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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.

A Sensible Tobacco Tax Plan to Benefit Smokers & States

Most tobacco taxes aim to punish tobacco consumers and companies.  My University of Louisville economics colleague Dr. Nantaporn Plurphanswat and I offer a rational tobacco tax plan (here) to benefit tobacco users and state governments.  It’s supported by 16 tobacco research and economic policy experts from across the nation, and it’s co-sponsored by the Pegasus Institute.  Watch my interview with Nick Storm of Spectrum News here, or click on the image above.Original author: Brad Rodu
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FDA wants to reduce nicotine in cigarettes – what could possibly go wrong (and right)?


October 25th, 2017

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New Vaping Insights Based on FDA’s PATH Survey 2013-2014



Analyzing data from the baseline 2013-14 FDA-funded Population Assessment of Tobacco and Health (PATH) Study, my economist colleague Dr. Nantaporn Plurphanswat and I have produced a comprehensive study of e-cigarette use in the United States.  The research appears in the journal Nicotine & Tobacco Research (abstract here). The standard vaping definition has two components: participants must have regularly vapedAND now vape every day or some days.  Using this definition, we estimate that there were 5.5 million current e-cigarette users (2.4% of the U.S. population), of which 2.3 million used them daily and 3.2 million used them some days. However, there are 7.4 million participants who have NOT “regularly vaped” but report that they use e-cigs every day or some days.  It is important to count them too, and to distinguish them from current users, so we call them “e-cigarette triers,” the vast majority of whom (95%) use them some days.  The total of current users and triers is 12.9 million (or about 5.6% of the population). (In a recent blog entry (here) I estimated that there were 8.9 million U.S. vapers in 2014, based on the National Health Interview Survey [NHIS].  The fact that the NHIS does not collect data on “regular” vaping likely accounts for the difference with our new PATH-based 12.9 million estimate.) The figure above shows that the vast majority of every day current vapers were either current smokers (47%) or former smokers (46%).  In contrast, most some day vapers and all e-cigarette triers were current smokers, and the percentage of never smokers was higher in these groups (discussed below).  PATH also collected more detailed cigarette smoking information than did NHIS.  In our new article we note that we use a similar “…classification strategy…for estimates of cigarette smoking. The number of current smokers in PATH was 41.5 million, and 80% were daily smokers, which is consistent with the 2014 NHIS.  However, there were also 7.1 million cigarette triers, who are distinguished by being every day or some day smokers who had not consumed 100 cigarettes in their lifetime.  Triers do not fit the traditional definition of current smokers, so we have included them as a subset of ‘never-smokers’ for comparison with NHIS surveys, where they would have been classified as never-smokers by answering ‘no’ to the 100-cigarette question and not being asked about every or some day smoking. This is an indication that a substantial number of American smokers may have been misclassified as never-smokers in previous national surveys.”These details illuminate critical characteristics of both vapers and smokers.  For example, as shown the chart at left, the vast majority of vapers who “never smoked” according to the NHIS definition are actually current or former cigarette triers.  Only a small fraction (7-11%) have never tried cigarettes.  This finding refutes the common claim that vaping attracts never smokers. Other vaping insights gleaned from the PATH survey will be discussed in a future post. Original author: Brad Rodu
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Is Australia falling behind on tobacco policy?


Sources: Office for National Statistics (UK). Smoking habits in the UK and its constituent countries, 2016.  Australian Institute of Health and Welfare, National Drug Strategy Household Survey, 2016.

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“Deception or Evasion” by FDA CTP & National Cancer Institute Regarding Smokeless Tobacco?


