{"items": [{"author": "Kiran", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680889684492", "anchor": "fb-680889684492", "service": "fb", "text": "Finally some sense on this issue. Too bad you're not a journalist working for an organization with a wide reach.
Of course you know some kinds of alcohol seem to have health benefits. I believe this is true of caffeine as well as coffee. Discover mag published a book except in November that listed a surprising number of benefits to nicotine (not smoking) that make me want to investigate it as a supplement.", "timestamp": "1409318831"}, {"author": "Victor", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680891905042", "anchor": "fb-680891905042", "service": "fb", "text": "You may be right, but as Yogi Berra said, \"Making predictions is really hard....especially abut the future\". With significant regulations, as you said, e-cigarettes might save lives.", "timestamp": "1409320080"}, {"author": "Mac", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680892753342", "anchor": "fb-680892753342", "service": "fb", "text": "Right on!! Cigarettes produce some 5000 compounds, most of which are really bad. I have read that the link between cigarettes and heart disease is brutally simple: carbon monoxide.
Personally, my mother died of emphysema after a lifetime of smoking. All three of my sisters smoked. One quit in her youth. Two have switched to e-cigarettes. As a medical device engineer, I have worked on an e-cigarette. Two other medical devices I've worked on: a Pap-smear preparation device that cuts the false negative rate by 75%, and a stool based DNA test system the can detect colon cancer by just providing a stool sample. The e-cigarette could save many more lives than the other two devices.
Truth in advertising: I own stock in the colon cancer company.", "timestamp": "1409320757"}, {"author": "Anna", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680892893062", "anchor": "fb-680892893062", "service": "fb", "text": "Lots of research needs to be done though! Our lab is studying metals and PAH's in e-cigs right now!", "timestamp": "1409320881"}, {"author": "Will", "source_link": "https://plus.google.com/115623320734956550423", "anchor": "gp-1409322210435", "service": "gp", "text": "Gwern on nicotine as a nootropic\n
\nhttp://www.gwern.net/Nicotine", "timestamp": 1409322210}, {"author": "Adam", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680898871082", "anchor": "fb-680898871082", "service": "fb", "text": "One of the problems of e-cigs is the market target. Many e products are flavored and designed to appeal to a youthful crowd just being introduced to nicotine. In a sense, they are being marketed as \"candy\" cigarettes.", "timestamp": "1409324142"}, {"author": "Penelope", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680899400022", "anchor": "fb-680899400022", "service": "fb", "text": "Erik, please link your comment to Jeff Kaufman", "timestamp": "1409324532"}, {"author": "Erik", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680903696412", "anchor": "fb-680903696412", "service": "fb", "text": "My letter to the FDA on their proposed \"Deeming\" regulations on e-cigarettes -
I have been an e-cigarette user for just short of two years. I am a 55 year old man who began smoking cigarettes at age twenty. In the intervening 35 years, I tried to quit smoking many times. Nicotine gum got me to quit twice for 6 months and a year. Snus also was successful for two occasions of similar length, but my cravings for nicotine never ceased. I would inevitably have a social smoke and the cycle would return. E-cigs are an entirely different animal. They are The Solution for nicotine addicts like myself. I do not crave a cigarette. I have no interest in them. All of the pleasures of smoking are fully replaced by my ecig.
I have not had a cigarette since the day my first ecig kit arrived at my door. My experience in this is far from unique. I have communicated with thousands of ecig users on ecigarette.com who have also switched for good, after decades of trying to quit by other means. Drug therapies, nic patches and gum, and all the FDA sanctioned options, are a sad excuse to the affordable e-cigarette.
It is appalling to me that the FDA is choosing to regulate this wonderful lifesaving product, solely in the financial interests of big pharmaceutical and tobacco companies. You want to push the performance of the available products back to its infancy. My first kit of this first generation approach, gave me a taste of what an ecigarette could do. A \"cig-a-like\" was enough to give me hope, but would not have sustained my abstinence from smoking. With-in a week of using my toy ecig, I was frustrated by its short comings. - Lack of battery power and longevity, minimal delivery of vapor,... it had promise, but the internet gave me stories of products that could provide a much more satisfying vape. I've explored the gambit of improved vaping technology, and your regulations, as proposed, would have blunted this journey. I would be a current smoker if the FDA regulations currently proposed would have been in place two years ago.
I Do think the FDA should regulate. Please do so with public health as your primary concern, not the financial interests of the large corporations that seem to own you. There are only four ingredients in ecig liquid. PG, VG, Nicotine, and Flavor. REGULATE THOSE! NOTHING ELSE!! All current e-cigarette hardware works in the same basic way. There is a battery that heats a resistance-wire coil. The coil is in direct contact with e-liquid, and vapor is created. If your regulations allow for a variety of clever ways to maximize the consistency and safety of this process, then by all means regulate away! But the critical component to regulate is the liquid. PG and VG are widely available. Perhaps a bio test that insures safe inhalation for the two would be in order. Nicotine is a well known chemical. It has a lot of guilt by association. Cigarettes kill! We all know this, but nicotine is Not The Killer!! Regulate the purity of the nicotine. That would be appreciated!
