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Health Officials Continue to Warn People Not to Use E-Cigarettes While Youth Get Life-Threatening Diseases from Vaping Marijuana

There is a complete disconnect between the facts regarding the investigation of the "mysterious" illness that is affecting more than 300 people in the U.S. (mostly youth and young adults) and the health warning messages that are being communicated by public health officials. The majority of the cases have been associated not with the use of electronic cigarettes (which use nicotine-containing e-liquids) purchased at stores, but with the use of marijuana (THC) vaping carts purchased from drug dealers.I have already reported that across California, New Mexico, and Wisconsin, 54 of the 57 cases that were reported as of last week were confirmed to have been associated with the use of THC oil (California: 21 of 21 cases; New Mexico: 8 of 8 cases; Wisconsin: 24 of 27 cases).Yesterday, it was reported that of eight case patients interviewed in Minnesota, every single one of them reported having vaped THC, not nicotine. According to a state health department official quoted in a Minneapolis Star-Tribune article: "All of the ones we’ve interviewed, eight of eight, said they used an illegal THC product."In addition, the second death caused by the outbreak, which occurred in Oregon, was also associated with the vaping of cannabis, although the product was apparently purchased at a licensed dispensary, not on the black market. So we now have five states, widely separated geographically, in which the vaping of THC oils or marijuana vape carts has been identified as the primary cause of the outbreak.In light of this information, you would think that health officials would be issuing very clear warnings to our nation's youth not to vape marijuana, especially THC oils purchased off the street. Instead, health officials continue to emphasize that the primary risk factor for these severe illnesses is "vaping" or "e-cigarettes" generally.This stark contrast is evidenced in an article reporting the death of a person in Oregon from vaping marijuana. After readers are informed about this marijuana-related death, they are given a CDC warning "that people who vape consider avoiding e-cigarettes while they investigate." Don't consider avoiding vaping marijuana, just avoid using an e-cigarette. Since many youth do not associate e-cigarettes with marijuana, even this broad recommendation is likely to go unheeded.Original author: Michael Siegel
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Michigan Ban on Flavored E-Cigarettes is a Terrible Policy with Devastating Public Health Consequences

Yesterday, Michigan Governor Gretchen Whitmer signed into law an executive order that bans the sale of all flavored e-cigarettes in the state. The ban includes both retail sales and online sales of all e-cigarettes, with the sole exception of tobacco-flavored products. In doing so, Michigan becomes the first state in the nation to promulgate a complete ban on the sale of the overwhelming majority of vaping products.In defending the ban, state health officials "pointed to studies indicating that young people who vape are more likely to start smoking regular cigarettes."The Rest of the StoryI cannot overemphasize how insane this policy is. From a public health perspective, it makes absolutely no sense to ban these fake cigarettes, but to allow the real ones to remain on the shelves. If electronic cigarettes, which have not been confirmed to have caused a single death, are so dangerous that they cannot be sold anywhere in the state, then certainly real tobacco cigarettes which kill more than 400,000 Americans each year should not be sold in Michigan.And if the chief concern of the governor and health officials is that e-cigarette use may lead to youth smoking, then how ludicrous is it to allow the sale of cigarettes to continue while thousands of kids in the state are apparently at high risk of starting to smoke?Certainly, if youth vaping is a public health emergency then youth smoking is even more of an emergency and so is youth alcohol use, especially youth binge drinking. But the governor is not banning the sale of cigarettes or alcohol. Why? There is simply no public health justification for this selective ban on the sale of electronic cigarettes.Not only is this terrible public policy, but it is going to have a devastating effect on the health of Michiganders. Tens of thousands of ex-smokers in Michigan rely upon flavored e-cigarettes to remain off of cigarettes. They successfully quit smoking completely by switching to vaping. When these products are taken off the market, they are not going to drive down to Ohio to purchase their favored vaping products. Instead, most of the them are going to simply go back to smoking. It's simply too inconvenient for them to have to drive long distances to continue vaping. And if you think that these tends of thousands of vapers are going to quit nicotine cold turkey, then you don't know anything about nicotine addiction.The other thing that some vapers will do is to start purchasing their products off what will be a new black market in Michigan. Unlike all other vaping products in the nation, these products will be the only ones that are completely unregulated. As of May 2020, the FDA will have complete scrutiny over every electronic cigarette device and e-liquid on the market throughout the nation, except for those in Michigan, which will be completely unregulated. This makes no sense at all. Given the outbreak of severe respiratory disease we are now seeing due to black market marijuana vaping products, the last thing we need is to have a new black market of nicotine e-liquids being developed. But vapers in Michigan will have no choice. For the overwhelming majority, it will be either returning to smoking or purchasing off the black market.I hope that the state legislature will override this completely irresponsible decision by the governor, but if not, I think there are strong grounds for a lawsuit to enjoin this regulation from taking effect. By banning electronic cigarettes but not real cigarettes, which are similarly situated with regards to their public health consequences (actually, not similarly situated but much more deadly), this is an arbitrary and capricious action and is therefore not justified as a health regulation.The rest of the story is that Michigan's ban on flavored e-cigarettes is an irresponsible and unjustified public health policy that is going to have devastating public health consequences. This is an example to the nation of exactly what not to do to respond to the epidemic of youth vaping.Instead, the state should simply restrict the sale of all tobacco products - including cigarettes and vaping products - to adult-only (age 21+) establishments that only sell these products. This would help to reduce youth vaping while at the same time allowing ex-smokers to continue accessing the vaping products that are literally saving their lives. And it would save thousands of small businesses - the vaping shops in Michigan that are essentially acting as smoking cessation clinics for the state's smokers. It's like having a statewide smoking cessation program without having to put out a penny in funding. Now why would you want to get rid of that?Original author: Michael Siegel
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Governor Whitmer’s Executive Ban on Vapor Products Is a Hazard to Public Health

