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Mountain Vapor Blog

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Anti-THR, anti-vaxx, disease denial, and the political science of institutional “knowing” of falsehoods

by Carl V Phillips

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“Reason(s) you vape” questions on surveys are generally stupid

by Carl V Phillips

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Tobacco Wars collateral damage: feature, not bug

by Carl V Phillips

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Lawsuit Against Juul/Altria Alleging Fraudulent Misinformation Provides Fraudulent Misinformation

Parents of a Florida teenager who became addicted to Juul have sued Juul, Altria, and Philip Morris USA based on a number of claims, including fraud, negligence, and violation of the RICO statute (the compliant is here). Dr. Stan Glantz and Lauren Lempert provide a nice summary of the reasoning behind the lawsuit and the specific claims being made. The case was filed on Monday in the federal district court for the middle district of Florida.The Rest of the StoryAlthough the main complaint is that the company fraudulently provided misinformation about the product, its health risks, and its addictiveness, the complaint itself provides a huge amount of misinformation and distortion of the scientific facts related to vaping and Juul. Here is a sampling of the false or completely unsupported information that is claimed in the complaint:1. Vaping causes chronic obstructive pulmonary disease (COPD): The lawsuit claims that "just like traditional cigarette smoke," vaping causes COPD because it "introduces foreign substances into the lung." There is absolutely no evidence to support this claim. Despite at least 12 years of use and prolonged vaping by millions of Americans, I'm not aware of a single case of COPD that has been documented to be caused by vaping. While vaping does cause acute respiratory irritation, there is no evidence at this point that prolonged exposure to e-cigarette aerosol is extensive enough to cause permanent lung obstruction.2. Nicotine is a carcinogen: The lawsuit claims that "nicotine itself is a carcinogen." The leading, objective, international body that studies carcinogens (the International Agency for Research on Cancer [IARC]) has not declared nicotine to be a carcinogen.3. Juul delivers carcinogens to users: The lawsuit claims that Juul "delivers toxins and carcinogens to users." However, the complaint does not specify exactly what toxins or carcinogens Juul delivers to users. Studies of the aerosol produced by Juuling, to the best of my knowledge, have not demonstrated the presence of detectable levels of carcinogens.4. Juul is designed to transition users to cigarette smoking: The lawsuit claims that Juul is designed to make it "easier for e-cigarette users to transition to conventional cigarettes." The truth is the exact opposite. Juul was designed specifically to transition conventional cigarette smokers to vaping. Juul Labs would be stupid if they designed the product such that its users would transition back to smoking. The company makes no money if its users go back to smoking. In fact, the economic incentive for Juul is to eliminate smoking altogether. The more smokers who switch from conventional cigarettes to Juul, the more money the company makes. There is abundant evidence that Juul has succeeded in transitioning hundreds of thousands of smokers away from conventional cigarette use, but no evidence that Juul has transitioned anyone to cigarette smoking.5. Juul is defectively designed: The lawsuit claims that the Juul e-cigarette is "defectively designed" because it delivers nicotine so effectively. The truth is that this is actually an incredibly effective design because it provides the greatest chance that a smoker will successfully quit smoking by switching to vaping. The problem with most other e-cigarettes is precisely that they do not deliver nicotine effectively. Juul corrected this problem and as a result, it has become the most effective smoking cessation product currently on the market. This is demonstrated by the tremendous market share that Juul holds among adult smokers trying to quit. 6. Juul aggravates nicotine addiction in cigarette smokers: The lawsuit claims that the company knew that Juul "posed a risk of aggravating nicotine addiction in those already addicted to cigarettes." There is no evidence to support this claim and the truth is likely the opposite. While smokers who switch to Juul are obviously still addicted to nicotine, they are no longer addicted to smoking. The behavior of smoking is a huge component of the addiction to nicotine that is observed in cigarette smokers. By eliminating that aspect of the addiction, the overall addiction is almost certainly lessened.7. Juul fails to inform users that its product has not been found to be safe: The lawsuit claims that the company "fails to inform users that its products have not been found to be safe." The truth is that Juul says right on its web site that: "No tobacco-based or nicotine e-liquid product should be considered safe." In addition, Juul informs customers that: "Inhalation of e-vapor from JUUL may aggravate pre-existing respiratory or heart conditions. Additionally, ingestion of nicotine, at any level, may cause other conditions (such as an increase in your heart rate and blood pressure, may cause dizziness, nausea, and stomach pain)." The company also warns users about ingesting the e-liquid, informing them that the product: "Contains nicotine, which is an addictive chemical and can be poisonous. Avoid contact with skin and eyes. Do not drink."8. Juul falsely claimed that it is not affiliated with Big Tobacco: It is true that Juul claimed that it had no affiliation with Big Tobacco. But that was prior to its partial acquisition by Altria. You can hardly blame the company for making a true statement, as long as they no longer make that claim. A Google search revealed that, ironically, the only current internet source of the claim that "Juul Labs is not Big Tobacco" is the lawsuit itself.9. Juul and Altria plan to use Juul as an entry point for youth to start smoking Marlboro cigarettes: Not only is there no evidence to back up this claim, but it is patently ridiculous. You don't get kids addicted to Marlboro by marketing Juul. You get kids addicted to Juul by marketing Juul. Data from the PATH study demonstrate that becoming a regular vaper is a path away from smoking, not towards smoking. In fact, the only kids who currently progress to smoking are those who do not become regular vapers. Why would a company think that by addicting kids to a mango-flavored product, they would suddenly develop a desire for the harsh taste of Marlboro? Altria may have a history of being sinister, but they are not stupid.None of this is to deny the fact that Juul use among youth has become a serious public health problem that needs to be addressed urgently. None of this is to deny that Juul carries some responsibility for having created the problem. However, it doesn't seem fair to file a lawsuit against the company for making false claims by putting false claims into the complaint.Ultimately, I go far beyond nearly all of my colleagues in public health because I believe that the use of nicotine salts is simply not a viable long-term option for a harm reduction strategy that is based on trying to get smokers to switch to vaping. Nevertheless, I don't think it is appropriate to sue the company based on alleged facts that are either completely undocumented or simply untrue.Original author: Michael Siegel
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New Study Finds Vaping is Not Associated with Cardiovascular Disease among Never Smokers; But Tobacco Control Researcher Dismisses Findings

