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Acute Effects of Electronic Cigarette Aerosol Inhalation on Vascular Function (rsna.org)
203 points by mzs 62 days ago | hide | past | web | favorite | 229 comments

If you believe E-Cigs are harmless, there's an easy experiment you can do for yourself. Go on a run, time yourself. The next day, vape for 30 min and then go on the same run.

This is what got me to personally switch away from E-Cigs. Vaping would add an additional 30-sec to 1-min per mile on my runs. I try to only use patches or gum now. Still not great but it's a lot better if you're trying to stay in shape.

That being said, if you're only two choices are cigarettes and vaping. Obviously, choose vaping.

I ride a bicycle daily and vape e-cigs. If anything I notice an increased performance immediately after vaping, I feel like I'm less tired and have more energy.

Overall this is an interesting topic because contrary to popular opinion many athletes use nicotine and find that it increases their performance: Nicotine [...] use is widespread amongst professional team/strength sports (e.g. American football, ice hockey, wrestling, bobsleigh, gymnastics, rugby, skiing) whereby active consumption of nicotine and nicotine-containing substances in-competition occurs in approximately 25–50% of such athletes [1].

The meta-analysis [1] found that two studies observed an ergogenic effect, one an ergolytic with the remaining seven reporting no change.

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684328/

Yeah, I never said I quit nicotine. Just switched to mostly gum.

It seems as if you were trying to maximize your performance, you'll ingest nicotine in a way that doesn't go through your lungs.

I cycle daily and vape. I feel when I vape more, my performance on a bicycle deteriorates very noticeably. My effective lung volume is noticeably lower.

Those athletes have trained for years and have a heart that is well conditioned with strength and cardio. A normal person who is moderately physically active is nowhere near their fitness level. That’s why nicotine is a dangerous thing to gamble with. You might be fine, or you might have afib/vfib that leads to an MI. Rather avoid the risk. Plenty of more potent PEDs out there that don’t cause adverse cardiac events.

> vape for 30 min

That seems like an excessively long time. I don't vape, but I have a few acquaintances who do. None vape for 30 minutes at a time - typically 5-10.

I imagine if you inhaled cold water vapor for a solid 30 minute time frame and ran, you'd see a similarly bad outcome. Doesn't mean it's bad for you.

I vape pretty heavy. If I am working from home, I can hit it a few times every 20 or so minutes. Thinking about vaping for 30 minutes straight seems unenjoyable.

I also work out, and often vape was I walk into the gym. I would say the thing I notice is that my heart rate is already a bit higher than I'd prefer. But once I started working out, my resting heart rate went down, and my breathing got way better. So, I'm not sure how much of that is attributed to vaping vs lack of fitness.

Careful, in addition to constricting/hardening blood vessels that is thought to lead to heart disease nicotine has other long term effects as seen in in this study of angiogenesis:

>In a series of experiments, the researchers found that nicotine could enhance new blood vessel growth in mice whose hind limbs were artificially starved of oxygen. They also found that lung cancer cells implanted into mice grew more quickly when the mice consumed nicotine in their drinking water. Mice susceptible to developing plaque in the arteries of their hearts also experienced more rapid plaque growth when exposed to nicotine than mice who were not exposed.

>The researchers believe nicotine works by binding to a receptor on the surface of endothelial cells that recognizes acetylcholine -- a chemical that nerve cells use to communicate with each other. Endothelial cells line the interior of blood vessels throughout the body. …


Nicotine is also, itself, a known carcinogen.

May I ask for a source on that? AFAIK the reason why cigarettes cause disease is because of the tar and all of the other byproducts of the Burning tobacco and that nicotine by itself is not the cause. I can't find a source of the top of my head but I smoked cigarettes for 4 years and enjoyed reading on them.

Ah, thanks HN community for correcting me!

> At present, it is not possible to draw a conclusion whether nicotine itself may act as a complete carcinogen.


In case anyone on HN reads this as saying that nicotine is safe to use, the end of that article is fairly clear:

> Although more studies on health effects of nicotine in humans are required, based on in vitro and in vivo effects of nicotine, patients should be advised not to use nicotine products during cancer treatment unless it is temporarily needed to stop tobacco smoking.

Similarly try running when you're a smoker vs a vaper.

I'd say vaping is a very good harm reduction path for smokers that hopefully leads to quitting altogether. It is definitely not harm free though. I just hope our society and laws don't go in a direction where people are pushed back into smoking.

Are most people in the type of shape that 30 seconds per mile variance day to day is surprising? I don't time myself, but I'd be surprised if any two of my sprints aren't this different normally.

Any dedicated smoker will subconciously try to run even faster, lest they be convinced of having made a mistake, sunken cost and all.

I run 5 miles 3 times a week. Usually on the same loop. I use the stopwatch app on my phone.

when i was in the army, i knew a few guys who swore by smoking before a fitness test. they'd suck down a cigarette just before the run and then pound out a quick 9 minute 1.5mi. it's not something i've bothered to test. i just found it interesting that they must have done something to put that idea in their head.

Water vapour has a similar effect.

So I take it, should these results be replicated and validated as scientifically sound, that smoke machines will be banned? Because it's the same kind of aerosol with virtually the same ingredients.

I'm also curious - and maybe I missed it; it's a dense paper - that while they mentioned the primary ingredients in "bare" vape liquids, they didn't seem to mention the concentrations of each used in the study? Again, maybe I missed it...

If it wasn't mentioned, I would be curious how different percentages of each affect the outcome.

For that matter - I would also be curious how "vaping" something similar - say perhaps atomized distilled water in a nebulizer - what kind of results are seen there, too.

While it may be that vaping liquids are "bad" (and any metals from the heating coil, as the study noted), how they compare to other similar liquids might be important in determining their relative danger.

Also - whether this reported danger is warranted or not? That is, when compared to other things in day-to-day breathing, where does this fall in terms of "danger"? Is it worse than being around a camp fire or fireplace? Is it worse than breathing air in a working kitchen? Is it worse than breathing the air while taking a hot shower?

Sure - the numbers can be made to look scary - but what is the objective truth, beyond the idea that "yes, vaping even base liquids is worse than just breathing" - I think we can agree that breathing in something more than clean air is worse for you, no matter what it is. But for all we know, we're constantly breathing in microparticles of plastic and other pollution in greater rates and more often than even a heavy vaping device user.

Lots of questions and avenues that could be pursued in follow-up research on this topic, certainly. It was interesting to read about, especially as someone who occasionally vapes a caffeine-based (non-niccotine) liquid.

> smoke machines will be banned

Do people put smoke machines up to their mouths and inhale it many times a day over many years?

Theater technicians and performers often spend many hours per day for most of their career in close proximity to large smoke machines - essentially huge mains-powered e-cigarettes that use nicotine-free vape juice by the quart.

> often spend many hours per day for most of their career

Assuming you mean running smoke machines, no they don't. Smoke machines are occasionally used, but not in most plays, let alone for hours. And even if the were, most actors rehearse for weeks or months between plays, and nobody is using a smoke machine on rehearsals, except maybe in the last few.

No. But that might be an unfair comparison.

People vape by choice.

Smoke machines on the other hand have more in common to going to a restaurant or bar back in the day and being subjected to other people's second hand smoke.

You go to a venue for music or something similar, and get exposed to smoke machines.

Never have I ever heard anyone say, we should go to a concert or night club because - smoke machines!

It may be common for workers in some businesses to be exposed to smoke machines on a daily basis.

Many people seem to believe that vaping is harmless, this is good to make the point clearly that vaping, while not as harmful as smoking cigarettes, isn't a "cost free" activity. I personally didn't realize that it could have these effects either.

My main concern with the way things are going is that it looks an awful lot like attacks on vaping are for the purpose of driving smokers back to cigarettes. I know of no one that things vaping is harmless. It is certainly much, much less harmful than cigarettes and is infinitely preferable to cigarettes.

I quit smoking, with the help of vaping. I was a pack-a-day Newport smoker that started on a ludicrously high 36mg nicotine level. I was down to 3mg within a year and quit entirely a year later.