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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DHHS Secretary's Statement on "E-Cigarette-Related" Respiratory Illnesses is Irresponsible; Does Not Even Mention E-Cannabis

Last Friday, the Secretary of the Department of Health and Human Services (DHHS) issued a statement on the recent upsurge in reported cases of respiratory illnesses that have occurred among more than 200 youth and young adults, all of whom reported "vaping."The statement made two recommendations to the public: "Americans who use e-cigarettes and are concerned about these specific, potential risks of illness should consider refraining from their use, and should not buy them off the street or modify them or add substances in ways not intended by the manufacturer.""Youth, young adults, and pregnant women should never be using e-cigarettes, and Americans who do not use tobacco products should not start using e-cigarettes."So essentially, the warning from the nation's leading public health official regarding this alarming outbreak of severe respiratory disease is: "Do not use e-cigarettes."The Rest of the StoryWhat is so irresponsible about this warning is not what is says, but what it doesn't say. Nowhere in the statement does it even mention that the majority of the cases have been associated not with the use of e-cigarettes, but with the use of e-cannabis, specifically, with THC oils purchased off the black market. Nowhere does it warn the public not to use THC oils, unless they are purchased from a licensed and regulated cannabis dispensary.What the HHS secretary is telling the public is that all we know is that these cases are associated with vaping, so don't vape. That's ridiculous advice. First of all, it will have no effect because it's far too vague to change anyone's behavior. Second of all, it is not specific enough to provide an appropriate warning.Inexplicably, the CDC has not released the most critical information that we need: What percentage of cases have been attributed to the use of THC oils, synthetic marijuana, or e-joints, as they are sometimes called? Why is the CDC hiding this information from the public?So far, three health departments have been responsible enough to tell us exactly what percentage of cases were linked to e-joints compared to e-cigarettes:California21 of 21 cases apparently were linked to vaping THC oil (100% of cases)New Mexico8 out of 8 cases confirmed to be associated with vaping THC oil (100% of cases)Wisconsin24 of 27 cases confirmed to be associated with vaping THC oil (89% of cases)Across these three states combined, 95% of the cases have been linked to the use of e-joints, not e-cigarettes.Even in the cases that have not been linked to the use of e-cannabis, it is still very possible that e-cannabis was involved. Youth may simply be reluctant to report that they were using cannabis that was purchased illegally from drug dealers. You can certainly understand why a youth may not want to readily admit this. In many cases, youth have initially failed to report the use of e-cannabis, but only reported it after further questioning. As the recent New York Times article reports, at least some youth did not reveal their THC use. This is understandable: in many high schools, the use of cannabis is punishable by a suspension of as much as 180 days.I am not arguing that we have enough information to conclude that no e-cigarette products are involved in these cases. However, we do have enough information to conclude that most of these cases are associated with the use of illicit e-cannabis products. Thus, it is imperative that people be warned very specifically about this connection.A fascinating question is why health officials are failing to describe this as an e-cannabis problem, rather than a "vaping" or "e-cigarette" problem. I don't think there's any doubt why: the CDC and other health agencies have demonstrated a strong bias against e-cigarettes from the beginning and are taking advantage of this unique opportunity to further bash e-cigarettes. They've been doing that for years. Only now, there's one difference. The health and lives of many youths are imminently at risk. Original author: Michael Siegel
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Tobacco Company Claims that Smoking is No Worse than Vaping for Human Lung Disease

