LONG THREAD: What happens when people switch from traditional cigarettes to nicotine vapes?

Does their risk of cancer, heart and/or lung disease increase or decrease? 10,000 scientific studies on e-cigarettes over the past decade. So no shortage of answers.
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First let's set the stage. Cigarette smoking is the starting point.

Here is a breakdown of cigarette smoking-related deaths: 36% cancer; 36% cardiovascular disease; 21% lung.

Lung cancer was the first evidence cigarettes kill half of all users.

Imagine if 7.7% of teens eat ice cream at least once in the past 30 days.

The field of Ice Cream Control calls that "current use."

This number has dropped 61% over the past 4 years.

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90% of "current ice cream eaters" ate 'flavored' ice cream.
10% ate coffee flavored ice cream.

For some strange reason, the field of Ice Cream Control calls artificial coffee flavor "unflavored."

25% of "current ice cream eaters" ate it daily.

Milestones in vaping history
2019: US-only outbreak of vape-related lung injuries caused by adulterated illicit THC vapes.

@CDCTobaccoFree deliberately blames this on legal nicotine vapes. Invents acronym "E-cigarette or Vaping-Related Lung Injuries" (EVALI).
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While @CDCTobaccoFree continues to claim "EVALI" is caused by nicotine vapes ("e-cigarettes"), numerous state health departments are telling a very different story.

Welcome to How to Lie with Percentages 101
This seems like a minor point in @FDATobacco Director King's recent Op/Ed in Nature. Here is a quote:

"In 2021, 11.3% of high-school students used e-cigarettes, compared with 4.5% of adults."

It's misleading in 4 ways.
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First, it's not 2021 anymore. The latest data from the @CDCgov NYTS and NHIS surveys are easily available to the authors.

In 2023, 10% of US high school students vape nicotine "at least once in the past month." And 7% of adults do so "daily or some days."

Humans have been burning leaves of the tobacco plant, and inhaling the smoke, for well over 8,000 years now.

It had ceremonial purposes, presumably when nicotine's psychoactive effects were needed: increased focus, attention and memory.

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For thousands of years, tobacco leaf smoking was only a thing in the Americas.

In the Old World plenty of people smoked, but not tobacco leaves. THEY smoked cannabis or opium.

Congratulations. You have invited PAVE to tell you about the dangers of vaping. Here's a head's up on what they are going to tell you....

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"Middle school use is up."

#FactCheck: MISLEADING. Middle & high school nicotine vaping dropped 61% over the past 4 years. 1.9% of teens vape nicotine daily, so may be 'hooked' (down >50% in the past 4 years).

2019:
2023: cdc.gov/mmwr/volumes/6…
cdc.gov/mmwr/volumes/7…

Consider "the Standard Narrative" *pushed* by tobacco control:

• Whole new generation addicted to nicotine
• E-cigarettes are a gateway to smoking
• Ecig use increased exponentially, especially among teens
• They target teens
• Nicotine harms developing brains

(1/X) 👇🧵👇 (1a) Where is this "whole new generation addicted to nicotine"?
In the USA, teen nicotine USE is lower today than at any time in the past 50 years.
#FactCheckMe: @CDCgov and @NIH survey data

Daily Brain Harm News
15 past-Presidents of the top professional society in tobacco control call "nicotine brain harm" claims "speculative" because there is no human evidence.

Yet @CDCgov continues to tell the public "nicotine harms developing brains" is a known fact.

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How do we sort that all out? First, we should consider what actually can, tragically, cause permanent life-long harm to developing brains.

- under-nutrition
- toxic stress factors (neglect, abuse, loss of parents,
and exposure to violence)

This VERY common "mistake" is a direct consequence of the way CDC & FDA present teen vaping data.

It confuses journalists, the public and members of Congress.

@CDCDirector Walensky & @FDACommissioner @DrCaliff_FDA: I demand you STOP reporting Daily Use as a % of 'current use'. (2)
Here is example #2 @CDCDirector Walensky and @DrCaliff_FDA. Another "trusted" source telling the public 1 in 4 teens use ecigs daily.

The reason this is happening is clear: You present the data in a deliberately confusing way (daily use as a percentage of 'current use').

@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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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.

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.

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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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?

@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…

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@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."

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.
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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...

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). ...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.

What happens when a smoker quits by switching to nicotine vapes ("e-cigarettes")?

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👇👇👇 (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…

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@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…

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?

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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.

LED candles (tea candles). No combustion. Our passive protest against #COP9FCTC efforts to - literally - kill us and other #SaferNicotine user like us.

From London, Day one of @MikeBloomberg-funded @WHO @FCTCofficial fiasco LED candles (tea candles). No combustion. Our passive protest against #COP9FCTC efforts to - literally - kill us and other #SaferNicotine user like us.

From London, Day one of @MikeBloomberg-funded @WHO @FCTCofficial fiasco.

Lets explore @FDATobacco infographics. These data come from @CDCTobaccoFree's National Youth Tobacco Survey.

US teen nicotine vaping increased in 2018 (to twice what it is today), so FDA's infographic focused on the percentage increase.
@DrWoodcockFDA

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In 2019, US teen vaping increased again, but it's not clear WHAT they were vaping. @CDCTobaccoFree forgot to ask that in 2019, so much of this "increase" may be THC vaping, not nicotine.

This time there's a graph, huge letters saying "ALARMING," and an absolute number.

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The death toll from smoking is staggering (including my own father). 8 million people die every year from smoking
who.int/news-room/fact…
...including 480,000 in the USA
cdc.gov/tobacco/data_s… 2
Harm reduction can reduce that death toll, according to 15 past-Presidents of the world's leading professional society in tobacco control.
ajph.aphapublications.org/doi/pdf/10.210…

...and over 70 respected scientific and public health organizations around the world.
drive.google.com/file/d/1Ty7pgR…