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FDA is considering drugs to help kids quit vaping (cnn.io)
61 points by LinuxBender 35 days ago | hide | past | web | favorite | 193 comments



Companies like JUUL have patented formulations for nicotine salts that quickly spike blood nicotine levels similar to levels of analog cigarettes, then the sudden drop off promotes stronger cravings and more frequent usage. Cavings resulting from this quick spike and drop off significantly increases habit forming behavior by boosting both the intensity of withdrawl symtoms and frequency of usage compared to freebase nicotine formulas that have been common in traditional "ejuice" of the past decade. Combine this with their cornering the teenage vaping market you can see why Altria (malboro parent co) just gave them 13B for 35%. These nic salt formulas can ease the transition from traditional cigarettes, but also increase the first time user to addict conversion rate and lessen the likelyhood of users tapering off usage by gradual reduction of comparibly stabilized nicotine levels of freebase formulations.

I've been rolling around an idea for a device to help ween off nicotine for years now. I need to consult with an EE, but don't have any in my network. If anyone's willing to chat for 30 mins, or interested in colaberating I'd love to hear from you, emails in my profile. If you're aware of any service out there to buy small block of consultation time, that would help at well.


JUUL was the only thing that got me off a pack-a-day 13 year habit. I think very highly of the product and it is a shame teenagers made it so 'cool'. (Much like cigarettes at one time...)


Conversely, I switch to Dipping Tobacco as my quitting smoking mechanism, I dont think I can quit nicotine and stick to it, but quitting dip does seem legitimately easier than smoking, as there is much less ritual associated with it.


> there is much less ritual associated with it.

This is very true, but try switching to Swedish snus. Dipping tobacco still has a lot of cancer risk, whereas snus doesn't, really, so you can take your time quitting. It's the difference between roasted and steamed tobacco; it's the combustion products that get you.


I'd have to dig for the source, but I found a source on the internet, which seemed incredibly credible for being a college professors wordpress blog.

Basically, since 2005, the nitrotesimne levels in US Style smokeless tobacco has declined by more than 75% due to changes in manufacturing (largely), and from say, 80mg to 5mg, in the 1975-2016 period.

Tobacco Specific Nitrosamines are widely acknowledged to be the single largest cancer causing agent in oral tobacco. (https://en.wikipedia.org/wiki/Tobacco-specific_nitrosamines)

https://rodutobaccotruth.blogspot.com/2016/07/is-snus-safer-...

https://rodutobaccotruth.blogspot.com/2012/10/more-evidence-...

https://rodutobaccotruth.blogspot.com/2012/01/informative-st...


Where are you getting that snus doesn’t have cancer risk?


It has pretty low risk, Scandinavia has the highest oral tobacco use, but the lowest oral cancer risk in europe.


Mouth cancer though. Horrible stuff.


My dad's dad smoked a lot when my dad was young, but managed to quit by chewing cigars. He died of mouth cancer.

My dad swore off of drugs and alcohol, and always said he wanted to work until the day he dies. He's instead spent the last 10 years dying of Alzheimer's.

For what it's worth, I'm inclined to follow my dad's approach. Perhaps with a different interpretation of retiring when I die. But there are some games you just can't win.


What death were you hoping for? I mean given a choice a first and fatal coronary blow-out as I sleep, seems pretty good. vapes bacon


Which is much lower than it used to be even for the same product type, you can see my other comment down thread.


Become an experienced nasal snuff user. Takes practice, but plenty of nicotine.


Juul helped me quit 2 packs a day


Sorry if this question is rude or arrogant, but I'm genuinely curious. How does one smoke 2 packs a day? That's 40 cigs a day. If you're active for 15 hours a day, that's a cigarette every 20 minutes. Assuming one cigarette takes 5 minutes to smoke, did you smoke one every 15 minutes? How were you able to work like this? Also didn't this cost you a fortune? That's like $30 a day, $10k a year. I spend less money on food, I'm curious how does one justify this much money on something.


Not to speak for GP, but a lot of people who "smoke" that much aren't really smoking it all. They're not like on a typical smoke break where they go outside expressly to consume a cig and go back to work. Some people just have a cig burning almost all of the time, but might actually only take 2 or 3 draws off of it and the rest just sits there burning. They tend to be self employed bc there is no way you could do that at a regular 9-5 job.

Anecdotally, I've had 2 experiences with people like that. One was a coder who was self employed and worked out of his house, and another was my auto mechanic before I moved. Both always had a cig burning sitting burning in an ashtray but only picked up and consumed maybe 25% of it while they were working.

In some places, cigs might cost $15/pack (your numbers), but I just passed by a Chevron gas station selling for $7 where I live (Portland, OR). The cost depends greatly on the local/state taxes and is not indicative of everywhere. A carton of Marlboros here (the most expensive brand) is around $60 ($6/pack). A quick scan of this table [1] shows rates by state. A cursory look shows a tax range of about 0.37% (Georgia) to 4.5% (DC), but those are only the state taxes and don't take into account other local taxes. I'm just pointing out your example of $30/day (I assume where you live) is quite different from $12/day where I live, and there are even cheaper places than where I live. Portland isn't exactly the boonies.

[1] https://en.wikipedia.org/wiki/Cigarette_taxes_in_the_United_...


> Not to speak for GP, but a lot of people who "smoke" that much aren't really smoking it all. They're not like on a typical smoke break where they go outside expressly to consume a cig and go back to work. Some people just have a cig burning almost all of the time, but might actually only take 2 or 3 draws off of it and the rest just sits there burning.

This wasn't me at all when I smoked two packs a day. I smoked the entire cigarette, and if I was going to put it down for a while, I put it out. And that was when they were cheap.

You just smoke all the time. The first thing I did when I woke up was light a cigarette, before I got out of bed. You choke a couple of cigarettes down during your break, not just one. You smoke through lunch. I was probably 5-7 cigarettes in before I even got to work.


Yeah, this is closer to my experience. I never reached two packs a day, but would hit 1.5 in the summer months no problem. It was wake up, smoke, make coffee, smoke, have a quick bite, smoke, get a shower, smoke, walk to work, three smokes. Easily seven before I got to the office, then it was out every 45 mins, three over lunch, three on the way home, and then basically chain all evening.

I started Juul in late 2017, was off smoking completely by April 2018 (3 pods a day) and quit Juul cold turkey January 1st, 2019. I’d tried to quit millions of times over 10 years, but Juul made it easy.


> wake up, smoke, make coffee, smoke, have a quick bite, smoke, get a shower, smoke

This rings absurdly true with me. I realized at some point that a cigarette was a little celebration ritual that I went through after completing anything.

It's also why I'm negative on vaping as a tool for quitting; it doesn't get rid of that ritual part. Snus (someone else also mentioned dipping elsewhere in the thread) does. Entirely quitting the impulse to the ritual took me a good two years, and having the nicotine hit from the snus helped me through it. Quitting the snus was a fairly miserable two weeks.

I'm not denouncing vapes, though, because although I don't think they're good for quitting nicotine addiction, they're good for quitting cigarettes, and that's good enough to lengthen your lifespan by 2-3 years, and the lifespan of your lungs by 10-20 probably. I don't know that we know what the long term effects of inhaling propylene glycol are, but there's no doubt there's a better outlook than cig smoke. I just can't help but recall how gross and unpleasant inhaling what smoke machines produced was when I was in a touring band.

edit: entirely incidentally, I feel that ritual made me more productive. Between cigarettes, I felt like I was supposed to do something before the next cigarette. It was like: finish writing that function, smoke, get to the point where I can run tests, smoke while the tests were running, get to the point where I can run benchmarks, smoke while benchmarks are running, get to the point where I can hand things off - make the call to the person I have to hand it to, smoke.

After quitting, life seems more dreamy, spacey, and unstructured. I think that's a point for vaping, although I think the fact that cigs are discrete units that lower in quality slightly after having been put out is both a factor affecting the ritual, and a quality that vaping does not have.

Quit smoking at least 7 years ago, so this isn't just addict wistfulness.


> Some people just have a cig burning almost all of the time, but might actually only take 2 or 3 draws off of it and the rest just sits there burning.

That describes pretty well how I smoke the ecig: all day long, maybe three puffs every few minutes. While the normal cigs (maybe four a day) I inhale greedily at high speed.


