My 57 y.o. man-friend quit cigarette smoking years ago, started up again and eventually switched to vaping. He vapes in my presence though I constantly ask him not to. His habit is deeply ingrained and mindless. I am a vehement non-smoker: dad died at 69 from lung cancer, I watched patients die from lung CA as a hospital R.N., and I'm sensitive to strong chemical smells, e.g. cleaning products, perfume. I tried cigarettes and went through a pot smoking phase in my youth, so I "get it".
My partner tells me his PCP, while not encouraging this behavior, said vaping is far better than smoking cigarettes. My partner says he has cut down and will eventually quit but I am not convinced. He is addicted.
He has a horrific sweet tooth (a whole 'notha topic!) so he vapes flavored nicotine, e.g. Blueberry, Passion Fruit, whatever. The smell is overpowering and downright nauseating to me. I worry that he is inhaling harmful chemicals via the flavors. He pooh poohs this concern. I also worry about second-hand flavored vape that I am forced to inhale. He assures me the exhale is simply "water vapor". The disgusting smell leads me to believe otherwise.
I'm not aware of any long-term studies re: the safety of flavored nicotine vape products which I understand are generally marketed to young people. Would greatly appreciate any updated info you may have. Thank you for writing this piece!
As someone who suffered 17 years of smoking parents (back in the 3-kg-size-pack-a-day times) and many health problems in the following years trying to be at work among smokers, I was incredibly happy when smoking was banned from all public spaces. My health has been awesome ever sense.
I don't really give a sh*t what people do to their own bodies, I just don't want their decisions ruining my life.
It was not "nicotine" that made me sick, it was the poor quality air. I must have CLEAN air in order to be alive and healthy.
Vapers tend to be the most impolite, because they assume I don't mind inhaling their bullsh*t.
If that could be corrected, I wouldn't mind about the rest.
I find harm reduction with regard to nicotine delivery to be quite curious. Nicotine is addictive. And quite addictive. Plenty of research supports this. People will go to incredible lengths for nicotine. So I have learned over time that abstinence is an excellent model for many and frankly most addictive drugs. I DO support liberal weaning - it’s important with any mood altering drug to take time and allow the brain to heal. Lifetime use of a mood altering drug as addictive as nicotine? I don’t see the data. To me it’s deciding whether or not to use blackpowder or smokeless powder in the case of the bullet in the gun aimed at oneself.
A question often asked. Smoke contains a complex mixture of around 7,000 chemical species, many of which are toxins. There is no definitive evidence that the combustion of the additives changes the consequences of long-term exposure. Of course, this is also another way of saying that there is no evidence that cigarette smoke from "pure" tobacco without additives is any safer.
None of this addresses the concern of long-term high-dose nicotine to adolescents who are not former smokers. One inhales approximately 1-2mg nicotine in the average cigarette. A zyn pouch contains 3 or 6mg. 20 pouches in a zyn can, which the typical user consumes in a day.
That's 3-6 packs of cigarette's nicotine per day! Do we have any idea what that does to a young person? I don't think we do.
I understand the author's concern re: former smokers, but this is not what we are dealing with here. We are dealing with an entirely different class of addictive substance being used by an entirely different population of YOUNG PEOPLE.
Presenting smokeless nicotine as primarily beneficial is misguided at best and frankly harmful at worst.
Interesting piece, thank you. I used to teach a vaping unit in my intro to public health class. I would teach it differently now, I think, with a more open mind. I thought there were some decent data showing the temperature of vaped smoke was harmful to lung tissue? I will look at the papers myself but maybe others have thoughts about whether that research held up over time. Also off label (eg made illegally) vapes can be quite harmful as well? Or has that issue been solved.
The previous 2 part series was extremely disappointing, in that part 2 never made the case that vaping was NOT a gateway towards youth smoking subsequently. (I know you can’t prove a negative….but the author suggested in part 1 that she would do so, and should have known the methodology she employed in part 2 would fall far short….and indeed it did).