A major U.S. tobacco company on Saturday issued a press release boasting that smoking its cigarettes is no more harmful than vaping an e-cigarette that contains no tobacco and involves no combustion, at least in terms of lung disease. A spokesperson for the company was kind enough to allow The Rest of the Story to interview him. The transcript appears below, with only slight editing for purposes of clarity. I was given permission to publish the interview, but under the condition that I not name the spokesperson.The Rest of the Story: Let me first make sure I have this correctly. You are saying that in terms of lung disease, smoking is no more dangerous than using an e-cigarette?Tobacco company spokesperson: That's right. E-cigarettes are as dangerous as cigarettes for human lung disease."The Rest of the Story: But that is almost impossible to believe. I mean, cigarettes cause more than 400,000 deaths a year, and more than 100,000 of those deaths are from chronic obstructive lung disease. You're saying that soon we're going to have more than 100,000 vapers dying every year from emphysema and chronic bronchitis?Tobacco company spokesperson: Yes.The Rest of the Story: But we haven't seen a single case. Shouldn't we observe a single case of vaping-induced COPD before we draw such a massive conclusion? I mean, as you know, there is probably no human disease that we conclude is caused by a particular exposure before we actually have at least one case. There were hundreds of thousands of deaths from smoking when the Surgeon General concluded that smoking causes heart disease, lung cancer, and chronic lung disease.Tobacco company spokesperson: No, we don't need to wait for the evidence. We can conclude that vaping is as dangerous as smoking based on what we know right now.The Rest of the Story: There are three types of epidemiological studies that are typically used to draw causal conclusions about an exposure and a disease. Going from the most definitive to the least, we have cohort studies, case control studies, and case studies. But even in the case studies - which are the weakest form of evidence - you have at least one case of the disease! Tobacco company spokesperson: But there is evidence.The Rest of the Story: OK, what is the evidence.Tobacco company spokesperson: Well, a paper came out recently in the American Journal of Respiratory and Critical Care Medicine showing e-cigarette use increases neutrophil elastase and matrix metalloprotease levels in the lung. The levels of enzymes in the vapers were actually about the same as those in the smokers. Thus, smoking is as hazardous as vaping.The Rest of the Story: And?Tobacco company spokesperson: And we know that higher levels of elastase and protease in the lung can lead to chronic obstructive lung disease.The Rest of the Story: OK, so how many of the vapers in the study had signs of chronic lung disease?Tobacco company spokesperson: None.The Rest of the Story: Well, what about a marker for early disease? How many of the vapers in the study had abnormal spirometry measurements?Tobacco company spokesperson: None.The Rest of the Story: Now will you acknowledge that if a lot of the vapers in the study were actually ex-smokers and they had a long history of smoking in the past, the observed changes in their lung enzymes might be attributable to their smoking history?Tobacco company spokesperson: Yes, and the paper clearly states that is the case.The Rest of the Story: OK, so how many vapers were there in the study, and how many were nonsmokers as opposed to former smokers?Tobacco company spokesperson: There were a total of 14 vapers in the study. Nine of them were former smokers. Only five were nonsmokers.The Rest of the Story: OK, so the majority of the vapers had actually smoked in the past. For how many years did they smoke and how long had it been since they quit smoking?Tobacco company spokesperson: It's not reported in the paper.The Rest of the Story: OK, well I assume that they reported results just for the vapers who were neversmokers. How did their enzyme levels compare with those of the smokers?Tobacco company spokesperson: It's not reported in the paper?The Rest of the Story: So the results of this paper could possibly be due to the fact that ex-smokers had suffered lung injury in the past, rather than that the investigators were finding signs of chronic lung damage in never smokers who started vaping?Tobacco company spokesperson: I suppose so.The Rest of the Story: Well, if that remains a possibility, then how can you possibly conclude that vaping as just as hazardous as smoking, even if you're only talking about the risk of chronic obstructive lung disease?Tobacco company spokesperson: We're not going to worry about the nit-picky details. This is simply a wonderful marketing opportunity for us. By equating smoking with being no more dangerous than vaping, which people don't generally view as particularly hazardous, we are able to make smoking look much less benign than was previously thought. This is helping us to undermine decades of public health education about the severe hazards of smoking.The Rest of the Story: Well aren't you worried about being attacked by anti-tobacco groups? I mean you're making a statement that is not supported by scientific evidence and which undermines the public's appreciation of the severe hazards of smoking. Tobacco company spokesperson: We don't worry about the anti-tobacco groups any more. They are too obsessed with criticizing vaping companies. They have practically forgotten that we even exist. They have basically forgotten that there are still 35 million smokers out there who are enjoying our products and sending our profits and stocks soaring. Frankly, the only thing that stands in the way of achieving our full stock value is the threat that e-cigarettes pose as an alternative for many smokers. So being able to convince people that vaping is just as bad as smoking is a dream-come-true for us. And we're licking our chops waiting for the FDA's regulations to go into effect next May. That's going to decimate the vaping product market and basically hand over the entire nicotine product market to us.The Rest of the Story: Sounds like I should go out and buy some stock in your company.Tobacco company spokesperson: You're not the only one. Our financial outlook has never been more positive.The Rest of the StoryCORRECTION: I apologize. I made a mistake. I pulled the trigger too quickly. Hearing that a press release was issued claiming that smoking was no more hazardous than vaping, I naturally assumed that it must have originated from a tobacco company. Who else would draw such a sweeping conclusion from a single study showing cellular changes in vapers, most of whom had a long history of smoking? And especially in light of the fact that the paper didn't even bother to present the results for the vapers who didn't smoke? But I stand corrected. The claim was actually made by an anti-tobacco researcher on his blog. I apologize for any inconvenience my mistake may have caused.Original author: Michael Siegel
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American Lung Association Condemns 2.5 Million Ex-Smokers for Using E-Cigarettes to Quit