In the "good old days" I used to know a woman that would always be smoking. She would light the next cigarette with the last of the old cigarette. I have no idea how many cigarettes she would go through a day, but it must have been more than 4 packs.


I chain smoked while on the computer. If I couldn't smoke inside I'd do things on my phone outside. Yeah it cost a fortune.


Well, guess why they quit.


How on earth did you have time to smoke two packs a day - I was a pack a day smoker, steady, could set your watch by it - I cant fathom having the time to finish 2 packs a day.


I was a half-pack smoker and I feel the same about you smoking a pack a day.


I'd chain smoke on the way home usually, or whenever driving.


Driving for your job is what did it for me. I was normally a pack a day, back when I smoked, but on days where I was driving a work truck all day long? Easy 2 pack day.


Do you feel any healthier after this switch?


Nicotine salt versions of "vape juice" have been available for ages - unsure how Juul have managed to patent this (possibly when used in a cartridge system with a juul brand on it). If you consider vaping to be a smoking cessation device, then I can't see how the salt version "isn't good" - it better mimics the thing you're trying to kick. To take an example of what existed before from pharma. Cessation was originally 'patches' - that gave you a low and slow release of nictotine. Problem with this was that it didn't mesh at all with the experience of smoking ~ "I feel tense, I need my hit hits Ahhhhh shudder" All the wonderfully approved pharma solutions recognized this. We had gum, we had mints, we had raw nicotine we could spray under our tongues to mazimize that hit to the brain. Anyway - my point from this paragraph is that I fail to see how quitting with a 'hit' based approach is suddenly wrong now it's done by vaping.

Secondary point is that "addiction to nicotine" isn't actually "bad for you". Well no more so than a double-espresso-shot. If you have a puritan streak in you that feels that all chemical influence on your mood 'is bad' then 99% of your potential target is not vaping. Let's start with "glass of wine after work"


>Nicotine salt versions of "vape juice" have been available for ages - unsure how Juul have managed to patent this (possibly when used in a cartridge system with a juul brand on it).

What sets Juul's liquid apart isn't the nicotine salts, which as you said have been done before. If I'm not mistaken Juul was the first company to use benzoic acid in their nicotine salts.


They may have been the first in the e-liquid world, I'm honestly not sure. However, this has been studied by tobacco companies decades prior:

https://www.degruyter.com/downloadpdf/j/cttr.1983.12.issue-2...

Also as a possible correction, they're not adding benzoic acid to nicotine salts, rather they're using benzoic acid and freebase nicotine to make nicotine benzoate - which is a nicotine salt. I may be misunderstanding your phrasing though, if I am I apologize.


Edit: did not intend this to be rude, and I ignored your "If you consider vaping to be a smoking cessation device" qualifier. It's good for that, and for hooking teenagers apearantly.

>I can't see how the salt version "isn't good" - it better mimics the thing you're trying to kick.

I think there may be a misunderstanding here.

This article is about the FDA "discussing the potential for drug therapy to help addicted young people quit". "The FDA has concluded that the level of addiction it is seeing among youthful e-cigarette users is so disturbing and so unprecedented that it needs to at least ask whether we need a solution that goes beyond what we ever did with cigarettes,"

>I fail to see how quitting with a 'hit' based approach is suddenly wrong

Breaking nicotine dependance is the goal. Nicotine salt versions were available but much less common vs freebase suspentions until recently. Introducing other drugs to combat nicotine addiction seems like a more drastic and less sucessful approach vs vaping of formulations that cause less violent blood nicotine level fluctuations combined with gradual reduction in nicotine concentration.

If electronic inhaled caffine delivery devices existed with newly popular caffine suspention formulations that promoted increased daily dependence and high frequency of device usage and also had rising popularity among teens and pre-teens, I would view them as a slightly more serious "bad for you" problem to address.


"Breaking nicotine dependance is the goal." I'd disagree. Stopping people smoking is the goal - as that's what causes the damage. Breaking nicotine dependency is definitely one way of doing this, but if it can't be broken, switching delivery mechanism from smoking is nearly as good.


I agree switching delivery mechanism from smoking to vaping is good, but in the case of this article the issue here is youth becoming nicotine addicts by going straight to vaping.

This phenomena will likely increase as Altria brings there centuries of proven addiction expertese and research to JUUL.


Nicotine damages the liver


Over on r/OpenPV on Reddit someone might be able to get you the right connections. It's a subreddit community for people who build/recycle e-cigarette batteries.

A lot of them are hobbyists but there's a few who've made a business out of it and they might know the right people.


thanks for the pointer I'll head down the reddit hole this weekend!


Vaping can easily ween people off nicotine all by itself. Start buying 3 nic & 0 nic juices and slowly reduce the nicotine count (i.e. you can mix the two proportionally).

Within a month or two you can be at 0 nic and smoke out of habit instead of compulsion. Soon after you start to forget to even do it and it fades away. The final trick though is to remember to throw it all away. Not right away - give it a few months. It'll be easy.


Wean. Ween is a kickass band.


What the biological rationale as to why nicotine salts deliver a higher peak?

It’s generally accepted that freebase alkaloids are most rapidly taken up by the body as they are non-polar and pass through cell membranes more quickly.


Anti-tobacco extremists believe the ends justify the means. They'll happily give people dangerous psychoactive drugs or get them hooked on nicotine replacement therapy if it means advancing their agenda.

I quit smoking a couple years back and I was baffled by the lack of quality information I could find online. It's 90% propaganda, thanks to the anti-smoking warriors. Most of it pushes these quit-smoking drugs or just different forms of nicotine intake (which is the very drug you're supposed to be trying to quit in the first place).

You'd think we would have collectively learned something from the abysmal failure of things like the DARE program and abstinence-only education. Facts work better than scare tactics and propaganda.


>Most of it pushes these quit-smoking drugs or just different forms of nicotine intake (which is the very drug you're supposed to be trying to quit in the first place).

Wait, what? I thought nicotine itself was pretty harmless, and that most of the harm from smoking comes from all the other junk you suck into your lungs? Wikipedia seems to agree:

>The health effects of long-term nicotine use are unknown. The general medical position is that nicotine itself poses few health risks, except among certain vulnerable groups, such as youth. Nicotine use as a tool for quitting smoking has a good safety history.

https://en.wikipedia.org/wiki/Nicotine


Nicotine is viciously addictive. I don't see how anyone could consider one of the most addictive substances, and its associated withdrawal symptoms, to be "harmless".

And yes, nicotine replacement therapy has a decent track record compared to other methods, which should not be surprising since you don't have to actual break the addiction. You just maintain the same addiction with a different delivery system.

Interestingly, vaping itself is just another nicotine delivery system, but one that the anti-smoking zealots decided to demonize, unlike the various inhalers, patches and gums they push.


>Nicotine is viciously addictive. I don't see how anyone could consider one of the most addictive substances, and its associated withdrawal symptoms, to be "harmless".

Addictive stuff is bad if taking it has other negative effects. Food, water, and air are likewise addictive, but that doesn’t mean you should do without. You’d need to cite something other than being addictive to establish a reason to avoid them entirely.

>And yes, nicotine replacement therapy has a decent track record compared to other methods, which should not be surprising since you don't have to actual break the addiction. You just maintain the same addiction with a different delivery system.

I think the idea is to follow them up with a tapering off of the nicotine levels, which is much easier at that point.


> Food, water, and air are likewise addictive

This is a perverse usage. The physiological need for food, water, or air is innate; it arises from your body itself, not the action of the external substance on your body. Additionally they do not induce the classical development of tolerance.

Many people would hold that addiction itself is bad. Even if there are no other negative effects, there is the effect of dependence on the addictive substance and commensurate loss of independence (the addiction always occupies some mental space since you must always think about how you are going to satisfy it).


Okay, if I may rephrase the point in a less cheeky manner:

It's not very informative that a substance is addictive in the sense that "you must use this every day or experience extreme negative side effects". You have to also look the cost of taking it and what it does to you when you use it.

I have to constantly eat to stay alive? Manageable. I have to consume water and breathe air? Manageable. I have to inject 50 cents of insulin? Manageable. I have to absorb 50 cents of nicotine? Manageable.