“A majority of adults do not think smokeless tobacco is less harmful than cigarettes,” according to a study by the FDA Center for Tobacco Products and the Tobacco Control Research Branch of National Cancer Institute (abstract here).  Sheri P. Feirman and colleagues analyzed responses to a question in the Health Information National Trends Survey (HINTS), 2012, 2014, and 2015: “Do you believe that some smokeless tobacco products, such as chewing tobacco and snuff, are less harmful than cigarettes?”  Do You Believe that Some Smokeless Tobacco Products…Are Less Harmful Than Cigarettes?201220142015Yes9.4%12.0%10.9%No73.5%72.1%66.8%Don’t Know17.1%15.9%22.2% Simply put, only 9 to 12% of Americans correctly believe that smokeless tobacco is less harmful than cigarettes. In a PubMed Commons commentary on this study, David Sweanor and I note: “The article failed to specify that the correct answer [to the question] is:  ‘Yes, smokeless tobacco products are less harmful than cigarettes.’  The article instead focuses on the majority of participants who inaccurately answered ‘No’ or ‘Don’t Know,’ which demonstrates the misperception fostered by an effective ‘quarantine’ of truthful risk information by federal agencies (Kozlowski and Sweanor, 2016). “Decades of epidemiologic studies have documented that the health risks of smokeless tobacco use are, at most, 2% those of smoking (Rodu and Godshall, 2006; Rodu, 2011; Fisher 2017; Royal College of Physicians, 2002; Lee and Hamling, 2009).  Unlike cigarettes, smokeless tobacco does not cause lung cancer, heart and circulatory diseases or emphysema.  The Royal College of Physicians concluded in 2002: ‘As a way of using nicotine, the consumption of non-combustible [smokeless] tobacco is on the order of 10–1,000 times less hazardous than smoking, depending on the product.’” (Royal College of Physicians, 2002) ”Low risks from smokeless tobacco use extend to mouth cancer.  A 2002 review documented that men in the U.S. who use moist snuff and chewing tobacco have minimal to no risk for mouth cancer (Rodu and Cole, 2002), and a recent federal study found no excess deaths from the disease among American men who use moist snuff or chewing tobacco (Wyss, 2016). “As one of us recently wrote, ‘Deception or evasion about major differences in product risks is not supported by public health ethics, health communication or consumer practices.  Public health agencies have an obligation to correct the current dramatic level of consumer misinformation on relative risks that they have fostered.’ (Kozlowski and Sweanor, 2018).” The FDA and NCI must be more forthcoming with the American public.Original author: Brad Rodu
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My Response to an Invitation to Consult for the Foundation for a Smoke-Free World

Below is my response to an invitation to consult for the Foundation for a Smoke-Free World, funded by Philip Morris International:Unfortunately, I will not be able to consult or play any advisory role on this project. Since Philip Morris International (PMI) continues to aggressively market cigarettes internationally and to aggressively fight public health efforts to reduce tobacco use, this is just not a project that I can participate in as a public health practitioner. PMI cannot be sincere in its intention to establish a smoke-free world when it continues to aggressively lobby against public health efforts to reduce tobacco use.Original author: Michael Siegel
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Note to readers: look for me at @TheDaily_Vaper

by Carl V Phillips

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Mythic Tobacco Endgames



A new $1.2 million campaign to promote tobacco prohibition on college campuses was announced on September 19 (here).  As I have noted, the federal government annually spends hundreds of millions of dollars in support of academic anti-tobacco research (here).  This time, the money is coming from pharmacy giant CVS’s Health Foundation as part of a five-year, $50 million campaign.  CVS collaborators include the misnamed Truth Initiative (see hereand here) and the American Cancer Society, whose numerous prohibitionist exploits are reported in this blog (here, here, here, here, here, here, here, here, here, here). Campaign awards to several Texas schools were reported in a Houston Chronicle article (here) that included illustrations offering and refuting four tobacco “myths”.  In this effort, the paper (or the campaign) repeated fantastical claims that are often made by prohibitionists. Myth #1: “Almost no one smokes any more [sic].”  A myth, by definition, is a widely held view, so this attempt fails from the start. The latest data from the CDC, for 2016, shows 38 million smokers in the United States – a substantial and highly visible group of people, all in need of effective quit-smoking tools and support. Myth #2: “e-Cigarettes, hookahs and cigars are safe alternatives.”  Again, few people hold this view (here).  Scientists, the industry and public health officials agree that no form of tobacco use is perfectly “safe.”  Eminent authorities like Britain’s Royal College of Physicians, however, have pronounced that vaping “is unlikely to exceed 5% of the harm from smoking tobacco.” (here)  Furthermore, FDA data shows that smoking one or two cigars a day have almost no health risks (hereand here). Myth #3: “Infrequent, social smoking is harmless.”  This is creating a myth when one doesn’t exist. Myth #4: “Smoking outside eliminates secondhand smoke dangers.”  Myths convey false information.  This statement is entirely true. Ironically, some viewers of the online Chronicle article are shown an advertisement for Nicorette gum, reproduced here.  While pharmaceutical nicotine has a known 93% quit-smoking failure rate (here), this ad touts one day of success – an extraordinarily low bar for cessation. Original author: Brad Rodu
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2016 CDC Data Shows E-Cigarette Use Declines Again



