Saturday, March 1, 2014

The Great White Hoax: E-cigarettes are delicious, but they don't deliver nicotine

Puff the "Magic" Draggin'
The power of blissful, wishful thinking.
   I love e-cigarettes. They're fun. They're beautiful. They're tasty! They offer comfort and relaxation.
   Opponents argue that they perpetuate addiction to nicotine -- even though they are vastly safer than tobacco cigarettes -- and that their exuberant, stylish marketing campaigns will create a whole new generation of nicotine addicts.
    But they -- and those who see e-cigs as a smoking-cessation aid -- have been the victims of a Great, Billowing White Hoax. That fragrant vapor -- from cartridges which can contain nicotine levels as high as 24 mg -- actually transmits virtually no nicotine to the bloodstream. Yet they are helping millions to quit. Cool!
    E-cigarettes, my review of the scientific literature suggests, are, generally speaking, a placebo. Users believe they are getting their "drug," but in fact they are engaging in an habitual behavior, and enjoying its sensual rewards. These hip, colorful, good-enough-to-eat products deliver "minimal or no nicotine."
    Is this a scandal, a killer blow to a dynamic new industry, or delightful news about our "need" for a "fix"?

 "Puff the Magic Dragon" just loves to puff. And other fancy stuff.
   I'm not positive, but I think it might be the latter: delightful. Millions of people are setting aside their tobacco cigarettes -- which contain 4,000 chemicals, 400 of which are poison and 40 of which cause cancer -- and replacing them with a relatively benign new technology. Self-described nicotine addicts are "satisfying" their "cravings" with a product that is not really providing nicotine to their bodies. This is astonishing and wonderful, isn't it? And it's a phenomenon that researchers have characterized as "entirely unexpected."
    To complicate matters, in a good way, it now seems that nicotine is not addictive, unless it is consumed in the form of tobacco, according to the book "Smarter: The New Science of Building Brain Power" by Dan Hurley (2013).
    "Nicotine has routinely been described in news accounts as among the most addictive substances known. As the New York Times Magazine famously put it in 1987, 'nicotine is as addictive as heroin, cocaine or amphetamines, and for most people more addictive than alcohol.'  But that’s just wrong," Hurley writes. "Tobacco may well be as addictive as heroin, crack, alcohol, and Cherry Garcia combined into one giant crazy sundae. But as laboratory scientists know, getting mice or other animals hooked on nicotine all by its lonesome is dauntingly difficult. As a 2007 paper in the journal Neuropharmacology put it, 'Tobacco use has one of the highest rates of addiction of any abused drug. Paradoxically, in animal models, nicotine appears to be a weak reinforcer.' That same study, like many others, found that other ingredients in tobacco smoke are necessary to amp up nicotine’s addictiveness. Those other chemical ingredients—things like acetaldehyde, anabasine, nornicotine, anatabine, cotinine, and myosmine—help to keep people hooked on tobacco. On its own, nicotine isn’t enough." 
    But, as I will explain below, there is reason to fear that those who have a vested interest in perpetuating real, physical nicotine addiction -- ie. Big Tobacco -- may now be able to do so with even greater finesse, if we don't regulate them aggressively. 
    Dr. Neal L. Benowitz, a professor of medicine at the University of California, San Francisco, has a great idea: The F.D.A. (if it had any balls) could gradually reduce the nicotine levels allowable in traditional cigarettes, nudging smokers to e-cigarettes.

    My first e-cig post, six months ago, was a colorful and rather joyful leap into this intriguing phenomenon. Even so, I expressed my concerns about the health and safety implications of "vaping" (http://kronstantinople.blogspot.com/2013/08/the-e-cigarette-seduction-are-we.html). I believe there has been a conspiracy of silence about the apparent dangers that clinical studies here and in Europe have already discovered. 

THE DELECTABLE VIXEN AND THE SMOKING GUN
    Everything about this debate is in dizzying disarray.  We have data that e-cigs deliver no nicotine and yet are still an attractive product to smokers. We have researchers, who in spite of user satisfaction, are insisting that we need to find ways to make these products deliver nicotine "more effectively and consistently." We have the anti-tobacco and public health people, who either hail e-cigs as a way to save millions of lives a year or who regard them as a disturbing step backward, to an era where smoking was socially acceptable.
    Some officials in both the political and public health arenas are calling for strict regulation. Others in those arenas warn that being too strict could stifle an technology that appears to have extraordinary value. State governments, cities and towns, school boards and universities, and individual commercial establishments are enacting their own laws limiting the sale and use of e-cigs, while decrying the federal government's ineptitude. The people at the FDA, as usual, have missed one deadline after another to issue definitive guidelines on the health and safety, and proper regulation, of this product.
Will e-cigarettes reverse decades of progress?
    And then there's the complicating factor that nicotine itself needs to be reconsidered. It is a valuable chemical that has numerous physiological and medicinal benefits. Demonizing it is a mistake.  
    A Feb. 9 article in Scientific American stated that nicotine—freed of its noxious host, tobacco—"may prove to be a weirdly, improbably effective cognitive enhancer and treatment for relieving or preventing a variety of neurological disorders, including Parkinson’s, mild cognitive impairment, ADHD, Tourette’s, and schizophrenia." (http://www.scientificamerican.com/article/will-a-nicotine-patch-make-you-smarter-excerpt/) I'll elaborate farther down about the larger nicotine issue.
    But with respect to the e-cigarette phenomenon, everyone keeps saying, "It's the Wild West out there." People are shooting all over the place, but no one seems to know much about who the villain is.
    While there is one persuasive study after another, as well as ardent testimonials on e-cig message boards, indicating that e-cigs have helped liberate countless people from smoking, the government requires this disclaimer on e-cig vendors' web sites:
   
WARNING: THIS IS AN ELECTRONIC CIGARETTE. THIS PRODUCT IS NOT AN AID FOR SMOKING CESSATION. THIS PRODUCT IN NO WAY INTENDS TO DIAGNOSE, TREAT, CURE, OR MITIGATE ANY DISEASE OR CONDITION. NICOTINE IS HIGHLY ADDICTIVE, AND THIS ELECTRONIC CIGARETTE HAS NOT YET BEEN APPROVED BY THE UNITED STATES FOOD AND DRUG ADMINISTRATION. THIS PRODUCT IN NO WAY CLAIMS TO ASSIST USER IN QUITTING OR LESSENING FREQUENCY OF SMOKING TRADITIONAL TOBACCO CIGARETTES. KEEP PRODUCT AND ITS COMPONENT PARTS OUT OF REACH OF CHILDREN. REFRAIN FROM USING THIS PRODUCT IF YOU ARE UNDER THE LEGAL SMOKING AGE IN YOUR STATE.
    