A new study published online ahead of print in the American Journal of Medicine reports that there is no association between vaping and cardiovascular disease among never smokers.Like previous studies of its kind, this was a cross-sectional study that examined the association between current vaping/smoking status and ever having been told that one has cardiovascular disease (including heart attack, coronary artery disease, or stroke). Previous studies used data from the National Health Interview Survey (NHIS) or the Population Assessment of Tobacco and Health (PATH) study; this paper used data from the Behavioral Risk Factor Surveillance Survey (BRFSS).The authors reported no association between current vaping and self-reported cardiovascular disease among never smokers. However, they found that among current dual users there was an increased odds of having ever been told that one has cardiovascular disease.In response to the study, one prominent tobacco control researcher concluded that dual use is causally associated with cardiovascular disease, while dismissing the negative finding that e-cigarette use was not associated with vaping among never smokers. He wrote: "The fact that the authors did not find an effect of e-cigarettes alone may be because they stratified the sample on e-cig and cigarette use, which reduces the sample size for each comparison, and so the power to detect an effect."The Rest of the StoryThis reminds me of what the tobacco industry used to do. If they saw a finding that they liked, they would emphasize that finding, but if they saw a finding that they didn't like, they would just dismiss it. This is sometimes called "cherrypicking." I've never picked cherries, but I assume that when doing so, one only picks the cherries that you like and disregards the ones that you don't.As objective scientists, we can't cherrypick. It allows one to have a pre-conceived conclusion and then to simply publicize findings that support the conclusion while dismissing those that do not. It appears that this is what is going on here.Cherrypicking is becoming more and more common among tobacco control researchers and advocacy groups. Recently I spoke at a conference on vaping, and one of the other speakers on the panel told the audience that there was no evidence vaping can help people quit smoking. The basis of that conclusion was that "there is no clinical trial that shows vaping to be effective ... we need a clinical trial." When I then pointed out that a randomized, clinical trial published last month in the prestigious New England Journal of Medicine found that vaping was twice as effective as nicotine replacement therapy for smoking cessation, they simply dismissed it, saying: "Well I still don't think it's effective." (The same person also did not think there is enough evidence to conclude that vaping is any safer than smoking.)The reality is that many tobacco control researchers and advocates will not be convinced by any amount of data. You could have two clinical trials, both finding that vaping is effective for some smokers, and they would still dismiss the findings. (In fact, we do have two clinical trials -- it's amazing to see how many tobacco control advocates continue to insist that there have not been any clinical trials on the use of vaping for smoking cessation.)Here, a positive finding is accepted and touted, while a negative finding is just dismissed. The reasoning given -- that the study didn't have the power to detect an effect -- doesn't hold water because the sample size of never smoking vapers in the study (15,863) exceeded the number of dual users (12,908).But even the conclusion that dual use is causally associated with cardiovascular disease is unsupported by the evidence presented in the paper. This is a cross-sectional study, so it is entirely possible that the onset of cardiovascular disease preceded the vaping. In fact, this is almost certainly the case for most of the study subjects because e-cigarettes have been popular for only about eight years, and it takes decades for cardiovascular disease to develop.It may actually be that the cardiovascular disease "caused" the vaping because having a heart attack or stroke is a strong stimulus for a smoker to try to quit, and many smokers try to quit by using e-cigarettes.Moreover, dual users are almost certainly a different population from exclusive vapers and one systematic difference between the groups is likely that dual users have a heavier or more intense smoking history, making it more difficult for them to get off of e-cigarettes. If this were the case, it would explain the observed finding that dual use was associated with a higher risk of reporting cardiovascular disease.  The bottom line is that we can't draw causal conclusions from a cross-sectional study like this one, especially one in which it is impossible to determine which came first: the heart attack or the vaping. So to tout the association between dual use and heart disease as a causal finding is bad enough. But cherrypicking findings that support a pre-determined conclusion, while dismissing those which do not support that conclusion, is sinking to the level of the tobacco industry which we once criticized for doing the very same thing.Original author: Michael Siegel
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What is a lie?, revisited.