NRT already involves nicotine by definition. So whether it’s gum, patch, or the currently discussed dip/chew/pouch, it’s really a difference in delivery vessel. Given established therapeutic uses, I have no issue with relatively short term nicotine replacement by any means.
But the issue really is long term use. It’s established that long term smoking is terrible. So there are 2 relevant questions:
1. Is long term use of tobacco chews better (ie safer, with less long term mortality) than long term smoking? (I would have a very strong prior that it is)
2. Is long term use of tobacco chews equivalent to non-use in terms of long term mortality? (I am not sure what type of prior is appropriate for this one).
The linked study for the gateway question still does not answer it. The trend in an 11-year cohort was for more youth vaping and less youth smoking….during those 11 years. But what happens to those youth vapers later? That is the crux of the matter. And that study fails to address it.
And I will need to know more about the “weak association” with head and neck cancers. Just as with smoking, that needs the Bradford-Hill test applied.
I welcome solutions that will help current smokers (a finite number). But we need to be wary of potential unintended consequences for current non-smokers (a not-so-finite number).
I'm curious to hear your thoughts on verrucous carcinoma. Granted it is generally considered much less aggressive than "routine" squamous cell carcinoma in the mouth, but I have never even heard of this diagnosis outside the use of chewing tobacco.
I routinely counsel people to stop using chewing tobacco and then I watch the soft tissues of the mouth return to normal. Sometimes patients tell me they won't stop using chewing tobacco. I then recommend they move it to the other side of their mouth. Over the course of several weeks to months, I typically watch the visible pathology resolve in the one area and form in the new area. Anecdotally, it seems quite clear that the progression from metaplasia to dysplasia to verrucous carcinoma is caused by chewing tobacco. I have never seen any research to indicate otherwise. I look forward to reading your article arguing otherwise.
I have conducted and published research on tobacco harm reduction since 1994 (https://louisville.app.box.com/file/1793592529260?s=ztqsq1ue1bdisllarvhpmi2ogrrvvjzj), and my funding has been a matter of public record for the entire period. From 1999 to 2018 my research was supported by unrestricted grants to the University of Alabama at Birmingham (1999-2005) and to the University of Louisville (2005-2018), which were publicly acknowledged. I now report no conflict of interest (COI), as six years without industry funding is a longer period than specified by the COI policies of professional journals and other relevant organizations. I have no personal or other professional conflict of interest.
I appreciate your transparency and the clarification on your funding history. It’s unfortunate that misconceptions about nicotine and harm reduction still persist in daily discussions, despite the evidence. I find your breakdown of these myths insightful and well-supported, and it’s helpful to know you’ve had no industry funding for six years while meeting COI standards.
Thank you Dr. Cifu. I think one of your most admirable traits is your willingness to reprint articles that may be contrary to your own opinions or conclusions on medical topics. The fact that you have a knowledge of and appreciation for baseball history also helps.
This feels like when all the sudden people were claiming smoking pot all the time isn't bad for you either. Why don't we not smoke, excessively drink, or do drugs?! Why is that so hard? Watching people constantly worried about next cigarette or sneaking a vape in a restaurant is no way to live. I couldn't imagine.
Well done, sir! Honest, wonderful translation of the actual data. As discussed in my podcast on Saturday (https://researchtranslation.substack.com/p/vaping-smoking-and-the-urban-myth), I believe vaping is caught in the crosshairs of a debate among public health authorities about harm reduction vs abstinence for smoking—there's irony there. Overwrought, disingenuous messaging has often been used to fearmonger as a means of changing behavior (think: Reefer Madness) and the hounds have now been released on vaping, due to misguided anecdotes about young people using vaping as a gateway to smoking.
As an ex tobacco smoker that had a hard time quitting and passed through most of the classic substitutes I'm still confused as to the addictive nature of nicotine - which is assumed almost everywhere by both laymen and health professionals.
I looked in the scientific literature some years ago (you're welcome to show me that I didn't look well enough) and I didn't find any significant bibliographic evidence showing that, indeed, nicotine BY ITSELF is addictive. And obviously doubting something like this, might easily lead to being taken for an idiot (or worse: a tobacco-industry puppet).