This is a very common story for former smokers that switched to vaping. There is a theory in the vaping community, or maybe its an urban myth, that the lack of MAO inhibitors is what allows people who vape to essentially lose their addiction. What I can tell you is that stopping vaping after two years was painless, very much unlike attempting to cold turkey cigarettes.

What's the supporting evidence for your concern that "attacks on vaping are for the purpose of driving smokers back to cigarettes"

Philip Morris (now known as Altria) put $13bn into Juul to do the exact opposite. The margins on vaping are higher, the current perception of vaping is that it's better than smoking, and it's way easier to get kids addicted to vaping than cigarettes.

I see too much evidence to the contrary... that big tobacco is now big vaping (which is really big nicotine).

We dont know just how bad vaping really is, it's hard to say its better than smoking, and its impossible to say its not bad for you at all.

>"attacks on vaping are for the purpose of driving smokers back to cigarettes"

I don't think it is intentionally on purpose, but it sure does seem this way sometimes.

A specific example that comes to mind: city of San Francisco banning sale of e-cigs completely, while keeping regular cigarettes just as legal as before [0].

0. https://www.npr.org/sections/health-shots/2019/06/25/7357140...

Good point. I don't see any of the politicians addressing why the didn't also ban cigarettes.

My guess is that banning cigarettes would go too far. It's unrealistic to expect cigarette smokers to quit over night and start using patches and lozenges.

It's a little more realistic to expect that people who vape to do so.

> It's a little more realistic to expect that people who vape to do so.


>It's unrealistic to expect cigarette smokers to quit over night and start using patches and lozenges.

>It's a little more realistic to expect that people who vape to do so.

From personal observations, what would actually happen is that those people will just switch to smoking cigarettes.


Vaping is really hard to tax unlike cigarettes. State and local governments are addicted to cigarette tax revenue, but that has been evaporating quickly, so outlawing vaping and not cigarettes is really profitable to them, even if causing more harm overall.

Why would vaping be hard to tax?

Mixing propylene glycol, glycerine, nicotine, and flavors can be easily done at home. Pretty hard to limit the distribution of any of the parts the way tobacco distribution is limited.

Couldn't you tax the liquid nicotine by itself?

Well, maybe you could, the way we tax ethanol. The problem with that is the duty-free sales (including ordering a year-supply of it online from China), and the moonshine (synthesized nicotine).

"We dont know just how bad vaping really is, it's hard to say its better than smoking, and its impossible to say its not bad for you at all."

This is absolutely true. Inhaling propylene glycol and glycerine daily for thirty years might cause you to grow three heads or have babies with 27 fingers. But the results of every reputable report I've seen until now has indicated that vaping is much, much better than smoking cigarettes.

We already have people that inhale propylene glycol and/or glycerine for 30 years: people that work in factories and hospitals.

Juul's creators increased the nicotine because they felt other vapes on the market couldn't compare to the sensations delivered by regular cigarettes.

The nicotine salts in Juul pods are a type of nicotine that supposedly feels more like a cigarette when inhaled, as opposed to other vapes that use freebase nicotine.

Philip Morris strategy to create confusion is obviously working. Don't buy from big tobacco if your goal is to quit smoking.

Personally, I couldn't stand the freebase nicotine juice. A hit off some 10mg juice made me feel like I'd just taken a fat haul on a cigar. My mouth started watering, I started twitching a bit and felt like was going to puke, then immediately i started craving a smoke. The nicotine salts don't feel that way, even with the 36mg. It actually takes the cravings away without really giving me that nicotine rush.

In a month I cut down my smoking by over half and I smoke less and less as time goes on. I find the flavours bother me though and is the main reason i haven't quit entirely. I actually enjoy the taste of cigarettes, I haven't found any ejuice I actually like the taste of it all reminds me of candy, even the ones that are supposed to taste like tobacco.

There is a lot of difference in the quality and composition of freebase juice. The differences between vaporizers is also massive.

I eventually settled on a juice with a coffee caramel flavor that smelled like someone just made a cake.

Go and try several combinations in a store that is specialized. The Juul is Big Tobacco still giving you an old fashion hit of nicotine.

Edit: if you are located in Europe this was my favorite.


I don't smoke the juul vapes, they're not the only company that makes nicotine salt juice. Nicotine salts are made by adding an acid to freebase nicotine, which is still made originally via extracting nicotine from tobacco and processing it with ammonia. If you smoke nicotine, you're inevitably supporting large tobacco producers, there's not really much way around that.

Then there's the matter of, freebasing an alkaloid makes it more bioavailable to your brain, you may be smoking lower concentrations, but your body's absorbing more nicotine per puff.

Kind of like the difference between snorting coke or smoking crack. Cocaine hydrochloride is cocaine in salt form, crack is the freebase form. Both are addictive nasty drugs, but with crack, you need less to get high, the high lasts longer and in the long term tends to really fuck people up from what I've seen.

Also, the first time I ever heard of freebase nicotine, was when I was reading about how it was added into cigarettes to increase the addictiveness and rush you get.

That cake flavoured one still sounds unappealing. I'd really prefer some kind of savoury or smokey flavour. I've never really enjoyed sweet things.

I have seen the effects of crack also from nearby but the effects usually lasts from 5–10 minutes. Snorting quality cocaine last an hour.

I'm not a chemist so you good be spot on in the information you provide. I'm just sharing my positive experience with freebase and hope more people can quit smoking.

Taste is such a personal thing, I don't like sweets either and this flavor was delivered by accident because the store made a mistake.


>Freebasing is a more efficient method of self-administering alkaloids via the smoking route. For example, cocaine hydrochloride decomposes at the high temperatures necessary for smoking. Free base cocaine, in which the cocaine alkaloid is "freed" from the hydrochloride salt, has a melting point of 98 ℃ and is volatile at temperatures above 90 ℃, therefore providing an active drug for smoking. After inhalation the alkaloid is absorbed into the blood stream and rapidly transported throughout the body. However, since blood is buffered with carbonate at physiological pH (near 7.4), free-base amines will be rapidly converted back into their acid form. In fact, 94.19% of cocaine will exist as the acid form under equilibrium at pH=7.4, calculated using the Henderson-Hasselbalch equation assuming a pKa of 8.61[1].

Thank you for your information I appreciate new insights! This is why I daily return to hn.

What did you hit it out of? 10 is really high man, I am not surprised. I remember my friend got a sub-ohm tank when they first started getting popular, and put 26 nic in there. We nearly died it felt like. If you were vaping off a sub-ohm tank at 10 nic, that's a massive dosage of nic in one hit. I vape 6 and it's often too high for people who vape.

If you were vaping off one of those little pens, then 10 makes a bit more sense, and maybe even a bit low. But, those never really hit right for me. I cough when I hit a Juul though, so idk.

It's not hard to say it's better than smoking. Every study done to date comparing the two days it's not nearly as harmful as smoking.

Smoking is one of the most harmful things you can possibly do to your body. Many people underestimate how much of a low bar being better than smoking is.

That seems like a foolish argument. The time horizon in which we discovered smoking was bad for you was decades, and over a massive population of users.

E-Cigarettes are only now becoming mainstream, and have only been in use for the better half of a decade.

We wont truly know the effects until we have a large sample size over a long period of time.

Ultimately, saying it's conclusively better for you than smoking is short sighted. We thought smoking was good for you in the 1920s...

You're right that science sometimes makes mistakes, though probably less than they used to. And we won't know conclusively for decades.

But best available evidence says 5% right now.

You seem to think that science do not have the ability to predict the effects from causes, it is possible to say if vaping is safer than normal cigarettes now itself, rather than have to wait for 50 years to make that declaration. Theoreticaly ecigs are much much safer, due to the lack of combustion and presence of carcinogenic smoke components.

Vaping has been mainstream for what, a little over 5 years? And it’s exploded in just the past couple years. Any research coming out saying it’s not dangerous is simply premature. Most young people who start smoking don’t really notice majorly harmful effects within their first couple years either. At this point, most studies can only demonstrate the short term effects. It’ll take a while to determine long term harm.

> I know of no one that things vaping is harmless.

To me this is up there with "I know of no one on HN who actually dislikes Javascript."

You're contradicting a mantra that is so ubiquitous that it's a bit hard to take you seriously.