by Carl V Phillips

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New statistics about vape risk misperception (and a subtle extra-bad implication)

Huang graphs of vape risk perception

by Carl V Phillips

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Public Misunderstanding of Health Risks is "a Good Thing" According to Some in the Tobacco Control Movement

Somewhere along the line, I must have gone astray. During my master's in public health program, I was taught that one major goal of public health is to educate the public about the risks of various exposures. I was also taught that accurately communicating these risks, as well as helping the public to accurately understand the relative risks between different hazardous behaviors or products was critical.Well, based on an editorial published this morning in the Journal of the American Medical Association (JAMA) Network Open, I was misguided. For in this editorial, it states that the increasing public misunderstanding of the relative risks of smoking compared to vaping is "a good thing."The editorial responds to new research also published this morning in the same journal which documents that the majority of adults in the U.S. completely misunderstand the dangers that smoking poses compared to those posed by vaping and furthermore, that the proportion of people with this misunderstanding has been growing substantially over time. (See: Huang J, Feng B, Weaver SR, Pechacek TF, Slovic P, Eriksen MP. Changing perceptions of harm of e-cigarette vs cigarette use among adults in 2 US national surveys from 2012 to 2017. JAMA Network Open. 2019;2(3):e191047).According to the study, in 2012, only 39.4% of adults perceived e-cigarettes as less harmful than real cigarettes. This is pitiful, given the overwhelming scientific evidence that vaping is much less hazardous than smoking. But even worse, the proportion of adults who correctly perceived vaping to be safer than smoking dropped to only 33.9% in 2017. Thus, two out of every three adults in the U.S. incorrectly believes that smoking is no more hazardous than vaping.Perhaps even scarier, nearly 10% of adults in 2017 perceived vaping to be more harmful than smoking!The Rest of the StoryInstead of lamenting the fact that the public's perception of the severe hazards associated with cigarette smoking has been seriously undermined over the past decade or so, the editorial almost joyfully celebrates this massive public deception that has occurred. (See: Glantz SA. The evidence of electronic cigarette risks is catching up with public perception. JAMA Network Open. 2019;2(3):e191032).It is quite a feat of magical writing to take the dismal news that the public is increasingly downplaying the severe risks of smoking and completely misunderstands the relative risks of smoking compared to vaping and to turn that into a tremendous public health victory.The truth is, however, that this public misunderstanding is having devastating public health consequences. Convinced that vaping is no safer than smoking, many former smokers who quit using e-cigarettes are returning to smoking. After all, what's the point of staying smoke-free using e-cigarettes if vaping is just as bad as smoking? You might as well go back to your Marlboros.In addition, this misinformation is deterring many smokers who would otherwise have tried to quit using e-cigarettes to just continue smoking. After all, why quit smoking and switch to e-cigarettes if vaping is every bit as harmful. You might as well just stick with your Marlboros.Huang et al., the authors of the featured article, correctly point out that: "The need for accurate communication of the risk of e-cigarettes to the public is urgent and should clearly differentiate the absolute from the relative harm of e-cigarettes." But somehow, Professor Glantz does not believe that accurate communication is the way to go. Apparently, inaccurate communication is better.This would almost be funny, were it not for the fact that many adults are going to die because of it. As Huang et al. point out: "Perception of e-cigarette harm [compared to smoking] may deter current smokers from initiating or continuing use of e-cigarettes. This perception may also deter a complete switch from cigarettes to e-cigarettes among smokers. In light of this possibility, the observed upward trend of perceiving e-cigarettes to be more as harmful as or more harmful than cigarette smoking among US adults warrants heightened attention."In public health, the means do not justify the ends. We do not lie to people in order to persuade them to change their behavior. Telling the truth is a core ethical value of public health practice. But maybe not so much in tobacco control. For us, it is apparently acceptable to spread hysteria using false comparisons and lies simply because we can't handle the idea that there are millions of vapers who have saved their lives using a device that delivers nicotine.Original author: Michael Siegel
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San Francisco is the stupidest place in the world to think of the children

