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Mountain Vapor Blog

Welcome to the blog area of our site where we hope to keep you updated on the trends of the e-cigarette industry as well as product reviews.

Opportunity For the World-Wide Research Community: Spend 15 Minutes to Counter Falsified Research in the Journal of the American Heart Association



The Journal of the American Heart Association on June 5, 2019, published a bogus research article, “Electronic cigarette use and myocardial infarction among adults in the US Population Assessment of Tobacco and Health [PATH],” by Dharma N. Bhatta and Stanton A. Glantz (here).  Drs. Bhatta and Glantz used PATH Wave 1 survey data to claim that e-cigarette use caused heart attacks. However, the public use data shows that 11 of the 38 current e-cigarette users in their study had a heart attack years before they first started using e-cigarettes. The article misrepresents the research record; presents a demonstrably inaccurate analysis; and omits critical information with respect to (a) when survey participants were first told that they had a heart attack, and (b) when participants first started using e-cigarettes.  The article represents a significant departure from accepted research practices.  I provided the JAHA editors with details about the false results on July 11 and July 18, and I urged them to consider an investigation and retraction.  They failed to provide a substantive response (here). As the JAHAeditors apparently need further encouragement to retract this article, I invite researchers at 776 ICPSR-member universities, government agencies and other institutions to conduct their own investigation of the article’s false claims.  Investigate and Take Action on the Bhatta-Glantz False Findings in Three Easy Steps 1.  Download the PATH Wave 1 public use dataset from ICPSR (here) using your preferred software (5 minutes).  The data is available in the popular programs SPSS, SAS, STATA or R. 2. Identify participants who are current users of e-cigarettes and who report having had a heart attack, then run a simple crosstabulation of the age range at which they had the heart attack and the age range at which they first used e-cigs (5 minutes).  Here are easy-to-follow programming codes for SPSS, SAS, STATAand R.*  The resulting table will reveal that 11 of the 38 current e-cigarette users were first told that they had a heart attack years before they started using e-cigarettes. 3. Send an email to the JAHA editors, asking them to retract the article (5 minutes).  Here are their email addresses: Barry London, Editor-in-Chief This email address is being protected from spambots. You need JavaScript enabled to view it.  Daniel T. Eitzman, Deputy Editor This email address is being protected from spambots. You need JavaScript enabled to view it.  Janice Weinberg, Statistical Editor This email address is being protected from spambots. You need JavaScript enabled to view it. Thank you for your assistance in correcting the scientific record on e-cigarettes and heart attacks. *You can download these programs with confidence.  I developed them with trusted colleagues. Original author: Brad Rodu
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High School Vaping Estimates Are Hyperinflated Via Reliance on National Youth Tobacco Survey




The federal government bases its assessment of a so-called teen vaping epidemic on data from the National Youth Tobacco Survey (NYTS).  Health officials typically advance the epidemic narrative by selectively releasing NYTS details before complete data sets are made available to external researchers.  This was the case with last week’s article in the Journal of the American Medical Association, in which it was reported that over four million high school students were current (past-30-day) users of e-cigarettes this year.  That’s 28%, up from 21% in 2018.  Unfortunately, we’ll have to wait until mid-2020 for access to all the underlying data; at that time, I will provide an analysis, much as I did for the 2018 survey hereand here. Given that state and national tobacco policies are being driven by the NYTS, it’s fair to ask: How accurate is this survey? I have had a long-term research interest in the differences in tobacco use data reported in federal surveys.  For example, I published a study 10 years ago comparing smoking rates in the National Health Interview Survey and the National Survey on Drug Use and Health.  I found that NSDUH’s 4.5% higher estimate in 2005 amounted to 9.1 million more smokers than the NHIS estimate.  NYTS is not immune to this problem.  Earlier this year I showed that its estimate of high school vapers was double that of the KnowledgePanel, another nationwide federal survey. Now I provide further evidence that NYTS vaping rates may be hyperinflated.  I analyzed public use files from the Population Assessment of Tobacco and Health (PATH) study, which is sponsored by the FDA and considered an authoritative resource on tobacco use among American youth and adults.  I compared the first three waves of the PATH survey with the 2014, ’15 and ‘16 NYTS, using matching age groups (15-17 years). The chart shows that PATH and NYTS have similar estimates of current smoking for all three years, but NYTS estimates of current e-cigarette use are much higher than those generated by PATH.  In fact, current e-cigarette use in NYTS was almost double that in PATH for all three years. There is no way to determine which federal survey more accurately reports high school vaping rates.  But NYTS vaping prevalence estimates were twice as high as PATH and KnowledgePanel, in four separate years.  What is clear is that students participating in the NYTS are different from those participating in the other surveys.  Despite these critical issues, federal health officials and their allies rely solely on the NYTS to argue for the existence of a teen vaping epidemic.  This is unacceptable.  While the FDA recently praisedthe PATH study -- “The data from the PATH Study gives us critical insights into adult and youth tobacco use of flavored tobacco products…” – federal officials never cite PATH when they discuss youth vaping prevalence.  The FDA has actually supplied the reason for this contradiction, advisingthat “…estimates of youth tobacco use from the household-based PATH Study were generally lower than those from school-based national surveys such as the NYTS and Monitoring the Future…”  The government intentionally uses the highest numbers to make its case.  No one doubts that American youth are using e-cigarettes, but teen vaping is mischaracterized as an epidemic by federal public health officials, politicians and tobacco prohibitionists.  The drastic measures they champion will make harm-reduction products less accessible to millions of current and former smokers.  Public health would be better served with the British approach including accurate use assessments and the promotion of a full range of cigarette substitutes. Original author: Brad Rodu
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The US vaping flavour ban: twenty things you should know




