    This is bizarro world. E-cigarettes ARE an aid for smoking cessation. They have already had a profound effect on our culture, and our health. The huge vaping community is passionate and committed. It is impossible not to be moved by their dramatic stories of serious smoking "addiction" that has been ended by e-cigs. These people are so happy, so relieved. They feel much healthier -- which is a clinically measurable fact -- and look forward to normal lives.
    Noted British researcher Professor Carl Phillips was quoted by the BBC last month as stating that the benefits of switching to e-cigarettes are almost identical to those of quitting. 
    And a scientist just last week said you ingest more chemicals by smoking tobacco for two months than you do if you "vape" for the rest of your life. I can't accept this is scientific fact, for obvious reasons, but it does help provide a sense of how different these new products are.

DEMYSTIFYING NICOTINE IN THE NICK 'O TIME
    This graph, graciously provided to me by Chris Bullen, director of the National Institute for Health Innovation at the University of Auckland, NZ, provides stunning evidence that study participants using a an e-cigarette that contained NO nicotine reported satisfaction that was nearly as high as those who used the 16 mg model. 
    Simply employing a device that allowed them to inhale and exhale flavored vapor produced an overwhelmingly positive response among "smoking addicts." The term "ENDD," used below, refers to e-cigarettes as Electronic Nicotine Delivery Devices. Note the high performance rates of the 0 mg ENDD:

    The graph is from ""Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial," in the journal Tobacco Control. Bullen, who is a PhD and MPH, was one of the three authors.

HAVING THE MIST PULLED OVER OUR EYES: A WHITE LIE
    E-cigarettes are perhaps the most charming fraud of our new millennium. They fail to do the precise thing they are supposed to do -- give us a "drug fix" -- and yet we love them. That's a lovely irony! We've been gypped, in a good way. But how and why was the public kept in the dark about the fundamental "flaw" in this "nicotine delivery device"? Maybe we should regard it as a well-meaning and beneficial deception.
    The extensive research generated by e-cigarettes reveals a varied landscape of psychological factors, health concerns and technological/ clinical challenges. And the e-cig phenomenon has unexpectedly unleashed innovative alternatives for achieving the pleasure that dangerous tobacco cigarettes have provided for generations -- alternatives that have little to do with nicotine, but that transform "vaping" into a whole new phenomenon based upon flavor, heat and steam. 
    This high-impact illustration is by Lindsay Fox, who publishes an excellent blog, e-cigarettereviewed.com:
I really do like vaping, but the "zealots" who oppose e-cigarettes raise legitimate concerns.
     Indeed, for many users, e-cigarettes are becoming a gourmet experience, a lifestyle accoutrement, rather than a drug addiction. (Participants in a study in the journal Addiction compared their use of e-cigarettes to "snacking" and "grazing.") I will delve into these aspects below.
    But first, I want to address the nicotine issue.
   There are many safety concerns with respect to e-cigs, as I will discuss in my next post. 
   But nicotine exposure, apparently, isn't one of them. In one study after another about the effectiveness of electronic cigarettes in delivering nicotine to the human body, the consensus is clear, with qualifications: "Electronic cigarettes do not expose users to measurable levels of nicotine."

Who needs nicotine? We can get our "fix" by being cool.
     According to an article in the journal Nicotine and Tobacco, "The bioavailability of nicotine from the EC aerosol is a key factor, since it limits the amount of inhaled nicotine that is absorbed into the bloodstream and reaches the nicotinic receptors in the brain. Analysis of the profiles indicates that only part of the nicotine present in a cartridge is vaporized, and only some of the nicotine from the cartridge is inhaled by EC users." That is a "design flaw" that just happens to have a very fortuitous outcome.
    A study published just weeks ago in a Nature journal, Scientific Reports, estimated that an e-cig would need approximately 50 mg/ml nicotine in order to deliver an amount equivalent to a tobacco cigarette. Lead researcher Konstantinos Farsalinos, a prominent Greek cardiologist whose insights I refer to below, discovered that both the "first generation" e-cigs, and the new-generation high-capacity batteries with electronic circuits that provide high energy to a refillable atomizer, deliver negligible nicotine to users.
    And yet, business is booming!

UPDATE: New research indicates that some higher-end brands and models of redesigned e-cigarettes, containing 16-24 mg nicotine and higher wattage, can effectively deliver substantial nicotine to the body. Even the mass-market "cigalikes" are being offered in higher doses, which do deliver nicotine (as I readily discovered when I tried the new "bold" menthol Fin. I didn't like the feeling.) Doesn't this seem unfortunate, when e-cig users were so satisfied with the "placebo effect"? I assume Big Tobacco was behind the "improvements" in performance. They're the ones who want us to be hooked. In any case, most e-cigs on the market don't fall into this "nicotine delivery" category. I hope people will avoid them and continue to enjoy the "smoking behavior" that comes with attractive products, delicious flavors, and ample vapor.

PLEASURE IS PRESENT. NICOTINE IS ABSENT
    The conclusion that "e-cigarettes expose users to little or no nicotine" was reached as early as 2010, and it has been repeatedly replicated by an array of differently designed studies, using various brands of e-cigarettes, and enlisting a diverse set of test subjects (including "intensive-mode smoking machines"). 
     E-cigarettes are being marketed as "an alternative to smoking that will satisfy your nicotine urges and cravings," and "help you quit, cut down or smoke healthier."

     That may be true, but if it is, it's not because they are replacing the nicotine you would otherwise be ingesting from tobacco cigarettes. You can buy e-cigs with nicotine levels that range from zero to low to high (24 mg), but when they "satisfy your cravings," they apparently are exerting primarily a psychological, not physical, influence on your body.
     This finding substantiates my original hunch that e-cigs have a powerful placebo effect in those who are "addicted" to nicotine. It is expressed succinctly and memorably by one of the world's top tobacco researchers, and one of my most helpful correspondents, Dr. Ricarrdo Polosa, Professor of Internal Medicine at the University of Catania, in Italy:


 “An e-cigarette is not a cessation device but a sensation device.”
     
    Polosa elaborates: "In principle, we all agree that traditional cigarettes are more efficient in term of nicotine release and also more attractive for some sensorial aspects associated with tobacco taste. The e-cigarette -- a much safer product that can reproduce the experience of 'smoking without smoking' -- is a revolutionary opportunity for smokers, who now can pursue abstinence without giving up the pleasure that derives from their smoking behavior."

Pleasure.
    Polosa's landmark ECLAT study, completed last year, was the first randomized controlled trial addressing the impact of e-cigarette use in relation to smoking reduction, smoking abstinence and safety long-term. Intriguingly, his 300 test subjects had expressed no desire to quit smoking -- they were simply willing to try e-cigarettes. What the study revealed, he said, was "important and persistent modifications in participants' smoking habits, resulting in significant smoking reduction and smoking abstinence."
    
E-CIGARETTES "RING OUR BELLS," AND WE CHIME ALONG
   Jonathan Foulds, Professor of Public Health Sciences & Psychiatry at Penn State University, College of Medicine, likens the effect of e-cigarettes that deliver little or no nicotine to the Pavlov's dog phenomenon. The smoker has come to associate the rituals of inhaling and exhaling a cigarette with the  rewards of nicotine (triggering the release of the pleasurable neurotransmitter dopamine in the brain). It becomes an automatic response, like Pavlov's dogs salivating at the mere sound of a bell that indicated a delicious serving of dessicated beef is headed their way. 