If I have to consume expensive amounts of crack, which also makes me homicidal? Okay, then that's a problem.

I was objecting to the OP's criticism of the lingering nicotine addiction and usage as some kind of be-all end-all deal-breaker. No, it depends on the relative harm. If you go from "expensively sucking down toxic junk to get your nicotine fix every day" to "taking a cheap nicotine-only does everyday", that's not defeating the purpose of anything, and it's very much missing the point to dismiss it as "still being addicted to nicotine".


There's a difference between a physiological need, like consuming water and air, and a chemical dependence.

> I have to constantly eat to stay alive? Manageable. I have to consume water and breathe air? Manageable.

No matter where you go, the entirety of society is structured around the fact that all people need to eat, drink and breathe.

> I have to inject 50 cents of insulin? Manageable. I have to absorb 50 cents of nicotine? Manageable.

This is where the disconnect is. The cost of insulin dependence is not merely the cost of insulin itself. An insulin dependent person must always be aware of their blood sugar levels and diet. They must always be prepared for a situation in which they're away from their insulin supply. They must be prepared for an emergency or incapacitation due to complications with their condition and its treatment. There's a significant cognitive load that isn't accounted for by the fabric of society like the need for food is.

Likewise, there's a psychological, social and occupational cost to nicotine addiction that isn't reflected in nicotine's price alone.

This is why people are saying that chemical dependence is inherently bad: it's an inconvenience at best, a costly burden to most and a killer at worst.


I think the idea is to follow them up with a tapering off of the nicotine levels, which is much easier at that point.

And indeed, if you fail to taper off, at least you’re doing yourself much less harm.


I'm guessing you have never struggled with nicotine addiction, or perhaps you're one of those people who experiences a more mild addiction than average.

But if most people were to develop nicotine addiction for several years and then stop for a week, they would experience mental anguish far beyond what anyone could consider "healthy". For long time smokers, that anguish can go on for months.

Healthy people do not experience intense mental suffering simply because they don't have nicotine. It's a disease - an illness - even if it does not cause cancer.


> Addictive stuff is bad if taking it has other negative effects.

I get your point, but I think it's a bit oversimplified. I think that addiction itself can cause problems, even if it's just distress from feeling a lack of control. I've had several people tell me that caffeine addiction is no big deal if you're getting it from mostly healthy or neutral sources, but I remember being addicted to caffeine for sleep/attention regulation and for me that dependence was stressful on its own.

Another example might be porn addiction, which is well-known to have negative effects due directly to the dependence on certain stimuli to achieve certain mental/physical states.


> Addictive stuff is bad if taking it has other negative effects.

The definition of addiction includes negative consequences. If there aren't any, it's not an addiction.


Then my point is equivalent to saying that the parent didn’t establish it as being addictive under that definition.

Dictionary definitions don't help resolve a debate on the substantive points.


Food water and air are not addictive. They are necessary for survival.


It is viciously addictive, yes, but it's all that other crap in cigarettes that lead to lung cancer and heart disease, two of the largest killers of all people.

Would you rather people be addicted to just the nocotine, or the nicotine plus carcinogens?


Don't forget the MAOI's that also contribute to the addiction.


Nicotine addictiveness seems to vary based on consumption method, I say that as someone who smokes cigars but doesn't inhale (common practice among cigar smokers), I don't find cigars addictive in the least.


how do you smoke without inhaling the smoke? Genuinely curious, I thought the whole point was to inhale the smoke, otherwise you don't get any flavor.


Ahh by inhale I mean you don't inhale into your lungs, mouth only.

You take the smoke into your mouth where you can taste it but continue to breath freely through your nose without taking any smoke down into your lungs.

You do absorb nicotine through the lining of your mouth and it's not without risk, mouth cancer is a possibility but my understanding is it's a much lesser risk than smoke in the lungs.

Finally you can retrohale where you allow some smoke to come up through the sinuses and out via the nose, which allows you to pickup some extra flavour.


You can taste wine and spit instead of swallowing, to give just one of many examples.


Your lungs don't have taste buds, those are in your mouth.

You take the smoke in your mouth, mainly. You might pump it through your nose, too.


Tobacco is viciously addictive. Nicotine on its own is only mildly addictive. Tobacco contains MAOIs that potentiate nicotine.


>> Nicotine is viciously addictive.

I hope you are equally against sugar which is also addictive and has much worse adverse effects than nicotine.


I've never had a panic attack at the airport because I couldn't have sugar for a couple of hours, but I have had one because I couldn't vape. I've never yelled at a coworker because I couldn't have a cookie, but I did when I was quitting nicotine because it made me feel insane. I've never lashed out at my girlfriend because I couldn't have a Coca-Cola, but I did many times when my vape's battery had died and she wanted to stay out of the house a little longer, or I had run out of e-juice. I quit a couple months ago and it's been life changing, just to not have the dependence.

When I give up sugar I do not instantly find that my relationships are easier to manage, for instance, without the demon of sugar addiction popping up into my brain to have me lash out at my loved ones who are standing in the way of another hit of sugar. Even putting it that way sounds absurd, but swap in nicotine and it makes perfect sense.

Obviously you don't understand the true mind-bending power of nicotine. The comparison to sugar is one that could really only be made by someone who has never experienced a nicotine addiction. I say this as someone who loves sugar and tries to cut back. It's not the same. It's not even slightly the same.


>I've never had a panic attack at the airport because I couldn't have sugar for a couple of hours, but I have had one because I couldn't vape.

Maybe you haven’t, but low blood sugar diabetic emergencies are a thing.


I worked with this guy. One day, there was a piece of paper stuck up outside his cube that said (as best I remember): "I am trying to quit smoking. I am a Vietnam vet and I have worked in the post office. All that is standing between you and sudden death is this silly little patch I am wearing. Be very kind to me."

Yeah, nicotine withdrawal can be a real thing.


According to your source the ld50 for nicotine is 6 mg/kg. Although the dosage taken is relatively low, nicotine is still way more toxic than most things people consume on purpose.


LD50 is entirely irrelevant to this discussion. No one goes to the store and orders 1mg/kg of a substance. When considering acute harm, the relevant metric is the ratio between a typical recreational dose and an overdose. For example, there are very few tobacco servings that contain more than 20mg nicotine. A person is very unlikely to come anywhere near the, say, 360mg lethal dose.


Nicotine is more toxic than tar and other substances, as measured by the LD50; it's just that those substances are all really hot and carcinogenic.

360 mg / 6 = 18, less than 1 pack has a lethal dose of nicotine. However, since uptake by the body is low for nicotine, smoking what would seem to be a lethal amount doesn't kill people.

https://www.webmd.com/smoking-cessation/nicotine-poisoning-c...


Does anyone else remember when marlboro released cigarettes with less nicotine in them and marketed it as a healthier choice?


Wait, they said the lower nicotine made it safer? I'd always heard it as being the lower tar that was supposed to be healthier?


Yup, a quick google turn this up. I remember being confused as a child when adults would tell me theses were healthier. They would always just smoke more.

https://www.nytimes.com/1992/01/18/business/new-philip-morri...


I guess the idea is not that nicotine is inherently unsafe, but lower nicotine levels will lead to lower addiction levels, leading to fewer cigarettes smoked?


The drug approach is pushed by the pharma industry of course, exploiting the natural appeal of the idea that one can just take a pill to fix a problem that is as complicated as addiction.

Doctors prescribe these because they (probably rightly) believe not that the drugs are harmless, but that the side effects of the drug are less harmful than the direct effects of continuing to smoke.

Really quitting takes either a major motivating scare like a cancer diagnosis (for some people even that isn't enough) or a very determined decision to stop.


Most of it pushes these quit-smoking drugs or just different forms of nicotine intake (which is the very drug you're supposed to be trying to quit in the first place).

Hell no. Nobody really gives a shit if you consume nicotine or not. We should just avoid doing so in the form of a horribly dangerous delivery system.


People who are addicted to nicotine care very, very much if they have or do not have nicotine.

You seem to be talking about yourself. I'm talking about people suffering from the addiction.


Definitely, but being addicted to something that will make you chronically ill and kill you is much worse than being addicted to something that won't.