The secret weapon against smoking – facing an existential threat from zealous regulators

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U.S. Military’s Misbegotten Message to Troops: Cigarettes Are Safer Than Vape Products




With regard to tobacco products, the U.S. Department of Defense isn’t serving the health interests of those who serve. As I have documented many times (here, here, hereand here), in pursuing a tobacco-free fighting force, DOD has grossly misinformed American service members about the relative safety of smokeless tobacco and e-cigarettes.  David Sweanor recently posted the photo at left from an Army and Air Force Exchange Service store.  Even worse is this Military Times article from September 24, about the removal of vaping products from Army, Air Force and Navy exchanges by October 1, owing to “the outbreak of mysterious vaping-related lung injuries.”  Actually, that mystery has been solved.  CDC Principle Deputy Director Dr. Anne Schuchat said on October 25, “The vast majority of patients with [lung injuries] including those who died…, had a history of use of e-cigarette, or vaping, products that contained THC.” DOD removed products that we now know did not kill 34 Americans who were instead vaping contaminated marijuana liquids, yet DOD continues to sell cigarettes, which have, in fact, killed 380,000 Americans so far this year. In this case, military intelligence is an attribute of our proud troops, but not of their health officers or administrators.  The Military Times notes: “Vaping now appears to be more common in the military than smoking regular cigarettes, according to results of the most recent Defense Department Health-Related Behaviors Survey of Active-Duty Service Members. The results of that survey, conducted in 2015, showed 11.1 percent of troops said they were daily e-cigarette users, compared to 7.4 percent who said they smoked cigarettes daily.  In the junior enlisted ranks, nearly 20 percent said they were current e-cigarette smokers.” The troops have made the switch to vastly safer smoke-free tobacco at far higher rates of use than are seen in the general U.S. population.  So far, the Marine Corps, which at 16% has the highest prevalence of vaping among the military branches, continues to permit the sale of vaping products, signalling semper fidelis to harm reduction.  The Army, Air Force and Navy exchanges should immediately reverse their egregious decision and return e-cigarettes and vaping products to their shelves. Original author: Brad Rodu
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FDA Awards “Modified Risk” Status to General Brand Snus Products from Swedish Match



“The U.S. Food and Drug Administration announced [on October 22] that, for the first time, it has authorized the marketing of products through the modified risk tobacco product (MRTP) pathway. The authorizations are for eight Swedish Match USA, Inc. snus smokeless tobacco products sold under the ‘General’ brand name” (from the FDA press release).  The FDA authorization allows Swedish Match to use this statement: “Using General Snus instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis.”  The approval will be in place for five years, but the agency can remove it at any time if it decides that it “no longer benefits the health of the population as a whole.” It took the FDA over five years (during which 2.56 million American smokers died prematurely) to approve this truthful statement that I have documented for 25 years.  Note, however, that the tobacco control act stacked the deck against harm reduction by mandating the term “modified risk” instead of the more accurate “reduced risk.” The FDA announcement received favorable media attention, with one analyst calling it a “gamechanger.”  While that may be true, there are some important things to remember. 1. The company filed its original application in 2014 to change the FDA’s mandated but grossly inaccurate smokeless tobacco warning labels.  The FDA, using flawed analysis, rejected that application in December 2016, and signaled that it would not jettison the required warnings, “cause mouth cancer” and “not a safe alternative to cigarettes.”  Swedish Match then filed an amended application with the statement that was approved. 2. The approved warning refers to “lower” risk of disease, which implies that risks are still present, when, in fact, snus has no risk for mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis.  Even worse, the FDA’s “not safe alternative” warning covering a large part of the package and advertisements annuls the “lower” risk statement from Swedish Match.  3. Swedish Match’s success was supported by a wealth of published epidemiologic research demonstrating snus’s negative impact on smoking and smoking-related diseases among Swedish men.  While Swedish boys use snus just like their fathers, use among American youth is nearly nonexistent.  These factors set a high standard of evidence for other current MRTP applications from Philip Morris International (IQOS), Reynolds (Camel snus) and and US Tobacco (Copenhagen moist snuff).    IQOS heat-not-burn tobacco.  Years of extensive research demonstrate that IQOS vapor is vastly less hazardous than smoke.  However, there is no epidemiology on the health effects of IQOS use, and there won’t be any for at least two decades.  In other countries, PMI sells IQOS devices only to adult smokers in special stores, so youth don’t have access.  PMI’s FDA application is now almost three years old (corresponding to 1.44 million dead smokers).Camel snus.  Produced in the same manner as Swedish snus, Reynolds’s Camel product should qualify for MRTP status with similar labeling, but Reynolds has no epidemiology for a product introduced in the U.S. around 2005.  The MRTP application is two and a half years old (1.24 million dead smokers).Copenhagen moist snuff.  The U.S. Smokeless Tobacco Company took a minimalist approach in its FDA MRTP application for this statement: “Switching completely to this product from cigarettes reduces risk of lung cancer.”  Still, the FDA, concerned with under-age use of dip products, claimsthat 350,000 “youth under 18 years of age use smokeless tobacco for the first time” yearly.  The agency will likely cite the youth issue to deny any statement about vastly lower risks, including lung cancer.  The MRTP application is one year, seven months old (760,000 dead smokers).E-cigarettes and vapor products.  The chances of these products getting an MRTP are approximately zero.  Research at American universities funded by the federal government is focused only on risks, epidemiologic studies are nonexistent, and federal officials consider vape products to be the cause of an exaggerated teen epidemic and mischaracterize them as the cause of lung injuries and deaths.  Manufacturers must first navigate widespread flavor and product bans, and then complete Premarket Tobacco Product Applications, a feat accomplished only by Swedish Match for General Snus and PMI for IQOS.  Swedish Match should be commended for establishing a precedent for successfully navigating the Reduced (not merely modified) Risk Tobacco Product Pathway.  Original author: Brad Rodu
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Age Counts: Who Vapes (Tobacco/Nicotine) and Who Gets Lung Injuries



