@NoahSCosi Good thread Noah. The public has many misperceptions. One is JUUL. Only 0.6% of US high school students use that product, so banning it will have little impact on teen vaping.
#FactCheckMe here:
cdc.gov/mmwr/volumes/7…
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@NoahSCosi 2
Another is the "whole new generation addicted to nicotine." US teen nicotine use is lower today than at any time in the past 50 years. This is easily fact-checked from @CDCgov's National Youth Tobacco Survey and @NIH Monitoring the Future survey.

It is a fact. Image
@NoahSCosi @CDCgov @NIH 3
Third, there is no escaping this: One obvious interpretation of what has happened over the past 10 years is that US teen nicotine vaping just drove teen smoking down to near zero.

Over the past 50 yrs, the avg drop was ~7% per decade. Suddenly... 90%. Teens don't smoke now. Image
@NoahSCosi @CDCgov @NIH 4
Since almost all smokers start in their teens, and smoking kills people, THAT interpretation (above) implies that we have just witnessed a massive health benefit.

Yet, if you work in tobacco control and even hint at this you will lose your job, research grants, and be shunned. Image
@NoahSCosi @CDCgov @NIH 5
Most Americans assume that most nicotine vapers are teens. #FactCheck: There are 12 million US adult nicotine vapers...
cdc.gov/nchs/data/nhis…

vs. 0.7m high school frequent vapers.
cdc.gov/mmwr/volumes/7…

95% are adults. In contrast, only 89% of alcohol users are adults.
@NoahSCosi @CDCgov @NIH 6/6
IMHO, the only way the American public, journalists and politicians could get as profoundly misinformed as they now are is as a result of a massive well-funded propaganda effort funded by two unaccountable foundations: @BloombergDotOrg and @truthinitiative.

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More from @ChaunceyGardner

May 11
It's pretty simple to ask any of the millions of adult smokers who have switched to nicotine vaping how they're doing. Like this (not scientific; just a social media survey).

But it borders on medical #malpractice that this is not a higher priority for the research community.
2
It's pretty simple to ask any of the millions of adult smokers who have switched to nicotine vaping how they're doing. Like this (not scientific; just a social media survey).

But it borders on medical #malpractice that this is not a higher priority for the research community.
3
It's pretty simple to ask any of the millions of adult smokers who have switched to nicotine vaping how they're doing. Like this (not scientific; just a social media survey).

But it borders on medical #malpractice that this is not a higher priority for the research community.
Read 7 tweets
Apr 22
OK, so... unlike nicotine:
- alcohol (and cannabis) intoxicate
- alcohol abuse actually DOES harm developing brains
- teen binge drinking causes 3,500 deaths every year

THREAD
👇👇👇
(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….
Read 16 tweets
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

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