People I know IRL and on Reddit (without even venturing into circlejerks like r/juul and r/vaping) think vaping is so harmless that health effects aren't even the tiniest part of the discourse while they puff on their vape pretty much every waking hour. Compare that to almost every cigarette smoker who is at least in a state of "yeah, I should quit someday." I'd be hard pressed to find someone who vapes saying that, and when it comes up it's usually just for financial reasons.

Not to say you aren't having the experience that you said you have, but rather to point out that you may be surrounded by a rather unique group.

> Not to say you aren't having the experience that you said you have, but rather to point out that you may be surrounded by a rather unique group.

Maybe its a fast evolving community and things have changed. I haven't touched vapes since 2016, so my involvement in the online community is zero these days. When I quit, Juul wasn't even a thing and mech mods were the norm. Everyone that talked about vaping was in the context of harm reduction, not harm elimination.

Those I do know IRL that still vape just aren't even trying to give it up, but they also weren't willing to give up cigarettes until vapes came along and took away the smells. Maybe it is also a factor of my social circles being 30+ and upper middle class now and smoking/vaping/drunkenness in general being frowned upon.

My concern is that any pushback on attacks on vaping just allows more room for more people to continue saying / believing that it's "ok, not 100% harmless, but almost completely" - enough so for the rise in nicotin intake among younger people (as referenced by other commenters) and enough for people to spontaneously start to vape in places where smoking is strictly prohibited, acting like it shouldn't bother anyone,("it's not like it's cigarette smoke") - even offices (happened in mine), public transportation etc...That boils my blood to no end.

I quit smoking in a similar way now 3 years ago. A cigaret is almost engineered to spike a nicotine shot. By only vaping my nicotine cravings decreased over time without effort. I recommend smokers to immediately start with an expensive vapor that works. Beating a nicotine addiction is not possible with a $20 solution that requires duck tape hacks after a week. I took away from Alan Carr's book it is not possible to just smoke one cigarette ever again.

I’m in the same case as you. I switched to vaping 2 years ago (August 14th). Started out at 9mg of nicotine, and now at 1mg. Switch to 0.5mg is planned for early September.

Every time I lower my dosage, I notice I vape 2-3 times more than usual, and after a week, I stabilise again (at around 15-20ml per day). I exclusively vape on an RDA.

Over the weekend, I was invited to go to a shisha bar. After 3-4 tokes, I was high as a kite. Hadn’t experienced such a nicotine high in a very long time.

I can’t wait to finally be off nicotine completely. I’m already noticing that I often forget my vape when leaving the house, and when I notice, I don’t really sweat it. It’s a slow process, but for me, it works.

And yes, I know that it’s possible that I might grow a 3rd arm 20 years from now. But I’m playing the odds: cigarettes will kill me dead for certain. Vaping, maybe not.

Don't worry about the negative effects of vaping. And your experience without backup and not sweating it is a clear sign of progress. I remember a time I couldn't go to sleep if I didn't have any cigarettes left for the next day. After the third vapor broke I decided not to buy a new one. Good luck!

My quit signal seems to be getting the flu or similar. I've heard from others as well. After a few days of being miserable and not wanting to smoke because of the flu you come out the other end not needing it.

I quit chewing tobacco this way. Picked up vaping a while later for no apparent reason. Will probably quit this the same way.

> "My main concern with the way things are going is that it looks an awful lot like attacks on vaping are for the purpose of driving smokers back to cigarettes"

I've heard this from enough vapers that I'm starting to suspect that vaping causes paranoia. Big tobacco is happy as a clam that so many people are vaping. Cigarettes were on the decline before vaping came along and gave nicotine addictions to a new generation.

The trouble is that studies haven't reliably shown vaping to be the superior smoking cessation aid. And if it's more dangerous than the patch...

The problem is that smokers --> vaping is being offset by non-smokers --> vaping.


> The CDC conducts an annual survey of tobacco use by middle and high school students, asking if they’ve used a tobacco product in the last 30 days. The most recent poll, released in February, found middle school use increased from 5.6% in 2017 to 7.2% in 2018; among high school students, it surged from 19.6% in 2017 to 27.1% last year.

> Almost all of the increase comes from e-cigarettes. Among middle school students, use rose from 3.3% in 2017 to 4.9% last year. Use nearly doubled among high schoolers, from 11.7% in 2017 to 20.8% in 2018.

> In other words, the number of high school smokers dropped by 1.2 million, while those using e-cigarettes rose by almost 3.5 million. That more than wipes out progress in reducing smoking during the last seven years.

This depends on the relative harm of smoking versus vaping.

Uk government estimates risks at 95% less than smoking which means we're still winning health wise by quite a bit.

Vaping appears to have stalled progress towards smoking cessation:


> For decades, the percentage of high school and middle school students who smoked cigarettes had been declining fairly steadily. For the past three years, it has flattened, according to new numbers released Monday.

It may also encourage relapses:


> Adults who smoke cigarettes may have an easier time cutting back or quitting altogether if they start vaping, but a new French study also suggests that vaping may make ex-smokers more likely to relapse.

From your first link:

“It’s not clear yet what’s going on and it’s best to not jump to any conclusions,” said David Levy, a Georgetown University researcher.

In the UK, teenage smoking is at record lows - just 16% of secondary school children have ever smoked tobacco, down from 19% in 2016. We have not seen a significant rise in youth e-cigarette use. This may have something to do with the 2014 Tobacco Products Directive, which introduced substantial new regulation on both cigarettes and e-cigarettes including restrictions on advertising.



Not if non-smokers are being recruited into vaping or smoking.

Hasn’t that always been the case though? Peer pressure is going to be directed somewhere, maybe cigarettes, maybe marijuana, maybe heroin, ... are kids really expected to be better these days than when we were kids?

Kids are better today than we were as kids. They drink less, they smoke less, they take drugs less often, they have fewer unplanned pregnancies, etc etc.

At the moment we don't think vaping turns non-smokers into smokers. But it's complicated, especially if there are companies that are marketing vaping to young non-smokers.

I personally think vaping is a useful public health measure, but I recognise the very many years of terrible behaviour from tobacco companies and it feels like light-touch regulation doesn't work.

to non-drugs?

Well balancing non-smokers becoming vapers relative to smokers becoming vapers definitely depends on the relative risks. But if vaping is increasing the number of smokers (which is definitely not true among adults, and probably not true among teens) you're right that wouldn't depend on relative risks.

> There is a theory in the vaping community, or maybe its an urban myth, that the lack of MAO inhibitors is what allows people who vape to essentially lose their addiction.

Definitely a myth, I never smoked but vaped for 2 years. I quit a few months ago because I was vaping so much I noticed some pretty bad side effects, the increase in blood pressure was real. Nicotine is highly addictive, I still feel like I want to do it and it takes willpower not to go back to it.

I think it's probably true that Vaping is less addicting than Smoking. But I also think, that the act of Vaping/Smoking/Inhaling/Ritual also has something to do with it.

Same. Those cigarettes are ugly to quit from.

Currently tapering on a vape.

After just two weeks, the improvement in overall body function was amazing. Benefits continued on for months after that.

Yeah I take issue with this also. I've tried to get my dad to stop smoking for the past 15 years and I've come to terms that it just won't happen.

So for me it's more about helping him risk manage, getting him on vaping instead of cigarettes is "less shitty" way of getting that fix for him, even if I'm fully aware that it's not healthy in any shape or form.

It's the lesser of two evils for sure, however, nobody should pick up vaping if you aren't currently smoking cigarettes.

But the likelihood is that vaping is order of magnitudes less harmful than smoking burning cigarettes, but the way narrative is being spun is that vaping is a grave danger to health.

Normal cigarettes have established to be undisputedly harmful, whereas ecigs while possibly addictive, the long term effects of consumption are merely not well known/studied.

Despite any studies, I would be very interested to hear a theoretical assessment of the safety of ecigs.

> Many people seem to believe that vaping is harmless

I don’t really buy that premise, at least for some significant definition of many (some definitely, but many?).

On the other hand, what is a cost free activity anyways? A can of Coke (sugar) is pretty bad for you, I’m glad I’ve given that up. My wife thinks the sugar free stuff I’ve switched to is still bad for me, ugh. I guess only water would be considered cost free in that context.