> Anti-tobacco extremists believe the ends justify the means. They'll happily give people dangerous psychoactive drugs or get them hooked on nicotine replacement therapy if it means advancing their agenda.

Their "agenda" of not dying of lung cancer? It sounds like you're vindictive towards people who don't appreciate smokers pumping our air full of carcinogens.

Nobody cares whether or how you get your high. The only reason anyone gives a shit about smoking is because we're tired of choking on ash and tar whenever a smoker walks by. You may think it's tolerable, but you're also the one inhaling through a filter: we have to breathe the shit that comes out the other end.


In this case, it's about vaping, which has nothing to do with lung cancer or your fear that you will smell a cigarette while walking next to a street filled with burning gasoline.


This particular sub-thread is about smoking, not vaping. My parent comment was complaining that most of the anti-smoking treatments still contained nicotine. Thus demonstrating that they missed the whole point of anti-smoking treatments.


I cannot fathom how people still use phrasing like "drugs and alcohol" and "drugs instead of vaping" etc.

How can there be such a disconnect, those are first class drugs! Is it cognitive dissonance, i.e. actively refusing to acknowledge it? It's pretty much universal too, not just one or two countries.


It's tempting to dismiss it as the alcohol lobby being powerful... But methinks this documentary gives a more appropriate answer:

https://www.youtube.com/watch?v=RX2opvj7WE8


This just reminded me of the time, not too long ago, I was on a date and she said to me, "I'm not into drugs." The problem was, she was on her second cocktail.


Personally...I like to be really pedantic and point that out to people who say that while drinking a coffee...and consuming the most widely used stimulant in the world.


Being pedantic can easily be addictive / a drug; win a little logic game, score some imaginary points! Especially on an internet forum.


Bad analogy... The drug you're thinking of might be dopamine released by your brain, but not a third-party drug like alcohol or caffeine, like everyone else is talking about.


It's not just that, it's also pharmaceutical drugs. As far as I know, I'm the only one to ever try to come up for an estimate of total deaths from all drugs, and people (including on HN) complained quite a lot about it.


If you objectively try to figure out the most dangerous drug in the world, you'll quickly find out it's alcohol. Alcohol makes people act dangerously and kills tens of thousands in car crashes(in the USA at least). In the USA alcoholism is also normalized in popular culture but especially on college campuses. It's absolutely insane how we turn a blind eye to alcoholism and yet demonize drugs like cannabis and psychedelics which have comparatively little harm to others.


Yes but alcohol has been widely used by people since before there really were any laws at all. It's deeply established in social rituals, religion, etc. So it has been normalized for millennia. You can create policy to try to control new harmful things, while at the same time recognizing that other things are too entrenched to really do anything about.

And we do have the converse also. Driving under the influence of alcohol is strictly prohibited, but rules for other drugs are much less standardized.


Most countries allow driving under the influence of some alcohol. How much varies. Rules for other drugs are usually zero tolerance or observable impairment.


>So it has been normalized for millennia

Alcohol abuse is not normalized in most developed nations. America is a harmful exception.


I don’t know where you are getting this info from. Both legitimate data (https://en.m.wikipedia.org/wiki/List_of_countries_by_alcohol...) and my personal anecdata support the fact that the US isn’t even close to being the country with the most normalized attitude towards alcoholism. Just visit South Korea and try to count the number of drunk salarymen passed out outside.

For those lazy to click the link: the US is 24th in terms of alcohol consumption per capita on that 2015 list of developed countries, out of 33 total. In the older list from 2010, which featured more countries, US was number 48.


This is a good case of statistics being insufficient without proper interpreting. There's a huge difference between the health of someone who has one drink with dinner every day and someone who has seven drinks in one night every Friday and passes out at a bar. Mere total alcohol consumption is insufficient to determine abuse.


Sure, but you'd need to give some evidence that the USA's distribution of consumption is notably different than similar Western countries, e.g., the UK or Germany, which consume 25-30% more per person than the US. Basically the US would need to have a lot more heavy drinkers and a lot more (near) teetotalers for it to have both a (non-trivially) lower average per capita AND more dangerous drinking habits.


I'm not sure if that evidence exists or is easy to find. From anecdotal evidence I can say that the people I've seen drinking in America either drink quite rarely (a couple times a week) and far too much at a time (vomiting) or hardly drink at all. Anecdotally I've learned that in parts of Ireland you can see people drinking very regularly but not so much that they get drunk when they do drink.


Your liver doesn't really care the time frame over which you drink the alcohol.


Are you sure about that? Steatosis is reversible if you give the liver time to recover, for example.


Whether it's one drink a night or seven on the weekend, yes, it doesn't really matter.


You are correct, but there could also be a point about binge drinking versus steady consumption.


Russia, England, Australia, New Zealand, Germany, and large parts of Eastern Europe disagree with that assertion.


Seems like another unnecessary slam on America. I think the UK, Canada, and most of Eastern Europe have greater alcohol consumption per capita.


>> If you objectively try to figure out the most dangerous drug in the world, you'll quickly find out it's alcohol. Alcohol makes people act dangerously and kills tens of thousands in car crashes(in the USA at least).

Well no. If you want to be objective (in the USA at least) it's opioids. Also, If we had better stats on suicide I bet more would be done with opioids than alcohol, but I'm speculating at this point.



That source is a few people in a room having a chat and creating a list of the most harmful drugs based on their opinions.

It's not really a source.


It's a survey from more than a couple dozen drug experts. If citing one expert is a source, then citing a survey of multiple experts is also a legitimate source.


That chart was an assessment of the situation in the UK in 2011, not the US in the present day.


Our drinking age is too high. This results in the negative outcomes related to alcohol use on campus, including habit forming behaviors that hurt people later in life.


I agree with this. I think the drinking age (21 in USA) should be several years before the driving age (14-16 depending on which State) -- if anything invert the two.

This way, young stupid people have a chance to get familiar with the judgement-clouding effects of alcohol long before they are able to propel a 2-ton weapon at others.


And long before they're on their own, susceptible to all kinds of peer pressure.


They didn't exactly turn a blind eye.

They tried prohibition in the US, it didn't work.


It did work, but there were a lot of unintended consequences. I no longer have the source link for this bit, but it's from a post-grad who extensively researched that era.

> It's a common myth that Prohibition did not work in the US. In reality it worked far better than those pushing for it realized. What we need to remember is that Prohibition was foisted on the US buy the upper class who felt that alcohol was keeping the working class poor and uneducated (the myth of Demon Rum is still a prevalent one today, albeit it's evolved quite a bit). Prohibition was actually effective at reducing the overall consumption of alcohol and shutting down illegal speakeasies. There were a number of unintentional consequences though 1) The alcohol industry brought in so much money to the state and federal governments that even the passage of Income Tax was unable to make up the loss. 2) Those who pushed for Prohibition never expected it to be equally enforced and once Law Enforcement was able to get working class consumption under control they started enforcing it on the upper class and politicians which of course did not go over well. 3) There was a surge in crime due to the creation of a massive black market which also encourage rampant political corruption both of which were a bad look for the United States. 4) There were so many loopholes in the Volstead Act that it was costing a fortune to enforce the law.


Not to mention that prohibition of a drug always makes the black market drug more concentrated and therefore more dangerous.


Prohibition worked in a not very meaningful sense. Alcohol consumption fell sharply at first but gradually recovered.[1] It didn't have the benefits its supporters said it would. Most people came to believe it did more harm than good.

[1] https://www.nber.org/papers/w3675.pdf


The exact same consequences are being seen again today primarily in the opiate market


Just because alcohol is bad doesn't mean other things are not also bad.


I never claimed that. I think that's derailing the conversation. The point is that our cultural (and law enforcement) ideas around drugs are straight up delusional and entirely detached from reality.


It's pretty clear that US laws don't treat alcohol the same as most other drugs with regards to the potential for harm, but I think it's a big leap to say that Americans are "straight up delusional and entirely detached from reality." I'm sure people do underestimate the dangers of alcohol, especially for long-term health, but I feel like it's very well-known that alcohol kills way more people than e.g. marijuana.


And yet, one is legalized in every state and the other is a schedule one drug on par with Heroin (although legal in some states).


Right. But public policy does not correlate strongly with what the public wants. I’m making the distinction between laws and culture.