Federal officials, most notably at the Centers for Disease Control and Prevention, continue to be remarkably vague about the cause of 1,299 acute lung disease injuries and 26 deaths among people who have vaped.  This ambiguity, which I believe is out of sync with normal CDC investigations, has led to a media frenzy and partial or full bans on e-cigarette sales in many localities.  Major retailers are scrapping e-cigarettes while continuing to sell cigarettes, which have killed 368,000 smokers already this year. Making vastly safer cigarette substitutes unavailable to 8 million adult vapers will inevitably increase cigarette consumption, driving the death count even higher.Officials have disclosed few details about the lung injuries and deaths.  On October 10, the CDC posted a report, once again highlighting “e-cigarettes, or vaping products” in the title while relegating critically important information about contaminated marijuana products to the fine print. CDC’s data on 1,043 cases confirmed that the injuries are concentrated among younger age groups.  If nicotine vaping was the cause, the age distribution of lung injuries would be similar to the age distribution of vapers.  I used the tobacco questions in the 2018 National Health Interview Survey and in the 2018 National Youth Tobacco Survey to generate estimates of the number of current adult and underage vapers (here).  The table shows the distribution of lung injuries compared with the distribution of current (tobacco/nicotine) vapers..nobr br { display: none } td { text-align: center} Age Distribution of Lung Injury Cases and Current VapersAge (years)Lung Injury Cases* Percent (number)Current Vapers** Percent (millions)Less than 1815% (156)8% (0.7)18 to 2021% (219)11% (1.0)21 to 2418% (188)14% (1.2)25 to 3426% (271)27% (2.4)35+20% (209)40% (3.5)All100% (1,043)100% (8.8)*Based on 1,043 patients https://www.cdc.gov/media/releases/2019/s-1010-vaping-injury-update.html  **Based on tobacco questions in the 2018 NHIS (18+ years, vaping every day or some days) and 2018 NYTS (< 18 years, vaping 20-30 days in past month)The table reveals starkly different age distributions.  While 36% of lung injuries affected those under 20 years, that group constitutes only 19% of all current vapers.  Forty percent of the 8.8 million current vapers were over age 35, compared with only 20% of lung injury patients.  The table underscores another striking comparison.  The main rationale for punitive action against e-cigarette retailers is the so-called teen vaping epidemic, which I have discussed previously (here, hereand here).  But federal surveys show that underage teens make up only 8% of the 8.8 million current vapers, or about 736,000 individuals.  Of those, about 59% (430,000) are current cigarette and/or cigar users.   Here’s the tradeoff: 92% of current U.S. vapers are adults, most of whom are either current or former smokers (here).  Federal and state actions that prohibit vape products to “save the children” will predominantly and permanently injure their smoking parents and grandparents who are desperate to stop.In summary, the age distribution of lung injury cases is considerably different than that of vapers, with injuries weighted toward the younger cohort.  This supports the emerging evidence that the outbreak is not related to commercial e-cigarettes and vape products, but rather to black market offerings.  Importantly, the misdirected campaign against the former threatens to disrupt availability to adult vapers, who desperately need them.Original author: Brad Rodu
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CDC Recognizes THC in Lung Injury Outbreak, But Teen Marijuana Use Ignored