A disgusting way to treat a dog, but Pavlov proved his point.
    E-cigs, "mimic the sensations and rituals of smoking so well, and so ring the bell for a smoker without delivering any meat (nicotine)," Dr. Foulds explained to me in an email. "This may be sufficient to satisfy a smoker for a while, and may even help him to stay off real cigarettes."
    Study participants who unknowingly received e-cigs containing no nicotine at all reported nearly as much relief and enjoyment as those who were inhaling the high-nicotine cartridges. In fact, the difference in their experiences -- including their confidence that the e-cig could help them quit smoking -- was statistically insignificant. Plainly speaking, there was no meaningful difference.

"JUST BREATHE. JUST BELIEVE" / TELEPOPMUSIK  
    Researchers have looked at and recorded specific brain activity under a variety of circumstances involving placebos (in this case, zero nicotine) and active drugs (nicotine). According to the American Cancer Society, when the patient believes the substance will work, “the patient’s mind somehow causes short-term physical changes in the body.” Researchers say the positive effect of the placebo may be due to release of the feel-good hormones, endorphins, in the brain.
     
Ahh..........I feel better already!
     The journal article "Electronic cigarettes (e-cigs): views of aficionados and clinical/public health perspectives," 2011,  by Foulds et al, reported that by September 2010, internet searches for e-cigs were several-hundred-fold greater than searches for nicotine replacement therapy products. 
    They discovered that "even e-cigs labelled as ‘high nicotine’ produced remarkably low nicotine absorption" -- levels not expected to produce therapeutic results. 
    Even so,  93 percent of those in the study said they were "extremely confident" they could succeed in staying of tobacco; 98-100 percent believed that e-cigs were helping them quit smoking; and 84-96 percent said they planned to continue using e-cigarettes for at least another year.

"You could blow, or just give me a big whistle."

JUST PUT YOUR LIPS TOGETHER AND BLOW OFF THAT NICOTINE MONKEY
    Among 3037 users of e-cigs surveyed in the study, 77 percent used e-cigs to quit smoking or avoid relapsing. Most of the ex-smokers in that study (79 percent) feared that they might relapse to smoking if they stopped using the e-cig. 
     A study co-authored in 2010 by Thomas Eissenberg, professor of Psychology and Co-director, Center for the Study of Tobacco Products, and published by the journal Cancer, Epidemiology, Biomarkers and Prevention -- "A Clinical Laboratory Model for Evaluating the Acute Effects of Electronic “Cigarettes”: Nicotine Delivery Profile and Cardiovascular and Subjective Effects" -- corroborates these findings:

In spite of delivering no measurable nicotine, both
electronic cigarettes tested in this study reduced ratings
of “craving a cigarette” and “urge to smoke” and
increased subjective ratings of product acceptability
(e.g., “satisfying,” “taste good,” “pleasant”). These results
are consistent with anecdotal reports from long-term
electronic cigarette users and support the notion that
electronic cigarettes may provide an alternative, perhaps
a substitute, to cigarette smoking in some cases.
Interestingly, denicotinized cigarettes have also been
shown to suppress tobacco abstinence symptoms.

    The fact that neither of the electronic cigarettes used in the Eissenberg study "exposed users to measurable levels of nicotine" is illustrated compellingly by an accompanying graph. Note that both remain near zero throughout the observation period, while levels soar among those smoking tobacco cigarettes:

No significant changes in plasma nicotine were observed for the e-cigs or the sham device.
    Even so, symptoms of “craving a cigarette” and “urge to smoke” were suppressed, Eissenberg told me.   
    He adds that subsequent studies with newer products have reflected improvements in performance. 

THE "UNPREDICTED" FINDINGS AREN'T LOSING ANY STEAM
    A 2013 study by Polosa et al, "Efficiency and Safety of an eLectronic cigAreTte (ECLAT) as Tobacco Cigarettes Substitute: A Prospective 12-Month Randomized Control Design Study," lends added credence to the placebo hypothesis: 

Soon after inclusion in the study, smokers substantially reduced cig/day use from baseline by more than 50% in all three study groups. The level of reduction in cig/day use reported here is in agreement with those reported in several other surveys of e-cigarette users and in our earlier work. The observed reduction in cig/day use appears to be unrelated to the nicotine content in the cartridges, the non-nicotine study group (C) behaving like both nicotine groups (A and B) at most time-points. This was unpredicted, bringing into question the key function of nicotine in cigarette dependence and suggesting that other factors such as the rituals associated with cigarette handling and manipulation may also play an important role.
   
     Over 70 percent of smokers surveyed in a University of London survey released last year quit smoking using e-cigarettes, and 38 percent had not had a cigarette for more than a year. Just 18 percent of e-cig users thought the devices were as "addictive" as tobacco cigarettes. 

     
    Their subjective insights seem likely to be correct: MAO inhibitor compounds in tobacco smoke are believed by many to greatly enhance the addictive potential of nicotine, according to a report released by Health New Zealand in 2008. "If this proves to be a strong factor with respect to tobacco smoke, then the e-cigarette will be much less addictive than smoking tobacco cigarettes.Vapours from the e-cigarette cartridge do not inhibit MAO enzymes," the authors concluded.
    And Professor Marc K. Siegel, associate professor of medicine at NYU Langone Medical Center found that electronic cigarettes were almost twice as effective in smoking cessation as conventional nicotine replacement products, despite their almost total failure to deliver nicotine to the bloodstream. Professor Siegel stated in 2012:

 "It appears that the role of nicotine addiction to smoking 
has been exaggerated, and that there are behavioral 
aspects to the addiction that play a very important role."

  
CRACKING THE 'HARD CORE'   
     Despite the exciting news that true nicotine addiction is overestimated as a factor in smoking behavior, there is a substantial subset of users who do have a physical dependency that is not satisfied by mass-market e-cigarettes.


