine level of that of smoker of one cigarette only after 35 min of vaping. Based on that finding they made outrageous recommendation to rise nicotine level of juice to 50 mg in attempt to rise nicotine level in blood of vaper as fast as that of smoker. They preferred not to pay attention to the fact that nicotine level in vapers continued to rise and after 65 min of vaping was 20% higher than that of smokers. Moreover, rise of nicotine continued at 65 min of test without any evidence that it will stop soon, that it is close to plateau.

We all know that vapers tend to be chain vapers. According to Dr. Farsalinos data they can rise their blood nicotine level much higher than smokers can and still he recommends to use stronger liquid…

Dr. Fasanos is a new guy in the science, he makes mistakes.

 

[Spazmelda]

I started a post to try to explain his rationale here, but I can't explain it like he can. I posted a link to this thread on his Facebook page, so hopefully he will come here and clarify his conclusions. IMO, he's a very good scientist!

 

[readeuler]

Wouldn't a high-nicotine liquid be great for someone who really wants to mimic smoking - take a few hits, and then be done for a while?

I enjoy chain-vaping, and would not make my liquid 50mg/ml. But perhaps if vapor irritated me, or I couldn't devote more than 2 minutes here and there to vaping, I would prefer to be completely satisfied. If that meant 50mg/ml liquid, I don't think that's a bad idea.

 

[JimmyDB]

I see where you are coming from... in order to make such a recommendation (to greatly increase strength of the juice), it should be based on observing the high end of the self-imposed limiting of the APV user instead of only suggesting that the APV user would self-limit much earlier IF they could reach the same blood test result as from using a tobacco leaf cigarette.

I can understand the logic... if there is such a thing as APV users self-regulating their nicotine (by feel or sensation, etc), it *should* be safe to assume it occurs at a generally fixed nicotine level for that person, despite the time required to get there, hence getting them there faster would lead to them using the APV less frequently.

The actual conclusion though is just to use more nicotine all the time so that the user can reach that 'leaf level' faster with respect to vaping being a more compatible alternative to leaf burning.

I can see where this information would be beneficial to BT companies wanting to make a more realistic electronic version of an analog. However, it seems when raising the nic level of analogs wasn't found to be realistic, they had resorted to messing with other ways to increase absorption rates (added chemicals) as well as using other chemicals for their own unique addictions and qualities.

The APV industry is also working on better ways to increase the absorption rates, but without touching the juice... higher wattage, different wicking materials, dripping versus only wicking, et cetera.

 

[Nermal]

I admit to skimming the report, but didn't see anything I thought would be a "recommendation" for a concentration of 50mg/ml. What I did see was the information that 50mg/ml would be needed to equal the adsorption of nicotine by smoking one cigarette. Can someone point me to the right section? I quote the only conclusion I could find.

In conclusion, new-generation EC devices delivering higher energy to the atomizer seem to be more effective than first-generation devices in nicotine delivery to the user and in reducing cravings for nicotine. However, both types of devices were significantly less effective in nicotine delivery compared to tobacco cigarettes when an 18 mg/ml nicotine containing liquid is used. It is reasonable to assume that nicotine levels in EC liquids should be considerably higher in order to improve their effectiveness in nicotine delivery, which is expected to make them more successful as smoking substitutes.

 

[JimmyDB]

Nermel,

I think you have it about right.

I'm not sure if increasing the nicotine would actually "improve their effectiveness in nicotine delivery", it would increase the nicotine delivery, sure. Since the only suggestion is to increase the nicotine, and since it says "to make them more" versus saying 'to make them as', we should actually presume it would be some number "considerably higher" than 18mg/ml and less than 50mg/ml. These are assumptions though.

 

[JimmyDB]

Correction: Opening paragraph.

the use of 18 mg/ml nicotine-concentration liquid probably compromises ecs' effectiveness as smoking substitutes; this study supports the need for higher levels of nicotine-containing liquids (approximately 50 mg/ml) in order to deliver nicotine more effectively and approach the nicotine-delivery profile of tobacco cigarettes.

I'm reading "supports the need" as a recommendation.

 

[Nermal]

I disagree. "supports the need" is only a recommendation if we assume the objective is "to approach the nicotine-delivery profile of tobacco cigarettes". That is certainly not my objective, and apparently not the objective of the many, many vapers using less than 18mg/ml.

 

[peraspera]

I know quite a few people who use very high nic and vape less often - they prefer to vape more like they smoked. Also, some people can only vape on breaks at work and prefer higher nic levels for that purpose.

