ROCHESTER, Minn. — Here, in the basement of the Stabile Building—just a few dozen feet away from a group of smokers and vapers standing outside of Dooley’s — Dr. Jon Ebbert is force-feeding an e-cigarette to a machine called a CSM.
CSM, literally, stands for Cigarette Smoking Machine.
When it inhales — when the motor-driven pump sucks superheated vapor from the e-cig into a whistling-lips-sized hole in its faceplate— CSM makes an adorable electronic chirping sound, like R2D2 whenever he’s reunited with C3PO.
“We call her BB-Vape,” says Ebbert, a reference to the spherical BB-8 droid from the last three Star Wars movies. Ebbert, incidentally, is wearing Yoda socks (“And it’s not Baby Yoda,” he points out).
The ‘we’ is really just Ebbert and Alexandra (Lexi) Ward, a recent Concordia College grad-turned-Mayo Clinic researcher. (And they’re supported by members of Mayo’s Metabolomics Core, who study the chemical processes of molecules.)
In this job, Ebbert serves as director of Mayo Clinic’s Inhaled Particle Aerosol Lab (IPAL).
But this job, when it comes to the actual time he spends in office, ranks about fifth in his daily workload.
Ebbert, an Edina kid and University of Minnesota grad, has served as a primary care doc at Mayo Clinic’s Community Internal Medicine in the Baldwin Building since 2000. He’s also the associate director at Mayo’s Nicotine Dependence Center. An associate chair in the Department of Medicine. A member of the Kern Center for the Science of Healthcare Delivery.
“Ninety-five percent of my time is my Baldwin gig,” says Ebbert. “But I spend 100 percent of my time thinking about this. It’s all I do, all day long. I just think vape.”
The next generation of drug delivery devices — e-cigs and vaping pens like the Smok, USoniCig, Towis HCigar, and Juul — are sitting on a counter.
“These,” says Ebbert, gesturing to the devices, “are the perfect marriage between device and drug. We fell in love with iPhones, and humans have this really strong predisposition for positive reinforcement from drug. And what more provocative, intriguing, seductive combination can you have than essentially an iPhone that delivers a drug? This is what we’re up against.”
The Inhaled Particle Aerosol Lab — and it’s really more of a space with a cart holding the CSM machine — was started in August of 2019.
“We created a lab, and I named myself medical director,” says Ebbert, laughing. “And now we’re squatters down here.”
‘Down here’ is Mayo’s Nuclear Magnetic Resonance (NMR) Spectroscopy lab. NMR is a technique that relies on magnetic fields around atomic nuclei to determine a sample’s molecular structure. Ebbert and Ward rely on the lab’s instrumentation to measure the chemical make-up of their vape samples.
Ebbert, for his part, has been working on tobacco reduction techniques for nearly 20 years.
“I started working on smokeless tobacco in 1999 when I became intrigued by the concept of harm reduction,” he says. “Others had hoped smokeless tobacco was the salvation for cigarette smokers to transition off of conventional cigarettes. It wasn’t.”
That focus completely shifted in 2006.
“What changed in 2006? All the oxygen in the room in 2006 was completely consumed by electronic cigarettes, because that was the year e-cigs came to the U.S. market,” says Ebbert.
By 2011, roughly 1% of American teenagers were using e-cigarettes at least once a month, according to the CDC. Today, that number has risen to an estimated 20% of teens — more than 3 million kids.
“One of the most increasingly prevalent behaviors in teens is inhalation of drugs,” says Ebbert. “That’s what we’re working on here in the IPAL — we focus on the systems that deliver those drugs. We focus on the atomizer, because that has unique properties that impact risk; the battery, because that has unique properties that impact risk; and then the liquid that you put into it.”
And that liquid is not always just the standard vape mix of water, food-grade flavoring, nicotine, propylene glycol, and vegetable glycerin.
They also study the effects of aerosolizing CBD. They store their THC in a locked closet.
“If I’m at a cocktail party and you ask me what we do here, I say ‘We study toxicants in the aerosol produced by heated coil aerosolization systems,’” Ebbert says.
Ward’s a little more succinct. “I just say ‘We study e-cigs. And CBD. And THC.’”
Here’s the dilemma: Dr. Ebbert wants to believe in e-cigs.
He’s a physician who, for nearly 20 years, has focused on harm reduction. A doctor who, working in the Nicotine Dependence Lab, has seen patients die because they couldn’t stop smoking, because dying was less painful than living another minute without a cigarette.
And Ebbert himself is a former tobacco chewer who quit with the help of nicotine gum.
“Nothing kills more people than conventional tobacco cigarettes,” he says. “So anything that can transition patients off of cigarettes is considered to be a potential solution to the harm that’s caused. Half a million people die in this country every year from cigarettes. I’d love to find something safe to reduce that harm.”
Here’s the problem: He doesn’t believe any of the current vaping products are safe.
“When you take an e-liquid, and put it in this device and heat it, you develop at least 18 new chemical compounds that didn’t exist in the e-liquid,” he says. “This is a reaction vessel with new chemical species being created, including chemicals like formaldehyde, which can cause cancer. I can’t safely recommend any of these products to my patients right now. And I wish I could.”
On the day of our mid-January interview, the Centers for Disease Control and Prevention reported two more deaths — and 41 more hospitalizations — from “a mysterious respiratory illness” linked to vaping in the previous week. That takes the vaping death toll to 57.