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by Carl V Phillips

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Response to Press Release Announcing Proposed Ban on Electronic Cigarettes in San Francisco

Here is my point-by-point response to several of the statements made in the press release issued by City Attorney Herrera announcing the introduction of legislation to ban the sale of all electronic cigarettes in the city of San Francisco: "City Attorney Dennis Herrera and Supervisor Shamann Walton today announced joint steps to curb the epidemic of youth e-cigarette use, which has erased more than a decade’s worth of progress in reducing youth tobacco consumption."The “epidemic” of youth e-cigarette use has not “erased” progress in reducing youth tobacco consumption. The gains in reducing youth smoking prevalence are very real and will translate into millions of lives saved down the road. The problem of vaping has nothing to do with tobacco use because e-liquids do not contain any tobacco. Youth who vape are not tobacco users. They are vapers. So youth e-cigarette use has not undermined gains in reducing smoking. It is a separate problem that, while serious, is far less of a hazard to the public’s health than the epidemic of youth smoking."San Francisco has never been afraid to lead,” Herrera said, “and we’re certainly not afraid to do so when the health and lives of our children are at stake."San Francisco is apparently afraid to lead because they are willing to take the politically expedient step of requiring safety testing for e-cigarettes, but they are not willing to place the same requirement on real cigarettes. In fact, tobacco cigarettes have already had their safety testing and they failed miserably. If San Francisco wants to lead, then why isn’t it taking cigarettes off the shelves?"Banning vaping products that target young people and push them towards addiction to nicotine and tobacco is the only way to ensure the safety of our youth."  Let’s stipulate that. But if that’s true, then certainly banning tobacco products (i.e., cigarettes and smokeless tobacco) that target young people and push them towards addiction to nicotine and tobacco is also the “only” way to ensure the safety of our youth."San Francisco, along with the City of Chicago and the City of New York, sent a letter to the FDA this morning demanding that the FDA do its job and immediately conduct the required public health review of e-cigarettes that, by law, was supposed to happen before these products were on the market." The law does not require the FDA to conduct a public health review of e-cigarettes. What it requires is that manufacturers who want their products to remain on the market must submit a pre-market tobacco application to the agency for approval. This review was not supposed to happen before the products were on the market. They were already on the market in 2014 when the FDA issued its regulations. The FDA delayed the deadline for these applications because not doing so would have resulted in the elimination of vaping products, forcing millions of ex-smokers back to smoking and removing a huge competitor to cigarettes. It would have been a huge gift for cigarette companies. So it’s a good thing that the FDA did not enforce its original August 2016 deadline."In coordination with the City Attorney’s Office, Supervisor Walton is introducing groundbreaking legislation at the Board of Supervisors today that would prohibit the sale in San Francisco of any e-cigarette that has not undergone FDA review." This is not ground-breaking. What would have been ground-breaking is if the city introduced legislation to ban all tobacco products that have not been reviewed by the FDA and found to be reasonably safe. Surely, cigarettes would have been on this list."This is not an outright ban on e-cigarettes. It’s a prohibition against any e-cigarettes that haven’t been reviewed by the FDA to confirm that they are appropriate for the protection of public health."It is essentially an outright ban on e-cigarettes because the city knows full well that there isn’t a single e-cigarette that has gone through the pre-market approval process (since that deadline was extended until 2021). But the more important question is why the Board of Supervisors believe that e-cigarettes should only be sold if they are shown to be appropriate for the public health, while they are allowing cigarettes to be sold even though we know for certain that they are not “appropriate for the public’s health.”"The FDA has simply failed to do its job in unprecedented fashion,” Herrera said. “These are prudent steps to ensure that we know the health and safety implications of products being sold here. If the FDA hasn’t reviewed it, it shouldn’t be on store shelves in San Francisco." If they really mean what they say, then certainly, cigarettes should be on store shelves in San Francisco. You can’t take as a serious public health effort a proposal that e-cigarettes should be taken off of store shelves in San Francisco because we’re not certain of their health implications, yet it’s perfectly fine to let cigarettes remain on store shelves in San Francisco despite the fact that they have dismally failed their “safety review.” There is simply no public health justification for banning e-cigarettes but not real cigarettes."Tobacco use is the leading cause of preventable disease and death in the United States. Tobacco kills more than 480,000 people a year in this country. That’s more than AIDS, alcohol, car accidents, illegal drugs, murders and suicides combined." Exactly! Yet vaping products are not responsible for a single one of those 480,000 deaths. And so the city of San Francisco’s response to 480,000 deaths from cigarettes is: Let’s ban the fake cigarettes and let the real ones, which are causing 480,000 deaths a year, to stay on the shelves."These companies may hide behind the veneer of harm reduction, but let’s be clear: their product is addiction." Veneer of harm reduction? There is overwhelming evidence that vaping is much safer than smoking. It is convenient to ignore this scientific evidence because it doesn’t make for as good of a story. But public health needs to be guided by science and evidence, not by political expediency.Original author: Michael Siegel
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San Francisco Considering Banning Electronic Cigarettes, But Letting Deadly Real Cigarettes Stay on the Shelves

