I do not promote or prescribe vaping. Rather, I recommend vaping as a form of harm reduction to smokers who are unable or unwilling to quit all nicotine/tobacco products, in order for them to avoid becoming one of the 480,000 smokers who prematurely and avoidably die each year in the U.S. At this time we already know that vaping is far less hazardous than smoking. In 2016 the British Royal College of Physicians, one of the oldest and most prestigious medical societies, said that “The hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5 percent of the harm from smoking tobacco.” Nothing has changed the Royal College’s hazard assessment.

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You were the one that kicked off this exchange implying the OP did this. Which was either mistaken, on your part, or hyperbole / propaganda.

So I'm glad we agree this did not happen.

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I tried to quit smoking many times, but couldn’t get past the physical and psychological effects until I tried Max Kirsten's hypocrisy tape. I listened to it at night for 2 weeks and noticed my cravings went down. After settling my quit date I listened to it once a day, but all night. No effects bothered me and I walked away from the habit. I highly recommend looking into it. The cost was the same as a pack of smokes.

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These are the same religious zealots who preach “harm reduction” by providing needles for drug use on the streets … in the absence of actual evidence of harm reduction.

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I love Sensible Medicine. But I am in shock with this story. One thing is to have a therapeutic option for smoking cessation and other is that we are playing into the hands of the tobacco industry.

I share this article from the Spanish newspaper El Pais:

When historians look back on our era, they won't believe that what causes the death of two-thirds of smokers is freely sold"

Rutger Bregman, El País (Spain), May 3, 2024:

This is the story of an invention that ended a hundred million lives in the 20th century and, if we continue as we are, will claim a billion lives in the 21st century. It's the story of the "most lethal artifact in human history," still killing eight million people a year. It's the story of a killer greater than malaria and tuberculosis, car accidents and climate change, war and disasters, all combined.

I'm referring, of course, to cigarettes. Or, more precisely: to the tobacco industry.

To get an idea of the level of devastation caused, let's imagine seeing this news: "A Jumbo jet crashes on the runway, no survivors"; half an hour later, we see the same news again: "Another Boeing 747 crashes, no survivors either"; and again 30 minutes later. Now imagine that the news keeps coming all day and all night, until more than 50 planes crash in 24 hours. And then imagine it continues like this for the whole year.

That's the number of deaths caused by the tobacco industry.

Of course, it's an incredibly profitable business. To put it in numbers: a current cigarette machine produces 20,000 cigarettes per minute, that is, 10 million in an eight-hour shift. According to epidemiologists, there is one death per million cigarettes, so we're talking about 10 deaths per shift. Companies make around one cent per cigarette, meaning that each death caused by tobacco is worth $10,000 to the industry. That is, five million dollars for each Jumbo, every 30 minutes.

Hold on, you might say: isn't this old news? Isn't the fight against the tobacco industry a thing of the nineties? But if smoking is declining, isn't it?

If only. Global revenues in the sector continue to rise. The number of smokers is slightly decreasing in wealthy countries, but this is more than offset by the rise of vaping and the growing popularity of tobacco in middle and low-income countries (where the industry operates almost unrestricted). Moreover, companies like Philip Morris love to say that tobacco is already tiresome, so they can continue doing the same as always.

As a result, we suffer from a kind of collective blindness. An insane thing — like 50 Jumbos crashing every day — has been normalized.

A history of lies and deceit

In reality, the cigarette is a fairly recent invention. Of course, people have always smoked, but the inhalable cigarette is a modern phenomenon. It's the result of decades of development work and billions in research budgets.

The composition of the current cigarette is only two-thirds tobacco, to which hundreds of substances are added: humectants, effect enhancers, cough suppressants, flavorings, you name it. Whatever it takes to make the product as addictive as possible.

To market this invention, the tobacco industry launched one of the biggest propaganda campaigns in human history. By 1960, nearly half of all television programs in the United States were sponsored by tobacco companies. In the early nineties, a study among young children revealed that the name and face of Joe Camel were as recognizable to them as Mickey Mouse.