The Centers for Disease Control and Prevention finally acknowledged on September 27 that contaminated liquids containing tetrahydrocannabinol (THC) and cannabinoid (CBD) oils are the likely cause of the recent outbreak of lung injuries.  The agency said that “Most patients report a history of using THC-containing products. The latest national and regional findings suggest products containing THC play a role in the outbreak.” As of October 1, there were 1,080 cases and 18 deaths.  Unfortunately, the lung injuries and deaths have been conflated with the so-called teen vaping epidemic, which I have put into perspective in this blog (here, here, here and here).  Federal officials, however, continue to ignore one critical link: teen marijuana use.  Government surveys document that the prevalence of current (past 30 days) marijuana use has been high among high schoolers for 25 years.  The link is further demonstrated in the 2018 National Youth Tobacco Survey.  Although officials portray current high school vapers as caught up in a tobacco/nicotine epidemic, they rarely acknowledged that the students had vaped marijuana, as shown in the chart that I presented on September 25 at the Global Tobacco and Nicotine Forum in Washington, DC.  Of the 3.1 million high school vapers in 2018, over half had vaped marijuana.  The more teens vaped, the more likely they had used marijuana.  It is therefore not surprising that 16% of the lung injuries occurred in high schoolers. Although the new CDC statement about THC is helpful, it over-emphasizes e-cigarettes, and it came weeks after state health authoritiesand the FDA implicated illicit liquids related to marijuana.  The CDC’s slow-walking and its continued conflation of e-cigarette use and nicotine vaping have had significant consequences.  First, officials have eroded the commitment of vapers who quit smoking, which may lead them to return to smoking.  Second, the CDC is discouraging current smokers from switching to e-cigarettes, even though such products have been used by millions of consumers nationwide for over a decade with no acute lung injuries.  Third, the CDC failed to warn consumers about using illicit THC liquids.  Earlier, more detailed warnings from the CDC might have save lives and limited injuries. The vaping-related injuries and deaths are clearly tragic, but so are the deaths from smoking: nearly a half million annually for the past 30+ years, or more than 1,300 every single day. Original author: Brad Rodu
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A Surge Strategy for Smokefree New Zealand 2025


October 7th, 2019

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A False Connection Between E-Cigarettes and Heart Attacks



The Journal of the American Heart Association on June 5, 2019, published an article, “Electronic cigarette use and myocardial infarction among adults in the US Population Assessment of Tobacco and Health [PATH],” by Dharma N. Bhatta and Stanton A. Glantz (here).  In reading the article, I discovered that the authors misrepresented the research record;  presented a grossly inaccurate analysis of PATH Wave 1 survey data, and omitted critical information with respect to (a) when survey participants were first told that they had a heart attack, and (b) when participants first started using e-cigarettes.  The article reflected a significant departure from accepted research practices.  The authors reported that current e-cigarette users were twice as likely as never users to have had a heart attack, based on information from 38 survey participants.  They reported odds ratios (ORs) of 2.25 (95% confidence interval, CI = 1.23 – 4.11) for 19 daily vapers, and 1.99 (CI = 1.11 – 3.58) for 19 some-day users (Abstract, Table 3 and Table S6).  Drs. Bhatta and Glantz claimed that their study confirmed that “e-cigarette use is an independent risk factor for having had a myocardial infarction…”  In a blog post on the University of California San Francisco website, Dr. Glantz cited the study as “more evidence that e-cigs cause heart attacks” (here). I have extensive experience conducting research on the PATH data files.  I conducted an analysis of the Public Use Wave 1 data, which has no restrictions on release of results.  I found that at least 11 of the 38 current e-cigarette users were first told that they had a heart attack years before they first started using e-cigarettes.  My research team conducted further analyses that were discussed in letters we sent to JAHAeditors on July 11 and July 18; these letters were never acknowledged.  At the instruction of the Inter-university Consortium for Political and Social Research, I am not able to share those letters with you.Original author: Brad Rodu
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Tobacco Companies’ Best Friends