Yesterday, San Francisco City Attorney Dennis Herrera and Supervisor Shamann Walton announced that they are introducing an ordinance to the Board of Supervisors that would ban all electronic cigarettes until they are officially reviewed and approved by the Food and Drug Administration (FDA). Since there is not a single e-cigarette on the market that has undergone such an approval process, the ordinance does indeed ban the sale of all electronic cigarettes in the city of San Francisco.The reasoning behind the proposal is as follows: "Today we are taking action to protect our kids. By law, before a new tobacco product goes to market, the Food and Drug Administration is supposed to conduct a review to evaluate its impact on public health. Inexplicably, the FDA has failed to do its job when it comes to e-cigarettes. Until the FDA does so, San Francisco has to step up. These products should not be on our shelves until the FDA has reviewed the threat they pose to public health."The Rest of the StoryThis has to be one of the most insane public health proposals I have ever seen. This legislation basically says: "We care so much about the health of our kids that we can't allow e-cigarettes to remain on the market until they have a complete safety review. However, we are perfectly happy allowing cigarettes--which have had extensive safety reviews and been found to be killing hundreds of thousands of Americans each year--to remain on the market. Let us be honest. We care enough about our kids to take the politically expedient step of making it look like we are truly protecting their health by banning e-cigarettes, but we don't care about our kids so much that we want to actually protect them by removing from the market a product that we know is going to kill half of those kids who become addicted to it."This is truly a political maneuver under the guise of a desire to protect children's health. Let's be clear. If the Board of Supervisors were sincerely committed to protecting kids, they would immediately remove cigarettes--the most deadly consumer product--from the market. Cigarettes are addicting and eventually killing more than 400,000 Americans each year. Yet you mean to tell me that in light of that, the Board of Supervisors wants to conduct a safety review for the fake cigarettes?And what's the point of such a safety review? We already have a safety review of cigarettes and know that they are deadly. And in light of that, the San Francisco Board of Supervisors nevertheless feels perfectly comfortable allowing those products to be sold. Do they think that electronic cigarettes are actually more hazardous than cigarettes? Of course not. They know full well that e-cigarettes are far safer than the real ones.Clearly, the reason why they want to ban the fake cigarettes but not the real ones is because they don't have the political courage to take the step that would most substantially protect the public's health. This is an easy opportunity to make it look like they are totally committed to protecting kids when in fact, they are apparently perfectly content to allow the most dangerous consumer product in history to be sold on retail shelves in gas stations, convenience stores, and other places that are easily accessible to kids throughout the city.This is an easy political victory because they know the vaping industry is not organized or centralized enough to fight it successfully. But if they are justified in banning e-cigarettes, then it is certainly imperative upon them - and actually much more justified - to ban real cigarettes. However, the tobacco industry is organized, centralized, and powerful.The rest of the story is that what is really going on here is that the proponents of this ordinance simply do not have the political courage to take the real action that would protect the public's health: banning cigarettes. Removing e-cigarettes from the shelves is an easy political victory that may make it seem like they desire to protect kids, but the truth is that they are apparently perfectly content with allowing deadly cigarettes to be sold to the kids who they purport to be protecting.Ultimately, this is politics, not public health.Original author: Michael Siegel
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Purported Links Between Vaping and Heart Attacks are Based on Crappy Science