And let's not forget everything the tobacco industry has done to cast doubt on whether cigarettes are lethal. By the early fifties, there was scientific consensus that smoking causes cancer, so the sector decided to take action. The conspiracy began on December 14, 1953, with a meeting of top executives from the major tobacco companies at the Plaza Hotel in Manhattan, New York. There they decided to hire a lobbying firm, Hill & Knowlton, to create a massive smokescreen.

For decades, the industry continued to say that more research was needed when, in fact, its own researchers already knew more. The sector's mantra was "our product is doubt," just like fossil fuel companies spent years sowing doubts about the reality of climate change. Millions were invested in "tobacco research" that actually studied other things (what historians call "decoy research").

The campaign was overwhelmingly successful. It wasn't until the eighties that most people began to realize that smoking is not just a little harmful, but one of the deadliest habits you can acquire. Two-thirds of all smokers die because of tobacco. Even so, as late as 1994, the seven CEOs of the major tobacco companies ("the seven dwarfs") swore under oath that nicotine is not addictive.

Meanwhile, the sector launched "innovations" that were supposed to make cigarettes "safer." But the tricks —filters, ventilation, light cigarettes— were pure fraud. Internal Philip Morris documents show that as early as the fifties the company considered "selective filtration" to be "thermodynamically impossible." A cigarette filter is like drinking beer through a very thin straw: you may have to suck harder, but you end up ingesting the same thing.

Cigarette ventilation is also nonsense. According to measurements from some smoke machines, "ventilated" cigarettes with small holes in the filter may seem less toxic, but the industry knows that smokers pinch these holes closed. It's like poking holes in a straw, closing them with your mouth, and saying that way you ingest less alcohol.

The tobacco industry's latest deception is the electronic cigarette (vaping), which is said to be less harmful than regular cigarettes.

However, several independent studies have shown that many vaping devices contain more toxic and addictive nicotine than a whole pack of cigarettes, and young people who vape are three times more likely to become smokers.

In the last decade, tobacco use among adolescents has skyrocketed across Europe. A leading British health expert has recently warned that if e-cigarette use continues to increase at this rate, almost every child will be vaping within five years.

"A free decision"

And, finally, we have the biggest story of all: that smoking cigarettes is a freely made decision. In reality, most smokers start when they are underage and around 70% want to quit. More than half try to quit every year, but, because cigarettes are made to be so addictive, the attempt usually fails. A Canadian study has concluded that an average of no less than 30 attempts are needed to break the addiction definitively.

The tobacco industry knows full well that nicotine consumption rewires the brain and creates a pharmacological dependence as strong as addiction to heroin or cocaine. That's a fundamental difference between nicotine and alcohol, because only 3% of drinkers become alcoholics, while in the case of cigarettes, the percentage is between 80 and 90%.

There are so few people who truly enjoy smoking that tobacco companies have coined a nickname: "The Enjoyers." Internal industry documents also have names for young people: they are the "apprentices," the "pre-smokers," or the "replacement smokers."

Someday historians will study our era and find it incredible that the tobacco industry could continue to thrive for so long. That a product containing arsenic, cyanide, and radioactive isotopes could be legally sold in supermarkets.

That so many people continued to underestimate the danger for so long, because how many people know that smoking also

causes hundreds of thousands of spontaneous abortions and ailments such as blindness, baldness, cataracts, premature menopause, and erectile dysfunction?

Future historians will be amazed at the number of chemists who did everything possible to make smoking as addictive as possible. They will be surprised by the number of commercial agents who did everything in their power to make smoking as sexy as possible.

All the lawyers who went to great lengths to cover up the lies of the tobacco industry. "I've been studying these companies for decades," writes eminent historian Robert N. Proctor, "and still, occasionally, I have to rub my eyes in astonishment at some new revelation that exposes prevarications or ruses."