Dr. Farsalinos did the study in response to the EU limiting nicotine levels available to vapers to 20mg. You are making assumptions that everyone will chain vape and continue to do so even after their bodies have adequate nicotine levels to prevent cravings as well as keeping chain vaping even though they would have symptoms of overdoing the nic. I don't think we see people doing that. We routinely see people posting on ECF that they adjust their nicotine levels to prevent cravings while avoiding getting nic sick. That would certainly seem to be the norm.

From Dr. Farsalinos in response to the EU, The European Commission has misinterpreted my scientific research on nicotine in e-cigarettes.
My research (cited by SANCO) specifically examined nicotine consumption and made absolutely clear that the determination of the upper limits needs to be determined based on nicotine absorption and delivery to the bloodstream (reference 2). My studies on nicotine absorption pharmacokinetics have shown that liquids with nicotine content similar to the upper limit decided by SANCO provides typically less than one-third of the nicotine delivered by one tobacco cigarette (references 4 and 5). We have calculated that a 50mg/ml nicotine-containing liquid is marginally equivalent to smoking one tobacco cigarette in terms of nicotine delivery to the bloodstream. In my second study cited by SANCO, I have clearly shown that 23% of smokers had to use higher than 20mg/ml nicotine-containing liquids in order to completely substitute smoking (reference 3, Figure 1). None can support that 23% of users is a small proportion; however, this has been ignored by SANCO. In fact, this study provides further support that 20mg/ml nicotine content in liquids is insufficient for smokers.

The study also showed that more advanced gear delivered more nic but most people outside ECF world seem to use cigalikes.

 

[defdock]

have to remember, cigs were laced with chemicals in the first place to make the nicotine absorb more quickly

 

[KFarsalinos]

I am starting a parallel thread about paper by Dr. Farsalinos Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices : Scientific Reports : Nature Publishing Group

I am pleased to see published test results (not too much was done to date in this field). I am very unhappy with conclusions authors made from these results.

They observed that nicotine level in blood samples of vapers (of 18 mg nicotine juice) reached nicotine level of that of smoker of one cigarette only after 35 min of vaping. Based on that finding they made outrageous recommendation to rise nicotine level of juice to 50 mg in attempt to rise nicotine level in blood of vaper as fast as that of smoker. They preferred not to pay attention to the fact that nicotine level in vapers continued to rise and after 65 min of vaping was 20% higher than that of smokers. Moreover, rise of nicotine continued at 65 min of test without any evidence that it will stop soon, that it is close to plateau.

We all know that vapers tend to be chain vapers. According to Dr. Farsalinos data they can rise their blood nicotine level much higher than smokers can and still he recommends to use stronger liquid…

Dr. Fasanos is a new guy in the science, he makes mistakes.

I admit that i am a new guy in science. However, i would suggest you to read a little bit more careful what i mention in the paper:
According to you, i said: "they made outrageous recommendation to rise nicotine level of juice to 50 mg in attempt to rise nicotine level in blood of vaper as fast as that of smoker."

If you go here Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices : Scientific Reports : Nature Publishing Group and search for the word "recommend" or "recommendation", you will not find it anywhere in the whole text.
What we said is: " this study supports the need for higher levels of nicotine-containing liquids (approximately 50 mg/ml) in order to deliver nicotine more effectively and approach the nicotine-delivery profile of tobacco cigarettes"

Which means exactly what it says: that the nicotine absorption profile from e-cigarettes is not comparable to tobacco. I am not recommending to VAPERS to use 50mg/ml. I just say what nicotine levels would result in comparable absorption.

Now, why do you think that if someone would use 50mg/ml if nicotine we would observe continuous elevation in plasma nicotine levels after 35 or 60 minutes? Obviously, you miss a major point about nicotine intake: users self-titrate nicotine intake.
If you were using a high-nicotine liquid and got similar to tobacco plasma nicotine levels, you WOULD NOT chain-vape. Moreover, smokers are not at all used to "chain-smoke". Have you ever thought that the huge failure rate of e-cigarettes (most smokers CANNOT switch with e-cigarettes) could be attributed to the inability of the smokers to get the nicotine hit they get from cigarettes?

The study supports the need that higher nicotine levels should be available, mostly for smokers who want to switch. For you, of course you can use lower levels and chain vapenow that you are used to. But many smokers do not want to chain vape and do not like the gradual elevation in plasma nicotine levels.