Another crappy study has come along, this one again using cross-sectional data from the National Health Interview Survey to claim that e-cigarette use is associated with a higher risk of having a heart attack, developing coronary artery disease, and having depression.This study, being presented tomorrow (Monday) morning at the annual meeting of the American College of Cardiology in New Orleans, reports that "adults who report puffing e-cigarettes, or vaping, are significantly more likely to have a heart attack, coronary artery disease and depression compared with those who don’t use them or any tobacco products."These conclusions were based on a cross-sectional analysis of data from the 2014, 2016, and 2017 National Health Interview Surveys. Respondents were asked to report whether they had ever been diagnosed with having had a heart attack, coronary artery disease, or depression. The analysis found that people who reported vaping were more likely to have ever had a heart attack, to have ever been told they have coronary artery disease, or to have ever been diagnosed with depression. The analysis did control for smoking by including smoking status as a variable in the regression model.The Rest of the StoryThis is yet another example of the junk science that is rapidly being spewed out by anti-tobacco researchers who are apparently more interested in demonizing vaping than in using rigorous scientific reasoning.The problem with the study's conclusion is that this is a cross-sectional analysis and the researchers have no idea which came first: the vaping or the heart attack, heart disease, or depression.Let's consider heart attacks. It is entirely possible (and actually quite likely) that most - if not all - of the respondents who reported that they are vapers had started vaping after, not before their heart attacks. In fact, a likely explanation for the findings is that smokers who experience a heart attack are much more likely to try to quit smoking, and since switching to vaping is a common method of attempting to quit smoking, they are more likely to respond that they are vapers.The investigators claim that they have controlled for smoking. But here's the problem: smoking is not only a confounder in the analysis; it is also an effect modifier. This means that the association between vaping and having had a heart attack is different for nonsmokers and smokers. For nonsmokers, there is no association. The association only holds for former smokers and current smokers. In the presence of effect modification, treating smoking purely as a confounder will yield inaccurate results. In order to model the relationship correctly, you need to stratify the analysis on smoking status: that is, you need to report the relationship separately for nonsmokers, former smokers, and current smokers.None of the papers that have claimed vaping causes heart attacks, heart disease, stroke, or COPD have done that. They treat smoking as a confounder, but do not test for effect modification.It is unfortunate that this crappy science is being reported at scientific conferences and in scientific journals. But what makes this a real tragedy is that this junk science is being used to justify policies to regulate vaping more harshly than smoking, by: (1) heavily taxing these products; (2) banning e-cigarette flavors; and/or (3) completely banning the sale of e-cigarettes in convenience stores.The rest of the story is that rather than demonstrating that vaping causes heart attacks, heart disease, COPD, and depression, what these studies show is that when smokers get very sick, they are highly motivated to quit in order to save their lives, and many of them do so by switching to vaping.This is about 11 million lives, not 11 million lies.Original author: Michael Siegel
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Sunday Science Lesson: phenomena and measurement

by Carl V Phillips

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11 Million Lies: The Tobacco Control Movement is Committing Public Health Malpractice by Misrepresenting the Health Effects of Vaping

My colleagues and I in the tobacco control movement have based our entire careers on the principle that it is wrong to lie to the public. The bulk of our campaign against Big Tobacco was based on the contention that the cigarette companies lied to the public about the health risks of smoking. Numerous lawsuits were filed against Big Tobacco, seeking damages based on the claim that the companies are responsible because they misrepresented the health effects of their products, thus preventing smokers from making an informed choice. The name of the major youth anti-tobacco campaign is called "Truth." Clearly, honesty is the central value that has been at the core of the tobacco control movement for decades.In the last few years, however, I believe that our movement has largely abandoned truth as a central value in our campaigns against vaping. Driven by an almost puritanical inability to accept the fact that a person could obtain pleasure from nicotine without it killing them, we have made the demonization of vaping the solitary goal of the movement, at the direct expense of what I always believed was our primary goal: to make smoking history.Why is vaping so threatening to the tobacco control movement? Is it threatening because it is extremely dangerous -- basically as harmful as smoking -- and therefore is is harming the health of the nation's 11 million adult vapers?No - it's precisely the opposite. It is threatening to us because it is not as harmful as smoking. We simply cannot tolerate the fact that there are millions of adults who are deriving pleasure from, and improving their health because of, the use of a much safer form of nicotine delivery. The problem with vaping is that it is not killing anyone, so there is no punishment for the vice of being addicted to nicotine. And that's something that the tobacco control movement can simply not tolerate.I believe that it is precisely because the truth is so threatening that many anti-tobacco groups, public health agencies, physicians, and researchers have resorted to lying to the public about the health effects of vaping.The Rest of the StoryWhile the tobacco control movement is spewing numerous lies about vaping, perhaps the most damaging to the public's health is the false claim that vaping is not any safer than smoking. This is a direct affront to each one of the 11 million adult vapers in the United States who are trying to improve their health by switching from combustible tobacco use (i.e., smoking) to the use of non-tobacco-containing, non-combusted vaping products. And it is particularly offensive to the more than 2.5 million adult vapers who quit smoking completely because of these products and who are now relying on vaping to keep them from returning to smoking. For these 2.5 million ex-smokers, vaping has literally saved their lives.So it is shameful that we are now trying to take that away from them based on a complete lie: that switching to vaping is doing nothing to protect their health.Today, I highlight just a few of the individuals and organizations that are spreading the lie that vaping is no safer than smoking. Keep in mind that by definition, what these groups are saying is that smoking is no more dangerous than vaping. That's quite a claim, given the fact that smoking kills more than 400,000 people a year, contains more than 10,000 chemicals, and contains more than 60 known human carcinogens, while vaping aerosol, at worst, contains a few chemicals of concern and has not, after 12 years of use by millions of people, resulted in a single death (excepting one person who was killed due to an exploding battery, but not to the health effects of vaping itself).So here is today's top 10 examples of the individuals, groups, and researchers who are helping to spread the false assertion that cigarette smoking is no more hazardous than vaping.#1) National Center for Health Research"The body’s reaction to many of the chemicals in traditional cigarette smoke causes long-lasting inflammation, which in turn leads to chronic diseases like bronchitis, emphysema, and heart disease. Since e-cigarettes also contain many of the same toxic chemicals, there is no reason to believe that they will significantly reduce the risks for these diseases. ... Because they are smokeless, many incorrectly assume that e-cigarettes are safer for non-smokers and the environment than traditional cigarettes. ... There are no long-term studies to back up claims that the vapor from e-cigarettes is less harmful than conventional smoke."#2) Loyola University Medical Center"E-cigarettes are not safer than cigarettes. .. They have not been scientifically proven as healthier or safer, and the U.S. surgeon general has not approved them for use in smoking cessation." #3) South Dakota Department of Health"Vape is not safer than cigarettes."#4) Tennessee Medical Association"Despite being marketed as a safe alternative to smoking, e-cigarettes are not safer and they never have been. They have simply been marketed that way. As a result, many people believe trading a traditional combustible cigarette for vaping is going to make them healthier, and that the vaping or e-cigarette use is far less damaging health-wise."#5) Harford County Health Department"E-cigarettes are not safer than smoking tobacco."#6) Jane Goodall Institute"E-cigarettes are the biggest problem, and for the third year in a row they are the first choice among youth smokers. But contrary to popular belief, they are not safer than other tobacco products, they are actually more addictive due to the menthol component that makes them so easy to consume."#7) Des Moines Children's Hospital"It is absolutely not safer than smoking, that is a fallacy that adolescents believe because it tastes good."#8) Texas Tech University School of Pharmacy"These data suggest, from a cerebrovascular perspective, that e-Cig vaping is not safer than tobacco smoking, and may pose a similar, if not higher risk for stroke severity."#9) University of Rochester Medical Center"Studies by his group and others, Rahman says, suggest that vaping is not safer than smoking: 'It’s equally bad.'"#10) East Rockaway Prevention Task Force"Too many teens, officials said, believe vaping is safer than smoking, when it’s not."Original author: Michael Siegel
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My first Patreon science lesson tutorial