This industry is too eager to make us believe that the battle against the big tobacco companies is over. That smoke-free spaces, warning labels, advertising bans, and high taxes have been enough to mitigate the problem. But it's not true, not by a long shot. There is still a long way to go.

The ban on advertisements has increased manufacturers' profit margins. The industry knows that educating young people often makes smoking even more popular. And tobacco taxes have been dubbed "the second addiction," not of the smoker, but of the Government, which makes so much money from smokers that it prefers not to make life too difficult for companies. (Last year, New Zealand revoked the smoking ban to compensate for tax cuts).

Nevertheless, this lethal industry can and will end someday. For this to happen, several things must occur. First, we have to get angry again. Without public outrage, there is no political pressure for these companies to be held accountable. Secondly, many more people—activists and pressure groups, lawyers and doctors—need to join the fight against the tobacco industry. Thirdly, we must be very clear about our fundamental goal: to ban the manufacture and sale of cigarettes.

Yes, people have always smoked. Anyone should have the freedom to grow tobacco in the garden for their own consumption. But no one should be allowed to poison others on an industrial scale. The cigarette is a fraudulent product that, like asbestos and lead in paint and gasoline, should not be manufactured or sold.

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Those future historians will say the same things about our pharmaceutical industry, which appeared to use the tobacco industry’s playbook.

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Where can we watch your videos now? Please post on YouTube or X.

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The intellectual content of the program is the property of the faculty. But the videos are owned by Medscape, and they are permanently cancelled. We are exploring other venues to make this important content available.

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Maybe you should not promote vaping without understanding the long term health effects. You really don't know that it's harm reduction compared to smoking.

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Funding for a study is absolutely relevant. That said, an unrestricted research grant where funders have no access to the data, and no role in collecting or analyzing the data, or in producing the manuscript or whatever form the end user content takes, is about as good as it can get. You certainly see , on the other end of the spectrum, nauseating “company-employed scientist was the lead investigator and first author “ business where the paper should do nothing more than line your birdcage.

Some might call this guilt-by-association. I’d say it’s just a healthy skepticism among those not born yesterday. That said, the authors here really did the best they could to be arms-length, and their frustration is understandable.

Medscape itself buckling to pressure is just more of the disgusting cancellation and woke nonsense that makes me want to hurl.

All that said, there already is evidence that vaping is maybe “not (entirely….or adequately) safe”….and some of it has been published on Medscape. I think it’s fine for the authors to say “vaping is better than actual smoking”….but vaping is NOT better than not vaping. So where rubber meets road for me is how to allow smokers access to vaping (cuz it’s a net benefit to them) while preventing access by current non-smokers. That is a far less black/white policy conundrum which may well be obscured by too-enthused promotion of vaping.

And again, recalling we weren’t born yesterday….do we really think Philip Morris et Al would be funding this for purely altruistic reasons? Or is it more likely they see this as a way to not only promote vaping to smokers but also to snatch a couple of non smokers along the way? For those who can’t decide, I’ve got a great deal on a bridge, with your name on it.

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As a person who quit combustible tobacco years ago in favor of vaping, I hear a variation of "but vaping is NOT better than not vaping" frequently. And it certainly FEELS like it's true.

But I've always been frustrated by attempts to find decent research beyond the bench, and beyond in vivo speculation, that the health risks are real. Let alone such research that gives me a sense of relative risk, so I can compare my vaping vice to other perfectly common vices that are generally not subject to such scorn.

But perhaps that's because I haven't looked in the right places, or because I'm beset by motivated reasoning on my own end. What research would you recommend I read to buy into that claim?

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If you were formerly a smoker, then vaping is quite likely a net benefit for you.

My concern is for non smokers. My prior is extremely pessimistic that vaping for non smokers is net neutral or net beneficial. However, there is no real evidence of clinical outcomes thus far. But I’d also view that in the context of how long it took to see clinical evidence of harm from actual smoking.

But as you say, so far it’s just a bunch of surrogate markers.