I won't bore anyone detailing why I have this very weird belief (though questioning the majority is essential to my contrarian nature), but I challenge this tenet: is pure nicotine truly highly addictive, or is it a myth as well?
I quit smoking. I now vape. My lungs are healthy. I love my vape. I love everything about it. I smoke way less. I don’t crave a cigarette every fifteen minutes.
I can’t stand being near a cigarette.
My apt complex has banned vaping inside apt units. Now must vape 15 feet from the building. Lol
I appreciate your thoughtful approach to this topic. Much of what you present aligns with other research I’ve seen. That said, transparency around funding is important. A quick search suggests your research has received support from tobacco and nicotine companies. While that doesn’t necessarily impact the validity of your conclusions, some might see it as a source of bias. Of course, I may have missed something, but I’m curious—how do you think we can move past funding concerns and focus purely on the data?
Should researchers with industry ties be more upfront? And how do we ensure strong research isn’t dismissed solely because of its funding source? I’d love to hear your thoughts.
ChatGPT was too polite. Anyone who writes an article of this nature without disclosing diectly relevant conflicts should be shunned as shameful, manipulative, and unworthy of trust. Unsubscribing from this stack.
My 57 y.o. man-friend quit cigarette smoking years ago, started up again and eventually switched to vaping. He vapes in my presence though I constantly ask him not to. His habit is deeply ingrained and mindless. I am a vehement non-smoker: dad died at 69 from lung cancer, I watched patients die from lung CA as a hospital R.N., and I'm sensitive to strong chemical smells, e.g. cleaning products, perfume. I tried cigarettes and went through a pot smoking phase in my youth, so I "get it".
My partner tells me his PCP, while not encouraging this behavior, said vaping is far better than smoking cigarettes. My partner says he has cut down and will eventually quit but I am not convinced. He is addicted.
He has a horrific sweet tooth (a whole 'notha topic!) so he vapes flavored nicotine, e.g. Blueberry, Passion Fruit, whatever. The smell is overpowering and downright nauseating to me. I worry that he is inhaling harmful chemicals via the flavors. He pooh poohs this concern. I also worry about second-hand flavored vape that I am forced to inhale. He assures me the exhale is simply "water vapor". The disgusting smell leads me to believe otherwise.
I'm not aware of any long-term studies re: the safety of flavored nicotine vape products which I understand are generally marketed to young people. Would greatly appreciate any updated info you may have. Thank you for writing this piece!
As someone who suffered 17 years of smoking parents (back in the 3-kg-size-pack-a-day times) and many health problems in the following years trying to be at work among smokers, I was incredibly happy when smoking was banned from all public spaces. My health has been awesome ever sense.
I don't really give a sh*t what people do to their own bodies, I just don't want their decisions ruining my life.
It was not "nicotine" that made me sick, it was the poor quality air. I must have CLEAN air in order to be alive and healthy.
Vapers tend to be the most impolite, because they assume I don't mind inhaling their bullsh*t.
If that could be corrected, I wouldn't mind about the rest.
I find harm reduction with regard to nicotine delivery to be quite curious. Nicotine is addictive. And quite addictive. Plenty of research supports this. People will go to incredible lengths for nicotine. So I have learned over time that abstinence is an excellent model for many and frankly most addictive drugs. I DO support liberal weaning - it’s important with any mood altering drug to take time and allow the brain to heal. Lifetime use of a mood altering drug as addictive as nicotine? I don’t see the data. To me it’s deciding whether or not to use blackpowder or smokeless powder in the case of the bullet in the gun aimed at oneself.
Is there any research on the common contention (amongst some) that “it’s not the tobacco, it’s the additives “?
MSKFB,
A question often asked. Smoke contains a complex mixture of around 7,000 chemical species, many of which are toxins. There is no definitive evidence that the combustion of the additives changes the consequences of long-term exposure. Of course, this is also another way of saying that there is no evidence that cigarette smoke from "pure" tobacco without additives is any safer.