Posted on 16 March 2019 by Carl V Phillips | Leave a comment

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Even Norwegians do not understand how low-risk snus is

by Carl V Phillips

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Smoking is not addictive

by Carl V Phillips

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Tobacco control ratf**king

by Carl V Phillips

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Switching from Smoking to Juul Reduces Toxic Chemical Biomarkers to the Same Degree as Quitting Cold Turkey

According to a study conducted by Juul and presented Saturday at the Big-Pharma funded SRNT annual meeting, there is no difference between switching from smoking to Juul and quitting smoking cold turkey in terms of the reduction in biomarkers of toxic chemicals.In the study, a group of 90 adult smokers were randomized to either: (1) continue to smoke as usual; (2) stop smoking cold turkey; or (3) switch completely from smoking to Juul. After five days, the researchers measured the change in the level of nine different biomarkers for toxic chemicals, which indicates the level of exposure to these chemicals.The key finding of the study was that the degree of reduction in exposure to these toxic chemicals was identical for the group that quit smoking cold turkey and the group that switched from smoking to Juul.The Rest of the StoryThis study adds to the already overwhelming evidence that vaping is much safer than smoking. And it further emphasizes the degree to which the Pennsylvania Department of Health is lying about the relative health effects of smoking vs. vaping. As I reported last week, the Pennsylvania Department of Health informs the public on its web site that: "E-cigarettes, also known as e-cigs, e-hookahs, mods, vape pens, vapes or ENDS, are not safer than other tobacco products for youth."This study is significant because it did not show that toxic chemical biomarker reduction with the Juul was at some level between continuing to smoke and quitting cold turkey. Instead, the level of reduction was indistinguishable from that resulting from cold turkey cessation.In other words, if someone presented to a physician and the physician had to determine whether that person had quit smoking cold turkey five days earlier or switched to Juul five days earlier, the physician could not tell the difference, at least not based on the level of these toxic chemical biomarkers.This new study adds to a large body of existing research that casts severe doubt on the assertions of many tobacco control researchers and organizations, and many health departments, that vaping is really not all that much different from smoking in terms of health.Original author: Michael Siegel
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Pennsylvania Department of Health Urges Parents to Lie to their Kids About the Dangers of E-Cigarettes