What do you say to a person who smoked two packs of cigarettes per day for 30 years and then quits completely by switching to vaping?I would say: Congratulations on this amazing and difficult accomplishment. You've saved your life and done a huge service not only to yourself but to your family and friends.The American Lung Association, in contrast, is saying to vapers: Shame on you! You shouldn't have done that. You're a bad person because you're still using a tobacco product. And you're at risk of dying from acute respiratory failure.Specifically, the American Lung Association stated: "The bottom line is that e-cigarettes are not safe, and from the American Lung Association’s perspective, no one should be using e-cigarettes."By saying that "no one" should be using e-cigarettes, that obviously includes ex-smokers who have quit smoking successfully using e-cigarettes and are reliant on these products to remain smoke-free. Based on data from the National Health Interview Survey, there are more than 2.5 million of these ex-smokers in the United States.Essentially, what the American Lung Association is saying to the 2.5 million vapers who accomplished the difficult task of quitting smoking is: "F... you."The Rest of the StoryI find this incredibly interesting because it demonstrates that the American Lung Association simply cannot tolerate the thought that someone could use a product in a way that "looks like" smoking to quit smoking, even though it is much safer than smoking and has been shown to be a much more effective of quitting smoking than using a nicotine patch or other nicotine replacement products. The efficacy of e-cigarettes for smoking cessation is on par with, if not better than that of varenicline, making it the most effective strategy for quitting smoking for anyone who is unable to quit cold turkey (which is the overwhelming majority of smokers).It's fascinating to me that the American Lung Association, whose goal is supposed to be to prevent lung disease, would be condemning vapers rather than congratulating them. That the ALA is essentially flipping vapers the bird is a clear sign that they really don't care if someone quits smoking; they only care that someone quit the way the ALA thinks they should quit: that is, using pharmaceutical products from companies with which the American Lung Association has had a financial relationship. If you look at the financial supporters of the ALA, you'll see almost the entire roster of Big Pharma, including corporations that manufacture smoking cessation products, such as Pfizer and GlaxoSmithKline.In addition to rubbing vapers' noses in the ground and showing them disrespect, the American Lung Association is lying through its teeth about the health consequences of e-cigarette use, claiming that they cause "popcorn lung" and "irreversible lung damage" and that e-liquid contains "formaldehyde and acrolein."All of these claims are false. E-liquid does not contain formaldehyde or acrolein. Think about what the ALA is saying: they are accusing e-liquid manufacturers of purposely putting formaldehyde and acrolein into the e-liquids, which would be criminal. The truth is that in some devices, the e-liquid may be overheated and the excipients (propylene glycol and glycerin) may degrade, resulting in the formation of aldehydes. But these chemicals are not present in the e-liquid as the American Lung Association is falsely claiming.The American Lung Association continues to tell the public that the use of e-cigarettes can cause "popcorn lung," even though there has not been a single case of this disease associated with vaping despite these products being used by millions of people and being on the market for more than a decade.The rest of the story is that the American Lung Association is acting in a way suggesting that protecting the public's health is not their most critical value. Their primary value seems to be purity: that is, freedom from any tobacco product. This suggests that they are viewing tobacco use on moral terms, not health ones. If you use tobacco products, you are a bad person. It is a character flaw. It is a vice that cannot be tolerated or accepted. You have to cleanse yourself completely or you remain tainted. Even if switching to vaping has saved your life!This is not public health. It is some form of puritanism. But more importantly, it is a type of public health malpractice. Recommending that ex-smokers who are relying on vaping to keep them smoke-free stop vaping is tantamount to telling them to return to smoking, since that would be the practical effect if they actually took such advice. If a physician instructed a vaping patient to return to smoking, that would essentially be malpractice.Whatever the biases or political views that are motivating the American Lung Association, it is clear that this organization is not in any position to be giving medical advice.Original author: Michael Siegel
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Boston Pulmonologist Provides Misinformation About the Cause of Severe Lung Disease Associated with "Vaping"