Anti-tobacco activists portray themselves as enemies of “Big Tobacco,” so they naturally characterize the current panic about vaping among American teens as a new campaign by the industry.  This is fundamentally wrong, according to David Sweanor, a veteran anti-smoking advocate and chair of the advisory board for the Center for Health Law, Policy and Ethics at the University of Ottawa.  In the following guest blog, Sweanor suggests that the war against vaping is cigarette manufacturers’ best hope for a lucrative future. The presence of the tobacco industry plays a huge role in discussions on tobacco harm reduction and disruptive technology, but I have long found that those who think they are that industry’s greatest enemies are often among its biggest enablers. Yet understanding the fundamentals in play should not be so hard. We can start with what the financial markets appear to think of the state of these companies, which is seen in the 5-year stock price charts at left. In early 2017, the combined value of the FT500 tobacco companies (PMI, BAT/Reynolds, Altria, Japan Tobacco, Imperial and ITC) surpassed US$700 billion. That was a continuation of a longstanding skyward march of these companies as they benefitted from their ‘nicotine maintenance monopoly’ and raised prices in a cartel-like fashion. Recently the combined value was down to US$372 billion. In looking at their stock charts we can see clearly when disruption started to bite. This makes sense when we consider that those valuations are the present value of future anticipated earnings. So long as the companies can, as in the US, make cigarettes for 28 cents a pack and sell them, pre-taxes etc., for over $2.00, and keep raising their prices aggressively, and price elasticity is low, it is a licence to print money. Regulatory barriers thwarting competition keep them secure. But just as OPEC’s cartel invited alternative sources of energy and taxi cartels created an opportunity for Uber, the nicotine market has long been at risk of disruption, of true competition breaking out. The global cigarette market, at well over $US800 billion annually, huge profit margins, high tax burdens putting them at a price disadvantage, and unhappy customers, creates a tempting target. Regulations, public misinformation, actions by self-styled anti-tobacco groups, and technological challenges protect the cartel. But that protection is no longer assured and buying shares in Big Tobacco today starts to look a bit like buying into New York City taxi medallions just as Uber was getting launched. The idea that cigarette companies welcome this disruption flies in the face of their stock prices. Yet many in the tobacco control field seem convinced that whatever happens with new technology Big Tobacco will win because, well, they have long dominated the market. Leaving aside that the market apparently disagrees, this is worth thinking about. Disruption has hit a great many businesses over a very long time. Would anyone care to list all the market-dominating companies that did well from such disruption? They typically get blown away, and for very good reasons. They are large, bureaucratic and risk-averse, and have much to lose if they make mistakes. They also typically lack the expertise in the emerging technologies and are held back by those in the company who are committed to the status quo. Meanwhile, lots of start-ups can compete for the emerging market with little to lose but huge upside if they are ultimate winners. Horse breeders did not come to dominate the tractor business, nor horseless carriages. IBM missed out on software, Microsoft on social media, the Yellow Pages on internet search, NYC taxi medallion owners were not the backers of Uber. Then there were makers of rotary dial phones, beat by the likes of Motorola, in turn beaten by the likes of Nokia, which was trounced by BlackBerry, which in turn lost out to Samsung and Apple.  The list of big, established, market-dominating companies ‘doing a Kodak’ is very, very long. Also, if Big Tobacco really wanted to facilitate a rapid transition to low risk products they would act very differently. They are, after all, in possession of the best market intelligence. They know what happens when vape products compete directly with cigarettes. They know how many smokers would seriously try to switch if adequately informed about relative risks, and they know how things like risk-proportionate regulation and taxation is likely to impact the markets. But they stay pretty quiet. I think it is helpful to think of Big Tobacco and alternative nicotine the way we would think of the House of Saud and alternatives to fossil fuels. Big Tobacco must prepare as best they can for a market they think is fundamentally changing. They must sound like they are very supportive, for public relation and legal liability reasons. But the slower the transition, the longer they can reap the rewards of their exceedingly lucrative cartel. Substituting market intelligence for the current ‘if they seem to want to do it, we will oppose it’ thinking, and the application of some strategy could lead to some quite extraordinary breakthroughs. Original author: Brad Rodu
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Leaked papers: WHO to intensify its pointless and destructive war against innovation – expect many dead

September 9th, 2019

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Exploiting Outlier Lung Disease Cases Does a Disservice to Public Health