The drug scheduling regulations are delusional and do not reflect the actual research potential, medical use, or harm potential of drugs. I'd remind you that marijuana is scheduled more harshly than cocaine, and so are a lot of other relatively harmless drugs.


Yes. I’m making the distinction between the laws and what the people actually believe.


Just because murder is bad doesn't mean jaywalking isn't also bad.


Alcohol has both culinary and intoxicant facets. Mild inebriation as part of its consumption with a meal or social occasion is in my mind a different phenomenon, and when someone speaks of "doing drugs" they are referring primarily to the latter, not the former. Certainly alcohol among college students or party goers is "doing drugs." But wine with dinner can only be considered such if one is being pedantic/legalistic/reductionist.

I don't enjoy being drunk. I enjoy wine or beer in small quantities, especially with food. The production of both has deep roots as a means of preserving fresh fruits and grains, and dealing with potentially non-potable water supplies. That it intoxicates I'm sure makes it more attractive, but heavy intoxication is generally frowned upon in cultures where beer and wine have deep historical roots.


It has to do how we define the word "drugs" culturally, not the reality of whether or not a substance is both addictive and toxic. Alcohol and vaping are culturally accepted drugs that everyone likes to use, so people don't like to think of them as being in the same category as the "bad drugs", which only addicts use.

Also, most people can regularly use alcohol and tobacco without it consuming their life, so I think this is an important factor. The same cannot be said for heroin or crack.

Edit: I'd also like to add that I know a number of people in my generation (millenial) who would consider themselves soft drug users. This would mean marijuana and maybe some hallucinogens occasionally. In Canada at least, regular usage of marijuana is very much normalized amongst my generation. It's not really considered any worse than drinking and I think you'll see over time that marijuana culturally is defined outside of the "bad drugs" category.


Bright idea: instead of letting kids vape (harm profile: uncertain, could be low), let's hook them to drugs like Varenicline (Champix) which are known to cause thing like cardiovascular diseases and suicide ideation.

(Actually, it's a bright idea for all the parties involved, because "think of the kids" brings positive karma points, and parents and insurance plan will cough up the money)


What a surprise: Varenicline is still under patent and available from only one provider in the USA https://www.drugs.com/availability/generic-chantix.html

I wonder who's paying the dinner bills after today's hearing.


I suppose we are both bad cynical people because I thought the same when reading the article


Chantix is known for causing weird gory nightmares of skin peeling off and menacing entities and such. Creeps me out, wouldn't want to give it to children.

http://nymag.com/news/features/43892/

The fact this wasn't caught until after this drug was approved by the FDA really makes me question the efficacy of our extremely expensive drug regulatory system.


> "I believe FDA posed the wrong questions for today's meeting," said Lauren Lempert, a law and policy specialist for the Center for Tobacco Control Research and Education at the University of California, San Francisco.

> Instead of debating the role of nicotine replacement and drug therapies, the agency "should be focusing on policies that will prevent youth initiation with e-cigarettes and addiction to nicotine,"

I've been noticing this form of argument... in case it's not clear why I find it strange: yes, for a hypothetical child it's ideal that he not get addicted in the first place. But you still have these children who are addicted, that's a real problem, so while it's useful to also consider prevention, a regulatory agency is mandated to address an actual problem.


Why would you plan to continuously use band-aids when you could prevent getting cuts in the first place?

It seems more important to address the source of the issue to prevent it from continuing to occur rather than only treating the symptoms. (Fixing the current is still important, but seems secondary to me)


I think the issue is some previous data that we also discussed here, this data shows that if before we had N children smoking now we have N1 = 10*N children using the cool looking, sweet tasting, less harmful e-cigarettes. If we had N1 = N then I would consider it a good thing but unfortunately is not that, Btw I invented this numbers but the point still stands.


It seems to me that it would be in the best (financial) interests of big tobacco and pharma that vaping be outlawed entirely.

Failing that they would probably both find it in the their best interests to force companies who want to produce vape related products through a regulatory process so expensive that only massive companies such as Marlboro or Pfizer can afford to comply - can’t have the little guy taking a slice of their poison pie.

I think that if kids are going to try nicotine (and let’s face it - they are) better it be through a vape than a cigarette.

Anecdotally as a person who has sometimes smoked as many as 100+ cigarettes a day - I am finding vaping to be helpful in quitting the horrible cigarettes and if it were not offered as an alternative, would probably go back to smoking because none of the other cessation methods have been effective for me.

I know both smoking and vaping are far from ideal but the lesser of two evils is still better any way you slice it.

When you have something that is taking significant profits from big companies, one of the first ports of call for them is to whip up some hysteria along the lines of “think of the children” if applicable.

The rhetoric surrounding this appeals to something deep within human nature and it becomes trivial to demonise people who have a contrary point of view - in this case people who happen to be proponents of harm reduction and freedom of choice.


https://www.hhs.gov/ash/oah/adolescent-development/substance...

I posted a very well researched response, to a similar article (unfortunately somewhere else, I can't remember where).

As a big opening gambit - "Smoking rates of children have gone off a cliff since ~ 2000". Not only have they dropped, they've accelerated. If any of this acceleration is associated to the corresponding increase in vaping over this time, then the vaping industry is possibly the leader in saving lives. (I'm open to other suggestions).


> If any of this acceleration is associated to the corresponding increase in vaping over this time, then the vaping industry is possibly the leader in saving lives.

That doesn't appear to be the case.

See the chart in https://www.motherjones.com/kevin-drum/2018/12/the-juul-fad-...


That's trends in percentages - not absolute numbers Makes perfect sense that. If there are more smokers than vapers (which there will be historically as vaping is new and smoking is old) - then a few switching to vaping will cause the smoking like do drop a little, and the vaping line to go up like a rocket. i.e. If there were 100 smokers and 10 vapers. Then one of them switches. Smoking has gone down 1% and vaping up 10%.

Plus doesn't seem to include relative harm. I'd have thought it would take a large number of non-smokers taking up vaping, to match the harm-reduction of one smoker switching to vaping.


What? No.

It's the percentage of high schoolers who've tried each. 1% of high schoolers switching from smoking to vaping will cause the percentage of high schoolers smoking to go down by one and the percentage of high schoolers vaping to go up by one.


My apologies. I was just recycling a previous argument against a different report (without reading this one properly).


Where there’s a way, pharmaceutical companies will make money.


I can't read this article without shuddering. It sounds completely hysterical about kids using what is considered a smoking cessation tool, that is not proven to cause any harm, and that delivers varying, but usually pretty low, if not zero, amounts of nicotine.

The solution? Prescribing other drugs to these kids (as if there are any that actually work against smoking, except the very one they're trying to gegt them off).


> I can't read this article without shuddering.

It's a wonderful example of fake news, using clever (but technically true, if someone ever called them on it) language to persuade people to be scared.


[flagged]


> The fact that the sweet potato in chief uses "fake news" to mean "news I don't like" doesn't mean that the rest of us should adopt that definition.

What is the proper definition of fake news? For me it means news that is presented as true fact but is not, or writing that forms an impression that is not conclusive based on known facts. If it's some propaganda website I don't give it much thought, but this CNN which many people claim is respectable, and the source organization is the FDA.

Just a few examples:

> A few years ago, it would've been incredible to me that we would be here today discussing the potential for drug therapy to help addicted young people quit

Is the addictive nature of smoking the reason why we discourage it's use?

> The agency announced in November that vaping had increased nearly 80% among high schoolers and 50% among middle schoolers since the year before.

Percentages starting from a low base are misleading. Were the actual numbers omitted for persuasive reasons?

> Experts worry that the devices could put kids' developing brains at risk...

"Worry"? Is this based on scientific studies?

> ...get them hooked on nicotine early in life and be a gateway to smoking and other drugs.

Is this based on scientific studies?

> But, the long-term effects aren't clear.

Neither are the short term effects. A more correct way to say it is: we don't know, what we're saying is pure speculation.

> "The FDA has concluded that the level of addiction it is seeing among youthful e-cigarette users is so disturbing and so unprecedented...

Why is it disturbing? Why does it matter if it is "unprecedented"?

> ...that it needs to at least ask whether we need a solution that goes beyond what we ever did with cigarettes," Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, previously told CNN.