Thanks for taking the time to reply, Dr Rodu. Appreciate it.
None of this addresses the concern of long-term high-dose nicotine to adolescents who are not former smokers. One inhales approximately 1-2mg nicotine in the average cigarette. A zyn pouch contains 3 or 6mg. 20 pouches in a zyn can, which the typical user consumes in a day.
That's 3-6 packs of cigarette's nicotine per day! Do we have any idea what that does to a young person? I don't think we do.
I understand the author's concern re: former smokers, but this is not what we are dealing with here. We are dealing with an entirely different class of addictive substance being used by an entirely different population of YOUNG PEOPLE.
Presenting smokeless nicotine as primarily beneficial is misguided at best and frankly harmful at worst.
Interesting piece, thank you. I used to teach a vaping unit in my intro to public health class. I would teach it differently now, I think, with a more open mind. I thought there were some decent data showing the temperature of vaped smoke was harmful to lung tissue? I will look at the papers myself but maybe others have thoughts about whether that research held up over time. Also off label (eg made illegally) vapes can be quite harmful as well? Or has that issue been solved.
Any research or studies on non-tobacco nicotine pouches like Zyn and Alp?
HenriO,
My research group published one of the first peer-reviewed articles on Zyn: https://pubmed.ncbi.nlm.nih.gov/32176374/. On January 16 the FDA authorized the marketing of 20 ZYN nicotine pouch products through the premarket tobacco product application (PMTA) pathway following an extensive scientific review (https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-20-zyn-nicotine-pouch-products-after-extensive-scientific-review).
Thank you! Are there any studies evaluating their potentially negative/positive health effects?
The previous 2 part series was extremely disappointing, in that part 2 never made the case that vaping was NOT a gateway towards youth smoking subsequently. (I know you can’t prove a negative….but the author suggested in part 1 that she would do so, and should have known the methodology she employed in part 2 would fall far short….and indeed it did).
NRT already involves nicotine by definition. So whether it’s gum, patch, or the currently discussed dip/chew/pouch, it’s really a difference in delivery vessel. Given established therapeutic uses, I have no issue with relatively short term nicotine replacement by any means.
But the issue really is long term use. It’s established that long term smoking is terrible. So there are 2 relevant questions:
1. Is long term use of tobacco chews better (ie safer, with less long term mortality) than long term smoking? (I would have a very strong prior that it is)
2. Is long term use of tobacco chews equivalent to non-use in terms of long term mortality? (I am not sure what type of prior is appropriate for this one).
The linked study for the gateway question still does not answer it. The trend in an 11-year cohort was for more youth vaping and less youth smoking….during those 11 years. But what happens to those youth vapers later? That is the crux of the matter. And that study fails to address it.
And I will need to know more about the “weak association” with head and neck cancers. Just as with smoking, that needs the Bradford-Hill test applied.
I welcome solutions that will help current smokers (a finite number). But we need to be wary of potential unintended consequences for current non-smokers (a not-so-finite number).
I'm curious to hear your thoughts on verrucous carcinoma. Granted it is generally considered much less aggressive than "routine" squamous cell carcinoma in the mouth, but I have never even heard of this diagnosis outside the use of chewing tobacco.
I routinely counsel people to stop using chewing tobacco and then I watch the soft tissues of the mouth return to normal. Sometimes patients tell me they won't stop using chewing tobacco. I then recommend they move it to the other side of their mouth. Over the course of several weeks to months, I typically watch the visible pathology resolve in the one area and form in the new area. Anecdotally, it seems quite clear that the progression from metaplasia to dysplasia to verrucous carcinoma is caused by chewing tobacco. I have never seen any research to indicate otherwise. I look forward to reading your article arguing otherwise.
Peaches,
I will address your question if Sensible Medicine editors consider my upcoming submission worthy of publication. Meanwhile, I please consider my previous peer-reviewed articles, published in 1995 (https://pubmed.ncbi.nlm.nih.gov/7552882/) and 2002 (https://pubmed.ncbi.nlm.nih.gov/12075196/).