In her excellent August 28 USA Today articleon the recent emergence of vaping-related lung illnesses, Jayne O’Donnell noted that “Some state health department and news reports suggest many of the cases of lung problems involve tetrahydrocannabinol, known as THC, the chemical in marijuana that causes psychological effects.” I fully agree with Boston University’s Dr. Michael Siegel, who said, “The Centers for Disease Control and Prevention is being ‘unnecessarily vague’ about describing the injuries as simply vaping-related when many people might have been injured by vaping THC oil.”  As he and New York University public health professor Ray Niaura pointed out, millions of Americans have vaped nicotine e-liquids over the last ten years, yet no lung problems were reported until recently.  The sudden appearance of these cases and links to THC strongly suggest that contaminated street liquids are at fault, not legitimate retailers’ e-cigarettes or vape products. Despite this, as noted by Jacob Sullum, the CDC Office on Smoking and Health’s Dr. Brian King focused his public remarks primarily on a purported general link between e-cigarettes and vapor products with lung disease: “So there’s a variety of harmful ingredients identified, including things like ultrafine particulates, heavy metals like lead and cancer causing chemicals. And flavoring used in e-cigarettes to give it a buttery flavor.  Diacetyl and it’s been related to severe respiratory illness.  That being said we haven’t specifically linked any of those specific ingredients to the current cases but we know that e-cigarette aerosol is not harmless…But the bottom line is there’s a variety of things in e-cigarette aerosol that could have implications for lung health.  A review recently identified a number of adverse health effects associated with e-cigarette use.”   Dr. Siegel excoriated federal officials for this approach: “In a disease outbreak such as this one, responsible public warnings need to be as specific as possible about the risk. In an outbreak of E. coli caused by a contaminated batch of lettuce, we don't tell the public that the disease is associated with eating, or even that it is associated with eating lettuce. People need much more specific guidance if they are to take appropriate action to avoid or reduce the risk of further spread of the outbreak. “Here, we need to start telling the public the truth. However much physicians or anti-nicotine groups may not like it, the truth is that the outbreak we are seeing is not due to the risks of using standard vaping products. It appears much more likely that the outbreak is mostly, if not completely attributable to illicit products--especially THC extracts--that are being sold by unlicensed sellers on the black market. Unless people are provided with this specific information, they will not take action to avoid the products that could put them at risk.” The potential downside of this scaremongering is even worse.  How many thousands of former smokers who currently vape will conclude that the risks aren’t worth it, and return to smoking?  How many millions of smokers will never consider this vastly safer smoke-free option? CDC’s hypocrisy was demonstrated in the August 23 statement of Director Dr. Robert R. Redfield: “We are saddened to hear of the first death related to the outbreak of severe lung disease in those who use e-cigarette or ‘vaping’ devices…This tragic death in Illinois reinforces the serious risks associated with e-cigarette products. Vaping exposes users to many different substances for which we have little information about related harms – including flavorings, nicotine, cannabinoids, and solvents.” The lung disease fatality was tragic, but Dr. Redfield exploited it by implicating all e-cigarettes and vapes.  Where is CDC’s sorrow for the 1,300+ smokers who die every day from cancers, circulatory diseases and emphysema?September 5, Reported by the Washington Post: "State & federal health officials investigating mysterious lung illnesses... have found the same chemical in samples of marijuana products used by people sickened in different parts of the country. The chemical is an oil derived from vitamin E." Original author: Brad Rodu
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Lancet commentary – Nicotine without smoke: fighting the tobacco epidemic with harm reduction


August 29th, 2019

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Federal Officials Admit That Smoking Among Young Adults E-VAPORates



One month ago I used data from the federal National Health Interview Survey (or NHIS, which is administered by the Centers for Disease Control and Prevention) to illustrate that smoking among young adults (age 18-24 years) is evaporating.  In fact, the prevalence of current smoking in this group, defined in NHIS as every day or some days, was 7.8% in 2018.  The federal National Survey on Drug Use and Health (NSDUH) is another annual survey that measures smoking.  It is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA).  Although the NSDUH collects information on smoking, in addition to alcohol and many other drugs, it does not use the every-day or some-day questions.  Instead, it asks about use in the past month. Recently SAMHSA published a report on the NSDUH, which contained information about smoking in young adults (defined as 18-25 years) and teens (12-17 years) from 2002 to 2018.  I’ve illustrated those results in the chart at left.       First, note that the green and blue lines demonstrate considerable decline in both age groups across the entire period.  The lines start at least 8 years before e-cigarettes were used by anyone in the U.S.  More importantly, note the numbers above the lines indicating the average annual decline over the periods outlined by the faint vertical lines.  There is no question that the declines accelerated during the last two periods, when vaping occurred at so-called epidemic rates among teens and young adults. It is remarkable that the prevalence of smoking among young adults in NSDUH is nearly the same as that in NHIS in 2018.  This is important, because NSDUH always has higher prevalence than NHIS, as I documented in previous research using these surveys. Curiously, the NSDUH does not collect information on vaping.  However, the government officials who wrote the NSDUH report commented, “Some of this decline [in smoking] may reflect the use of electronic vaporizing devices (‘vaping’), such as e-cigarettes, as a substitute for delivering nicotine.” A surprising and welcome admission from a federal source.  FDA and CDC: follow the data. H/T to Jacob Sullum for writing about this story. Original author: Brad Rodu
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Vaping risk compared to smoking: challenging a false and dangerous claim by Professor Stanton Glantz


HINTS 2017 Risk perceptions


…and VAPING IS SMOKING

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Nick Buonoconti Spoke Truth to Power on Smokeless Tobacco



