OK, so... unlike nicotine:
- alcohol (and cannabis) intoxicate
- alcohol abuse actually DOES harm developing brains
- teen binge drinking causes 3,500 deaths every year

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(2)
FAR fewer teens vape than drink. FAR fewer teens vape nicotine daily than binge drink.

It's very clear here, that vape firms do a FAR better job keeping their products away from teens than alcohol companies do.

So why the irrational #MoralPanic over teen nicotine vaping?
(3)
So... Why the irrational #MoralPanic over teen nicotine vaping?

I assume that's because 4 decades of tobacco control messaging have convinced the public and physicians that nicotine is FAR more harmful than alcohol or cannabis.
rutgers.edu/news/rutgers-l….
(4)
Seriously though... nicotine? Doesn't intoxicate. Slightly increases focus, attention and memory, while paradoxically reducing stress and anxiety.

Difficult to see how any of that is bad.
rsph.org.uk/about-us/news/…
(5)
But the 1988 @Surgeon_General report says, "The pharmacologic and behavioral PROCESSES that determine TOBACCO addiction are SIMILAR to those that determine addiction to drugs such as heroin and cocaine."
wwwn.cdc.gov/osh_pub_catalo….
(6)
Ever since 1988, based on the above statement (processes; tobacco; similar), people in tobacco control, and journalists, have been stating confidently that "nicotine is as addictive as heroin and cocaine."

That sounds like a harm. But it's a wild exaggeration.
(7)
So how dependence-forming is nicotine, really? Rats don't like it (it's super difficult to get them to push a lever for it, though they're happy to press the lever for cocaine).
(8)
...and the @US_FDA says, very clearly, that nicotine patches and nicotine gum are not dependence-forming or "subject to abuse."
federalregister.gov/documents/2013…
(9)
So... how is the pharmaceutical grade nicotine in a vape, #snus or nicotine pouch magically transformed into "highly addictive"...

...when the exact same molecule in nicotine patches and gum is not even dependence-forming?

Or is wild exaggeration now a public health tactic?
(10)
How is it possible for nicotine to be "highly addictive," but for US high school nicotine vaping to drop 60% in just two years?
(11)
Which it clearly did. Down by nearly 2/3rds in 2 years. The kids just quit. This is NOT consistent with "highly addictive" claims.
(12)
So... Did those kids quit vaping and switch to smoking to get their "highly addictive" nicotine fix? Woah. No.

Seriously no. US teen cigarette smoking has plummeted to 1.9%. Only 0.38% now smoke frequently (>20 days/month).
(13)
But maybe kids who vaped nicotine in high school will transition to cigarette smoking once they become young adults? No... That's wrong too.

Among all US adults, the age group with the steepest rate of smoking decline is - you guessed it - young adults.
(14)
So, basically, in the United States of America, smoking is dead. As this cohort of teens and young adults ages, smoking is dead.

And here's a little secret: Total teen nicotine use is lower now than at any time in the past 50 years.
(15)
Which brings us back to today. Again I ask, why is teen use of a mildly psychoactive drug (nicotine) which is no more harmful than caffeine, which they use far less today than at any time in the past 50 years, and use FAR less than alcohol, causing so much #MoralPanic?
(16/16)
Obviously, teens should not vape, drink or smoke. But only one of these things helps US adults quit using a deadly thing (cigarettes) that kills 480,000/year.

Alcohol? Legal. Cannabis? Lgalization is roaring ahead. Why is nicotine the new target in the War on Drugs?

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More from @ChaunceyGardner

Mar 5
@DrCaliff_FDA's @US_FDA says that e-cigarettes are “potentially less harmful forms of nicotine delivery for adults, [and] many studies suggest e-cigarettes and noncombustible tobacco products may be less harmful than combustible cigarettes.”
fda.gov/tobacco-produc…

THREAD
👇👇👇
(2)
@DrCaliff_FDA's @US_FDA notes further: A Cochrane 2020 systematic evidence review found:

"ENDS [ecigs] may help more people stop smoking for six months or longer than using nicotine patches or gum [&] the overall incidence of serious adverse effects related to ENDS is low."
(3)
@DrCaliff_FDA's @US_FDA notes further: “Existing studies have shown that daily ENDS [e-cigarette] use is associated with significant reductions in combusted cigarette use.”
fda.gov/media/153017/d…
Read 11 tweets
Dec 26, 2021
Truth-telling and "utility" (greatest good for greatest number) are 2 basic principles in healthcare ethics that may come into conflict. For example:

17% of adults are salt-sensitive (more salt => higher blood pressure). 83% can eat as much salt as they like.
THREAD
(2)
The above figure comes from this peer-reviewed paper.
ncbi.nlm.nih.gov/pmc/articles/P…

Now, let's consider how truth-telling and utility come into conflict...
(3)
The dilemma for public health is this: If we tell EVERYONE to reduce their salt intake, this will help the 17% who are salt-sensitive. It may save lives.

But that requires us to violate truth-telling (i.e., it requires public health authorities to lie to 83% of adults).
Read 13 tweets
Dec 25, 2021
Classic ethics thought experiment (updated)

Trolley Problem: You can flip the track and save the lives of 5 adult smokers. But the cost of doing so is one teen becoming dependent on nicotine.

Note: Death is final. Dependence is not (e.g., 2/3rds of teen smokers later quit). Image
...OK. Let's be more accurate. Teens who vape today may later quit. In fact, nearly 2/3rds of them just did quit (over the past two years).

Adult smoking shortens the lives of 50% of lifelong smokers by ~10 years. So that's not certain either. But death remains final. Image
So... Why 5 to 1?

4.6 million US adult vapers have quit smoking completely (this does not include smokers who quit with ecigs and later quit vaping).
cdc.gov/mmwr/volumes/6…

0.5 million US high school students vape nicotine daily.

>2.3 million lives saved vs. 0.5m 'hooked'?
Read 4 tweets
Dec 7, 2021
What happens when a smoker quits by switching to nicotine vapes ("e-cigarettes")?

THREAD
👇👇👇
(2) when a smoker switches to nicotine vapes

Excess lifetime cancer risk drops >10,000-fold, and is “lower than guideline values defined by EPA and WHO.” 2nd hand vapor risks are obviously even lower than that.
sciencedirect.com/science/articl…
(3) when a smoker switches to nicotine vapes

A more conservative estimate found lifetime cancer risk drops “only” 99.5%. Lifetime cancer risk from smoking is 18%. 0.05% of that = 9 in 10,000 (a risk so low it would be difficult to measure).
tobaccocontrol.bmj.com/content/27/1/10
Read 18 tweets
Nov 15, 2021
1/2
@CJBoyd_Research: No one vapes THC in "ENDS." THC vs. nicotine vapes = different devices.

Your study found “wheezing or whistling” in teens who vaped THC. And it found that teens who vape nicotine ("ecigs") have no respiratory symptoms. None.
sciencedirect.com/science/articl…
2/2
So, consider the logic of your statement on @CNN:

"Without a doubt, e-cigarettes are unhealthy and not good for lungs." ["Of course, we couldn't find any harms from nicotine vaping ('e-cigarettes'), but it just stands to reason there must be some."]
cnn.com/2021/03/03/hea…
PS: I cannot state strongly enough how the community of millions of adult ex-smokers who use #SaferNicotine to avoid toxic forms of tobacco HATE the term "ENDS."

And how much we hate @CDCgov's insistence that some people vape THC in "Electronic NICOTINE Delivery Systems."
Read 5 tweets
Nov 11, 2021
REMINDER
If nicotine vapes ("e-cigarettes") are, in fact, safer than smoking, and help smokers quit, they are (obviously) profoundly different from recreational drugs like alcohol, caffeine & cannabis.

So, what if we just ask ex-smokers who vape how they're doing?

THREAD
👇👇👇
(2)
Among ex-smokers who quit by switching to nicotine vapes, 93% say their health improved. 62% say "improved dramatically." The 5% who said "no change" said "I was healthy to begin with."

Healthier. This is so different from daily screaming headlines.
(3)
Among ex-smokers who quit by switching to nicotine vapes ("e-cigarettes"), 90% say they now have fewer and less sever lung infections. We're healthier. Does no one care?

Confirmed by these peer-reviewed studies.
nejm.org/doi/full/10.10…
omicsonline.org/open-access/ch…
Read 7 tweets

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