From a very quick Google scholar search:




Stuff like that, in the context of my priors, is enough for me to say “vaping is NOT better than not vaping” for people who are not currently smokers and stand to gain nothing from starting to vape.

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But it doesn't really help me in the least with relative risk.

Driving with your windows down, skiing, eating spicy foods, caffeine, enjoying a glass of wine with dinner, singing around a campfire ... all of these things are more dangerous to do than not do. And I do derive genuine pleasure-- and, for that matter, a certain invigorating efficiency-- from vaping nicotine products.

Without any real sense of relative risk, the vehemence with which the scolds approach this subject strikes me instinctively as disproportionate.

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May 10·edited May 10

If you equate the potential risk of driving with window down Vs the potential risk of inhaling artificial chemicals, I can’t really help you.

And again, as an ex-smoker, the risk of vaping is most likely lower than that of smoking for you, so fly at’er. The point is the bar of “no harm” is much higher for someone who has never smoked (ie doing nothing Vs starting to inhale chemicals). And that is the cohort that is of much more importance to me.

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Have you gotten a load of highway pollution? Vaping is the same technology used for some nebulized inhaled medications. It's not some crazy thing.

But, again, you MIGHT be correct! But it's definitely not a thing we know.

But I appreciate you confirming you are also unaware of what the actual relative risk is. If someone did have work detailing it, I might care to quit. Just like how I quit drinking alcohol and smoking weed.

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rapid global boycott by healthcare professionals disgusted by their behavior? Oh that’s so rich coming from them. No one was disgusted by anyone’s behavior over the last four years, but this THIS is just over the top. Good grief.

Is there any way to view those videos, Doctor? I would be interested. And definitely not disgusted

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The intellectual content of the program is the property of the faculty. We are exploring other venues to make this important content available.

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Is there an option to just leave "people...unwilling to quit smoking..." alone?

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Absolutely. Tobacco harm reduction is entirely about -- and ends with-- informing smokers that they have options to substantially reduce the hazards of smoking other than total nicotine/tobacco abstinence.

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This situation is rampant in our culture today, especially among those on the left, where the narrative trumps reality. This is a just another example of many.

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All industry sponsored research has an innate bias. The researchers can try to be unbiased, but it is hard if you are pulling for a certain outcome. The US needs to put money towards independent research not funded by the pharma or tobacco lobby.

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Tell me more about this "independent" research.

I mean, I guess I don't disagree. But it's also certainly true that the academy itself, and associated research institutions, *also* have their own biases that corrupt research as well, no?

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Not only the US but internationally. Through a research scientist far from US shores, I learned that US pharma companies fund researchers all over the world, not only in academic institutions but in smaller private research set-ups.

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Well spoken!!!

Another question as a former educator of tobacco reduction is the need for studies of the impurities and additives found in the liquid nicotine used in e-cigs… We have no clue as to the long -term effects on the lungs, blood vessels or brain etc. Are they intentionally ignoring this issue?? This is the new Tobacco Big- Business aka pharma sacred-cow as far as I can assess.

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Ultimately, anyone is able to not ingest nicotine. Eliminate it and its simply gone and not one person is worse off. "Harm reduction" is no solution, it's simply the enabling of continued toxic cultural paradigms.

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Ultimately anyone is able to not ingest sugar, caffiene, alcohol, meat, and on and on and on. Anyone can not have sex..... Make procreation artificial insemination only. Why not just get rid of anything that causes any known harms?

Oh, I remember why, because no one wants to live in that world. A life worth living involves risk and known harms. If this harms less than that, have an open and honest conversation about it. Let all sites be heard and we can all make up our own minds. There is nothing more dangerous than a zealous do-gooder.

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May 9·edited May 10

"Harm reduction" is a fallacy. It's propaganda for industry and cartels.

In Canada we took the wrong approach. This country is obsessed with virtue signal of "harm reduction", we pay for it through the nose, and it does not work, doesn't achieve what propagandists purport to achieve. It simply transfers profits and power from one industry to another.