In an article published today in the Boston Herald, a Boston pulmonologist attributed the growing number of cases of severe, acute respiratory disease to "vaping" in general, giving the impression that the risk factor for these illnesses is any type of e-cigarette use and implying that any youth who uses electronic cigarettes is at risk. She hyped up this claim about calling vaping "the number one respiratory public health concern in youth and young adults worldwide."The more than 200 cases of severe lung illness that have been reported in 22 states is indeed an important public health concern. But it is misleading, alarmist, and irresponsible to tell the public that these cases are being caused by retail e-cigarette products generally. Moreover, it is damaging misinformation because it does nothing to prevent further cases from occurring. The attribution for these cases is so broad that it is tantamount to giving no advice at all. Scaring people into believing that any vaping could cause you to die of respiratory failure is not only untrue, but it is not going to result in any change in behavior because it is far too vague.This is a public health crisis and I think that any physician who makes public statements about these cases has a responsibility to provide accurate information that will actually help to prevent further cases from occurring. Scaring people into thinking that any vaping product can cause respiratory failure is not only inaccurate, but it is irresponsible because it doesn't provide useful information that can help youth avoid the specific products that are responsible for the observed cases. The Rest of the StoryAs an trained epidemiologist, it was immediately clear to me that these cases are not being caused by vaping products generally because these products have been on the market for years without any significant problems and because the reports are clustered in specific geographic areas. Now that further information is available, it is clear that the majority of the observed cases are associated with the use of THC oils that were obtained from unlicensed sellers. It is also likely that cases occurring among people using nicotine-containing e-liquids without THC are due to a contaminant that is appearing in products being sold on the black market, not in retail stores.According to an article in yesterday's Washington Post, "Officials are narrowing the possible culprits to adulterants in vaping products purported to have THC, the component in marijuana that makes users high, as well as adulterants in nicotine vaping products."The article also states that: "The sudden onset of these mysterious illnesses and the patients’ severe and distinctive symptoms have led investigators to focus on contaminants, rather than standard vaping products that have been in wide use for many years" and that "The investigation is “starting to point to what solvents are being used, and that can vary a lot” — especially in counterfeit or black-market products, including potentially mislabeled solvents that consumers buy themselves to make do-it-yourself “home brews,” said an official at the Centers for Disease Control and Prevention, which is heading the investigation."The Boston pulmonologist quoted in the Boston Herald story is telling the public just the opposite, as she is attributing these cases to standard vaping products. This undermines the warnings that several state health departments have given to avoid black market products, especially THC oils. It also unduly scares parents into thinking, for example, that if their child is JUULing, they may die of acute respiratory distress syndrome. There is plenty for a parent of a youth who is JUULing to worry about (namely, the fact that it is addictive), but there is no reason to believe that acute respiratory disease is one of them.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.Original author: Michael Siegel
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Lancet commentary – Nicotine without smoke: fighting the tobacco epidemic with harm reduction


