Thank you, Sally. I am a retired pediatric pulmonologist. As a professional niche, I would say my colleagues are firmly against tobacco and highly suspicious of the tobacco industry. On the other hand, the general response to vaping has generally ranged from ambivalent to hostile. There are many anecdotal reports of lung disease in adolescent papers but when the data is examined, most are from young people who have doctored the vaping cartridges with other substances, especially THC. The data that you present on vaping as a means of avoiding or weaning off tobacco products is encouraging. What is the endgame? We do not know but THC is very tempting and quite available.
I'd feel a lot better about vaping if there was disclosure about the contents. The "real" vapers have detail about their juices and machines (battery devices). Others are only interested in the huge clouds of smoke they can produce while many vape and produce no smoke-like output at all. I suspect the chemicals in the clouds might be an issue.
This was disappointing. Part 2 was supposed to be an evidence based attempt to dispel concerns about vaping as a gateway to youth smoking. For that, you can’t simply present correlation of current vaping use among youth, with current smoking trends among youth. The point is to try to argue (with evidence) that potentially exponential increase of youth vaping today would not result in downstream increase of youth smoking tomorrow. Nothing presented here comes close to establishing that point, IMO.
I could support an increase in vaping as a means to reduce current adult smoking, if there are concurrent policy initiatives that aim to prevent an increase in adult smoking in the future. The author here does not appear to present evidence or policy recommendations that would provide adequate reassurances.
This is just another nail in a very ugly coffin for anything in the US described as "public health". There has been literally nothing that public health, writ large, has done that is really constructive over the past five years. Please do not whine to me about how everyone works so hard and wants the best things to happen. Covid is an even better example of the disaster that "public health" is, but the list is long, including the vaping issue.
If we wish to make America healthier, the right place to start would be completely dismantling the current "public health" structures and (if people insist) starting over. Clean water, etc. are in a different category and have been addressed well for 100 years. But vaping, vaxxing, diets are part of medicine -- not community cleanliness. Since medicine is an n-of-1 profession, it is unclear how much benefit population measures homogenized by governments led by those with other agendas will ever do. And the tendency of "public health" to squelch all dissenting opinions is reprehensible at best and lethal at worst -- as we are increasingly finding out.
Personally, I believe that the worst part of the "public health" debacle is that it has taken down the medical profession with it. After decades of gaining people's trust, patients now disbelieve much of what we physicians say...and I cannot blame them. Some of that belongs to each practitioner who (AB2098 before the law) just recited the government pabulum -- although some of us did not. But a lion's share of the loss of trust belongs to the NIH/CDC/FDA axis that promotes things that most normal people can detect are just wrong. (Note the number of boosters given, or the continuing strength of vaping.)
It will be decades if forever before medical practice/health care regains the credibility many of us have worked hard to earn to provide the best care we know how for our patients. If "public health" remains as it is, it will NEVER happen. People are now in the "fool me twice" position. They know better.
As a physician training in public health, can't really argue against the demise of its credibility, but that doesn't meant that there is no ingenuous meaning of the term.
Love your thoughts. It’s so hard to trust - I watched public health fumble locally with addiction - literally watched a high ranking government official get bought by a for profit treatment (I should stress NON treatment) organization who was basically buying MDs’ DEA licenses and paying them well. Still several more around here doing it. I as an ex healthcare provider do not trust anymore and I’m not sure that will come back, but that had been waning for a long time.
thank you for daring to say something that is "bad" is really not so bad.
I also think everyone ought to be free. They have a choice to smoke cigarettes, joints, toads, bananas, or vape. Why should anyone dictate a personal choice?
Interesting take, as a former smoker who absolutely loved smoking, my thoughts:
1) Looks like "Mission Accomplished" by the graphs already. Very few teens are smoking cigarettes. Vaping has displaced cigarettes in youth. The graphs match anecdotally what I have seen - my kids friends who smoke only vape. I rarely ever see anyone under the age of 30 with a cigarette - so what am I missing? Short of going full New Zealand we will never completely eradicate smoking, < 2% seems like the lowest you could ever hope for.
2) If the hope is that adult smokers convert to e-cigs as a means of quitting or reducing harm, that's unrealistic. Vaping is grade school T-ball to cigarettes' New York Yankees... It's tepid off-brand generic cola compared to Classic Coke. All vaping does is remind you how much more enjoyable a real cigarette would be. If you want to quit, better off with Zyban, Chantix, Allen Carr's "The Easy Way to Stop Smoking", or simply the will power of Cold Turkey.