Yes and we still don't know the long term effects of heavy use for a decade or two. Cigarettes were great and good for you for decades too.

I’m not sure there exists a cost free activity as far as people are concerned.

Sex is pretty cost free. Meditation is cost free.

Unless you are defining time usage as a cost which is absurd.

> Sex is pretty cost free

Not sure if you are joking or not, but I would wager the costs of sex are actually enormous even compared to drugs. Look no further than the costs and issues surrounding the following: adoption, foster care, abortion, child support, single parent welfare rates, STDs, etc.

In theory sex is a "cost free" recreational activity, but in practice it isn't.

well, if you’re super careful with your contraception and have easy access to abortion...also lots of queer sex runs no risk of reproducing accidentally. STIs, on the other hand, are definitely a risk.

A man having casual sex is basically gambling that the condom works and that the woman will abort if it comes to that, something he has zero say in. I don't know how anyone can say sex is very risk-free.

As I get older, "don't stick your dick in crazy" makes more and more sense. Pretty much all the STIs in my demographic can be cured with a $20 pill. And almost all of my post-nut clarity revolves around fearing becoming a father prematurely.

I grew up hearing about the archetype of the heroic man getting laid constantly. In my 30s I now meet that man all the time: he's now saddled with a kid with a woman he rarely sees while trying to date for real.

> Pretty much all the STIs in my demographic can be cured with a $20 pill

If only. HSV2 affects 1 out of 6 people, rarely shows its symptoms and can be latent for years, has a big stigma associated with it, and there's no amount of $$$ you can pay to make that go away, unfortunately. Also the occasional antibiotic-resistant variants of the $20 ones, if you get sufficiently unlucky.

Fair enough. I mainly was trying to elevate the fears of unwanted children rather than downplay the risk of STIs.

Though among the people I know close enough to know this about them, nobody has HSV2 and almost none of them know somebody who has it. Meanwhile I know a dozen men stuck with accidental children with women they never wanted anything to do with.

CDC says HSV2 has 12% penetration into the population aged 14-49 but has no further demographic info. HIV is even more common yet I don't know anybody with it because I'm just not in the high risk demographic. So these just aren't part of my perception of day to day worries (perhaps incorrectly, as you would point out) compared to unwanted children.

The person I replied to made it sound like unwanted pregnancy is a solved problem which isn't even true for women, thus categorically less true for their partners.

Sure thing. A couple of points:

1. 90% of people with HSV2 allegedly don't know about it, because it's not a standard STD test you'll be given unless you have an outbreak 2. People with these conditions aren't parading about it, there's no upside to it, so most just keep it to themselves and their doctors. People are afraid of being "outed". Some will go so far as not to tell the people they're hooking up with about it. (not ethically recommended / legal, but that's humans for you)

If you’re a man, sure. But I’m not a man, people with uteruses sometimes have hysterectomies, and birth control is a thing. It’s not 100% but you should absolutely be thinking about that when you have sex if you’re a man. Your say in it is accepting the risk and living with it.

Besides conception, sex exposes you to pathogens that might cost you your ability to reproduce or have sex again, or to live, in the worst case scenario. Sex is very much of a tradeoff, unless you're oblivious to the risks.

Kinda depends on your choice of partner(s), doesn't it? They didn't say that "sex" must automatically imply that you do it with countless people you don't know well.

Screw the wrong person and the state will screw your bank account for the next 18yr.

Considering all the negative health outcomes that are correlated with money (well, a lack thereof) that doesn't sound cost free to me.

The number one controllable risk factor for stroke and heart attack is smoking. By far. Not diet, not exercise, smoking. A significant part of that is because nicotine will constrict blood vessels leading to hypertension[1], this leads to destruction of the surface of an artery, leading to atherosclerosis formation. One day the atherosclerotic plaque ruptures and then you see me.

We once thought that atherosclerosis is an old persons disease, where health habits later in life lead are what predicates plaque formation. The Army started noticing fatty streak formation(first stage of atherosclerosis)[2] in arteries of dead soldiers during autopsy, which now leads us to believe this starts in youth and progresses from there.

1) https://www.ingentaconnect.com/content/ben/vdp/2005/00000002...

2) https://media.jamanetwork.com/news-item/autopsy-based-study-...

Smoking is one of the leading risk factors for cardiovascular disease: agreed

It starts earlier than a lot of people thought: agreed

The primary contributor to smoking's detrimental effects on the cardiovascular system is nicotine: disagree

Mind linking to something that shows this? That doesn't agree with the results from the UK study on effects of nicotine versus smoking which puts nicotine's effects at about 5% of the risk of smoking.

This is definitely a point which needs more exploring. Seems to me most damage from smoking is all the crap in smoking. The chemical nicotine - by itself - transiently raises BP, feels nice, and that's about it.

It's also only a part of the addictiveness of smoking. Probably a small part, as everyone I know who has consumed nicotine in any form has no trouble without it if they vape, but often shows discomfort/restlessness if they smoke. Amazingly, this holds true for those who consume far more nicotine through vaping compared to others that get it through smoking.

I've been a long-time smoker, and at least for me, nicotine alone does absolutely nothing to alleviate cravings. Gum, patches, lozenges, vaping, etc. do zero to alleviate my craving for a cigarette. I'm not discounting that nicotine is addictive (I'm in no position to say), but there's got to be something else in tobacco that is part of the addiction.

Nicotine only makes me sick. I've tried gums, vapes, and nicotine salt pouches. I smoke a tobacco pipe when I want to relax.

There are MAOIs in tobacco smoke. I'm not sure that's what makes me feel calm though.

It could be the interaction between the MAOIs and the nicotine. Or more accurately, the MAOIs altering how your body handles nicotine.

There are sibling comments discussing MAOIs, and I've heard about them before in relation to smoking. It makes me wonder if MAOIs alone would be better for smoking cessation. I don't think I'm all that addicted to the nicotine itself. There are plenty of other supposedly-addictive stimulants that I can take or leave at will and with no feelings of withdrawal, and nicotine does nothing to alleviate cigarette withdrawal for me, so I'm not sure it's even a necessary component. There are some NIH studies about MAOIs and smoking, but I'm not going to link them because I find them incomprehensibly dense.

I don’t remember what family of antidepressant Bupropion (Wellbutrin/Zyban) is, but it helped me immensely the first time I quit. I literally just woke up one day (a few days before my target quit date) and had no craving at all.

It also made me a little bit manic, and weaning off it sucked, but it worked well in general.

Addiction has two components: chemical(i.e. nicotine) and psychological (i.e. the habit of the ritual).

My mom recently switched to e-cigarettes, and she said that she still occasionally gets the urge to smoke a real cigarette. But she said the urge is a lot weaker than when she used to go prolonged periods without smoking cigarettes, such as after a long plane ride.

Have you tried vaping using those e-cigs that look realistic, have a light up tip, and deliver a reasonable throat hit?

For me the addiction was partly psychological around the form factor. Using "light sabre" style vapes didn't work. However I was able to wean myself off smokes using realistic e-cigs (which I also eventually quit).

They do nothing for me. They're also cheaply made and don't work well or consistently (and I've tried many brands).

The only thing that got me to quit smoking is the Juul. I tried everything else, but with the Juul, I just quit without having to consciously discipline myself 20 times a day. The gum was close though, but it took too long to kill the craving, so I'd end up chewing it constantly for it to work.

I've been smoking for a little over 20 years (since a teenager). Good luck.

Have you ever tried Swedish Snus? It's supposedly healthier than smoking, and no need to spit like chewing tobacco.

If you try it. make sure you get fresh stuff before you pass judgment, because it ferments inside the package if left out for too long.

That’s how you get mouth cancer.

It's still considered the safest form of tobacco out there, and the increased risk of mouth cancer is quite small to non existent.



Telling addicts they "just need more willpower" is condescending and worthless advice.

We're talking about cigarettes here, not heroin. It's the only advice that matters.

I think I remember reading some research at some point that backs this up, if I remember correctly they found it was a lot easier to get rats addicted to smoking than nicotine

Yep evilterran linked to the study I was thinking about.