August 29th, 2019

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Why is the American Lung Association More Interested in Demonizing Electronic Cigarettes than Saving Kids' Lives?

In response to former FDA Commissioner Scott Gottlieb's warning that the spike in vaping-related lung disease among young people appears to be largely associated with counterfeit e-liquid products, especially THC oils, the American Lung Association contradicted Dr. Gottlieb and tried to cast the blame on traditional nicotine-containing e-cigarettes instead.The spokesperson for the American Lung Association was quoted as saying: "With all due respect to former FDA Commissioner Gottlieb, I think it's too soon to speculate about the cause or the reason why we're seeing this ... I firmly believe that had FDA not delayed the oversight of these products in July of 2017 that we would be in a much different position than we are today. ... The tobacco industry has long been happy to place fingers when there have been issues of counterfeit cigarettes … The bottom line is that e-cigarettes are not safe, and from the American Lung Association’s perspective, no one should be using e-cigarettes."The Rest of the StoryAlas, the truth is revealed. At the end of the day, the American Lung Association's chief aim is to demonize e-cigarettes and anyone who is using them.What's astounding to me is that the American Lung Association is actually undermining Dr. Gottlieb's warning to the public to avoid vaping THC oils and counterfeit e-liquids purchased off the street. Moreover, Dr. Gottlieb is not "speculating." At least five different health departments and the CDC itself have stated that many of the reported cases appear to be associated with the use of THC oils purchased off the street. We don't need to wait until there is absolute certainty about the cause of every single case. There is enough information to warn people not to use THC oils or any e-liquids purchased from unlicensed sellers or pop-up shops. That's exactly what Dr. Gottlieb was doing and it's deplorable that the American Lung Association would attempt to undermine his warning just to get in a jab against vapers.Seriously, it's very clear to me that the American Lung Association truly hates vapers and wishes them nothing but the worst. It's almost as if they are hoping that the cases end up being tied to traditional vaping products so they can say "We told you so."Ironically, while the American Lung Association castigated Dr. Gottlieb for jumping to conclusions, it then proceeded to jump to conclusions itself, asserting that the cause of these cases is the failure of the FDA to implement the pre-market tobacco application requirement. But that presupposes that the cases are due to e-liquids being manufactured by legitimate companies that would be complying with the FDA regulations. If the cause of many or most of these cases is THC oils, then those wouldn't be subject to FDA regulation in the first place. The ALA's statement is essentially concluding that the THC oils are not a major cause. This is irresponsible and dangerous and threatens the health and lives of the nation's young people.Original author: Michael Siegel
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Marijuana Reform Organization Issues Warning Against Vaping THC Oils Obtained from Unlicensed Sellers; CDC Does Not