Some 7.8 million American adults used e-cigarettes in 2016, according to data from the 2016 National Health Interview Survey, the source for CDC national smoking estimates.  That is about half a million fewer than a year earlier, and 1.1 million fewer than in 2014, the first year NHIS surveyed for vaping.  As the CDC reported a month ago (here), the 2016 data indicates 3.2% adult prevalence – 3.9% (about 4.5 million) for men, and 2.6%, (about 3.3 million) for women.   The 2.62 million former smokers who are current vapers comprised an increasing percentage of all vapers, from 22% in 2014, to almost 34% in 2016.  This is more evidence that smokers are using e-cigarettes to quit their habit.  As the following chart shows, 87% of former smokers currently using e-cigarettes quit in the last 5 years, suggesting that e-cigarettes played a significant role.  Meanwhile, 13% of former-smoker current-vapers quit over 6 years ago.  The CDC admits that relapse among former smokers is common (here), so health advocates should applaud these former-smokers’ choice of e-cigarettes over far more dangerous cigarettes. As noted previously (here), the 2.6 million former smokers represent more than mere anecdotal evidence; their documented experience ought to carry substantial weight with government policymakers.  In view of the important positive health implications of switching to smoke-free products, the number of former smokers ought to be growing faster.  Unfortunately, the sustained war on all smoke-free products is likely suppressing broader transition away from cigarettes.Original author: Brad Rodu
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Guest post: BAT executive on disruption of the tobacco industry

On June 12th, I published a blog, Pariahs, predators or players? The tobacco industry and the end of smoking, in which I tried to guess how tobacco companies are thinking about the future from my vantage point on the sidelines.  But I also asked if any industry figures would like to offer an informed insider’s view and offered a right of reply. Well, to my surprise one executive did reply.  David O’Reilly is BAT’s Group Scientific and R&D Director, and here is his perspective.

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Advertising code at fault over e-cigarette public health ad ban


This year’s Stoptober campaign encourages smokers to try vaping – bravo!

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Sunday Science Lesson: Debunking the claim that only 16,000 smokers switched to vaping (England, 2014)

by Carl V Phillips

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Antidote to NEJM Formaldehype Arrives at Last