> The chemical nicotine - by itself - transiently raises BP, feels nice, and that's about it.

This is not entirely true. I believe it can put you at risk for cardiac arrhythmia, and the risk goes up steeply the more nicotine you intake to simply cardiac arrest. I believe this is depicted in Thank You For Smoking when the protagonist is covered in nicotine patches and almost dies. It’s entirely possible that was do to BP issues but I wouldn’t dismiss it as trivial in that case.

Also if you read about the native american experience of smoking uncured tobacco, it seems like it was likely a near death shamanic experience and it did kill people occasionally.

That said, it’s rather easy to moderate your intake with the percentages, so it’s not a problem for most people (I hope).

Nicotine is a poison and will unquestionably kill you at high doses. Same thing with water. Drink enough and you'll die. The relevant question is, what are the negative effects of nicotine at common therapeutic doses?

Is there any research on what other chemicals might be addictive?

There is evidence that some additives enhance addiction and that others suppress the side effects from smoking (coughing, burnt throat, feeling ill, etc.) so that when someone quits smoking they have essentially stopped treating themselves for all these side effects, which then appear and make the person feel miserable. Smoking instantly relieves symptoms again (for a while):


"Our findings indicated that more than 100 of 599 documented cigarette additives have pharmacological actions that camouflage the odor of environmental tobacco smoke emitted from cigarettes, enhance or maintain nicotine delivery, could increase the addictiveness of cigarettes, and mask symptoms and illnesses associated with smoking behaviors."

So it appears that although nicotine is mildly addictive, commercial tobacco was engineered to suppress the side effects of smoking which essentially made it much more (technically) addictive. Hence quitting tobacco is much more difficult than quitting nicotine because you are also quitting the additives which are suppressing cough and hiding the feeling of illness smoking causes.

There's a great PDF (British action group I believe? I read it ages ago) which goes in to depth on the various mechanisms the tobacco companies employed in order to increase the addiction potential of cigarettes.

A modern cigarette is not just a roll of tobacco. It's pretty much been 'bred', A-B tested, into being a drug delivery system.

>So it appears that although nicotine is mildly addictive

It's not mildly addictive


Nicotine is not on that list.

Here's one: https://www.jneurosci.org/content/25/38/8593


Nicotine is the major neuroactive compound of tobacco, which has, by itself, weak reinforcing properties. It is known that levels of the enzymes monoamine oxidase A (MAO-A) and MAO-B are reduced in the platelets and brains of smokers and that substances, other than nicotine, present in tobacco smoke have MAO-inhibitory activities. Here, we report that inhibition of MAO dramatically and specifically increases the motivation to self-administer nicotine in rats. These effects were more prominent in rats selected for high responsiveness to novelty than in rats with low responsiveness to novelty. The results suggest that the inhibition of MAO activity by compounds present in tobacco smoke may combine with nicotine to produce the intense reinforcing properties of cigarette smoking that lead to addiction.

There's research that the heat alone in some forms of abuse of smoking things can cause lung issues.

The difference I've found with vaping is both a) I use a very cool setting so it's not nearly as hot as a cigarette (which you can't control the temperature of) and b) I used far less nicotine, starting from 24mg->3mg in the course of a year.

I can easily stop vaping for days at a time now without having a strong pang of nicotine dependency which I used to have.

Could you link the study you're talking about? I found this - https://www.theguardian.com/society/2018/dec/28/vaping-is-95...

But the only "study" referenced comparing smoking and nicotine was a video experiment that didn't even use humans.


Click on "how safe are e-cigarettes" which link to two studies, one by the royal physicians and one by public health England.

The one by the PHE is 118 pages and is a summary of all the available evidence as of 2015.

And the RCP does something similar in 189 pages.

They do not exclusively focus on comparing the relative harm, but that is a large section in each.

If you just look at what a pipe looks like if not cleaned properly, and picture the lungs looking the same, maybe the blood vessels too, then nicotene seems like the least of the problems. However, confounding factors means that a simple additive measure cannot illuminate the problem.

Short breath alone, which invariably follows the exposure to aggressive gases, leads to contraction of the vessels and increased heart rate, to keep up the oxygen level in vital parts.

Even if tar should not enter the blood streem in a healthy tester, which I'm not sure, the built up tar pits so to speak are cozy breeding grounds for all kinds of pathogens. Excess water in the lungs, or vice versa dry lungs impact the imunosystem as well.

>The primary contributor to smoking's detrimental effects on the cardiovascular system is nicotine: disagree

Where did I say that?

I don't what UK study you're referring to, the ones I used are published in American and Middle Eastern journals.

Is that 5% of the risk of cardiovascular disease or 5% of risk from any disease?

Total risk

You can test this yourself. Test your blood pressure prior to vaping and then after. If you choose to ignore all else you could argue the rise in BP is transient and not concerning. I personally would not bet my life on it.

I don't know if identifying whether or not something transiently raise my blood pressure is a better measure than a comprehensive report by the UK equivalent of the NIH.

Jogging in place will also transiently raise your blood pressure.

But it then over time it lowers your resting blood pressure. Not sure nicotine would since most users constantly use it (and it may not with occasional use either, I'm not sure).

Yeah, but it's supposed to. Inhaling something and then your BP goes up means you should not inhale that thing, eh?

Indeed, too much training can be counter productive. Vice versa, runners can't just stop and settle down, neither after a race nor after a carreer, or they'd risk heart failure. I cannot explain it but I think it's common knowledge.


Interesting so if my BP crashes I should smoke or vape :-)

I have had a BP crash I was cooking the Christmas dinner (the full works ) and accidently forgot I had taken my bp pills that morning and took a second set.

I passed out and vomited about 10 mins after sitting down to eat

I smoked for ~3 years and one of my favorite smoking memories was with a doctor in San Diego.

He was going down the standard visit questionnaire and asked if i smoked, so I said yes. He put down his pen, looked me in the eye, and loudly said "STOP". He looked back at the form, picked up his pen, and we carried on.

I don't know if your doctor or anyone in this thread is aware of the classic Bob Newhart sketch:


Or the Fry and Laurie "Dr Tobacco" sketch:


Does that mean that caffeine is a risk too? Doesn't it have similar effects to nicotine? (I drink a loooooot of coffee).

Really disappointed there’s no comments here. I scrolled this whole thread to see if anyone had talked about coffee.

It got me thinking because I know someone who never drank coffee in their life and lived a pretty full life nonetheless otherwise ... they’re over 100 as of recently and still self mobile, super active, sharp as a tack. She even had quite a few children.

I consume like 4-5 actual brewed coffees per day. Am I doomed?

Doomed to a slightly shorter life, made richer by the enjoyment of a beverage.

The evidence is inconclusive. Some studies show slightly higher all-cause mortality for coffee drinkers, some studies show slightly lower mortality. Either way, the effect size is clinically insignificant.


Coffee's fine. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA....

A nonlinear association between coffee consumption and CVD risk was observed in this meta-analysis. Moderate coffee consumption was inversely significantly associated with CVD risk, with the lowest CVD risk at 3 to 5 cups per day, and heavy coffee consumption was not associated with elevated CVD risk.

Its bad for blood pressure - I switched to decaf for that reason.

How something raises BP might be important, tho.


> The number one controllable risk factor for stroke and heart attack is smoking

Can you clarify? Do you mean smoking cigarettes? Or do you mean consuming nicotine? What about vaping? How about smoking marijuana?

There's an information imbalance so definitive claims can't be made about cannabis smoking in the way that they can be made about Tobacco smoking.

Imsuspect marijuana smoking is just as harmful. The bulk of the trouble from tobacco is from the smoke. And if you look at the health effects of air pollution, they’re very similar to smoking: respiratory infections, heart disease, COPD, stroke and lung cancer

Inhaling any burning thing is quite bad for the human organism.


I don't know any people who smoke 20-40 joints a day

Having smoked both, tobacco seems more irritating.

Have any of your patients tried reversing the plaque with k2/d3/magnesium. It works for lowering CAC scores, just curious if it also helps with any of the other buildup beyond calcium. Or perhaps serrapeptase/natto.

Look up Linus Pauling's therapy.