It is a sad state of affairs in public health when we have to rely upon a marijuana law reform organization to issue a critical health warning on the severe risks of vaping unlicensed THC oils, while the CDC remains silent.According to an article in USA Today, the National Organization for the Reform of Marijuana Laws (NORML) warned consumers "not to buy THC vape products from unlicensed retailers." The organization's Deputy Director--Paul Armentano--explained the danger associated with the use of illicit THC vaping products: "Unregulated illicit market cannabis products, like products in any unregulated marketplace, are of variable quality and may put some consumers at risk. These incidents linked to the use of unregulated, illicit market vapor cartridges reinforce the need for greater market regulation, standardization, and oversight ... Consumers must also be aware that not all products are created equal; quality control testing is critical and only exists in the legally regulated marketplace."In response to the occurrence of seven cases of acute respiratory distress syndrome that were linked to the use of THC or CBD oil extracts purchased from the illicit market, the Hanford (CA) health department issued a very specific warning to the public not to vape cannabis or CBD oils obtained from an unlicensed seller. The warning was issued in no uncertain terms: "Under no circumstances should you vape cannabis or CBD oils obtained from a “pop-up shop."The Rest of the StoryThe CDC continues to remain silent, even though it has become clear that vaping THC oils, particularly those obtained on the street from unlicensed sellers, is a risk factor for the "mysterious" respiratory illness that has affected close to 200 individuals. The CDC has yet to issue any kind of warning, preferring instead to continue to scare people about the dangers of all vaping products, making no distinctions whatsoever between the myriad types of vaping products on the market.The Office on Smoking and Health continues to hammer home its meaningless mantra that e-cigarette aerosol is "not harmless." In its August 23rd media briefing, the Office on Smoking and Health not once but twice reiterated the earth-shattering statement that "e-cigarettes do not emit a harmless aerosol."And then once again in the excellent USA Today article from yesterday, the Office on Smoking and Health once again offered the extremely helpful information that "e-cigarette aerosol is not harmless."In addition, the Office on Smoking and Health continued to harp on the dangers of "traditional nicotine vape liquid." And even when given the opportunity to emphasize the dangers of vaping THC oil, the Office on Smoking and Health tried to divert attention from that concern back to the thousands of other vaping products that are not causing any problem: "Though the government knows people use substances including THC in vape pens, King said, "the bottom line is there’s a variety of things in e-cigarette aerosol that could have implications for lung health."This is completely irresponsible. People are dying or having severe, life-threatening illnesses and instead of warning people about the risks of using illicit THC oils that have been linked to many of the cases, CDC is more concerned about making a political statement demonizing e-cigarette aerosol without any evidence that traditional e-cigarette aerosol has been associated with any of the reported cases.In fact, it appears that the Office on Smoking and Health tried to imply that traditional nicotine e-liquids could cause respiratory disease before acknowledging that none of the cases has been linked to traditional nicotine e-liquids but then warning anyway about the respiratory risks of the traditional vaping of retail e-cigarette products: "Dr. Brian King of the CDC's Office on Smoking and Health told reporters that harmful ingredients in traditional nicotine vape liquid had been identified that included ultrafine particulates, heavy metals such as lead, cancer-causing chemicals and flavoring used in e-cigarettes to give it a buttery flavor. Those ingredients had been related to severe respiratory illness, he said. While they haven't been linked to the current cases, 'we know that e-cigarette aerosol is not harmless,' King said." Why is the CDC pointing the finger at every constituent in normal e-cigarette aerosol, implying that any of these chemicals could be the cause of acute respiratory distress syndrome, but protecting illicit cannabis vaping?The rest of the story is that in its zeal to demonize electronic cigarettes, the CDC is actually protecting illegal drug dealers at the expense of the protection of the health of our nation's youth.Original author: Michael Siegel
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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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IN MY VIEW: CDC and Health Groups' Bias Against E-Cigarettes is Putting Kids' Lives at Risk