In January 2015, R. Paul Jensen and colleagues created global headlines with a defective e-cigarette experiment (here).  They claimed in the New England Journal of Medicine that vapor contains “hidden” formaldehyde at far higher levels than cigarettes (here).  Their measurements required overheating or “dry-puffing” e-cigarette liquid, a process that produces such harsh (not hidden) oral sensations that the vapor is intolerable to normal consumers.  As Churchill said, “A lie gets halfway around the world before the truth has a chance to get its pants on.”  The Jensen mischaracterization caused considerable damage, as it encouraged smokers to believe that vaping is more dangerous than smoking.  Last week, the formaldehyde fallacy was laid bare.  Dr. Konstantinos Farsalinos and colleagues reproduced the Jensen experiment and found that “The high levels of formaldehyde emissions that were reported in [the Jensen] study were caused by unrealistic use conditions that create the unpleasant taste of dry puffs to e-cigarette users and are thus avoided.” Their work appears in Food and Chemical Toxicology (abstract here).  Farsalinos’ group painstakingly reproduced the earlier experiment, using the same now-outdated vaping equipment that was prone to dry puffs.  First, they had experienced vapers identify at what settings the “burning” taste of a dry puff was detected: 4.2 volts, 8.0 watts.  They then used Jensen’s methods to measure formaldehyde at various voltage-power settings, seen in the chart (above) adapted from their publication. Vapers detected dry puffs when the formaldehyde level was 100 micrograms (per 10 puffs).  Given that a microgram is one-millionth of a gram, Jensen’s formaldehyde level wasn’t hidden at all; at 380 micrograms, it was much higher than vapers could tolerate.  At lower, normal vaping power, formaldehyde was only 20 micrograms, or two-thirds that of cigarettes. Farsalinos cautions the scientific community: “blindly testing e-cigarettes in the laboratory setting without evaluating realistic use is a serious omission that can result in misleading conclusions about the risk to consumers compared to smoking;” and such conclusions can wrongly imply “that there is little to be gained by switching to e-cigarettes.” In response to the Jensen article in 2015, Clive Bates and Konstantinos Farsalinos published a letter in Addiction calling for its retraction (here); the demand was ignored.  The current publication is a much-needed antidote to Jensen’s seriously flawed and misleading findings. Original author: Brad Rodu
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What is Tobacco Harm Reduction?

by Carl V Phillips

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Do Smokers Quit After Hospital Cessation Trials? Don’t Count on It, or Them


Do smokers lie about quitting?  A new study analyzes smokers’ self-reports of their smoking habits six months after their participation in quit-smoking clinical trials. Several years ago, researchers recruited sick smokers at a group of hospitals – the Consortium of Hospitals Advancing Research on Tobacco, or CHART – and conducted federally-supported smoking cessation trials.  Now Taneisha Scheuermann et al. in the journal Addiction (abstract here) examine the post-trial results, focusing on levels of cotinine, a nicotine breakdown product, in trial participants’ saliva. Hospitals in six cities provided 5,827 smoking patients with a variety of quit-smoking interventions.  Six months later, 4,206 of those subjects completed a survey, with 1,708 reporting that they had not smoked in the past seven days.  Nearly 10% of them reported using pharmaceutical nicotine, e-cigarettes or other tobacco harm reduction products in the past seven days; those subjects were among the 530 excluded from the Scheuermann analysis.  Self-described non-smokers were offered $50 to $100 in exchange for saliva samples, but only 923 participants responded; of those, 822 supplied usable samples. Scheuermann used a standard saliva cotinine cutoff of 10 nanograms per milliliter: participants below this level were considered to be not smoking, while those at or above were still smoking. Of the 822 participants who reported 7-day abstinence, 347 (42.2%) were dissembling, as their saliva cotinine levels indicated they were smoking.  That so many individuals failed to quit evidences a fact that tobacco prohibitionists often ignore: The vast majority of smokers are unable or unwilling to quit.  The 475 verified quitters constituted roughly 8% of the 5,827 patients who started the trials – a percentage that is consistent with the quit rate among the general population.  Also note that these smokers were recruited during a hospitalization, when their focus on health issues might have increased their motivation to quit. Treating smokers as social outcasts may influence their decision to lie about the results of their quit attempts. The CHART study was supported from 2009 to 2014 by five NIH grants costing taxpayers $15.5 million.      Original author: Brad Rodu
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The War on Nicotine begins

by Carl V Phillips

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Center for Tobacco Products is Lying to the Public About Youth Tobacco Use