I'm not following the logic of why anything "needs" to be done.

> Medical experts say there is an urgent need for research on using therapies to treat kids who are addicted to nicotine.

Is this "urgent need" based on science?

> According to experts, most of what we know about nicotine addiction in teens, we know from cigarettes. But the technology and chemistry of vaping might pose an entirely different threat.

"Might".

> "These products deliver very high levels of nicotine, meaning that even brief experimentation is likely to put adolescents at risk for long-term dependence,"

"likely...at risk" - this one is fantastic because it has two levels of uncertainty, yet still communicates fear to those who lack (or choose not to exercise) critical thinking skills.

And again: is this vague claim based on science?

> "Clinicians urgently require new solutions to safely and effectively help stop them using these and all tobacco products for good," said Tanski

Why?

> "Preventing youth use in the first place should be FDA's primary goal," she said.

Why? Taxpayers pay for this, they have a right to ask such questions.

> "We must all recognize that if an adolescent has developed a nicotine addiction as a result of vaping, we've already failed."

Is preventing nicotine dependence even part of the mandate of the FDA? If so, why?

I'm rather skeptical about any "news" written in this style, especially when it comes from an institution like the FDA who we are told(?) are fact-based and work at arms lengths from corporate influence (there are several billion dollar industries with conflicting interests in this topic).


I understand what you mean, it's an excessively alarmistic article that doesn't seem to adopt any critical perspective on what it is reporting. However, almost all that it's reported is quotes from interviewed people, so it's hard to call them "fake news": if FDA commissioner Scott Gottlieb says that

"a few years ago it would've been incredible to me that we would be here today discussing the potential for drug therapy to help addicted young people quit"

that's his opinion, and the news that he made this statement isn't fake.

On the other hand, the article also contains a lot of vague attributions, such as "Experts worry that..." "Medical experts say..." "According to experts..." "Health advocates said..." which are sloppy and could hide partisan or minority points of view. But it's mostly a very trivial report of a public hearing of the FDA on the topic that happened today.


> that doesn't seem to adopt any critical perspective on what it is reporting.

The article as well as the statements of the FDA employees are not just non-critical, they are one-sided and misleading, implying serious risk where none has been detected.

> that's his opinion, and the news that he made this statement isn't fake.

It's not false, but whether it is fake is a different question (see my sibling comment here: https://news.ycombinator.com/item?id=18943914).


Sounds like you disagree with the author about the implications of the news. So read from a paper with a different editorial angle. Having different political opinions than the author doesn't make it fake.

As to your question, fake news is news that is fake. Made up, fabricated.

Here are some examples of fake news.

Nancy Pelosi was thrown out of the House for being drunk. http://archive.is/CNjNG

President Trump donated a billion dollars to the border wall http://archive.fo/dnstc

The Democratic Party of Arizona revealed to be a front for a child sex trafficking ring. https://archive.fo/D8w9E

The NFL has banned the national anthem. https://www.snopes.com/tachyon/2016/06/13321907_101534732086...

Obama banned 4th of July fireworks. https://www.truthorfiction.com/4th-july-fireworks-canceled-d...

Pokemon's creator admits the game was invented to promote satanism. http://www.p4rgaming.com/pokemon-creator-admits-games-aimed-...

George HW Bush was indicted post mortem for human trafficking (this one is weird) https://www.docdroid.net/S6vrLhN/hv1-indictment-george-herbe...

The UN is taking direct control of all American cities. https://www.youtube.com/watch?v=SxWj0LySPB4&app=desktop&fbcl...

Chinese artillery is shelling the US west coast: San Diego and Tacoma https://www.youtube.com/watch?v=-unBq8QCqCU

It's not so much of an issue any more, but crap like this was ALL over the internet in 2015 and 2016, especially in conservative circles on Facebook. I lived in a heavily Republican area at the time, and had a lot of conservative friends who got taken in by it, and some of them never broke out of it, still believing that Snopes is a Jewish NWO front or whatever else the Macedonian huxters told them with an authoritative-looking website.


> As to your question, fake news is news that is fake.

I believe that is called a tautology?

The examples you give are examples of "a" form of fake news, but as far as I know there is no formal definition of it. My understanding is that a democrat coined the phrase to describe the type of fake news spouted by Republicans (your examples), it was then co-opted by Trump to describe news that implies something that is not based on actual facts, but rather uses clever narrative and specific word choices not to inform, but to persuade without technically lying. That's what this article is and once you learn the techniques and start reading with an eye out for them, you'll see how common this tactic is in today's media. If not read with a skeptical eye, this kind of article leaves the reader with a false impression of risk, and the article is based on statements from FDA officials that also communicate a false impression of risk.

Perhaps I'll forgive a CNN reporter for stretching the truth a little (their livelihood is based on attracting attention, desperate times call for desperate measures and all that), but I think it's fair to hold an FDA commissioner to a higher standard, don't you think?


>Experts worry that the devices could put kids' developing brains at risk, get them hooked on nicotine early in life and be a gateway to smoking and other drugs. But, the long-term effects aren't clear.

The vast majority of smoking’s harmful effects are due to the combustion products not the nicotine. It is really unclear if vaping will really have a long term effect on kids. In addition, given that vaping doesn’t really hurt other people via second hand smoke or altered behavior(see alcohol) this whole panic about vaping seems overblown. How much do you want to bet that the “medical experts” who are harping about the dangers of vaping without a lot of data are “consultants” for pharmaceutical companies looking to get their “anti-addiction” drug approved.


Vaping certainly does damage air quality by releasing ultafine aerosol particulate matter (also known as pm10 or pm2.5) [0]. It's worth noting that these are associated with respiratory distress and can contribute to stroke and heart attacks as well as asthma. In fact, we now have compelling epidemiological evidence that vaping almost doubles risk of cardiac events [1].

Think about it like this: would I want to run a marathon on a bad air day in China? Probably not.

[0]. https://www.nature.com/articles/s41370-017-0005-x?fbclid=IwA... [1]. https://www.ucsf.edu/news/2018/08/411476/risk-heart-attacks-...

Edit: Study 1 focused on PM10 (particulate matter smaller than 10 microns) air quality levels, and not PM2.5. PM 10 tends to be associated with more acute respiratory distress, while PM2.5 is a more chronic threat [2]. Nevertheless, there is sufficient evidence that monitoring environmental PM10 levels remains an important public health metric.


> In fact, we now have compelling epidemiological evidence that vaping almost doubles risk of cardiac events

If you continue to smoke tobacco.

"Scientific" studies like this that assert causation when all they have is correlation, based on surveys that we know little about (and likely wouldn't be able to learn the full details of even if one was energetic enough to hunt down the original paper), certainly don't do anything to convince me. If anything, it just increases my suspicion around the "science" we're fed.


Well they have correlation that remains correlated after you adjust the model for other risk factors. So is that direct evidence? No.

But when you add in the other lines of evidence, you start building a case. It's sorta like a murder trial (not withstanding a separate discussion of our criminal justice system...) where the case is built over lines of evidence.

And as one of my graduate professors once said, "there is no double blind randomized trial for the efficacy of parachutes" ;) [0].

[0]. https://www.bmj.com/content/327/7429/1459


> But when you add in the other lines of evidence, you start building a case. It's sorta like a murder trial (not withstanding a separate discussion of our criminal justice system...) where the case is built over lines of evidence.

When you're dealing with a murder trial, whether harm has occurred is clear. In this case, not only is there a lack of evidence for causation, there's not even any evidence for harm.


People have died of cardiac events and lung cancer. Some people have used e-cigarettes. Some have not. Is there evidence that connects the use of e-cigarettes to these deaths? That's for science to decide.


Similarly: People have died of cardiac events and lung cancer. Some people have chewed gum while walking. Some have not. Is there evidence that connects chewing gum while walking? That's for science to decide. As it is, we have none. But until then, I'd rather not have it outlawed or be forced to pay for research without some reasonable reasoning that there may be some significant risk involved.


This is literally the same argument that was used in the 60s to defend full-blown tobacco smoking. There are ways to establish causation besides the randomized controlled trial.