I actually ran across his studies some time ago. I've always been curious if the testing to validate his work used real vitamin-C or ascorbic acid. I will dig deeper into that now that you bring it up.

I'm not an expert, but my understanding is its not at all clear enough to make such a strong, simplistic statement. For example:


Are there any similar studies for marijuana vapor inhalation?

One of the frustrating things about ecig studies is that they always use the worst quality hardware and puff really hard on them. The "Epuffer" looks like one of those "cig-a-like" which are notoriously worse than the much more expensive hobbyist mech mods. The cig-a-likes usually don't get enough juice to the heating element so when you're puffing a lot (16 consecutive 3s pulls) you end up burning the wick.

Out of curiosity, are most people that use ecigs going for the expensive mods, or are they going for the more popular brands that are closer in quality to the epuffer?

I don't have any science to back up this, just an opinion. Epuffer is like a conversion product. Once you try it, you likely invest in better equipment. This is what happened to me... Started with a cheap gas station stick, then quickly upgraded to a decent set up. Was able to get my dad to stop smoking by buying him a cheap puffer to test it out. Now he has a full set up.

I'm a little confused - can someone knowledgable in the area help out? In the introduction they assert:

"Once inhaled, ultrafine particles and the oxidant species located on their surface can translocate into the vascular space (13), resulting in a state of chronic vascular inflammation and oxidative stress noxious to endothelial function."

However in the conclusion they state:

"Inhaling nicotine-free electronic cigarette aerosol transiently impacted endothelial function in healthy nonsmokers"

It sounds like in the introduction they are aware of studies that concluded the aerosol inhalation causes chronic issues with endothelial function, but they concluded that it only has a transient effect. Are they refuting those claims? Did I miss something?

Maybe the duration of the study is too short to definitively conclude a chronic effect, even though they suspect it is there.

While I don't think e-cigarettes are completely harmless, anything can be proved (fudged in a way) if there is an intention to.

Yes, we don't know what the effects of vaping are but they appear to be a decent (and possibly more addictive) alternative to tobacco smokers who can't quit.

Transient in healthy nonsmokers. Since most vapers do it regularly it's a fair to assume that they are in a "permanently transient" state. A permanently acute state is basically a chronic state.

Imo permanent === persisting after whatever was causing this state in the first place is gone. If those "transient" effects are gone after a chronic user is done using after a long time, then I would still consider the effect to be transient rather than permanent.

The study is about the transient effects of vaping on healthy never-smokers. The chronic effects were observed as part of other studies and just cited here.

Are there good comprehensive guides out there regarding vaping?

My mother has been a smoker for a long time, and she bought a "myblu" on a whim. However, she is concrned about the need to buy small recharges, as it is obviously not environment-friendly. Moreover, she had issues with the battery (I think it's not charging anymore, or maybe charged but not producing vapor) after a couple months of extremely light use. As she finds the product unreliable (battery capacity, etc), she always have cigarette "backups".

I do not know anything about the mechanical parts used, nor the chemicals (for DIY liquid), or even the various vapes on the market.

Are there good, reputable and independent review sites or wikis on this topic? Preferably not with toxic kitchen recipes. I think a good vape could accept either standard or homemade products, with a standardized battery, and as much replaceable parts as possible.

I started with a myBlu and ended up going through 6 different devices before finding one that doesn't suck. There is a huge quality problem in the market at the moment. The device I settled on, and which I've had zero problems with, is the "Smok Nord AIO 19". It's about 25GBP. Note that I had also bought a "Smok Novo" and DID have problems with that, it leaked everywhere, so even within the same brand quality varies dramatically.

The reviews on YouTube aren't useful because they don't usually use a device long enough for problems to become apparent. I've been using the Nord AIO 19 for several weeks now and swear by it. And it's not to be confused with the regular Nord... Which looks like the Novo and also has leaking problems.

If you're in the UK, Totally Wicked are a company that, while expensive, can be trusted. They only sell quality devices, but they're all rebranded versions of other manufacturers. They've recently struck a deal with WHSmith who will also be selling their kits (that's how trustworthy they are).

Why don't ecigs come with the same warnings that regular cigs do?

Because nicotine doesn't kill you, the way it is delivered does. Tobacco products are the most popular delivery method and is especially harmful due to level of carcinogens and other elements. Essentially no one cared much about nicotine as a chemical specifically much more than they did about caffeine.

Regulation hasn't caught up. Think of Juul as the Uber of nicotine.

I don't know where you live, but in my jurisdiction they do (WA state). Same big black or white paper with giant print saying the same stuff that is said on cig packs.

While I have no doubts or reservations about the ill effects of E-cigarettes, can a sample size of 31 people provide a definitive conclusion?

I readily buy their conclusions, but this really should be placebo controlled.

MRIs are loud and obnoxious and upleasant. If you told me that this result (observed on MRI#2) was entirely the consequence of having done MRI#1, I would find it plausible.

> ... on healthy non-smokers ...

That’s unlikely to be surprising. Would really love to know what the impact is in smokers versus an actual cigarette.

Isn’t nicotine already known to have this effect?

The vascular effects are very similar to prior research on cigarette smoke. It's precisely the same initial effects thought to lead to heart disease in smokers.

edit: You my have edited your comment while I was relying. The second of two sentences under Background (first section) mentions that this was a nicotine free study unlike earlier ones.

It seems clear that e-cigs are better than smoking.

It also seems clear that e-cig manufacturers are hoping to hook young non-smokers to expand their market.

Both are valuable bits of info, but "e-cigs do confirmed damage" is extremely important info from a public health perspective.

That's correct but I worry that all this will result in banning e-cigs (in my state at least), based on the idea that cigarettes (and many other things) wouldn't have been legal/popular if they appeared today but we tolerate them because they are already a thing. The last thing I want is for my SO to go back to smoking real cigs because e-cigs become unavailable here :(

There are tons of resources for building your own DIY e-cigarette. it might not be as slim and sleek as a Juul, but it will perform better, be cheaper to maintain and produce much less waste.

I'd like to see them made available via a prescription for smoking cessation.

Sure. While you're at it, please ban red meat. I eat far too much of it and need to be protected.

If someone starts selling nicotine-laced steaks, I'll be the first to advocate for an FDA crackdown on it.

Nicotine is in the same drug class as caffiene. Want to ban coffee as well?

Plenty of drugs are in the same class with substantially differing impacts - take heroin vs. morphine vs. fentanyl vs. oxycodone as an example, or ask someone taking antipsychotic psych meds if they're all the same.

Or try taking some strychnine because it's an alkaloid like nicotine and caffeine and see how well that works out.

Since you picked coffee as an example, most of the studies I've seen indicate probably health benefits from it. Nicotine it's not.

I guess I shouldn't have used the word "class" as you're not the only person to come back with that. I mean that it's generally recognized as safe (GRAS) by the FDA. I think you know that comparing heroin to nicotine is just silly and, as far as I'm aware, there's no data that shows that nicotine is any more or substantially more harmful than caffeine.

So back in reality where we're talking about banning e-cigs; why should they be subject to a prescription?

"So back in reality" GRAS does not mean what you think it means.


> Despite scientific uncertainty regarding the safety of inhaling aerosol and flavorant substances from electronic cigarettes (e-cigarettes) relative to inhaling smoke from traditional cigarettes, some consumers and vape shop employees suggest that the U.S. Food and Drug Administration’s (FDA) “generally recognized as safe” (GRAS) designation of constituents provides clear evidence of overall e-cigarette safety.

> Although the Flavor and Extract Manufacturers Association (FEMA) has clarified that the GRAS program only assesses product safety for ingestion in food, not inhalation, public confusion appears to continue.

Nicotine isn't even on the GRAS list at all. Some of the additives (like glycerol) and flavorants are.


>"So back in reality" GRAS does not mean what you think it means.

I know exactly what GRAS means. Why do you assume otherwise? I never claimed that vaping is safe; you'd have to be an idiot to make that argument. That doesn't mean you ban it.

I could have sworn it was on the list... but either way, it doesn't change the fact that nicotine is, by itself, not significantly harmful. What argument are you trying to make here?

It seems like all you want to do is nitpick and completely avoid the subject at hand. Why should nicotine and/or e-cigs be more tightly controlled than coffee, cigarettes, beef, alcohol, etc?