The main thing that needs some overview and control here is the last ingredient. - Flavors. We do not need to limit the variety. Folks can market baby food flavors for all I care. Kids are not into ecigs for flavors. E-cigs simply are not cool. Look at the studies out there and it is clear. The flavors need to be looked into for safety and health. Are they safe to inhale? What is in them? This is something the FDA could regulate in a healthful and helpful way!
In closing, I write this submission for the benefit of future vapers. I own enough ecig hardware to get me through many many years. I have stock piled enough nicotine and flavors for the coming FDA apocalypse (as it is commonly referred to amongst vapers on the net). If the FDA's final rules follow the proposed guide lines, I will go to the black market for future needs. This is truly sad. I would like to believe that the FDA is there to support and encourage public heath and safe consumer goods, not to force someone like myself into a much more dangerous black market.
Please do what is best for current and future vapers, and potential ex- smokers. Please regulate for health and safety with no weight given to tax money or corporate greed.
Erik", "timestamp": "1409326598"}, {"author": "Hollis", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680904754292", "anchor": "fb-680904754292", "service": "fb", "text": "A few thoughts:
- The public health people I know who've studied ecigs are not thrilled about them. They have spent more time studying it than I have, so I'll fallaciously appeal to authority a little bit there.
- \"They're only a few years old so we don't have the decades of collected evidence we have with cigarettes, but from what we know about how they work they should be much safer, both for the smoker and people around them.\" This strikes me less as \"science\" and more as \"guessing\", given that the stuff I've read has said, basically, that it's too early to know what their health effects are.
- The existing tobacco industry is investing heavily in ecigs. Their safety record for what they choose to put into cigarettes leads me not to trust that they'll magically become safety-conscious for ecigs.
All of those things are basically science-based concerns, and I'm willing to let them go if the data shows I should. My last concern is more behavioral and health-based.
- I am a person with a ton of allergies, including pretty severe smoking allergies. The bans on smoking in public places have been an absolute godsend for me; I remember marveling at how wonderful it was to be able to go to restaurants when they banned smoking in them in NY; previously, I would get too sick to be able to go.
Ecigs and vaping have created a grey area. They're marketed as being \"not cigarettes\" and \"not smoking\", which means nobody's quite sure what to do with them. This is anecdata, but of the people I personally know who vape, all of them have felt comfortable sitting next to me, indoors, and vaping. Because it's perceived to be safer than smoking, they also vape much longer per day than they did when they were smokers.
Now. Whatever is in vape-juice, we can safely call it \"drugs\" because it's designed to have an effect on the body and it ain't food. Some of it comes back out of the vaper's mouth and into the air, which you can tell because (a) you can smell it and (b) you can see it. Most indoor air spaces have pretty poor air replacement unless they're carefully designed industrial spaces; we know from other data that the air pollutant rate indoors is often 50-60x what it is outside. All of that stuff is floating around in the shared air indoors, and some of us are probably allergic or sensitive to it.
I don't want to have to breathe someone else's ecig chemistry set, but I don't have a choice because ecigs have been so comprehensively marketed as \"safe\" and \"not smoking\".
A last point: people thought smoking tobacco was safe, and even health promoting, for a long time. It takes a pretty large number of years for the negative effects to show up. I am therefore skeptical, if only by association, of people saying conclusively how safe ecigs are after only a few years of study in which ecig contents are not controlled, regulated, or even disclosed. There's also the dose-dependent issue: a lot of people use ecigs far more often than they used actual cigarettes, so the dose-dependent health effect assumptions are likely to be wrong because people aren't using ecigs the same way they use real cigarettes.
TLDR: I am in favor of regulating ecig ingredients for purity and safety; In favor of treating ecigs exactly like real cigarettes in terms of where the law permits users to vape; In favor of meaningful studies, started soon, with large sample sizes, at the public expenses and free from corporate funding; and I am in favor of limiting the way drug companies can call ecigs \"safer alternatives\" until there is more-conclusive evidence that that's true.", "timestamp": "1409327184"}, {"author": "Mac", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680908367052", "anchor": "fb-680908367052", "service": "fb", "text": "\"Vaping saves smokers' lives! Don't over-regulate!\" \"Vaping carries unknown risks! Regulate like tobacco!\" Both are absolute truths -- but like many arguments, half truths.
We need to consider three populations: smokers, vapers, and non-smoker-vapers. Of these three, clearly the last group are the healthiest. The entire issue is the total deaths (NOT death rates, but TOTAL deaths in the US) in the other two populations. Regulations need to be written that allow an increasing vaping population to reduce significantly the total deaths of the smoking and vaping populations combined.
