But there is another important factor that Glantz is forgetting. In the existing studies, the smokers examined had simply cut down on the amount they smoked without substituting another source of nicotine. Therefore, they were highly likely to be compensating by inhaling much more heavily on the cigarettes that they smoked. In contrast, when dual users of e-cigarettes and cigarettes cut down substantially on their smoking, they are doing so by substituting non-tobacco, nicotine cigarettes. One would expect much less, if any, compensation. Thus, the studies that Glantz cites are not quite as relevant as they would otherwise be.

Stated another way, Dr. Glantz is cautioning the FDA against assuming that e-cigarettes are safer than conventional cigarettes in terms of their effects on lung function.

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