A basic principle of public health ethics is that we don't lie to people. Telling the truth is a critical component of the public health code of ethics. It is important not only because it is unethical to lie, but also because we greatly risk losing credibility and the public's trust if we are found to be lying. And once that public trust is lost, it is extremely difficult, if not impossible, to gain back.Therefore, it pains me today to have to report that the Pennsylvania Department of Health is urging parents to lie to their kids about e-cigarettes in order to dissuade them from vaping. In addition, the Pennsylvania Department of Health is lying to the public about the dangers of e-cigarettes and tobacco cigarettes as well.The Pennsylvania Department of Health put out a tweet that read: "E-cigarettes, e-cigs, e-hookahs, mods, vape pens or vapes—whatever you call them, they are NOT safer than other tobacco products. Learn how you can help protect you child's health by talking about the dangers of vaping → http://bit.ly/2RuVOev  #NoEcigs4Kids."On its web site, the Pennsylvania Department of Health informs the public that: "E-cigarettes, also known as e-cigs, e-hookahs, mods, vape pens, vapes or ENDS, are not safer than other tobacco products for youth."The Rest of the StoryIt is simply not true that e-cigarettes are as dangerous as tobacco cigarettes, or that vaping is as dangerous as smoking. At this point, there is abundant scientific evidence that vaping is much safer than smoking. In fact, smokers who switch to e-cigarettes experience dramatic improvement in their respiratory symptoms and lung function.The Royal College of Physicians concluded that vaping is at least 95% safer than smoking, but even if you don't agree that the risk difference can be quantified, the evidence demonstrates that e-cigarettes are a much safer product than real tobacco cigarettes. The reason for this is that e-cigarettes contain no tobacco and involve no combustion. While tobacco smoke contains more than 10,000 chemicals including more than 60 known human carcinogens, e-cigarette aerosol, at worst, contains more like 20 chemicals and perhaps 1 or 2 carcinogens. And this is only the case for e-cigarette brands that do not properly regulate the temperature of the heating coil. Studies of the aerosol of brands that have proper temperature regulation have not detected significant levels of any hazardous chemicals.There is no question that e-cigarettes are much safer than cigarettes in terms of lung damage and in terms of cancer risk. E-cigarettes have been on the market now for 12 years and have been used by millions without any identified health effects (other than some mild respiratory irritation).So what the Pennsylvania Department of Health is doing is lying to the public by telling us that vaping is no safer than smoking. Or, put another way, these health officials are asserting that cigarette smoking is no more hazardous than vaping.Were a tobacco company to make the same statement, it would be rightly accused of fraud and deception. So why can a state health department make that statement with immunity?The reason, I believe, is that most tobacco control groups no longer care about the truth and about scientific accuracy. They are more concerned with creating hysteria about vaping and scaring the public. While the ultimate goal - reducing youth vaping - may be considered to be laudable, the ends do not justify the means. Lying to kids to discourage them from engaging in a particular behavior is not the way to go. And it is not something that we condone in public health.The Department of Health's message is also deceptive because it instructs parents that by preventing their kids from vaping, they can keep their kids tobacco-free. This is highly deceptive because it implies that a youth who vapes is using tobacco. That simply isn't true as there is no tobacco in an e-cigarette. In fact, the very thing that distinguishes an e-cigarette from a real cigarette or from a heat-not-burn tobacco product is the absence of tobacco. If an e-cigarette actually contained tobacco, then it would not be an e-cigarette. It would be a heat-not-burn tobacco product.A youth who vapes is tobacco-free. They are not nicotine-free (unless they use an e-liquid that does not contain nicotine), but they are smoke-free and they are tobacco-free.I believe that one of the reasons why public health groups have been so ineffective in reaching youth with anti-vaping messages is that the kids are seeing right through these lies. Kids are not stupid. They can see with their own eyes that when someone lights up a cigarette, the health effects are immediately apparent. Smokers cough, they are typically short of breath upon exertion, they are more prone to pneumonia and upper respiratory infections, etc. But kids see plenty of other kids vaping and Juuling without any visible health effects. Today's kids are just not going to buy the lies that the Pennsylvania Department of Health and other anti-nicotine groups are selling them.Ultimately, I believe that the credibility and reputation of public health groups and agencies is going to be seriously undermined by the widespread lying and deception that is taking place regarding the relative risks of vaping compared to smoking. Disseminating false facts like this is unethical, it specifically violates the public health code of ethics, it puts the reputation of public health itself at risk, and at the end of the day, it doesn't even accomplish its intended objective of discouraging kids from vaping.If you're going to tarnish the image of public health and violate our ethical code, at least do it in a way that accomplishes some great public health objective. Lying about vaping is doing plenty of tarnishing, but nothing to protect the public's health.The rest of the story is that lying to kids isn't justified even if it did prevent them from vaping. But it is doing just the opposite, as kids see through the lies and in some ways, it makes vaping more attractive.Original author: Michael Siegel
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