On a side note, it's been close to 18 years since the majority of the United States banned smoking indoors throughout the country, 30+ years since it was banned in public transportation.
Is there evidence it has made a dent in cancer rates and all cause mortality? A quick look through Wonder doesn't appear so.
“All vaping does is remind you how much more enjoyable a real cigarette would be.”
I 100% disagree. I smoked more than a pack a day. I switched to vaping and never looked back. But you have to start with the comparable amount of nicotine that you were smoking in order to get satisfaction out of vaping. I enjoyed vaping from the very first draw because there was enough nicotine in it to satisfy me with only one draw. Then you can slowly taper down the amount of nicotine in your vape juice. I also chose a vape juice that closely matched the flavor of the cigarettes I was smoking, menthol.
I love vaping. I don’t annoy people with a big vape cloud. If you hold it for a moment you can barely see the vape exhaled. And other people don’t smell the vape. Ugh I hate the smell of cigarette smoke.
For me, part of the enjoyment was the tactile feel of a cigarette... rolling it between your fingers between drags, ashing, pinching the filter lightly as you get near the end... something just felt hollow when I tried vaping as a replacement. Strangely for me I enjoy the smell of cigarette smoke, or, my brain seems to get a pleasant memory triggered when the rare times I come into contact with it.
With all due respect, as the mother of 3 peri-adults, the incidence of e-cigarette use is dramatically higher than this data suggests. All 3 of my children (ages 18,20, and 22) use it to varying degrees (much to my despair, and my fear mongering with my 2 boys that nicotine use is a leading cause of ED later in life) and they will tell you that “99% of HS age kids use it”... no matter if their social, academic, or athletic status. My kids ran/run with a variety of kids, not just one group. They were all high level athletes (1 will play a division 1 sport in college). It is pervasive and they lie about using it.
Seems to me that one needs to conduct a proper RCT as to whether vaping is harmful or not and what those harms actually are. If an RCT is not feasible, then thorough appropriate testing in monkeys needs to be done (not mice). If it's not harmful and not carcinogenic (in humans or monkeys), then there is no reason not to discourage vaping. After all, better to vape than continually food graze and become obese, which is in itself a massive healthcare problem in the US. If anything, the Covid lockdowns should have taught us that as the average weight gain was really very substantial as people were sitting home getting bored and just eating and snacking all the time. Had they vaped instead this problem would have been avoided.
Interesting that the National Academies came out against vaping. No surprise as they always support the status quo and the government, even though they claim to assemble panels of experts and produce unbiased reports. Yet they always chose their panel members to get the end result they want. In short, they are nothing more than a think tank whose credibility is artificially enhanced by the distinction of their membership (an honor society), the vast majority of whom have absolutely nothing to do with the reports they produce.
This almost feels like a marketing article for a vape company. It doesn’t sit well with me so I’m going yo go back and re-read part one and this one again. I guess it’s partly bc of my lack of trust in public health and general distaste in the phrase “harm reduction” so I will see what I can do to loosen personal bias prior to re-reading. Ahh such is my brain on a Thursday morning. 🤷🏻♂️
Absolutely agree. Where I tend to go deeper is what about the harm caused by the vaping chemical itself? For example, do we even know those harms yet? Will we ever know those harms? I absolutely applaud you and don’t want to diminish your success with these questions!
Oh I get that - ultimately it’s kind of my point - who do we trust anymore? I think that’s everybody’s point these days too. And believe me, I do not have a flag to fly as far as my habits! I eat poorly sometimes, I don’t exercise enough, and I probably don’t hydrate nearly as well as I should. Ultimately, my hope is that we all have the best opportunity to be our best. I like a forum like this to challenge myself and appreciate your comment very much.
I am so glad you acknowledged your distaste for the term harm reduction. I breathed a sigh of relief. I am so with you on your sentiments. HR is less than treatment, so much less. Seems as if we have given up and lowered the bar so very low.
Thank you, Sally. I am a retired pediatric pulmonologist. As a professional niche, I would say my colleagues are firmly against tobacco and highly suspicious of the tobacco industry. On the other hand, the general response to vaping has generally ranged from ambivalent to hostile. There are many anecdotal reports of lung disease in adolescent papers but when the data is examined, most are from young people who have doctored the vaping cartridges with other substances, especially THC. The data that you present on vaping as a means of avoiding or weaning off tobacco products is encouraging. What is the endgame? We do not know but THC is very tempting and quite available.