This month, the FDA's Center for Tobacco Products (CTP) updated a chart purporting to show trends in youth tobacco use over the past 5 years.Here are the facts (i.e., the "true" facts) displayed in the chart:1. Youth cigarette use (among high school students) dropped by a huge amount from 2011 to 2016.2. Cigar use dropped substantially from 2011 to 2016.3. Pipe use dropped substantially from 2011 to 2016.4. Smokeless tobacco use dropped slightly from 2011 to 2016.5. Hookah use was essentially the same in 2011 and 2016.Given those facts, here is the key question:What happened to overall use of tobacco among high school students during the time period 2011-2016?It doesn't take any fancy math or statistics to figure out that overall tobacco use among high school students must have declined substantially from 2011 to 2016. Since youth cigarette use dropped by a huge amount, cigar use dropped substantially, pipe used dropped substantially, smokeless tobacco use didn't change  much, and hookah use didn't change much, it stands to reason that overall tobacco use went down substantially. There is no way that youth tobacco use went up or even stayed the same from 2011 to 2016 because it dropped substantially for three categories of use but didn't change much in the other two categories.The Rest of the StoryBut that is not what the Center for Tobacco Products chose to tell the public. Here is what the Center for Tobacco Products titled the chart:The CTP chose to tell the public that there was no significant decline in overall tobacco use over the past 5 years. However, as I showed above, that is simply not true. Youth tobacco use declined substantially.So how does CTP justify this dishonesty?It plays a trick on the public. It classifies e-cigarette use as a form of tobacco use and includes e-cigarette use in the totals for overall tobacco use. Since there was a huge increase in e-cigarette use from 2011 to 2016, CTP is able to completely undermine the fact that there was a dramatic drop in youth smoking, cigar use, and pipe use by adding youth who experimented with e-cigarettes. This is dishonest and inaccurate because e-cigarette use is not a form of tobacco use. The truth is -- and CTP knows this -- that e-cigarettes do not contain tobacco. In fact, the whole point of e-cigarettes is that they are an alternative to using tobacco. The rest of the story is that the Center for Tobacco Products is lying to the public. This is unfortunate because it risks losing the public's trust. It is also unfortunate because this deception could have deleterious public health effects, as misinforming people to think that e-cigarettes contain tobacco may dissuade many smokers from quitting and may even induce many ex-smokers to return to smoking. On top of all of this, it is - in my view- unethical to lie to the public, even if the aim were to discourage us from engaging in a potentially harmful behavior. I think the public deserves to know the truth. Someone has to start telling them the rest of the story. Note: Thanks to Clive Bates for alerting me to the deceptive headline in this dishonest communication. Original author: Michael Siegel
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Teen Smoking Unconnected to Cinematic Smoking


In a July report (here), the CDC Office on Smoking and Health asserted the following about tobacco use in movies: “The Surgeon General has concluded that there is a causal relationship between depictions of smoking in the movies and the initiation of smoking among young persons.” “…the decline in the total number of tobacco incidents [in top-grossing movies] has not progressed since 2010.” “Reducing tobacco incidents that appear in youth-related movies would prevent the initiation of tobacco use among young persons.” “An R rating for movies with tobacco use could potentially reduce the number of teen smokers by 18%...” Responding, Guy Bentley published an excellent commentary noting that any connection between smoking in movies and among teens is illusory (here).  I provide statistical evidence of this by analyzing the CDC report’s numbers together with smoking prevalence rates among high school seniors for the same years.  The resulting chart fails to support any of the above claims.  The number of tobacco incidents per year in top-grossing movies varied from 1,600 to 3,300 over 25 years, 1991-2016, except for a couple years around 2005.  Smoking among high school seniors plummeted continuously after 1996.  There appears to be no connection between the two data sets. The report clearly lacks objectivity.  It was authored by CDC staffer Michael Tynan; Jonathan Polansky, founder of the advocacy firm Onbeyond and creator of the Smokefree Movies campaign (here); Kori Titus and Renata Atayeva from Breathe California Sacramento Region (here), an organization that “…has been fighting for…tobacco-free communities [otherwise known as prohibition] since 1917…”; and Stanton Glantz, faculty member of the University of California, San Francisco, and long-time tobacco opponent.  Polansky, Titus and Glantz acknowledge grant support from the Truth Initiative as their only conflict of interest. Note that the tobacco incident numbers were collected by “Youth volunteers between the ages of 14-22… trained to analyze tobacco content in films…Their data is posted weekly on our sister website SceneSmoking.org and is used by university-level researchers and public health professionals across the globe….”  This underlying data does not appear to be publicly available.  The link to SceneSmoking was not functional and redirected to Breathe California Sacramento.   Original author: Brad Rodu
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Negligible Evidence of Radical Nicotine Reduction Benefit