     A small 2013 study conducted by Dr. Thomas Eissenberg, who was very generous in his help with my research, found that  "experienced EC users who provided their preferred ECs loaded with their selected flavor/nicotine concentration (and) completed a 10-puff (30-s IPI) bout and a 1-hr ad lib puffing period. Under these conditions, EC use resulted in reliable nicotine delivery. These results are the first to demonstrate unequivocally that ECs alone are capable of increasing plasma nicotine concentrations to levels seen during cigarette smoking." 
    Another 2013 study involving very few test subjects -- by Dawkins and Corcoran, published in Psychopharmacology -- examined the effect of using an 18-mg/ml nicotine first-generation e-cigarette. Researchers found " reliable blood nicotine delivery after the acute use of this brand/model of e-cigarette in a sample of regular users."  These experienced users had apparently learned how to "prime" their e-cigs with several puffs before inhaling, bumping up the amount of nicotine ingested. 
    No large, representative studies have replicated the Dawkins results, which rely on only seven complete blood samples and one brand of e-cigarette.
    "Surprisingly, the long-term users typically used lower nicotine strength liquid" than that which is generally used in clinical trials, according to Vansickel et al in an International Journal of Clinical Practice article. This is yet another "juicy" twist, which I will explain below.
"Vaping" is the new "juicing."
E-CIG COOL SCHOOL: LEARNING HOW TO DO IT RIGHT
    Eissenberg noted in 2010 that e-cigs' potential (as nicotine replacement therapy)  was undermined by ineffective devices and a requirement that users learn "specific but as-yet-undetermined behaviors in order to maximize nicotine delivery." For this population, he advocated research into "the parametric manipulation of device characteristics and user behavior (i.e., puff topography) as well as other factors (e.g., nicotine concentration) that might contribute to safety and efficacy."
    (Puff topography. I love that!)
    He added: "E-cigarettes and their nicotine-containing solution should be evaluated, regulated, labelled and packaged in a manner consistent with cartridge content and product effect."
    Or should we shield e-cig users from the notion that they may not be getting a significant dose of their drug, in order to sustain the placebo benefit? This is an issue that encompasses both medical ethics and marketing ethics. I don't know what we should do about it. Do you?

(No drug fix, but they're cute.)
    Chris Bullen, MPH PhD, Director of the National Institute for Health Innovation at the University of Auckland, has seen disappointing smoking cessation rates in some studies of e-cigarettes, and observes that simply providing users with the devices is not a realistic strategy.
    "It is possible that cessation rates would be higher if participants had instructions and newer, more reliable and efficient devices with higher nicotine content in the e-liquid. Another element missing from our trial was behavioural support and instructions for use," he told me in an email.
    I don't know why e-cigs, despite their failure to deliver nicotine, were effective in some studies and not in others. The variability in all of the clinical trials relative to e-cig safety and effectiveness is confusing, but the power of the placebo effect seems to be incontrovertible. 

WAITING TO EXHALE: IS IT JUST A GRAND ILLUSION? 
    Do the hundreds of slick e-cig brands, with their cool designs and high-tech gloss, realize that they are selling a Grand Illusion? I say "grand" in a good way, kind of (except for the deception), because smokers believe they will get relief from their "cravings," and they do. It's fantastic, isn't it?    

This ad sends the message that e-cigs are for Real Men, who refuse to relinquish their freedom. Sexy!

    A preponderance of the research I scrutinized suggested that smoking is a much more complex behavior than is generally recognized. It seems clear that "nicotine dependence" is a grossly exaggerated factor -- an "affliction" that smoker have been taught is the motivating factor for their cigarette use -- when in fact the comfort and satisfaction smokers experience may be a learned response that pertains to habit, to oral gratification, to pleasurable sensation (aroma, "throat hit"), and to social cohesion.
   To me, this is a fascinating discovery, and it bodes well for public health. As I will discuss farther down, the more serious and committed "vapers" express little interest in nicotine. They're after heat, flavor and vapor volume. Even if you're after a nicotine hit, you'll sacrifice the possibility of getting it, if you go for vapor volume. The vapor carries away what little nicotine is bioavailable. So this has become a new recreational technology that challenges our preconceptions about smoking. 

Cigarettes have become "bling." The motto is: Pimp your vape.

NICOTINE IN A NEW LIGHT
    Nicotine scare-mongers point out that it is a natural insecticide. So is caffeine. Both have numerous well-documented benefits if used in moderation, and both have been employed therapeutically for hundreds of years. Most American adults are dependent -- if not "addicted" -- to their daily jolt of caffeine (NPR talks to Murray Carpenter, author of Caffeinated: How Our Daily Habit Helps, Hurts and Hooks Us http://www.npr.org/2014/03/13/289750754/wake-up-and-smell-the-caffeine-its-a-powerful-drug). But we have refused to look objectively at nicotine, and to take advantage of its therapeutic potential, without stigma.
    Like other pleasures and medicinals, it has been demonized to an absurd and irrational degree by the same people who find nothing wrong with a martini or a lovely hit of Xanax. And it may well be that it is truly addictive only in a subset of users, just as most drinkers don't become alcoholics.

The tobacco plant is deceptively beautiful and vibrant.
    Nevertheless, Prof. Eissenberg, who is unquestionably one of the world's most dedicated tobacco researchers, told me he fears the perils of e-cigarettes may outweigh the promise.
   There are at least three bad things that could come from ECIGs, he says:
    1) Cigarette smokers use them IN ADDITION to smoking
    2) Former cigarette smokers relapse to nicotine because of them
    3) Non-smokers initiate nicotine with them.
    I could put myself in the second category, except that I didn't relapse into nicotine; I resumed my smoking behavior, with no desire to ingest nicotine. In fact, I had to discard a product I ordered because I could sense the nicotine in it, and I found it very uncomfortable. 

The British brand E-Lites is for those with a low tolerance for nicotine.

DOES NICOTINE HAVE A 'DEPENDENCY' ON TOBACCO?
    Scientists who are investigating so-called nicotine addiction are calling the whole concept into question, with one researcher arguing: “There is very little to no evidence for the abuse of nicotine when not delivered in a tobacco vehicle.”
    “The whole problem with nicotine is that it happens to be found in cigarettes,” according to Maryka Quik, director of the Neurodegenerative Diseases Program at SRI International, a nonprofit research institute based in California’s Silicon Valley. For years "Quik has endured the skepticism and downright hostility of many of her fellow neuroscientists as she has published some three dozen studies revealing the (beneficial) actions of nicotine within the mammalian brain," according to author Dan Hurley.
      Greek cardiologist Konstantinos Farsalinos may have the explanation. He states that there are several other chemicals in tobacco, such as alkaloids, alkanes and monoamine oxidase inhibitors, which make cigarettes more addictive to susceptible invididuals. He suggests that e-cigarettes, which do not contain these alkaloids, are likely to be less "addictive" than cigarettes.
  