I'd feel a lot better about vaping if there was disclosure about the contents. The "real" vapers have detail about their juices and machines (battery devices). Others are only interested in the huge clouds of smoke they can produce while many vape and produce no smoke-like output at all. I suspect the chemicals in the clouds might be an issue.
This was disappointing. Part 2 was supposed to be an evidence based attempt to dispel concerns about vaping as a gateway to youth smoking. For that, you can’t simply present correlation of current vaping use among youth, with current smoking trends among youth. The point is to try to argue (with evidence) that potentially exponential increase of youth vaping today would not result in downstream increase of youth smoking tomorrow. Nothing presented here comes close to establishing that point, IMO.
I could support an increase in vaping as a means to reduce current adult smoking, if there are concurrent policy initiatives that aim to prevent an increase in adult smoking in the future. The author here does not appear to present evidence or policy recommendations that would provide adequate reassurances.
This is just another nail in a very ugly coffin for anything in the US described as "public health". There has been literally nothing that public health, writ large, has done that is really constructive over the past five years. Please do not whine to me about how everyone works so hard and wants the best things to happen. Covid is an even better example of the disaster that "public health" is, but the list is long, including the vaping issue.
If we wish to make America healthier, the right place to start would be completely dismantling the current "public health" structures and (if people insist) starting over. Clean water, etc. are in a different category and have been addressed well for 100 years. But vaping, vaxxing, diets are part of medicine -- not community cleanliness. Since medicine is an n-of-1 profession, it is unclear how much benefit population measures homogenized by governments led by those with other agendas will ever do. And the tendency of "public health" to squelch all dissenting opinions is reprehensible at best and lethal at worst -- as we are increasingly finding out.
Personally, I believe that the worst part of the "public health" debacle is that it has taken down the medical profession with it. After decades of gaining people's trust, patients now disbelieve much of what we physicians say...and I cannot blame them. Some of that belongs to each practitioner who (AB2098 before the law) just recited the government pabulum -- although some of us did not. But a lion's share of the loss of trust belongs to the NIH/CDC/FDA axis that promotes things that most normal people can detect are just wrong. (Note the number of boosters given, or the continuing strength of vaping.)
It will be decades if forever before medical practice/health care regains the credibility many of us have worked hard to earn to provide the best care we know how for our patients. If "public health" remains as it is, it will NEVER happen. People are now in the "fool me twice" position. They know better.
As a physician training in public health, can't really argue against the demise of its credibility, but that doesn't meant that there is no ingenuous meaning of the term.
Love your thoughts. It’s so hard to trust - I watched public health fumble locally with addiction - literally watched a high ranking government official get bought by a for profit treatment (I should stress NON treatment) organization who was basically buying MDs’ DEA licenses and paying them well. Still several more around here doing it. I as an ex healthcare provider do not trust anymore and I’m not sure that will come back, but that had been waning for a long time.
thank you for daring to say something that is "bad" is really not so bad.
I also think everyone ought to be free. They have a choice to smoke cigarettes, joints, toads, bananas, or vape. Why should anyone dictate a personal choice?
Interesting take, as a former smoker who absolutely loved smoking, my thoughts:
1) Looks like "Mission Accomplished" by the graphs already. Very few teens are smoking cigarettes. Vaping has displaced cigarettes in youth. The graphs match anecdotally what I have seen - my kids friends who smoke only vape. I rarely ever see anyone under the age of 30 with a cigarette - so what am I missing? Short of going full New Zealand we will never completely eradicate smoking, < 2% seems like the lowest you could ever hope for.
2) If the hope is that adult smokers convert to e-cigs as a means of quitting or reducing harm, that's unrealistic. Vaping is grade school T-ball to cigarettes' New York Yankees... It's tepid off-brand generic cola compared to Classic Coke. All vaping does is remind you how much more enjoyable a real cigarette would be. If you want to quit, better off with Zyban, Chantix, Allen Carr's "The Easy Way to Stop Smoking", or simply the will power of Cold Turkey.
On a side note, it's been close to 18 years since the majority of the United States banned smoking indoors throughout the country, 30+ years since it was banned in public transportation.