Nick Buonoconti, a 15-year All-Pro NFL linebacker who contributed to the Miami Dolphins’s 1972 perfect season and Super Bowl win, died on July 31 at age 78, following a battle with dementia.  Buonoconti’s tenacity, dedication and intelligence made him an NFL star, despite the fact that scouts had considered him undersized. Buonoconti found success well beyond football.  The new HBO documentary “The Many Lives of Nick Buonoconti,” describes his influential roles as lawyer, advocate and negotiator for pro athletes; NFL commentator; and dedicated fundraiser for the Miami Project, where he generated nearly $500 million for spinal injury research following his son’s catastrophic injury in a 1985 college football game.  Buonoconti was also an unlikely hero for smokeless tobacco users.  According to Sports Illustrated, in the 1970s he started working with US Tobacco, the maker of Copenhagen and Skoal dip products.  In 1983, he became executive vice president for legal and federal affairs and public relations; two years later he was named president and chief operating officer. As I noted previously, the campaign against smokeless tobacco started in 1981, with an articlein the New England Journal of Medicine.  In February 1985, Buonoconti squared off with Ed Bradley on the influential news show “60 Minutes”.  The following exchange from that appearance appears at 24:35 in the HBO Buonoconti documentary:     Ed Bradley: “The people who are dipping smokeless may think they are avoiding the dangers of tobacco by not smoking.  But there is substantial evidence that they’re not.” Buonoconti: “The science as we know it today tells us that smokeless tobacco has never been scientifically established to cause any harm to humans.  That includes oral cancer.  There is no one saying it does cause a problem.” Bradley: “The Surgeon General says it does.  The American Health Foundation says it does.” Steve Croft, another “60 Minutes” correspondent, defends Buonoconti in the HBO documentary: “My feeling is he handled it very well, better than most CEOs that we interview and ask tough questions.”  However, the interview inaccurately and permanently stained Buonoconti as a tobacco industry shill.  He assumed that he had made a terrible mistake, noting, “I have to live with it.” It turns out that Buonoconti was perfectly on target in challenging the bogus claim that dip and chew products cause mouth cancer.  Like everyone else, he was deceived by three decades of distorted research, exaggerated findings and unscrupulous campaigning by supposedly credible medical organizations.  His remarks proved prescient when a large 2016 federal study found no elevated risk for mouth cancer among American men who dip or chew tobacco. HBO has done a public service in chronicling the many achievements of this multi-talented football legend.Original author: Brad Rodu
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Panel Examines Youth Vaping ‘Epidemic,’ Overlooks Real Threats



Yesterday Inside Sources published my column on how Congress focused on the vaping “epidemic” while ignoring legitimate threats to American teens.  Read it here or at Inside Sources. The House Committee on Oversight and Reform held two days of hearings last week on “JUUL’s Role in the Youth Nicotine Epidemic.” Make no mistake: the hearings were about congressional grandstanding, not a discussion of what really threatens American teens. According to data from the Centers for Disease Control, the high school vaping rate is lower than that for marijuana and alcohol use. It’s about the same as binge drinking (four or five drinks within a couple hours).  And, as we know, these activities don’t typically occur in a vacuum. High school students frequently drive after marijuana use, ride with a driver who has been drinking, text or email while driving, have sexual intercourse, and consider suicide. But despite these truly worrisome activities, tobacco prohibitionists like Campaign for Tobacco-Free Kids have convinced Congress, school boards and parents that e-cigarettes have created “a public health emergency.”  Former FDA Commissioner Scott Gottlieb and other government officials fueled this anxiety by referring to the rise in teen vaping as an “epidemic.” The hysteria stems from the CDC’s National Youth Tobacco Survey, which federal officials refer to as the gold standard of information about teen vaping. But they tout these numbers without any context.  And that context is critical. We frequently hear that 3 million high school students in 2018 were “current vapers.” But if you look closer at the data, 3 million teens had used an e-cigarette at least once in the past 30 days. And 600,000 of the high school vapers were 18 or older, so they could purchase tobacco products legally in most states. The rest were underage. Of the 2.5 million underage vapers, about 1.7 million had also smoked a cigarette, cigar and/or had used smokeless tobacco. Of the 807,000 underage vapers with no history of other tobacco use, 70 percent had used e-cigarettes only one to five days during the month — the equivalent of trying one at a party. Only 95,000 students had used the products 20 to 30 days, suggesting that they might be addicted.  And this represents just 0.6 percent of the nation’s nearly 15 million high school students — a far cry from Gottlieb’s hysteria that we’re “hooking an entire generation of children on tobacco and nicotine.” These estimates are based on the CDC’s youth tobacco survey, so they’re certainly not “underestimates.”  Yet the rabidly anti-tobacco Truth Initiative produced an estimate for 2018 that is nearly half that of the 3 million number touted by the CDC. In addition to faulty data, the House hearing echoed the government’s false narrative blaming teen vaping on illegal retail sales and “kid-friendly marketing.”  But the FDA’s own research shows that more than 90 percent of teens who use e-cigarettes obtain them from social sources, such as friends or family. Only 10 percent of current teen vapers buy their own — and many of those are of age. Raising the purchasing age from 18 to 21 could potentially disrupt high school “black markets.” Lawmakers also go after fears about nicotine. They reference the Surgeon General’s claim that nicotine is “very and uniquely harmful” to the developing brain, and that vaping can impair learning and memory in those up to age 25.  Scientific evidence to support this is non-existent. In contrast, there is unequivocal evidence linking youth football and other concussion-producing sports activities to chronic traumatic encephalopathy (CTE) (here, for example).  If Congress wanted to protect children’s brains, this would be a more productive area for their focus. Nicotine is about as safe to use as caffeine, which is also addictive, but it doesn’t cause any of the many cancers, heart attacks, strokes and emphysema that come from the toxins released from burning tobacco. Congress wants you to believe that the increase in teen vaping will lead to a surge in young adult smoking.  But the reality is just the opposite. Cigarette smoking dropped in half among young adults between 2014 and 2018. And while vaping increased, use of both products fell during the same period. Vaping is contributing to the evaporation of smoking among young Americans. American teenagers are engaged in lots of risky behavior — but vaping, which the prestigious British Royal College of Physicians says is 95 percent less hazardous than smoking — is not one of them. Congress should focus on how to really keep high school students safe. Original author: Brad Rodu
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As Young Adult Smoking Evaporates, “Teen Vaping Epidemic” Appears Overblown