     Once we minimize the role of nicotine delivery in how e-cigarettes have been working up to this point, we are left with several implications and more recent findings. Some are  rather paradoxical and others are cause for concern:
  • Most researchers, it appears, are now advocating that new e-cig users be given instruction in how to achieve the greatest nicotine exposure from the products that are readily available. This seems unfortunate, since so many users enjoy the existing devices, even though they are ingesting "little or no" nicotine (one scientist described it as "remarkably little," another as "not even measurable," and a third as "totally contrary to expectations"). An article in the International Journal of Clinical Practice referred to a typical study, in which e-cigarette users obtained only 1.3 ng/ml from a cartridge labelled as containing 16 mg of nicotine, rendering it "useless" as a nicotine-delivery device. 
  • Prof. Polosa reports that his research team at the University of Catania is "collecting evidence that individual sensorial expectations are critical for improving success rates in e-cig clinical trials. Therefore, we have designed study protocols that include a run-in phase in which participants could try different brands/models/aromas, so that they can adopt the one they considered their personal best, before being formally enrolled in the trial." 
  •  
  • Many researchers advocate "systematic manipulation of the variables" to achieve better-designed and regulated products that deliver nicotine readily and consistently. Presently, a user must puff harder and longer to get a "fix" -- which could have unforseen physiological consequences -- and the amount of vaporized nicotine declines after the first 100-150 puffs, which clinicians regard as a defect (it seems like a constructive "defect" to me.) 
  • Isn't there a way to capitalize upon the obvious placebo effect that an e-cig can have, rather than going in the opposite direction, ensuring that people really will get super-charged doses of their "drug of choice"? 
  •                                               
    Just puff away, and you'll be happy all day. Let yourself be fooled!
  • Dr. JF Etter, of the University of Geneva Medical School, predicts: "The e-cig manufacturers who best control the speed of nicotine delivery to the brain will dominate the e-cig market." That is probably true, if we accept that people who want to engage in a smoking-like activity also want to be drug addicts. 
  • But there is suddenly a lot of great evidence that this is not the case. We want to suck and blow! We want to be cloud-makers! We want fragrant flavors wafting through us! We need to keep our oral apparatus pleasantly occupied, one way or another. This may be infantile, from a psychological point of view, but it's a very common fixation, as both smokers and overeaters know only too well.
  • This brilliant, feisty "redhead full of steam" has posted a wonderfully well-reasoned and persuasive account of her journey in to the world of e-cigarettes. It's excellent. And she is on a consistent trajectory downward with respect to nicotine use, without even trying. She is the perfect illustration of what these "disruptive technologies" can do to our bad habits. (http://www.redheadfullofsteam.com/dear-public-health/)
  • It hadn't occurred to me to worry much about the sweeping influx of Big Tobacco into the e-cig market. It seems like a reasonable way for them to stay alive. But then I had a TERRIBLE THOUGHT. We are all aware of this industry's ruthlessness in creating the most addictive product possible. The nicotine content of popular American-brand cigarettes has slowly risen over the years, and a study published in 2006 found that there was an average increase of 1.78 percent per year between the years of 1998 and 2005, a trend that has continued. 

    Big Tobacco is determined to retain its stranglehold on the market.
        Even more disturbing are recent revelations about how Big Tobacco has continued, secretly and heartlessly, to "tweak" the chemicals they use to make the nicotine "hit" stronger and more pleasurable. We are just lab rats with cash in hand, as far as they're concerned.
        Just imagine what they are likely to do with e-cigs. Every player in Big Tobacco has made major inroads into the new e-cig market. They are not simply creating new brands -- they are rebranding themselves, as entirely new creatures whose goal is "innovation" in "responsible and healthful" tobacco use. They urge those who have safety concerns to abstain from their products, which they then proceed to make very enticing.

    The Marlboro Man has left the building (in a coffin).
        Last June, Altria Group, the largest cigarette maker in the U.S. (the Marlboro guys), began selling its new MarkTen e-cigs -- with its "unique FourDraw™ technology -- in an undisclosed Indiana market. Last month, it bought Israeli  e-cigarette upstart Green Smoke Inc. for $110 million-- nearly three times the $40 million that the private company, which launched in 2008, earned in sales last year --  "in the latest sign the battery-powered devices are moving from fad to mainstay and pose a rising competitive threat to traditional smokes," according to the Wall Street Journal.
        Lorillard's Blu e-cig is the most widely available brand in the world. Its biggest sellers contain 16-24 mg nicotine. It's reaping huge profits without having had any women taking their clothes off, but for the Sports Illustrated swimsuit edition, it couldn't resist. The less well-known brands are making flagrant and unsavory use of the old "sex sells" ad nostrum.

    Blu was already dominating the market, without exploiting female bodies. (nice wax job)

         Reynolds Tobacco, which manufacturers such cigarette brands as Camel and Pall Mall, has jumped into the "vapor" market big-time, with its self-serving promise to "redefine enjoyment for adult tobacco consumers," using its "bold vision." 
        That vision consists of the Vuse cigarette, which Reynolds says is "the only e-cigarette that finally delivers a satisfying and great tasting vapor experience combined with consistent and reliable performance."
        I'm sure there are quite a few brands that would beg to differ.
    The claim: Vuse is powered by "smart technology."
        Vuse uses algorithms and microchips, which "adjust the power and heat up to 2,000 times a second," Reynolds claims. 
       Doesn't this sound like massive overkill? But that's what the cigarette industry has always been about: Overkill, over and over, generation after murderously profitable generation. 
        The e-cigarette industry needs several kinds of regulation, but I think forcing Big Tobacco to behave itself, rather than continuing to be a sinister, cabalistic dope dealer, should be one of the highest priorities.  

    INHALING DESSERT INSTEAD OF SMOKY NICOTINE
        But there is another blossoming industry whose exuberance and dynamism I hope will slay the nicotine purveyors. It is a fascinating phenomenon: Those who formerly smoked for a drug hit (at least that's what they thought) (and a lot of them were probably right) but who have shifted their focus entirely to "personal vaporizers," (PVs) in which nicotine plays little or no role. Their devices look so serious and techy -- with lots of gauges and buttons -- that I had assumed they inflicted huge a "pow!" of nicotine. It ain't necessarily so, to quote from the Gershwins' "Porgy and Bess."

    VapeCigs "Discreet" model isn't cute -- it means business.

    I have a feeling we're not in Kansas anymore. Smoking is a new animal! Or musical!
  • We aren't in Kansas anymore in more ways than one. The Tin Man didn't have a brain, until the Wizard of Oz "gave" him one, and suddenly he felt brilliant. A tobacco addict thinks he desperately needs a nicotine "fix" until you give him an aromatic little oral-gratification device, and suddenly he's feelin' fine. It's a good thing to be able to trick ourselves. If I wasn't a pro, I'd be a blitzed-out old lady, instead of a hot, rocking babe in a "Clash" T-shirt. 
  • The most experienced, dedicated and discerning "vapers" have created a magnificently monstrous new obsession that is akin to dessert or rapturous meditation, rather than smoking. I think this is fun and kind of funny. Their PVs look more like musical instruments or weapons than cigarettes. Some of them are big, mean machines. But according to their web sites and blogs, to store proprietors I've interviewed, and to emails I've received, the goal is INTENSE FLAVOR, INTENSE HEAT/ THROAT SENSATION AND LOTS OF VAPOR -- NOT NICOTINE. 
  • They love to blow that banana-cream steam out of their noses. And it does sound delicious, doesn't it? (I am so hungry right now.) Nicotine is never even mentioned on their colorful, high-spirited web sites. All those gauges and buttons measure and control several aspects of users' vaping pleasure, but not nicotine. 
Sometimes, a banana's just a banana. Other times, it's a smoke.
  • Most of the connoisseurs of these extreme devices are former smokers who were weaned off of nicotine by conventional e-cigarettes (often without realizing it), and are now ardent advocates for this tasty new pastime. On Saturdays, especially, vape shops around the country are packed with people sharing insights, techniques and tweaks. They rave about the newest flavors: "Have you tried Purple Dragon? Shit, man, it's better than sex." Or, "Hey, thanks for the tip about Pineapple Rum. It really chilled me out."
  • The flavor biz is going wild. I thought it was silly at first. I wanted a plain, menthol e-cig that looked just like a homely, olden-days tobacco cigarette. But the "foodie" aspect of vaping is intriguing. It seems that every day, dozens of new flavors are put online. 
  • Peanut butter! Over your palate and out your nose! What could be more divine?