That's interesting, but there's something I don't quite get about it, so I am genuinely asking: are the pm2.5 or pm10 the problem, or is it what they're made of? Because I can understand that a 2.5micron sized soot particle (or droplet of water containing soot) can cause health issues when it ends up in the lungs; but what if the droplet is entirely made of something that doesn't cause irritation and is immediately metabolised to something else?


I believe it's the fact that it causes inflammation when your body tries to remove foreign masses. It's a good function that your body does to keep things anew. However, doing it constantly is a problem because it causes long term inflammation and oxidative stress. [0]

[0]. https://www.jacionline.org/article/S0091-6749(18)30029-0/pdf


Yes, I sort of understand, but you're talking about "masses".

I am wondering if the particulate in the studies cited above is not simply made of droplets of propylene glycol and glycerol- which might be well tolerated and simply absorbed and metabolised.

The pdf you linked starts with the statement:

"Decades of research has converged on an understanding that all combustion-derived particulate matter (PM) is inflammatory to some extent in the lungs". (Italics mine)

Particulate emitted by an ecig should not be combustion-derived.


Well two things. You don't need combustion to make chemical changes to organic material. E-cigs still chemically change the organic compounds. We know this experimentally [0].

Second, just because it's not a combustion product, doesn't mean it's safe. The reason why we get lung cancer form asbestos is that the mineral fibers are unable to be fully broken down, and cause long term irritation. Think sand or dust [1].

[0]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954153/ [1]. http://www.npi.gov.au/resource/particulate-matter-pm10-and-p...


I remain with my original question: the original study you cited compares aerosols generated by e-cig smokers with the similar sized dust, pollution and soot particles commonly found outside. There is a correct assumption that particles of that size, when found outside in polluted environments, are especially harmful, because of their geometrical properties combined with the fact that they carry harmful substances. Is it correct to compare pm10 generated by combustion engines with pm10 generated by an atomizer that vaporizes a pharmacy-grade pure- and in theory harmless- substance? Would the same instruments have classified as pm10 water droplets of the appropriate size?


Hmm, your first link only measured PM10 at a vaping convention. Have they compared this to the PM10 of a non-vaping convention in the same space with similar amounts of people? Isn't PM10 a lot less harmful than PM2.5?

The article does discuss other studies on PM2.5, but they seem to be conflicting (some says indoor vaping increases PM2.5, some say it doesn't. Can you edit your comment to reflect the uncertainty here?

For what it's worth, the marathons in China are quite fun.


Looking over the methods, I don't think this specific study included measurements of similar conference density. That said, I would suppose that most conferences wouldn't generate much PM10. Off the top of my head, you could probably compare it to a poorly ventilated kitchen.

For scientific rigor I will edit to include this nuance. PM10 tends to be associated with more acute problems, while PM2.5 is associated with more chronic problems [0]. PM10 remains a closely monitored public health reporting metric. Taken together however, the notion that vaping is "just water vapor" is fraudulent (and knowing the historical context of the tobacco industry, knowingly so [1]).

I will allow myself to complain that there are many threads in this comment section that make very broad statements that are unsubstantiated by science. Though I suppose it's the cross to bear for scientists arguing in good faith.

[0]. http://www.euro.who.int/__data/assets/pdf_file/0006/189051/H... [1]. https://www.wnyc.org/story/gleaning-truth-merchants-doubt/


>In fact, we now have compelling epidemiological evidence that vaping almost doubles risk of cardiac events [1].

Somewhat misleading since more than half of those studied were smoking and vaping. From the study:

Among the 9,352 current and former e-cigarette users, 333 (3.6 percent) had experienced a heart attack at some point, with the highest percentage (6.1 percent) among those who used e-cigarettes daily. In the analysis, a quarter of the 2,259 people who currently used e-cigarettes were former smokers of conventional cigarettes and about 66 percent of current e-cigarette users were also current cigarette smokers.


There is a strong prohibitionist inclination with anti-toboccao advocates, and I think it's based on a fairly common aversion to substances percieved as unclean. Though I vape so I'm self-interested.


What's the current data on the negative effects of vaping? I know it hasn't been out long yet, but I think nicotine has some slight negative effect, and then others complain about the polyethylene glycol.

Especially useful would be to see a burn-down chart of say, new smokers and new vapers of the same age range, and seeing cumulative lung disease and mortality, and seeing how the progress of that differs (or is the same).


Nicotine is still an addictive stimulant so I'd expect you'd get at least the level of bad consequences as letting teenagers make heavy use of caffeine.


I like my air nicotine free please.


I'd like my kids drugs free please.


When you use most drugs they don't go into the air that others breathe in public spaces.



>It's possible that there's a cumulative effect on people from even tiny amounts of these and other pharmaceuticals in drinking water, but this hasn't been proven. And perhaps vulnerable populations (pregnant women, people with disabilities) are affected, although that's also unproven.

So as far as we know it does nothing.


....like cigarette smoke?


Those goals seem to require each other as opposed to being mutually exclusive.


Does nicotine have an medicinal value? It seems to me, it's used as an additive with one ends in mind: addiction.

While I'm not in favor of the Nanny State, the fact that tobacco products (read: known carcinogens) are sold freely boggles my mind. Imagine if a terrorist (e.g., UBL) had said, "I'm going to developer a product that addicts it's users. This product will cause health issue, and perhaps even cause cancer. I'm going to bring this product to the masses wolrdwide."

If such an proclamation where made, the public and the governments would FLIP OUT. The war on terror would ratchet up ten-fold. It's a mad world


Yes. It's an appetite suppressant, helps you focus similar to ADHD drugs, and relaxes you. Snus (steamed tobacco) doesn't have carcinogens, cause cancer, or reduce lifespan. Pipe Tobacco users live on average 3 years longer than non Pipe Tobacco users. Nicotine is not an issue with respect to cancer. It's everything else in cigarette smoke. Nicotine's not even that addictive by itself. What's more addictive are the social behaviors surrounding it. Overcooked steaks are carcinogens and psychologically addictive, should we ban those too?


Quite a few studies implicate nicotine as a carcinogenic agent. Further, nicotine is absolutely terrible for cardiovascular health.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363846/


Thank you! This is an important point that I almost never see mentioned.


There are many who claim that nicotine is like caffeine: an addictive stimulant with no significant downsides.

Note that most of the people who make this argument are either addicts or nicotine sellers, so I am highly skeptical and you should be too, especially since there hasn't been much study on the direct effects of mere nicotine.

If the science comes in and it turns out nicotine really is harmless on its own, and it really does help you focus and suppress appetite and whatever, then I'll be all aboard the vape train, love myself a good nootropic. Until such a time, I think it's wise not to take chances. Give it a few years for the science to settle before getting addicted.


Addiction[0] comes in many forms, and I agree that addictions to things like caffeine and nicotine do not present serious social issues with withdrawal. We all know people that go on and off coffee/tea and we all know people that quit cigarettes. The vast majority of these types of addicts don't have anywhere near the withdrawal issues that methamphetamine and opiate addicts suffer through.

That said, it's still an addiction. I'd advise against any form of addiction [1], and I'd further advise against compounding addictions upon each other. Especially when it comes to nicotine, it's a HARD habit to quit.

Unsurprisingly, the science of nicotine is murky[2], especially the science around non-cigarette based nicotine. That's likely to change as vaping becomes more popular. I would not be surprised if vaping turns out to be slightly less bad than cigarettes, these companies like PM aren't known for their ethics. Vaping on it's own, sure maybe it's not any less bad than living next to the 405. But corporate sold stuff? COme on.

That said, nicotine is a drug just like all drugs. There are good things about it and bad things. With nicotine, the bad mostly outweighs the good. The bad is easy enough to google and isn't something to dismiss at all. The 'good' is vasoconstriction, alertness boosting, and short-lived memory retention; that's about it. These things are really useful if you have a reasonable suspicion that grievous bodily injury may occur to you in the next few hours. So, if you aren't in an active warzone, I'd stay away. Office politics can be vicious, but not that bad ;)

[0] https://www.psychiatry.org/patients-families/addiction/what-...

[1] There is a coffee mug not 2 feet from me at the moment.

[2] https://en.wikipedia.org/wiki/Nicotine


Yes, it's an excellent mild antidepressant. I use it seasonally for SAD and it works wonders. I had no problem quitting last spring and I expect the same will be true this spring - on days this past month when it was above 55F I forgot to even pick up my vape until the next day. If I didn't have this I'd be on bupropion, which is supposed to be really hard to cycle off of and has some terrible side effects.