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Harm reduction is a loophole to save a few lives against the real problem, prohibition. Reportedly Canada is failing in multiple ways, so I don't believe that they are a decent example of any argument. Plus, I have not been there so I can't say one way or the other. I do know that in the US, there is no Constitutional or justifiable reason whatsoever for the criminalization and subsequent creation of this black market industry supplying substances people do by choice. Harm reduction is merely a way to save a few victims of prohibition from earlier death.

We simply need to end prohibition. We did for alcohol, why not for everything else. BTW, it took a Constitutional amendment to ban liquor. They have yet to enact one to ban the rest, therefor their laws criminalizing the rest should be repealed or judged unconstitutional.

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This! Yes, end prohibition. Every time the govt goes the prohibition route, death ensues.

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I see a lot of back and forth over whether or not these studies should have caused outrage or whether or not e-cigs should be discouraged fully. I don’t really believe the focus of outrage here should be about whether or not these products should be defended and/or promoted or completely removed. There are great arguments on both sides of this issue. I see this article as placing the outrage on the censorship by bullying and shutting down the discourse. That is the real problem highlighted by this article. You can disagree all you want with the doctors in favor of e-cigs for specific populations, but we shouldn’t seek to shut down their studies. This kind of censorship is happening over so many medical subjects today (Covid!) and causes the public to only be able to hear one side of the narrative. Most of us are smart enough to digest both sides of an argument and come to valid intellectual conclusions. We should have the freedoms to hear all studies and not be spoon fed only what one side with the most power want us to believe. Be outraged, please! But not at these doctors or their professional findings and opinions. Be outraged that they are being canceled and silenced, because if it happens to them one day it will surely happen to you too.

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May 9·edited May 9

The tragedy of this article is lost on me. Who cares if Medscape takes down videos encouraging people to vape? Doctors becoming spokespeople for the vaping industry is somehow better than doctors becoming spokespeople for the tobacco industry? It's like telling people it's better to play with hand grenades instead of land mines.

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These videos encouraged "people" to vape?

Citation, please.

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As far as I can tell, these videos do not suggest people who don't vape start vaping.

So care to get me squared away on this claim?

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May 11·edited May 11

As far as I can tell, the videos encourage smokers unwilling to stop, to vape instead. " Two planned videos on the topic of tobacco harm reduction (THR), the practice of delivering nicotine in safer ways through lower-risk products such as e-cigarettes and smokeless tobacco....The videos would show why THR is an answer to combustible tobacco (aka cigarettes), for people unable or unwilling to quit smoking using FDA-approved cessation tools, such as nicotine patch or gum." Unless my command of the english language is somehow deficient, THR being an "answer" to smokers not willing to use FDA approved cessation tools, means the would have to start vaping. Maybe you can derive a different meaning from that statement. Physicians making videos to tell people to vape instead of smoke seems ethically tenuous, especially in light of the lack data on the long term effects of vaping.

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Ethically tenuous? England's NHS recommends it.


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I take it you're now admitting that the videos encourage people that don't vape to vape. Congrats on that. Doctors used to recommend people smoke before they understood the long term consequences of that. So yes, it is ethically tenuous for them to recommend vaping without understanding the long term consequences. Really not that hard a concept.

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Science requires that you NOT consider the influence of the sponsor, without clear evidence, if the authors say the sponsor had no influence. If you think cashews increase longevity (or decrease longevity), you would sensibly go to the Cashew Foundation (not real). You must report the results honestly. If the foundation stops funding you, they should explain why but either way, letting the results affect the scientific decision is a very serious charge and should be supported. Otherwise there is not science. You may think that they made a mistake in the science or have suspicions and over coffee or lunch you might describe them as dirty as the US Supreme Court but in the professional realm, you have to stay with the data.

But cutting to the case, Medscape is asserting that it is not playing by scientific rules. That’s worth investigation. If nothing else, it might be time to consider what they do cover.

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