    The flavor is the thing -- not the nicotine -- and there are no calories!
  • (Yuck: I just tried four disposable hookahs from Vapor Corp.'s VaporX line, and the flavors are so sickening, I'm tossing them all. The strawberry-banana tastes like shampoo. The hot cafe latte tastes like dried steer manure. The vanilla -- how do you mess that up? -- tastes like baby lotion. And the chocolate mint tastes like Neutrogena SPF 50 sunscreen. Barf, you guys! What a waste of $45.) 
  • This experience created reservations in me about the whole flavor craze. Maybe I'm better off sticking with the simple menthol Fin cigarette (with a touch of vanilla), which is what I've been using since I first tried vaping in August. After tasting the "variety pack" I ordered from Vapor Corp.,  I realized that most of the artificial flavors/aromas used in e-cigarettes would probably be unappealing to me. Other women may relate to this more than men: The fruity flavors/aromas used in e-cigs are the same ones that are in our shampoo (such as strawberry, coconut, kiwi-lime, blackberry-sage, mint tea, etc.), our body lotion (vanilla, almond, freesia, cucumber, etc.), our room fresheners (chocolate-cookie, apple cinnamon, cashew custard, etc.), our detergents (mango tango, peach jubilee, etc.) our fruity lip gloss, lemony dish soap, bubble-gum bubble baths, minty mouthwash (and on and on) that when we attempt to VAPE these flavors, it is revolting. I don't want to "smoke" my honeydew body splash or wintergreen carpet deodorizer or "orange oil" furniture polish! But that's what it tastes like. 
  • My lip various lip balms alone have ruined me for vaping so many flavors. Cherry Chapstick! I kissed a girl and I liked it! (not really me -- Katy Perry) (not that there's anything wrong with that). I've also used grape, watermelon. bubble gum, root beer, strawberry, chocolate, raspberry, Orange Crush, cola. I got sick of these artificial flavors 20 years ago, and returned to menthol lip balm.
  • For awhile, I was crazy about scented candles, too. So many yummy scents, like peppermint and "angel food," and maple syrup. It all got to be too much. I became a clean-air advocate. Is "vapor" clean? We don't really know yet.
  • I have written about the synthetic flavor/aroma industry in two posts -- it's shocking what those guys are doing, and how, and why -- and these articles remain among the most-read on my blog (http://kronstantinople.blogspot.com/2011/08/elderly-girl-brazenly-advocates-life-of.htmlhttp://kronstantinople.blogspot.com/2011/08/holy-sheet-elderly-girl-could-lie-here.html).
    These chemicals are not benign. They can have powerful effects on the brain and other bodily systems.  I hold my breath when I walk down the personal care and detergent/housecleaning aisles at the grocery store. I can smell the poison.
    (Maybe this is why men seem to be vapers to a much greater extent than women -- they don't have the same associations that women do to these flavors/aromas. ) 
  • I do think it's amusing that all those former Marlboro Men are laying about, billowing fruit- and dessert-scented vapor everywhere, but I guess that's sexist on my part. Lumberjacks of the world: Enjoy your cotton candy, mocha-creme cheesecake, gummy bears and "berry deliteful" exhalations. Would you happen to have any Grey Poupon?
  • British blogger James Dunworth and proprietor writes that "with higher power and a huge variety of strengths and flavours, it’s not a surprise that tank systems are quickly becoming the most popular alternative to both tobacco cigarettes and regular e-cigarettes."
  •  
  • A tank that doesn't "tank." It clearomizes -- whatever that means.
  • Phil Busardo, of Taste Your Juice, writes in Duworth's excelllent Ashtray Blog, "I think we’re going to see more and more liquid companies doing things the right way. Clean rooms, immaculate mixing facilities, documented processes, correct air handling systems, etc. I think these are the e-liquid companies who will be around for the long haul. Self regulation is the key to success here. More focus on airflow and where it’s provided. This will allow the ability to tailor your device to the e-liquid you’re using or the environment you’re using it in. Juice flow control would help out here as well. Different heating elements. More power and safer devices."
         Joe Petner of Vaper Joe’s adds that he predicts juice will continue to become "more and more boutique style with fancier packaging, labels, and unique shaped bottles." 
        
  • If I have to open my mouth this wide, I'll scream first.
  • A case study: Kent Brooks is proprietor and "master mixologist" at NicoTicket.com (he is also a licensed clinical mental health professional -- what a nice combination). His firm was the overwhelming winner in all of the best-flavor categories at the Electronic Cigarette Forum convention in 2013, and was named Vendor of the Year. 
  • He creates the recipes for all of his flavors, which include FreNilla, a creamy french vanilla liquid that is "highly variable with regard to a wattage sweet spot," as well as Custard's Last Stand, and Doodle, a tribute to the beloved Snickerdoodle cookie, with its hint of ginger. 
  • The two most original creations currently on his ever-changing menu are Gravity, which blends tangerine, cranberry, peach and pomegranate, and H1N1, Kent's personal favorite, which he regards as his first "masterpiece." Despite the "ample throat hit," it is a very smooth vape, he reassures his fans. The flavor is "affectionately known as 'The Virus'."
  • Kent's Gravity flavor is a fruit-lover's dream.
    "Catch H1N1 before it catches you," Kent jokingly warns.
  • The predominant flavor notes "depend on device and steep time -- many customers have noted that H1N1 'changes flavor profiles more frequently than a teenage drama queen changes clothes.' Early in the life-cycle of H1N1, notes of chocolate, peanuts, and caramel serve to accent an even-bodied dry tobacco flavor.  There is a faint cinnamon hue that resides underneath," Kent explains, like a true celebrity chef.   
  • "Nicoticket.com "was formed for one reason... we are passionate about vaping," he says. "There is a sense of solidarity, a common experience if you will... this is a community you can be proud to be a member of." 
  • Kent is the first vaping expert with whom I corresponded about this intriguing business model. I asked him if I was correct in my impression that gourmet vapers are not particularly interested in nicotine.
  • "Typically with performance increases in the delivery device, the nicotine content in the liquid decreases.  Less nicotine in the liquid itself actually tastes better.  All the high-end gear I have collected is in the interest of flavor and vapor production," he wrote to me. "It has almost nothing to do with  nicotine. (Like most people) I started with low-end gear and 18mg, and now I vape 6mg and it's almost too much.  Soon I'll be on 3mg.  We're all trying to get off nicotine, no one likes being addicted." He likes to think of his product as "dessert without the calories," and that's how I like to think of it as well. I stopped eating desserts decades ago. Now I can resume my decadent gorging, if I can find some flavors that don't smell/taste like Nyquil or liquid veterinary antibiotics.                                                                 
    To quote The Temptations, "Look out baby, 'cause here I come!"
        John Manzione, publisher of Spinfuel Magazine, predicts that the top-shelf companies “will continue to put out delicious new flavors, some even managing to avoid the ‘variation on a theme’ curse and come up with something brand new… see The Plume Room’s ‘Angel Sauce’ for example, or Rocket Fuel Vapes ‘Limerick.' Both are fine examples of the huge improvements in great tasting eJuice.”    
        Spinfuel's review of "Angel Sauce" sounds like an adorable satire: "It is exactly the kind of eLiquid that gets you excited about vaping. That great fruit-sherbet flavor, the great dessert flavor, that one flavor you see among your collection and think “Oh yeah, that one! Come here you!”… And without warning Angel Sauce becomes the all-day vape that you want, you hope for, for one reason; you don’t want to stop vaping it. "