Federal officials have portrayed teen vaping as a pending disaster, creating a new generation of nicotine addicts heading for lifetimes of smoking and disease, culminating in early deaths.  The scenario is primarily based on a distorted and exaggerated interpretation of data in the National Youth Tobacco Survey.  One way to judge the validity of these teen vaping claims is to look at what’s happening among young adults 18-24 years old.  If the government claims are accurate, we should see the disaster starting to unfold in this group. The chart at left, based on the CDC’s National Health Interview Survey, shows the prevalence of current smoking and vaping among young adults from 2014 to 2018.  Exclusive smoking is in red, dual use is in pink, and vaping is in green (with former smokers in lighter green).  The chart’s main message is seen in the sharp decline of red-pink.  Exclusive smoking prevalence dropped in half, from 13.3% to 6.1%, as did dual use.  Vaping increased, but only from 1.7% to 5.9%.  In fact, alluse went from 18.3% in 2014, all the way down to 10.1% in 2018 – an impressive decline.  The clear takeaway is that smoking is evaporating among young Americans. Some in Congress are intent on addressing the so-called crisis, as seen by Representatives Frank Pallone (D-NJ) and Donna Shalala’s (D-FL) June 20 call for co-sponsors for H.R. 2339, the Reversing the Youth Tobacco Epidemic Act of 2019.  In reality, the “epidemic” is already in reverse. Original author: Brad Rodu
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With the National Health Interview Survey, Never Smokers May Have Smoked



Last week I revealed that, based on the 2018 National Health Interview Survey (NHIS), there were about 8.07 million American adult vapers, up from 6.9 million in 2017.  I noted that there were 1.71 million vapers who were never smokers, which is also a substantial increase from the prior year – and potentially troubling.  Let’s take a closer look. First, it’s important to understand how the NHIS defines never smokers.  They are not necessarily cigarette virgins; they just never smoked 100 cigarettes in their life, which is the cutoff for ever smokers.  The NHIS never smoker definition includes those who smoked up to five packs.  In contrast, the FDA-funded Population Assessment of Tobacco and Health (PATH) survey asks more detailed questions that allow us to distinguish between people who truly never smoked from those who smoked fewer than 100 cigarettes.  We called the latter group triers in our comprehensive study of e-cigarette users published in Nicotine & Tobacco Research.  We documented that almost all so-called never smokers were, in fact, current or former cigarette triers. Further examination of the 2018 NHIS reveals that about three-quarters of the so-called never smoking vapers (1.31 million) used the products some days; the rest were daily users.  About 70% were 18-24 years old, and 20% were age 25-34 years.  Thirty-one percent had smoked a cigar, 3.5% had used smokeless tobacco, and 12% had used both products.  Forty-one percent had at least one episode of binge drinking in the month prior to the survey (that is, 5+ drinks for men, and 4+ for women).  In summary, many current vapers who never smoked in the 2018 NHIS were young, had used other tobacco products, probably had smoked cigarettes and consumed alcohol.  As I have noted previously, these characteristics refute the claim that vaping is attracting tobacco virgins and creating a new generation of nicotine addicts. Original author: Brad Rodu
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CDC Data: Vaping Increased in 2018, Particularly Among Former Smokers



Before 2018 even ended (here), federal officials were obsessed with that year’s “teen vaping epidemic,” based on a distorted interpretation of data from the National Youth Tobacco Survey (here).  But what about adult smoking and vaping in 2018?  Our government has had the 2018 National Health Interview Survey (NHIS) data for months, but there has been no public release or discussion.  In all likelihood, the results don’t fit the government’s vision for a tobacco-free society.  There were about 8.07 million American adult vapers in 2018, up from 6.9 million the year before, according to just-released 2018 NHIS data.  That’s the first increase since the CDC started tracking e-cigarette use in 2014.     Thirty eight percent of current vapers – over 3 million -- were  were former smokers, also the highest number in five years. Note that there were 1.71 million vapers in 2018 who were never smokers, and for the second year in a row, over two-thirds were 18-24 years old.  Importantly, this establishes the fact that increased rates of high school vaping (here) are resulting in lower prevalence of smoking among young adults.  In fact, the prevalence of current smoking was 7.8% in this group, which is way down compared to historical levels.  The vaping rate was almost the same (7.6%, with 1.7% currently using both products).  Tobacco and nicotine prohibitionists in government and elsewhere continue to portray vaping as dangerous and evil.  Despite this, more Americans are moving from cigarettes to this vastly safer smoke-free nicotine delivery system. Original author: Brad Rodu
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