I have conducted and published research on tobacco harm reduction since 1994 (https://louisville.app.box.com/file/1793592529260?s=ztqsq1ue1bdisllarvhpmi2ogrrvvjzj), and my funding has been a matter of public record for the entire period. From 1999 to 2018 my research was supported by unrestricted grants to the University of Alabama at Birmingham (1999-2005) and to the University of Louisville (2005-2018), which were publicly acknowledged. I now report no conflict of interest (COI), as six years without industry funding is a longer period than specified by the COI policies of professional journals and other relevant organizations. I have no personal or other professional conflict of interest.
Dr. Rodu,
I appreciate your transparency and the clarification on your funding history. It’s unfortunate that misconceptions about nicotine and harm reduction still persist in daily discussions, despite the evidence. I find your breakdown of these myths insightful and well-supported, and it’s helpful to know you’ve had no industry funding for six years while meeting COI standards.
Best,
Andrew Burton
(Written with assistance from ChatGPT)
Thank you Dr. Cifu. I think one of your most admirable traits is your willingness to reprint articles that may be contrary to your own opinions or conclusions on medical topics. The fact that you have a knowledge of and appreciation for baseball history also helps.
This feels like when all the sudden people were claiming smoking pot all the time isn't bad for you either. Why don't we not smoke, excessively drink, or do drugs?! Why is that so hard? Watching people constantly worried about next cigarette or sneaking a vape in a restaurant is no way to live. I couldn't imagine.
Well done, sir! Honest, wonderful translation of the actual data. As discussed in my podcast on Saturday (https://researchtranslation.substack.com/p/vaping-smoking-and-the-urban-myth), I believe vaping is caught in the crosshairs of a debate among public health authorities about harm reduction vs abstinence for smoking—there's irony there. Overwrought, disingenuous messaging has often been used to fearmonger as a means of changing behavior (think: Reefer Madness) and the hounds have now been released on vaping, due to misguided anecdotes about young people using vaping as a gateway to smoking.
As an ex tobacco smoker that had a hard time quitting and passed through most of the classic substitutes I'm still confused as to the addictive nature of nicotine - which is assumed almost everywhere by both laymen and health professionals.
I looked in the scientific literature some years ago (you're welcome to show me that I didn't look well enough) and I didn't find any significant bibliographic evidence showing that, indeed, nicotine BY ITSELF is addictive. And obviously doubting something like this, might easily lead to being taken for an idiot (or worse: a tobacco-industry puppet).
I won't bore anyone detailing why I have this very weird belief (though questioning the majority is essential to my contrarian nature), but I challenge this tenet: is pure nicotine truly highly addictive, or is it a myth as well?
I quit smoking. I now vape. My lungs are healthy. I love my vape. I love everything about it. I smoke way less. I don’t crave a cigarette every fifteen minutes.
I can’t stand being near a cigarette.
My apt complex has banned vaping inside apt units. Now must vape 15 feet from the building. Lol
Good luck policing that!
Dr. Rodu,
I appreciate your thoughtful approach to this topic. Much of what you present aligns with other research I’ve seen. That said, transparency around funding is important. A quick search suggests your research has received support from tobacco and nicotine companies. While that doesn’t necessarily impact the validity of your conclusions, some might see it as a source of bias. Of course, I may have missed something, but I’m curious—how do you think we can move past funding concerns and focus purely on the data?
Should researchers with industry ties be more upfront? And how do we ensure strong research isn’t dismissed solely because of its funding source? I’d love to hear your thoughts.
Best,
Andrew Burton
(Written with assistance from ChatGPT)
Please see Dr. Rodu's comment.
ChatGPT was too polite. Anyone who writes an article of this nature without disclosing diectly relevant conflicts should be shunned as shameful, manipulative, and unworthy of trust. Unsubscribing from this stack.
Please see Dr. Rodu's comment.