Is there evidence it has made a dent in cancer rates and all cause mortality? A quick look through Wonder doesn't appear so.
“All vaping does is remind you how much more enjoyable a real cigarette would be.”
I 100% disagree. I smoked more than a pack a day. I switched to vaping and never looked back. But you have to start with the comparable amount of nicotine that you were smoking in order to get satisfaction out of vaping. I enjoyed vaping from the very first draw because there was enough nicotine in it to satisfy me with only one draw. Then you can slowly taper down the amount of nicotine in your vape juice. I also chose a vape juice that closely matched the flavor of the cigarettes I was smoking, menthol.
I love vaping. I don’t annoy people with a big vape cloud. If you hold it for a moment you can barely see the vape exhaled. And other people don’t smell the vape. Ugh I hate the smell of cigarette smoke.
Interesting, and glad you found a substitute.
For me, part of the enjoyment was the tactile feel of a cigarette... rolling it between your fingers between drags, ashing, pinching the filter lightly as you get near the end... something just felt hollow when I tried vaping as a replacement. Strangely for me I enjoy the smell of cigarette smoke, or, my brain seems to get a pleasant memory triggered when the rare times I come into contact with it.
With all due respect, as the mother of 3 peri-adults, the incidence of e-cigarette use is dramatically higher than this data suggests. All 3 of my children (ages 18,20, and 22) use it to varying degrees (much to my despair, and my fear mongering with my 2 boys that nicotine use is a leading cause of ED later in life) and they will tell you that “99% of HS age kids use it”... no matter if their social, academic, or athletic status. My kids ran/run with a variety of kids, not just one group. They were all high level athletes (1 will play a division 1 sport in college). It is pervasive and they lie about using it.
If there’s a mood altering chemical in anything, the addiction rules apply!
Seems to me that one needs to conduct a proper RCT as to whether vaping is harmful or not and what those harms actually are. If an RCT is not feasible, then thorough appropriate testing in monkeys needs to be done (not mice). If it's not harmful and not carcinogenic (in humans or monkeys), then there is no reason not to discourage vaping. After all, better to vape than continually food graze and become obese, which is in itself a massive healthcare problem in the US. If anything, the Covid lockdowns should have taught us that as the average weight gain was really very substantial as people were sitting home getting bored and just eating and snacking all the time. Had they vaped instead this problem would have been avoided.
Interesting that the National Academies came out against vaping. No surprise as they always support the status quo and the government, even though they claim to assemble panels of experts and produce unbiased reports. Yet they always chose their panel members to get the end result they want. In short, they are nothing more than a think tank whose credibility is artificially enhanced by the distinction of their membership (an honor society), the vast majority of whom have absolutely nothing to do with the reports they produce.
This almost feels like a marketing article for a vape company. It doesn’t sit well with me so I’m going yo go back and re-read part one and this one again. I guess it’s partly bc of my lack of trust in public health and general distaste in the phrase “harm reduction” so I will see what I can do to loosen personal bias prior to re-reading. Ahh such is my brain on a Thursday morning. 🤷🏻♂️
I switched from over a pack a day to vaping about 10 years ago and my latest lung x-ray shows them to be clear. I call that harm reduction
Absolutely agree. Where I tend to go deeper is what about the harm caused by the vaping chemical itself? For example, do we even know those harms yet? Will we ever know those harms? I absolutely applaud you and don’t want to diminish your success with these questions!
I’m leery of over-the-counter juice. My local shop custom blends my juice while I wait. And use pharmaceutical grade oil
Oh I get that - ultimately it’s kind of my point - who do we trust anymore? I think that’s everybody’s point these days too. And believe me, I do not have a flag to fly as far as my habits! I eat poorly sometimes, I don’t exercise enough, and I probably don’t hydrate nearly as well as I should. Ultimately, my hope is that we all have the best opportunity to be our best. I like a forum like this to challenge myself and appreciate your comment very much.
I would also like to add that nicotine is effective for neuropathic pain, which I live with daily from small fiber neuropathy.
Is there any research on nicotine and neuropathic pain? Totally unfamiliar with this claim.
I am so glad you acknowledged your distaste for the term harm reduction. I breathed a sigh of relief. I am so with you on your sentiments. HR is less than treatment, so much less. Seems as if we have given up and lowered the bar so very low.
That has always been my take - keeping a low bar low. We deserve better and frankly should expect better. 💜