E-cigarette Research: Looking for love in all the wrong places?

Two recent blog posts by Carl Philips brought to me the realization that reduced-harm researchers may be looking at e-cigarette research all wrong. His first post regarding a recent study by Dr. Michael Siegel got me thinking and the second one critiquing the study actually inspired me to comment.

It seems that even well-meaning researchers don't quite "get" e-cigarettes or their users and that is hampering their efforts to analyze them and their effectiveness.

As I mentioned in my comment on the blog post, e-cigarette users posting on forums (who have successfully switched and are fans) were not necessarily looking to "quit smoking," yet they seem to be the most successful at doing just that. Researchers, however, seem to focus their efforts on smokers who are unfamiliar with e-cigarettes and are looking for a smoking/nicotine cessation alternative rather than a smoking alternative. It seems that after so many years of researching nicotine cessation products that it is difficult even for reduced harm supporters to think outside of the box when it comes to researching a product as unique as electronic cigarettes.

In researching nicotine cessation products, one would obviously want to avoid surveys of "avid fans" of a particular product, as their opinion would be biased due to their satisfaction. Those subjects would also be in a particular segment of the population that was already in the mindset of wanting to quit anything to do with smoking and not indicative of the average smoker. Based upon my observations of the "avid fans" of e-cigarettes, this is not usually the case. Most e-cigarette users posting on forums comment that they specifically were NOT trying to quit. While they may have attempted to quit using traditional NRTs in the past, the most common reasons listed for trying e-cigarettes include saving money, protesting taxes, bypassing indoor use bans and the ability to "smoke" without the same health risks. Many e-cigarette users claim that they "accidentally" quit smoking. No one starts using NRTs without the intention to quit smoking!

Most research that I have seen to date has used test subjects who were looking to quit smoking and/or were previously unfamiliar with e-cigarettes. They were given or questioned about inferior products and had little to no instruction on technique. It's no wonder that they (and researchers) were underwhelmed with the results. Conversely, e-cigarette users who have successfully switched are not your average consumer. They typically purchased "mall brands" (basic and often over-priced e-cigarettes typically found in mall kiosks or through online advertisers), saw the potential and then went online to not only discover better products, but also learned techniques for using and maintaining the devices. In doing so, they have become knowledgeable and biased - precisely the "educated" consumers which researchers would normally avoid. Yet educated consumers are the key to the e-cigarette's success.

Researchers looking to determine the efficacy and safety of e-cigarettes need to take a step back and rethink their modus operandi. Traditional NRTs have an obvious purpose for consumers - to wean smokers from nicotine in order to help them quit smoking. The purpose of e-cigarettes for each individual smoker is less clear - those who try them aren't necessarily looking to quit. So, simply testing them in the same way and with the same pool of subjects as you would traditional NRTs is looking for the answer to the wrong question. Instead of asking, "Is this product a safer and effective smoking cessation product?" they need to ask, "Is this product proving to be a safer and effective smoking alternative?"

Therefore, the best course would be to first study those who have embraced the products, not those who have never used the product or are really looking for an NRT. Look at e-cigarettes not as if they could be successful NRT products but at how they are already being successfully utilized as smoking alternatives. Researchers must to tap into the established e-cigarette community to understand why they are being chosen, how they are successfully being used as reduced harm alternatives and to determine if there have been any adverse health effects with their sustained use. This large pool of subjects can show how e-cigarettes are already being used safely and effectively both to the general public and to the smokers who most need reduced harm alternatives. If researchers look in the right place and ask the right questions, they will find the love.