         The review continues enticingly: "After that sweet delicate raspberry sherbet flavor comes a rush of sweet lime with gentle orange notes, as they mix together to form a combination that your taste buds recognize but just haven’t encountered in vapor form until now. Vaping Angel Sauce feels good. I mean you expect it to taste good, but to feel good? That’s new, that’s rare."
        It feels good. Like a cigarette should. And there's no mention of nicotine, just the ecstasy of vaping good flavor
        Spinfuel adds: "Angel Sauce says something about the great talent of The Plume Room’s Andrea, a master of flavor, but it also says something about the future of eLiquids, how after all this time new flavor experiences are possible, that the eJuice marketplace doesn’t have to be a market full of ‘variations on a theme’. There remains room for originality and creativity, room for great new flavors that will satisfy in ways you never thought were possible. That’s a lot of responsibility for a single new flavor, but Angel Sauce truly carries that weight marvelously."
        I find all of this to be "marvelously" amazing. And to think that this whole new phenomenon is based upon an aversion to one of the deadliest consumables ever devised: cigarettes.  

    Rocket Fuel''s "Limerick" is intended to taste like Key Lime pie.
          The PV hobbyists are cobbling together "mods" that have a modified battery housing to enable the atomizer to maintain a higher, more consistent temperature to achieve a hotter more intense vapor. According to the International Journal of Clinical Pharmacology, this can be done in a number of ways, including (i) using more powerful (often larger) batteries, (ii) using batteries that last longer (and so produce consistent high heat for each use throughout the day), (iii) using a manual switch to initiate the atomiser prior to inhalation and enable a longer inhalation if necessary (pneumatic/airflow activation may result in the inhalation taking place before the atomiser had achieved a sufficient temperature). 
        So when you walk into a vape shop, don't expect to see a lot of nicely packaged, ready-to-use e-cigs. When I mentioned to a shop proprietor that I use Fins, he kind of scoffed. The implication was that I was a sissy, a newbie, a timid old lady, a dabbler! These shops sell Gear. They sell Components. They expect you to Build and constantly perfect your Awesome Dude PV collection. They have big inventories of tanks, mods, atomisers, clearomisers, cartomisers, drip tips, batteries and accessories. It's like being in Home Depot's plumbing department, or an auto parts store. They have all kinds of strange, intimidating, totally uncigarette-like stuff that scream "committment." The term "committed vaper" is used a lot.  Get me out of here! I'm not committed -- I just want a little puff now and then!  







Sigellei ZMAX: Take charge of your vapor, my people!
    Talk about high tech: The Sigelei ZMAX v5, shown above, “basically takes all of the best features of the ZMAX v3 and the Innokin iTaste MVP and blends them: A telescoping body to accommodate 18350-18650 batteries. Variable voltage. Puff counter. Resistance battery life indicator, power protection. External charging ability.” 
    All this stuff is way over my head. I can't imagine having to cope with all that tech gear, but I guess today's younger people find it gratifying. They modify and hack everything, don't they? It's nice to keep these testosterone-afflicted dudes harmlessly occupied, since they can't work on their cars anymore, and some warm-hearted, hardworking Mexican gentleman is outside mowing their lawns for them.

Note the digital readout and control buttons that characterize PVs. Is this TMI, or just right?


It's hard work being a committed vaper, but it keeps our bad boys out of trouble.
The XVaper Variable Voltage Personal Vaporizer. One to match every T-shirt.
Innokin's latest device has an ominous James Bond look.
    Innokin's iTaste VTR hammer mod is a "solid variable wattage and voltage vaping device with detailed finish. It features a rotational wheel and a protective skeleton to hold the tank inside. The voltage and wattage can be adjusted with the rotational wheel; the screen displays voltage or wattage and offers intuitive control over settings leading to more accurate performance."
    Does anyone besides me think it looks kind of perverse? Actually, quite a few of them do. The one below, though, just looks like a baby monitor, or something else that's quite mundane. A bug zapper?
The NO2 Vaporiser: For afficianados of aroma.
    The digital NO2 Vaporiser, by Vapir, "allows customers to specifically control the heat with its patented digital display which is fully accurate within 2-5 degrees," and promises "the most fresh and flavorful vapor available."

WHAT'S THE SHELF LIFE?
    Will the enthusiasm for vaping endure, or is it just a fad? It seems to me that vaping does satisfy something primal in us (or some of us, anyway), and that if the quality of the experience is good, it might become a lasting part of the culture. I think vaping could easily become a habit, without necessarily being a vice or an addiction. It might establish itself in the accepted smorgasbord of life's little pleasures: a mode of relaxation, an aspect of socializing, a comfort, an aid to contemplation and an after-dinner treat. Those who have never smoked at all might not relate to this scenario, but I think those who have would agree.

Ah....it's so nice just to kick back and let the thoughts flow.
 NICOTINE ISN'T A TERRORIST -- IT CAN BE YOUR FRIEND 
    Whether one chooses to continue using nicotine or not, it is worthwhile to know that it isn't the Devil. The diseases attributed to smoking are a result of tobacco combustion, not nicotine, Prof. Polosa states. A meta-analysis of 35 clinical trials found no evidence of cardiovascular or other life-threatening adverse effects caused by nicotine intake, he adds. 