You claimed nicotine and caffeine are "in the same drug class", then clarified you meant GRAS, but that makes the statement false, as nicotine isn't GRAS.

I "assume otherwise" because trying to bring GRAS into the discussion about vaping at all indicates a lack of understanding of what GRAS applies to.

Contrary to your assertions, nicotine isn't "not significantly harmful": https://www.ingentaconnect.com/content/ben/vdp/2005/00000002...

> Why should nicotine and/or e-cigs be more tightly controlled than coffee, cigarettes, beef, alcohol, etc?

As linked up-thread, e-cigs appear to have slowed or halted the progress of smoking cessation efforts, and are seeing substantial uptick in teens. They're a major public health danger.

Coffee does not appear to be harmful, as we previously discussed in this comments thread. Cigarettes should be further restricted alongside e-cigs. Beef isn't addictive. Alcohol abuse is a serious problem, but societal acceptance makes it a difficult to tackle one on a practical level. Whataboutism isn't a great approach to medical issues, either.

Did you link to an abstract of a pay-walled article? Where are the conclusions?

>In this paper we review these implications of nicotine use and also examine the role of nicotine in the development of several cardiovascular diseases.

That would be nice to read. I can't find anything conclusive that would suggest it is a significant risk factor such that should be outlawed in the name of protecting adults from themselves.

>As linked up-thread, e-cigs appear to have slowed or halted the progress of smoking cessation efforts, and are seeing substantial uptick in teens. They're a major public health danger.

Yep, they have, and it's a shame. That doesn't mean the correct course of action is to take it away from adults. I am all for further regulation of companies who make the liquid. I am not for banning them, scheduling them, or outlawing flavors that don't taste like crap.

I started smoking when I was very young. E-cigs are the only thing that helped me to quit. You take them away and, guess what? People go back to smoking cigarettes. Some of us just like to smoke and will always do it.

>Beef isn't addictive

You sure about that? Perhaps not chemically, but there are many examples of food addiction. Why not ban everything that is potentially harmful?

I understand that food and nicotine aren't on the same level, just as you knew heroin and nicotine aren't. It's not "whataboutism" to hold the opinion that freedoms shouldn't be handed over at the first sign of a negative affect Your argument seems to boil down to "but think of the children!".

Cocaine is also in the same drug class as both nicotine and caffeine.

Drug class is irrelevant in this situation.

Not talking about that class "stimulants". See comment below.

I don't understand why making them available via a prescription would solve anything. I do not smoke or vape, but I have a friend who stopped smoking because vaping was accessible without going to a doctor. He just tried it because he wanted to see if it would work, and it did. He no longer vapes or smokes.

The stated concern is e-cigs becoming unavailable to smokers looking to quit. Making it available via a prescription permits that use, while limiting access for recreational uptake by kids.

No, it means every smoker has to go to a doctor just to try to use vaping to quit! Fuck that. That’s insane. No adult should have to go to a doctor for permission to use an e-cig. It’s not medicine.

Let the state go after the businesses promoting and selling e-cigs to kids—and levy astronomical fines against them. Sponsor PSAs that scare kids away from doing it. Educate everyone on the potential risks. If these “kids” are 18, they’re adults, so let them do as they please.

Cigarettes don’t require a prescription to get hooked on them. Adults should be free to recreationally use e-cigs just as much as cigarettes, weed, alcohol, and plenty of other substances. It’s their body. Increase taxes on them to try and discourage it and pay for PSAs against vaping. Whatever. But let’s dispense with the think-of-the-children crap, and let adults be adults.

It should also be clear that not using electronic cigarettes is better than using them.

I've never seen anyone argue they are harmless, just that they are less harmful than actual cigarettes.

The problem is that places are banning e-cigs, which presumably drives people back to smoking. Which is worse for everyone.

Anecdotally, I hear many friends say they are harmless. Surprisingly a nurse friend of mine vapes Juuls and isn't worried about the health impacts. I think plenty of people actually take it that since they are not cigarettes and are "just nicotine" they don't worry about their safety.

She probably just thinks that those risks are acceptable, not that she doesn't understand them.

Quite a few doctors I know drink alcohol, but it doesn't mean they don't know the health risks of that activity.

I too have heard many people say they were harmless.

Regarding your nurse friend, it's not that surprising to me that addicted medical professionals engage in motivated reasoning related to their addictions. It seems like just another version of the classic "I'm fine; I can quit any time" routine.

> surprisingly a nurse friend of mine vapes Juuls and isn't worried about the health impacts.

Thats your nurse friend's own personal choice for their own body. The health professional aspect not being an endorsement, but maybe helps them decide what they will tolerate for their own body.

I don't think that's true. The case against vaping is that it draws in people younger and ones that wouldn't otherwise smoke. In that case, the marginal harm from vaping might outweigh the marginal gain for smokers. Particular, since it's worse than quitting entirely, and you'd have to see how many people do not quit nicotine products because vaping is available.

Less harmful than tobacco is a very low bar. Especially for non-smokers. If it was treated like methadone then cool, but seems like these days most of the vapers are young, new users. Not recovering cigarette addicts.

Getting banned in the US means you didn't pay enough people off.

Only difference between US municipalities and other markets is that it is masqueraded as an endorsement for good under a respected system of due process (even though it is often unilateral decisions by unelected officials at health agencies with delegated powers)

The industry is going to fight that conclusion tooth and nail, though, so solid evidence of it is valuable.

Younger users might not have context like https://en.wikipedia.org/wiki/Operation_Berkshire or the acrimony leading up to https://en.wikipedia.org/wiki/Tobacco_Master_Settlement_Agre....

> It should also be clear that not using electronic cigarettes is better than using them.

That is obvious. But switching the current cigarette smokers to electronic cigarettes seems clear to be a better alternative for both the smokers and the people around them.

> It also seems clear that e-cig manufacturers are hoping to hook young non-smokers to expand their market.

This is mentioned a lot, but I find it questionable. I’ve never seen an ad that made me feel like Joe Camel or the Marlboro Man did when I was a kid. My teenagers haven’t ever thought vaping was cool based on ads or plenty of people doing it. This sounds too much like a general truism of capitalist enterprise—always find ways to expand your markets—while combining it with a direct accusation that it’s being done perniciously to “hook” them. Everyone who is selling anything is trying to hook people on their product, if that’s the terminology we’re using—new clothes, new cars, new TVs, the latest deals ... every company is using advertising to hook people on their products. People go into financial ruin for cars and homes and stupid stuff. Maybe we should just ban advertising to people so no company can try to hook young people on their products to expand their markets.

> Maybe we should just ban advertising to people so no company can try to hook young people on their products to expand their markets.

Yes, we should.

Advertising works. It influences you, affects your behaviour. To extract money from you. For someone else's benefit. Without your prior informed consent.

We should ban it.

Yeah, exactly. That’s what I’m driving at.

At the same time, I find it a bizarre bit of cognitive dissonance when people blame the product, and not the people in the company behind it. In most cases, at least. The product isn’t pushing itself on the public. It’s people doing that work, and people should be held responsible for it. Yes, there are bad products—but they aren’t making themselves.

It’s strange that we find it so easy to think up ways to ban a product, but never consider banning the advertising that pushes it on everyone and convinces them they just have to have it.

Do you think Juul’s school curriculum - which they paid schools to accept - was genuinely well-intentioned?


> In April 2017, a Juul representative visited the Dwight School in New York City to meet with students — with no teachers present — and told them the company’s e-cigarettes were “totally safe.”

Do you really think I would argue that is well-intentioned—no matter what company it is? Did my comment really leave the impression I’d give that a thumbs up? Companies shouldn’t be permitted to do that, regardless of their product—so fine them exorbitantly, and let’s do the same to the morons who accepted such a proposal while we’re at it. What I’m pointing out is this is standard behavior for corporations, and nobody does a thing to go after them or their profits when they behave badly—instead, people use this for lame think-of-the-children arguments against the products, calling for public bans, suggesting we force adults to get prescriptions for an e-cig, when what we ought to do is aggressively go after the bad corporate behavior—or make it illegal to manufacture and sell things if we don’t like them. But in the case of e-cigs, let’s start with cigarettes first, or admit we aren’t going to ever do that, move onto more productive conversations, and stop acting like e-cigs and actual tobacco products are at all equivalent—aside from the very narrow category of nicotine-delivery device.