“I’ve been working in tobacco control for 20 years,” says Ebbert. “When you think about 57 deaths, that’s how many people die in one hour from tobacco. Vaping deaths are an important issue, but the bigger issue is that, every hour, as many people die from tobacco and have since 1950 in this country than have died in the entire vaping crisis.”
So when those tobacco-addicted patients — those dealing with the chronic pain of emphysema or heart disease or peripheral vascular disease or cancer — started asking him about things like CBD and THC, Ebbert wanted to give them an answer.
“They would say, My life is miserable. I’m in so much pain. I want to use CBD or THC. Is it safe?’ And I said, ‘I have no idea, but I can go into a lab, and we can figure it out.’”
So Ebbert went into the lab. Hoped he would find a safe e-cig, or at least find ways to make e-cigarettes safer.
“That’s what we did with cars, right?” says Ebbert. “We figured out that maybe we shouldn’t have glass in the windshield that shatters and cuts everybody apart. Maybe we should have a seat belt. It’s the same thing. Here’s a product. People are going to use them. How can we make them safer? That’s kind of where we’re coming at it from.”
But then came Ebbert’s initial testing of e-cigs. When the device heats those vaping liquids, they soon found, it creates new, often dangerous, chemical compounds.
And since you’re heating those liquids in a metal chamber, they discovered, you aerosolize and inhale various metals. Like lead. And nickel. And cadmium.
“Those e-liquids, when heated, result in potentially toxic exposure,” he says. “And those metals result in potentially toxic exposure. The bottom line is that vaping poses health risks. We know that. And we know that teens are drawn to these devices. That’s a deadly combo.”
If he were king of the world, Ebbert says, he’d make every drug, including tobacco and alcohol, illegal — completely inaccessible, even— to everyone under the age of 25.
Twenty-five, he says, is that magical age when those insurance actuarial tables — the stats on auto accidents that keep you from renting a car until then — intersect with brain scan research that points to 25 as the age your brain stops developing. Twenty-five is when you understand the reality of risk-taking. Twenty-five is when people stop experimenting with drugs.
“Ninety-nine percent of all addiction happens before the age of 25,” he says. “And the likelihood anybody would ever be addicted to a potentially addictive substance if they start after age 25 is almost zero. So it’s all about keeping addictive substances away from kids as long as possible.”
Ebbert, though, understands this isn’t a real option.
“The idea that people shouldn’t do drugs, end of story, is not a reality frame for me,” he says. “Kids are going to do drugs because kids experiment. But the longer we can keep them away from addictive substances the better. And the safer we can make any products the better.”
‘The brain is a self-contained system.
’“I have always been fascinated by the fact that people use extraneous drugs to cope,” says Ebbert. “The brain is a self-contained system. The brain does not produce any neurotransmitters for which there are no receptors and it doesn’t make any receptors for which there are no neurotransmitters. We make our own cannabinoids. We make our own morphine. We make everything. We don’t need anything. Then something changes. And we need a drug to get through life.”
He gets it, he says. “I saw a lot of addiction growing up. I know the damage it can do.”
That’s it. He won’t elaborate.
One of his patients from the Nicotine Dependence Center, describes Dr. Ebbert this way: “I say ‘hot mess,’ he understands.”
“I do think I understand,” Ebbert says. “I understand that life is complicated. I understand that what drives drug addiction is the innate desire that we all have to escape pain and discomfort. I understand that we all need coping mechanisms.”
Ebbert’s coping mechanisms include regular morning runs (30 minutes five times per week around Soldiers Field with his Goldendoodle, Finnegan). Playing guitar (“Mostly Jane’s Addiction and Elton John-type stuff.”). Spending time with his wife, Andrea and their two daughters, 16-year-old Jade and 14-year-old Ruby (visiting art museums, playing guitar while the girls play ukulele).
And — for fun, at home — working on the vaping issue.
“I have what I call a ‘pre-lab’ at home in my workroom,” he says. “I’ve got all the products and all the devices, and I like to take them apart and see how they work. I take pictures for my presentations.”
Those presentations — webinars like “Vaping in Teens and Young Adults,” papers like “Commercial Cannabidiol Caution: A New Gold Rush,” speeches like “Beyond the Vapor” — have put Ebbert at the forefront of the nation’s vaping discussion.
Like with other Mayo docs-turned-researchers, Ebbert can combine those research results with real-life patient practice.
“I can talk to a patient about how they actually use a vaping device, how much, how often,” he says. “Then I can come down here and test that. We can give you results and advice in real time.”
Ebbert, for now, is staying opportunistic, trying to keep ahead of the trends.
“Today we’re working on CBD, which was just legalized in Minnesota at the beginning of this year. No one really knows what happens when you vaporize it. Tomorrow is THC. The next day is e-cigarettes,” he says. “It’s incredibly easy for me and Lexi to innovate. We can pivot based on need. We’ve taken e-cigarette science and summarized it. Now we can bring that to other aspects of vaping.”
In between testing, they’re consolidating vaping research and writing grants.
“We’re just trying to get that information out there so people can make better decisions about something they may not really understand,” says Ebbert. “We want to find something that can save people. And we’re trying to inform them about the things we find that could kill them.”
Then, they’re both back to the lab — the cart, actually — to force-feed that Cigarette Smoking Machine another e-cig, and listen to her chirp, and collect those results that, maybe, no one else yet has.