Boy, does this look familiar. How many tens of thousands did I smoke?
     (The Institute of Social and Preventive Medicine at the University of Geneva offered a cautionary note, though. "The origin of the nicotine in e-cigarettes is uncertain, as pesticide-grade nicotine rather than pharmacological-grade nicotine may be used," it warns. I have found no other references to this potential problem, but it's worth keeping in mind.) 
    Nicotine is an excellent medication for brain function according to the Feb. 2014 Scientific American article cited above. "The nicotine molecule fits into receptors for the neurotransmitter acetylcholine like a key into a lock. By managing to slip through doors marked 'Acetylcholine Only,' nicotine revealed a special family of acetylcholine receptors hitherto unknown. And what a family. Nicotinic receptors turn out to have the extraordinary capacity to moderate other families of receptors, quieting or amplifying their functioning. According to psychopharmacologist Paul Newhouse, director of the Center for Cognitive Medicine at Vanderbilt University School of Medicine in Nashville, “Nicotinic receptors in the brain appear to work by regulating other receptor systems. If you’re sleepy, nicotine tends to make you more alert. If you’re anxious, it tends to calm you.” The primary neurotransmitter that nicotine nudges is dopamine, which plays an important role in modulating attention, reward-seeking behaviors, drug addictions, and movement."

    In "An Update of 40 years of Nicotine Research," Danish scientists Niels Ipsen and Klaus Kjellerup attempt to mitigate the demonization of this psychoactive substance.  
    Here are some key points from the study:

  • nicotine can make your brain up to 30% more efficient
  • if you use nicotine, your brain will have more stamina than non-smokers’ brains
  • nicotine makes you more attentive, more precise and faster
  • nicotine improves your attention and your memory
  • nicotine makes you less aggressive in stressful situations
   In the journal Biology, an article, "Nicotine as Therapy" goes into greater detail. It refers to nicotine as "a cheap, common, and mostly safe drug, in daily use for centuries by hundreds of millions of people, that only lately has been investigated for its therapeutic potential for a long list of common ills." 
    The list includes Alzheimer's disease, Parkinson disease, depression and anxiety, ulcerative colitis, schizophrenia, attention deficit hyperactivity disorder (ADHD), and even pain and obesity. 
    (A 2012 article in the journal Neurology reported that nicotine patches helped patients with mild cognitive impairment gain 46 percent of normal performance, while a test group who did not receive nicotine declined by 26 percent in the same period.)
    "Nicotine is an alkaloid in the tobacco plant Nicotiana tabacum, which was smoked or chewed in the Americas for thousands of years before European invaders also succumbed to its pleasures and shipped it back to the Old World. Nicotine has always been regarded as medicinal and enjoyable at its usual low doses," the paper notes. "It triggers the release of dopamine, which enables us not only to recognize potential rewards, but also to take action to move toward them."
Nicotine activates dopamine, which relates to pleasure and gratification.
    (There was also a period in the 1700s when tobacco-smoke enemas were quite popular, but apparently everyone's decided to repress this provocative concept. So I won't elaborate.)
    Researchers at the National Institute on Drug Abuse have shown via functional magnetic resonance imaging that nicotine activates specific brain areas during tasks that demand attention. 

A SPLENDID COMPLEMENT TO YOUR OXYCONTIN
   Nicotine is also being investigated as an analgesic in humans. Pamela Flood, an anesthesiologist at Columbia University, is quoted in a National Center for Biotechnology Information article as saying: “The nice thing about nicotine and drugs like nicotine is that they have opposite side effects to anesthetics. Instead of being respiratory depressants, they are respiratory stimulants. Instead of being sedating, they increase alertness. So theoretically this class of drugs is actually the perfect thing to add to an opioid regimen. The fact that they're synergistic was a fortuitous thing that we had never looked at, and neither had anybody else.”
    I admit that I don't understand the illustration below at all, but what it depicts, according to researchers, is how "the various assemblies of nicotinic acetylcholine receptor subtypes are broadly distributed in the brain, which gives nicotine its versatility in alleviating pain." 

    "Will nicotine-based therapy consist mostly of costly new drugs from the pharmaceutical industry? Or can less expensive nicotine products like the patch, chewing gum, and nasal spray—which are generally intended for smoking cessation but widely available, usually without prescription—find their way into the world's medicine cabinets?" the article asks.
    "Much of the work to date showing nicotine's effectiveness on a huge range of disorders has involved products available at any drugstore and intended to help people quit smoking. Newhouse is using patches for mild cognitive impairment. Flood has demonstrated pain relief with nasal spray and will use patches in her next study," the authors add. 
    Let's keep that in mind when Big Pharma rolls out an array of pricey, nicotine-based medicinals. Buy some patches and nasal spray for a few dollars and tell the Bad Boys to stop trying to jerk you around.

I GUESS I'LL HAVE TO AWAKEN FROM A DREAM COME TRUE 


  For me, e-cigarettes have been a dream come true. After 10 years of smoking abstinence, I have spent the past six months in a lovely vanilla cloud. How delightful! I pretend my club soda with a twist of lemon is champagne.
    I have been uneasy from the start, though. I love my lungs. Breathing deeply, being able to jog with joy and power, being generally healthy, and being as un-stupid as possible, are very important to me. 
    I was surprised to learn that several surveys of e-cig users reflected the same concerns about safety that have troubled me. People who have been indulging in horrendously toxic tobacco cigarettes are suddenly very inquisitive about the health impacts of e-cigs. That's ironic, in a way, but it represents a monumental shift in smokers' hopes and priorities, which is a testament to the excellent anti-smoking public health campaigns that have been waged for decades.
    E-cigarettes, we've been assured by marketers, "give you all the pleasure and satisfaction of traditional smoking, without the health, social and economic problems."
They are such a joy! So are big sunglasses!
    Doesn't that sound like a dream come true that's too good to be true?
    I have been corresponding with scientists in the U.S. and three other countries about their work. I have been swimming through the seemingly endless ocean of Google Scholar journal articles on the numerous potential health dangers posed by e-cigarettes. (Google Scholar itself perhaps should be investigated for its addictive potential. I can't put it down unless my bladder is on the verge of exploding. And it gives me the "shakes," and triggers "cravings for more," unlike tobacco, which supposedly relieves these problems.) 

YOU CAN'T HANDLE THE TRUTH! OR ANYWAY, I CAN'T
    My next post will provide a review of the research into the health and safety implications of e-cigarette use. The findings are troubling, but there is so much contradiction, so much flawed design in the studies, and so many gaps in what has been examined, that I still have hope that I can justify my continued use of these products.
    It's a very dim hope. I asked every scientist with whom I corresponded if he would feel OK about his wife or young adult child using e-cigarettes, if he or she was not currently using tobacco.
    Every one of them said no. They agreed unequivocally that e-cigarettes are an inconsequential health hazard compared to tobacco cigarettes, and they would wholeheartedly recommend them to anyone who felt compelled to "smoke" something.
    I don't feel compelled. I quit tobacco years ago, and I handled abstinence quite well. But I never stopped longing for the comfort and relaxed pleasure I had given up. I felt deprived every day.
    Once I force myself to face the facts, I expect I'll return to my state of deprivation. I'm grieving the loss already. 
(April 4, 2014: I quit. I threw it all away http://kronstantinople.blogspot.com/2014/04/praise-lord-i-got-bored-i-quit.html. I don't feel a huge sense of relief, but I am relieved that my experiment is over. And I'm not grieving, just moving on.)