They absolutely intend to stay in business. I have that from a chance, frank conversation with someone high enough in that industry to know.

Let's be honest. It is great money. People do not give that up. It gets taken from them.

It seems clear that e-cigs are better than smoking.

How can this be clear without long-term usage data?

Well, that's the seems part.

It certainly stands to reason that inhaling vaporized nicotine will be better than inhaling vaporized nicotine plus ash and tar and pesticides and whatnot.

Fair enough. Although I think a researcher would say our bags of meat often surprise us.

Yes, nicotine itself is known to have this impact on the vascular system.

Not surprising you see it with nicotine vaping.

Is there a theoretical model for the effect of ecigs on the effect on the human body? What would such a model say about their safety in comparison to normal cigarettes.

I’m tired of vaping companies claiming it’s safe. Glad the truth is finally getting out. The only safe alternative to cigarettes is to not smoke at all.

Can you point me towards any advertising campaigns or promotional material claiming that vaping is "Safe"? Not safer, but safe.

sorry if this comment is against the spirit of the community (i don't think it is, but I have been blocked from posting in the past oblivious to the fact that I wasn't contributing anything meaningful), but that being said...

am I the only one who isn't surprised that someone managed to find that if you introduce something into the body that isn't generally there, that there is obviously going to be an acute response of some sort? seems sort of like a simple "you introduce a thing to your body, your body responds to it" type thing, though perhaps I misunderstood the nature of the acute systems that were measured? they just didn't seem too horribly negative to me from my reading of it. granted, that being said, im all for further testing and gathering of further evidence, as a vaping enthusiast myself i think it's quite important that science keeps studying it so that we know exactly what it does, especially over long term exposure. and perhaps maybe I'm just being unnecessarily reactive against some imagined people that might take this and say "hey look it's proof that vaping is bad for you because things happen when you do it!"

> is obviously going to be an acute response of some sort?

That's not how science works. They don't just act on something because someone thinks "it's obvious". They need hard evidence because the body is very complex and requires specific experiments to show anything. It's not about what get who suprised or not surprised, this is about establishing a definitive scientific truth. And there can absolutely be a substance that you introduce into the body and there is no meaningful effect. (You can probably always measure some effect, but it could be so small that it doesn't affect anything of value.) (no downvote from me fyi)

sometimes i really wish that people would actually tell me why they downvote what I have to say, rather than just silently doing so and condemning me to the bottom of the comments. i can't really really do the revision part of performance, feedback, revision without any actual feedback of substance to inform me as to what it is that I did wrong in the first place.

Downvotes usually equilibrate "correctly" over time. Best response to downvotes is to re-read and see if anything said was wrong or inflammatory, and if not, just wait it out.

In general, I'd say that using proper capitalization and avoiding walls of text - stripping down to your actual point - would help your comments.

oh interesting, i never seem to find mine to equilibriate over time; they generally get zero engagement. i honestly did not realize that people really put that much import into proper capitalization; i figured most people understand that, given the heavy market share of mobile users, that most of the time, all lowercase text is more often an intentional choice and not necessarily one made of intellectual laziness.

as for the wall of text thing, that certainly makes sense to me. i always have a tendency to write those, and i could understand why others would find them cumbersome to parse. all in all, good advice, and i highly thank you for sharing it with me. i suppose i may have to rethink how i present myself here, esp wrt the whole orthography of my posts :)

> given the heavy market share of mobile users, that most of the time, all lowercase text is more often an intentional choice and not necessarily one made of intellectual laziness.

This formatting works in instant messengers because people use short discrete messages, which are visually bound in little highlighted boxes. In a paragraph you don't have the same visual aid, and it makes it harder to read.

you're using too many words to say something simple. that and the comment comes off a little as "well i can see the point of X, but I can also see the point of Y"... which isn't really saying anything. Just my 2 cents.

If you were being heavily down-voted (flagged) here on HN you'd get steadily greyed out and then just disappear behind a [flagged] status. Looking at your comment history, this doesn't appear to be the case.

Even if the above is not true, I am guessing that your posts are simply being ignored by many people. Walls of text with no capitalization, and extremely long sentences are very unapproachable. This will naturally push you down below comments that get up-voted.

Very frustrating that there is so much attention around e-cigarettes and so little around cannabis vaporisers.

I would be curious to compare this to smoking an actual cigarette to see if there is any difference. Inhaling any vapor/smoke that isn't meant for your lungs is going to cause damage and it would be neat to see a comparison between the two.

Anecdotal story time:

My grandfather who is currently 81, has been smoking since he was 12. He grew up in a very small town, and had 6 people in his graduating class other than himself.

Around January of this year, during a visit he seemed inquisitive as to the vaping device I was using. He still at this time was smoking 1.5-2 packs a day of roll-your-own cigarettes.

The reason he still was smoking so much is he has severe health issues from being legally blind from diabetes, and having extreme back pain since he returned from the service. In his hold age the only place he can sit and relax is this very old chair that sits on his porch that for whatever reason the angle on it relieves his back pain. He sits on that porch, smoking I would say 85% of his time, and the habit of playing with cigarettes while sitting there was the biggest factor.

After inquiring about my device and having me explain it to him he wanted to buy one right away and get on the e-cig bandwagon. I was skeptical as he has a whole multitude of health issues and if I were to switch him without consultation and something were to happen the guilt would be very great and I could not live with that.

I went with him to one of his visits to the V.A. and he brought up the subject of e-cigs to his doctor. We all had a conversation that pretty much came to the conclusion that continuing to smoke cigarettes wouldn't be any better than e-cigs, and there is always a chance that the e-cig could be worse but there was nothing definitive.

I was able to get him to transition to smoking 0% nicotine juice, with a higher PV/VG ratio (from what I've gathered online in smoker forums high VG juice tends to inflame those with asthma more than the PG). He did use nicotine patches for two weeks when he came off the cigarettes.

He slipped up and did smoke about 3 cigarettes during this transition, but starting the beginning of February he has been nicotine free and smoking the e-cig.

He recently had a lung test or something where they measure your 02 etc. He had said when he was smoking his 2 packs a day that his 02 was at 65% or so, and that it had gotten up to 78% at his last test.

Now I'm not a doctor and there are probably a billion variables that are unaccounted for, however he said that his breathing is much easier and doesn't have a hard time sleeping when it is hot and humid out as much as before. For him the switch seems to be working with regards to his lungs/breathing.

As far as other issues becoming more exacerbated because of this, only time will tell I guess.

He does want to quite completely, I suggested switching to sugar free candies or something to keep his oral fixation at bay while he sits in his chair. He seemed open to the idea, but like most smokers it really is a mental game and trying to get him to change his ways is pretty tough as he is a stubborn old man.

If your 02 is 68%, or even 75%, you’re likely about to be put in a coffin. Patients with severe COPD/emphysema might have arterial oxygen levels in the mid to high 80s without supplemental oxygen

Yeah, the mortality rate of people in this condition (resting O2 levels in the 60-70%) is probably at least 50% 1-year mortality (half will die in the next year).

Which is not exactly the population this paper is trying to shed light on, but thanks for sharing his experience.

Yeah he is in rough shape, to be honest we (doctors/wife/family) expected him to go when he was 75-76 or so. He has been hanging on that is for sure. I figure if I can extend his 1 year, to be even say 1 year and 6 months, it would be worth it.

He has been on/off oxygen in the past and he's at that stage where he is waiting to kick the can, and is a very lucky man who has a wife of 66 years, who still takes care of him everyday.

I can guarantee if his wife passed, he would go the next day and that he is holding on because he knows how much she loves him.

Sounds like it was more of a lung function test. Maybe 68% of a healthy adult? Who knows what metric or baseline.

Increases my conviction that vaping products should only be available by prescription, which any primary care physician would be more than happy to prescribe for a smoker hoping to quit.

As for the ~40% of 7th and 8th graders that are vaping at my kids middle school, well, that number would hopefully decrease.

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