In reality, 50mg/ml nicotine concentration will induce significant throat irritation, which few people could withstand i know few people who vape 50mg/ml though). Thus, we should find other ways to improve nicotine delivery.

 

[KFarsalinos]

Allow me to expand a bit more. I know that most vapers chain vape. Why do they do it? Were they used to it when they were smokers? Obviously not.
Perhaps they like the flavor and want to vape all time. That is definitely a possibility. However, there is another possibility. They just want to get the nicotine they need, and cannot do it unless they chain vape. In reality, the slow nicotine delivery causes higher liquid consumption. In my opinion, any small residual risk from e-cigarette use will not come from nicotine but from other chemicals (e.g. aldehydes, due to heat). If you had the ability to use the e-cigarette as smoking (get significant nicotine hit), then you would probably consume much less liquid. This would make vaping even safer.
Of course now most vapers are used to chain vape, and it will be difficult to change their habit. But for new vapers, perhaps it would be better (and preferable to them) to use the e-cigarette in the same way as smoking.

 

[Nermal]

Which means exactly what it says: that the nicotine absorption profile from e-cigarettes is not comparable to tobacco. I am not recommending to VAPERS to use 50mg/ml. I just say what nicotine levels would result in comparable absorption.

So good to hearing a real authority say what I just said.

 

[Iffy]

However, there is another possibility. They just want to get the nicotine they need, and cannot do it unless they chain vape. In reality, the slow nicotine delivery causes higher liquid consumption.

Ah ha! Someone actually read and understood the report... oh, wait...

Thanx KF for your post!

 

[readeuler]

Well, there you have it, from the man himself.

And also, a thought. Given that e-cigarettes in their current form have existed since 2006(being generous) and Dr. Farsalinos has been researching vaporizing for approximately the past two years, that would be roughly 12.5% to 25% of its existence. Hardly "new"!

Either way, he's doing quality research with us in mind, and willing to interact with those whom his work concerns. A classier act than you will ever find in public health!

 

[FlamingoTutu]

Thank you for your posts KF.

Just want to add that I was a chain smoker, at least when I was sitting down doing something like driving, on the computer, reading, writing, etc. There were many times when I’d light the dang thing and never take another hit off of it before stubbing it out. After 43 years this became a pretty ingrained habit and has crossed over into vaping. Did it even when I dropped to 0mg but am happier with 3mg more often now. I suppose I could fiddle with a pencil but the erased doesn’t taste nearly as good as DIY blackberry.

Thank you again for posting.

 

[JoppaRoadCruiser]

Awesome having Dr. F posting in here. Thank you for all that you do!

 

[dr g]

I admit that i am a new guy in science. However, i would suggest you to read a little bit more careful what i mention in the paper:
According to you, i said: "they made outrageous recommendation to rise nicotine level of juice to 50 mg in attempt to rise nicotine level in blood of vaper as fast as that of smoker."

If you go here Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices : Scientific Reports : Nature Publishing Group and search for the word "recommend" or "recommendation", you will not find it anywhere in the whole text.
What we said is: " this study supports the need for higher levels of nicotine-containing liquids (approximately 50 mg/ml) in order to deliver nicotine more effectively and approach the nicotine-delivery profile of tobacco cigarettes"

Which means exactly what it says: that the nicotine absorption profile from e-cigarettes is not comparable to tobacco. I am not recommending to VAPERS to use 50mg/ml. I just say what nicotine levels would result in comparable absorption.

Now, why do you think that if someone would use 50mg/ml if nicotine we would observe continuous elevation in plasma nicotine levels after 35 or 60 minutes? Obviously, you miss a major point about nicotine intake: users self-titrate nicotine intake.
If you were using a high-nicotine liquid and got similar to tobacco plasma nicotine levels, you WOULD NOT chain-vape. Moreover, smokers are not at all used to "chain-smoke". Have you ever thought that the huge failure rate of e-cigarettes (most smokers CANNOT switch with e-cigarettes) could be attributed to the inability of the smokers to get the nicotine hit they get from cigarettes?

The study supports the need that higher nicotine levels should be available, mostly for smokers who want to switch. For you, of course you can use lower levels and chain vapenow that you are used to. But many smokers do not want to chain vape and do not like the gradual elevation in plasma nicotine levels.

In reality, 50mg/ml nicotine concentration will induce significant throat irritation, which few people could withstand i know few people who vape 50mg/ml though). Thus, we should find other ways to improve nicotine delivery.