According to the Centers for Disease Control and Prevention (CDC), there have now been 153 reported cases of severe, acute lung disease caused by "vaping" across 19 states. Tragically, one of these cases resulted in a death. Most of the cases are occurring among youth or young adults. The acute disease appears to be taking the form of lipoid pnemonia, acute respiratory distress syndrome, and/or chemical pneumonitis.Physicians, health departments, and the CDC have almost uniformly informed the public that these cases are caused by "vaping" and have advised youth and young adults to avoid using "e-cigarettes."The Rest of the StoryThe advice from health agencies, including the CDC, to avoid using "e-cigarettes" is irresponsible. This is such a broad category of products that it doesn't really give people any guidance whatsoever in terms of what to avoid. There are millions of people who are vaping nicotine-containing e-liquids and it would not be prudent for these millions of people to return to smoking in order to avoid the risk of this "unknown" and "mysterious" medical condition. Moreover, with such vague advice, no one is likely to change their behavior because they are not being warned about any specific, identifiable risk.The truth is that in every case so far in which a specific e-liquid has been identified, that product has been a THC-containing e-liquid, typically purchased off the street and often in open cartridges such that they could contain a contaminant or other drug. In at least some of the cases, the use of a THC oil, such as butane hash oil, has been implicated. In January of this year, there was a published case report of a severe, acute respiratory illness attributable to the use of butane hash oil. Apparently, all 21 cases in California were attributed to vaping of marijuana with all the THC e-liquids being purchased on the street.Since lipoid pneumonia is caused by oil inhalation, it seems pretty clear that those cases diagnosed as lipoid pneumonia are being caused by the use of e-liquids that are oil-based, not alcohol-based. Most nicotine-containing e-liquids are alcohol-based, meaning that they contain as excipients some combination of propylene glycol and glycerin. These products do not pose a risk of lipoid pneumonia. There are some nicotine-containing e-liquids that are oil-based, and these should absolutely be avoided.Although we do not have a single common link between all the reported cases, there are useful recommendations that the CDC could be giving. At a minimum, they should be telling the public not to vape THC oils, including butane hash oil. Second, they should be telling people not to use any oil-based vaping e-liquid product. Third, they should be telling people not to use any e-liquid unless you know what is in it -- that is, do not buy products off-the-street and stick to products being sold at retail stores, especially closed cartridges where there is no risk of contamination or the presence of unknown drugs.These would actually be useful recommendations that could possibly help prevent further cases. Instead, the CDC and other health groups are providing such generalized and vague advice that it is essentially meaningless.Sadly, the failure of CDC and other health agencies to provide appropriate recommendations is putting kids' lives at risk. Since there has been no admonition to avoid the use of THC oils, kids are going to continue to use these products. This is why the CDC's recommendations are irresponsible.The question is: why are the CDC and other health groups being so broad in their statements, warning broadly against "vaping" or using "e-cigarettes" but failing to warn against the use of THC oil?The answer, I believe, is that these organizations have such a pre-conceived conclusion that vaping is hazardous and such a bias against the use of e-cigarettes for smoking cessation that they are hoping to be able to attribute these cases to traditional nicotine vaping.   By no means are we in a position currently to be able to conclude that vaping THC oils or other oil-based e-liquids is solely responsible for the observed cases nor are we sure that street-purchased products are solely to blame. However, I think we know enough to be able to offer a specific recommendation that people not use these products. That CDC has failed to do this is irresponsible, putting lives at risk, and demonstrating the agency's bias in its views of the science around smoking and vaping.Original author: Michael Siegel
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Sunday Science Lesson: spookiness bias

 

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Essay on bans by Marewa Glover

by Carl V Phillips

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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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Heads Up – News – Updates 7.31.2019

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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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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CASAA Tobacco 21 policy statement: “Including low-risk alternatives in T21 laws is unwise, misleading”

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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Heads Up – News – Updates 7.25.2019

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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