One striking and highly suggestive statistic: 60-80% of people diagnosed with schizophrenia are smokers. (see e.g. the wiki article "schizophrenia and tobacco smoking", or https://slatestarcodex.com/2016/01/11/schizophrenia-no-smoki...)

While there are many possible explanations for this, a particularly compelling theory is that this is self-medication: nicotine directly alleviates some of the symptoms of schizophrenia, so schizophrenics naturally gravitate towards becoming heavy users.

Along these lines, albeit very anecdotally, many people take up smoking as self-medication for high levels of stress and anxiety.


Nicotine increases alertness among other things:

https://www.gwern.net/Nicotine#effects


Can’t we make some sort of waxy nanostructure material in the form of a cigarette that burns with zero particulates? Won’t help the issue directly but will help smokers.

Here’s an idea - since all vapes except home made devices are electronic, put a Bluetooth chip that requires a phone app that securely identifies the age of the vaper. Make it mandatory for all vaping devices and boom - massive cut in underage vaping.


How about if we make it so they do not start?


like, say, 0% nicotine vaping?


This is exactly how I quit vaping a few years ago. Crazy, right? Offer 0% nic Juul pods for parents to buy their kids and they'll stop giving a shit after a while.


This was originally going to be a reply to ben509's comment but turned into a rambling mess only even tangentially related to the original article. Rather than throwing it away, I am posting it as a top-level one.

I don't think it's just the substance that is perceived as unclean. Even for a libertarian, there is a slimy texture to any industry based around an inherently addictive product. Especially when it comes to marketing to kids -- potential lifelong loyal customers if you can hook them while they're more easily influenced.

Suppose there was a substance that was completely neutral in terms of its effects on your body. It has no caloric content, is not caught on drug tests, it tastes like water, and doesn't even make you feel different when you take it. The only effect that it has is that, several hours after your last dose, you find yourself craving another.

How would you feel about this substance being marketed? It's not hurting anyone, other than that they spend a portion of their money on the habit. But the companies selling it aren't doing their own customers any good, either, and in fact, each new customer they get to try the substance is just being roped into a life of either willing themselves through the cravings or spending a little money to make them go away.

Now, obviously nicotine is not this substance. For one, I do think nicotine users actually enjoy the products and also get some alertness benefits from them. But there is that skeevy layer to it too.

I'm not coming at this from a place of puritanism. I'm not a nicotine user but I do consume alcohol. I think we all know alcohol is worse than nicotine in terms of health effects, and the alcohol industry has done an extremely effective job of positioning their product as something cool grown-up adult people use, joke about, and have "sophisticated" tastes in. Just run through your favorite TV shows from the past 20 years or so and try to find any that don't show main characters either a. enjoying alcohol as part of all their social events, or b. abusing alcohol and it's played off as funny, or c. abusing alcohol as part of a "tortured genius" trope.

In a lot of industries the top 10-20% of customers account for the majority of sales. It just gets weird when you have an industry that has to pretend it cares about "responsibility" when its bottom line is as dependent on its most addicted users as they are on the product.

I guess my point is, at some point we call people adults and let them weigh the benefits vs. the risks. Even if they suck at doing that, it's on them. But I'm totally OK with the FDA's aggressive stance on e.g. Juul marketing to teenagers, because that seems to me to be all about getting somebody to start the habit when they're least likely to make wise decisions.


> But I'm totally OK with the FDA's aggressive stance on e.g. Juul marketing to teenagers, because that seems to me to be all about getting somebody to start the habit when they're least likely to make wise decisions.

is there any evidence that juul is marketing to teenagers? genuinely asking, as I receive their promotional emails and they never strike me as targeting underage users.


Good question. I took too firm a stance on it for something I don't know enough about.

From what I can gather, the reported issues are mostly with their early advertising, showing a lot of vaguely 20ish people looking cool and having fun. They also did a lot of social media marketing and some music events.

I can see the argument that, hey, say your goal is purely to help people transition from cigarettes to a less harmful nicotine vehicle. Won't using the marketing techniques of other successful startups be the best way to accomplish that goal? People aren't going to want to switch from cigarettes to something that has the social image of "desperate addict trying to quit". It helps if it looks like something normal people enjoy socially, and hey, maybe makes them feel a bit more youthful.

That makes perfect sense. But is it possible to succeed in that, without also appealing to teenagers? If not, is it worth it?

Those aren't rhetorical questions, I genuinely don't know the answers to them. It's a complex area to think about.


Trying to get their "anti-vaping" curriculum in schools (aping what the tobacco industry did):

https://www.nytimes.com/2018/08/27/science/juul-vaping-teen-...

> Five days later, Carrie Yantzer, the principal at Nederland Middle-Senior High School, received an email that immediately struck her as suspicious. The writer introduced himself as Bruce Harter, a former educator working with Juul to develop an anti-vaping curriculum for schools.

> “I read about the challenges you’re having with Juul,” Mr. Harter wrote. He offered a free, three-hour curriculum provided by Juul to discourage teens from using e-cigarettes by teaching them about their brains and giving them mindfulness exercises.

The "cool flavors" thing was a (now banned) tobacco industry trick, too:

https://www.smithsonianmag.com/history/electronic-cigarettes...

> Other efforts from Big Tobacco to target children were eventually stymied by the government as well. In the late '90s, the Federal Trade Commission banned the indelible Joe Camel, and the Food and Drug Administration banned kid-friendly flavors like strawberry, grape, and chocolate from traditional, or combustible, cigarettes in 2009.


> Trying to get their "anti-vaping" curriculum in schools

I can agree, that seems suspicious.

> The "cool flavors" thing was a (now banned) tobacco industry trick, too

this is more along the lines of what I expected, and I strongly object to this argument for two reasons. the first is just that, as an adult, I don't accept that I should be prohibited from buying something that tastes good to me just because a child might also enjoy the flavor. the second is that having vape flavors that actually taste good makes it a much more effective harm reduction tool; after a giving it a chance, many smokers actually end up preferring the experience of vaping. if you ban all the good flavors, a good chunk of these people are just going to switch back to smoking.

also, I notice there are a lot of people that support the flavored cigarette ban of the 90s and are now railing against vape flavors. I never hear these people complain about sweet, fruity liquors. if strawberry vape juice is targeting children, who is strawberry vodka for? do we also need to think about banning sweet wines?


[flagged]


The bigger problem, and the one we can't write software to combat, is these accusations. Please don't!

> Please don't impute astroturfing or shillage. That degrades discussion and is usually mistaken. If you're worried about it, email us and we'll look at the data.

https://news.ycombinator.com/newsguidelines.html


You're surprised that baseless conspiratorial speculation is downvoted on hackernews?


Actually it's something I noticed and was wondering about.

However, it was too fast to be part of a coordinated campaign.


I'm not saying it is or isn't, but...

>However, it was too fast to be part of a coordinated campaign

Being able to act fast doesn't mean something isn't coordinated does it?

If I had an army of bots designed to reduce exposure or otherwise AstroTurf a topic I could put them into action as fast (potentially more suspicious) or slow as I wanted (would seem more natural).


You have a great point.

It is highly likely that many topics are astroturfed on many websites, but I would think HN is too small and too specific of a target to be of any interest to pharmaceutical companies.

However, if they use a subcontractor, it could certainly "cover" HN among its astroturfing portfolio, especially if it frequently does jobs for tech companies. Some stories I read in the new section when I'm taking a break have very suspicious rises, compared to identical stories of about the same technical topic.

Also, it feels funny to see the same story again the next day, as if it was "tried" but with different parameters until it catches up.

Without further evidence, it is just suspicious. I hope that YC has a commercial interest in keeping the site clean from astroturfing.


Ah yes, lets drug our kids even more to fix the fact that we drug our kids so much. We have to think about those poor pharma execs who need more mansions and private jets. When your paycheck depends on it, I guess drugs are the answer for everything.

Do people still believed that government and its agencies exist for the benefit of the public rather than to benefit capital and corporate interests?

The US government has never been a country of the people, by the people, for the people. It's been a government of the rich, by the rich, for the rich.




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