Interesting, it seems this is a miscommunication issue, just a slight difference in English usage. The words as written do indeed seem to recommend 50mg/ml when the author simply meant to say that "you would need 50mg/ml to have absorption similar to cigarettes."

Also if I'm not mistaken, the context in which this study was released was with the EU moving to limit maximum nicotine concentration to 20 mg/ml?

 

[Spazmelda]

One thing I think we often forget here on ECF is that we don't really represent the 'typical vaper'. It's easy to think that we do because there are so many of us and those of us who post the most are really the most enthusiastic of enthusiasts. As a couple of people have posted here, sucking on an ecig all day may not be typical or desirable, especially for someone new to ecigs. A new, non-enthusiast, ecig user might well be better off using a higher nicotine strength to get nicotine levels up more quickly. They are used to a fast acting blast of nicotine from combustible cigarettes. They might not need as high as 50 mg/ml, but the paper is a good rebuttal to the EUs idea that 20 mg/ml is the highest ecigs should go for safety reasons. The EUs assumption is that concentrations over 20 mg/ml are too high, higher than cigarettes, but they did not take into account delivery. Dr. Farsalinos' paper clearly shows that ecig users of 20 or so mg/ml are not really blasting their bodies with high levels of quickly absorbed nicotine, and suggests the possibility that some transitioning users might well need over 20 mg/ml to able to successfully transition from cigarettes to ecigs.

 

[Alien Traveler]

I admit that i am a new guy in science. However, i would suggest you to read a little bit more careful what i mention in the paper:
According to you, i said: "they made outrageous recommendation to rise nicotine level of juice to 50 mg in attempt to rise nicotine level in blood of vaper as fast as that of smoker."

If you go here Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices : Scientific Reports : Nature Publishing Group and search for the word "recommend" or "recommendation", you will not find it anywhere in the whole text.
What we said is: " this study supports the need for higher levels of nicotine-containing liquids (approximately 50 mg/ml) in order to deliver nicotine more effectively and approach the nicotine-delivery profile of tobacco cigarettes"

In making recommendation utilizing word “recommendation” is not a mandatory part. Even decision shy US Supreme Court would confirm it.

Which means exactly what it says: that the nicotine absorption profile from e-cigarettes is not comparable to tobacco. I am not recommending to VAPERS to use 50mg/ml. I just say what nicotine levels would result in comparable absorption.

Now, why do you think that if someone would use 50mg/ml if nicotine we would observe continuous elevation in plasma nicotine levels after 35 or 60 minutes? Obviously, you miss a major point about nicotine intake: users self-titrate nicotine intake.

Sorry, cigarette smokers self-titrate nicotine intake. Nothing was proved about self-titrating for vapers. However I believe (just believe, not know) that vapers do self-titrate. But at what levels? From your paper I see that even after 65 min of vaping and after nicotine level in vaper’s blood was 20% higher that after smoking the self-titration level was not reached. Moreover, there were no slowing down of nicotine level increase in a time interval from 35 to 65 min. So I am free to suppose that that vaper's self-titration level could be at twice (if not higher) of nicotine absorption level of smoker. You have stopped your measurements at 65 min, so we do not know for how self-titration works for vapers, but we do see from your results that consumption of 18 mg juice leads to higher nicotine level than smoking.

If you were using a high-nicotine liquid and got similar to tobacco plasma nicotine levels, you WOULD NOT chain-vape. Moreover, smokers are not at all used to "chain-smoke". Have you ever thought that the huge failure rate of e-cigarettes (most smokers CANNOT switch with e-cigarettes) could be attributed to the inability of the smokers to get the nicotine hit they get from cigarettes?

Could be attributed. But should it? There is no data confirming that it can help. Easy study: to compare success levels for vapers in smoking succession in countries with limited and not limited nicotine level in juices OK, may be not really an easy one, I know nothing about availability of needed data.

The study supports the need that higher nicotine levels should be available, mostly for smokers who want to switch. For you, of course you can use lower levels and chain vapenow that you are used to. But many smokers do not want to chain vape and do not like the gradual elevation in plasma nicotine levels.

In reality, 50mg/ml nicotine concentration will induce significant throat irritation, which few people could withstand i know few people who vape 50mg/ml though). Thus, we should find other ways to improve nicotine delivery.

I am for freedom for vapers. As a political statement your paper is very good, but unfortunately for this forum (as you know you are very popular here) it is misleading for vapers. Some vapers greatly misunderstood such things as “self-titration”, “slower delivery”, etc. For example I see here such recommendations as “vape as much as you can” based unfortunately in part on your work.