An August 17 commentary in the New England Journal of Medicine (here) by FDA Commissioner Scott Gottlieb and Center for Tobacco Products Director Mitchell Zeller raises some concern about the agency’s new tobacco regulation strategy. The piece touches on “less harmful tobacco products,” which Commissioner Gottlieb wrote favorably about earlier (here), but it includes descriptors – “potential” (four times) and “conceivable” (once) – that suggest the authors are not convinced that e-cigarettes are truly lower-risk. Smokeless tobacco, already demonstrated to be vastly safer than cigarettes, isn’t mentioned. In their commentary, the FDA officials advocate for radical nicotine reduction (RNR) in cigarettes.  RNR is a variation on a failed concept: supply-side elimination of popular products.  Full-on cigarette prohibition was adopted, then jettisoned, in 12 states from 1899 to 1909 (here). During Prohibition a decade later, brewers tried to market an alcohol-free product called near beer (here).  That bombed just as badly as Vector Group’s RNR cigarettes in 2003 (here).  Any new RNR products will likely be rejected as well, causing smokers to seek out higher-nicotine-level products, licit or otherwise. Despite a significant expenditure of taxpayer dollars on RNR research, this approach has not been demonstrated to reduce adult smoking. For example, a $29 million clinical trial by Dr. Neal Benowitz, reported in 2015, produced dismal results (my review here). The FDA commissioner and his co-author remain optimistic: “A recent 6-week study by Donny et al. showed that cigarettes with lower nicotine content reduced nicotine exposure and dependence, as well as the number of cigarettes smoked, as compared with cigarettes with standard nicotine levels.”  They are referring to another 2015 report (here), but that study’s results were unimpressive as well. Dr. Eric Donny recruited 840 smokers uninterested in quitting, and randomly provided them with one of seven types of cigarettes to use for 6 weeks: their usual brand, a full-nicotine study cigarette and five others with varying low nicotine levels (2% to 33% of the full-nicotine cigarette).  Subjects were paid up to $835 for 10 clinic visits, which probably contributed to a 92% completion rate. While it was not surprising that smokers using reduced nicotine cigarettes had lower nicotine levels in their urine, most of the low-nicotine smokers (73-81%) admitted that they smoked three or four “wildcat” cigarettes (products not distributed as part of the study) on 24-35% of days in the trial. There was little consistency regarding changes in dependence.  On the Wisconsin scale, smokers in all groups had lower scores after six weeks than at baseline, with only one of the reduced nicotine groups significantly lower than the full-nicotine group.  On the Fagerström scale, three low-nicotine groups were significantly lower than the full-nicotine group, but the changes from baseline were not impressive.  In other words, it is not clear if the low-nicotine cigarettes reduced dependence. The number of cigarettes smoked in the Donny study is interesting.  At baseline, every group was smoking about 15 cigarettes per day.  Although Commissioner Gottlieb and Mr. Zeller imply that low-nicotine groups smoked fewer cigarettes at the end of the study, they actually averaged 15-16 cigarettes per day.  Smokers of usual-brand and full-nicotine cigarettes smoked 21-22 per day after six weeks, an increase of 6-7.  Perhaps Donny contributed to this increased consumption by providing full nicotine cigarettes for free. Like the Benowitz study, the Donny study does not prove that reduced-nicotine cigarettes produce meaningful benefits for smokers. It should be noted that the Donny study was supported by $93.3 million in grants from the National Institute on Drug Abuse and the FDA. Original author: Brad Rodu
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My Testimony for Electronic Cigarette Hearing in Windham, New Hampshire

Attorney Fred Kelly Grant conducted a very nice interview with me regarding electronic cigarettes which will be submitted as testimony for an e-cigarette informational hearing in Windham, New Hampshire. Fred did a great job of asking questions that covered the gamut of important scientific and regulatory issues, so I hope this will be a good resource to provide a solid background on this issue.Original author: Michael Siegel
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