Are there paths to death via vaping? Absolutely. Blood transfusions and air bags kill people. Regulating vaping to the point of denying smokers an easy alternative to tobacco does not seem likely to be good public health policy.", "timestamp": "1409328098"}, {"author": "Gianna", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680908451882", "anchor": "fb-680908451882", "service": "fb", "text": "Your blog post doesn't mention anything about the use case of people starting with e-cigs and then moving on to \"real\" cigarettes, rather than the (beneficial) reverse. I have no idea if this is actually happening, but I imagine that it's a big fear for people concerned with public health.", "timestamp": "1409328179"}, {"author": "Erik", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680910053672", "anchor": "fb-680910053672", "service": "fb", "text": "There have been surveys about ecigs as a gateway to smoking. It is a fear, but doesn't appear to be occurring in numbers that can justify the ban by any other name that the FDA is trying to impose. Ecigs are being taken up by current smokers to replace cigarettes in part or entirely. A fraction of one percent of ecig buyers have never smoked.", "timestamp": "1409329476"}, {"author": "Erik", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680912413942", "anchor": "fb-680912413942", "service": "fb", "text": "Anyone seeking solid information on this topic should take the time to read this - http://casaa.org/uploads/CASAA-FDA-Comment-8-7-14.pdf", "timestamp": "1409331196"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680912853062", "anchor": "fb-680912853062", "service": "fb", "text": "@Hollis: \"In favor of treating ecigs exactly like real cigarettes in terms of where the law permits users to vape\"
Over time we keep restricting the areas where it's legal to smoke because of (1) public health benefits of dissuading people from smoking, (2) fire risks from cigarettes, and (3) dangers of secondhand smoke. These mostly don't apply to e-cigs. For example, I couldn't open a restaurant and allow smoking or have a smoking area: does that mean I also shouldn't be able to allow vaping at my hypothetical restaurant?
Do you have any reason to think that the chemicals released when people vape are any more of an issue than the chemicals released by common deodorants and perfumes? The main chemicals released are propylene glycol and glycerine (these are the ones you can see) and both of these are very safe and don't have a smell.", "timestamp": "1409331573"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680912997772", "anchor": "fb-680912997772", "service": "fb", "text": "(Hollis: and \"whatever is in vape-juice, we can safely call it 'drugs' because it's designed to have an effect on the body and it ain't food\" is a classic application of the noncentral fallacy -- http://squid314.livejournal.com/323694.html)", "timestamp": "1409331657"}, {"author": "Erik", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680914614532", "anchor": "fb-680914614532", "service": "fb", "text": "I mix my own vape juice. This is quite common amongst experienced vapers. There are four ingredients. PG (poly glycol) VG (vegetable glycerin) concentrated flavoring and nicotine. PG and VG are well known and commonly used liquids found in everything from hand cream to cough medicine. They make up over 90% of the liquid by volume. Nicotine is mixed at between .6-2.4%, depending on desired strength. I vape liquids in the 1.5-1.8% nicotine range. Flavors are anywhere from 2-8% of the liquid by volume. The PG, VG and nicotine I buy are from FDA approved facilities. The flavors I use are FDA approved food grade flavorings. The ingredients are cheap! About $10 for a months worth for me at retail, purchased in quantity. There is no economic reason to monkey with what is used to make this stuff, so the only danger or threat would be from contamination of some sort. There is no \"second hand smoke\" from vaping. It isn't smoke you know, though you might detect a slightly sweet scent from the flavoring.", "timestamp": "1409332957"}, {"author": "opted out", "source_link": "#", "anchor": "unknown", "service": "unknown", "text": "this user has requested that their comments not be shown here", "timestamp": "1409333652"}, {"author": "Hollis", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680916560632", "anchor": "fb-680916560632", "service": "fb", "text": "Jeff: \"Do you have any reason to think that the chemicals released when people vape are any more of an issue than the chemicals released by common deodorants and perfumes? \"
No. But as someone who has chemical sensitivities to many of those things and often has to go home from work because of people's deodorants and perfumes, I have an interest in not adding more of those things to my environment. Also, just because Erik mixes his own vape juice and only puts four ingredients in doesn't tell me anything about what's available on the shelf, and I would expect \"experienced vapers\", i.e., experts, to be a similarly small proportion of the market to what they are for most other consumer goods.
If you're going to argue with me that vape-smoke isn't possibly a drug because it's mostly PG and VG, and that 100% of that 0.6 - 2.4% nicotine gets absorbed in the vaper's lungs and doesn't get exhausted to where I can breathe it, and that there's definitely nothing else in the vape juice, I guess I won't have much to discuss.", "timestamp": "1409334219"}, {"author": "Erik", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680917608532", "anchor": "fb-680917608532", "service": "fb", "text": "\"just because Erik mixes his own vape juice and only puts four ingredients in doesn't tell me anything about what's available on the shelf\" Hollis, I know the e-cig market very well. There are just the four ingredients. True for me and true for anyone offering liquids. There is no economic incentive to put other stuff in there. I can buy a gallon of VG or PG for $35 at retail. This is 90% of the liquid. I vape about 5ml of liquid/day. A gallon would last over two years.", "timestamp": "1409335154"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680922957812", "anchor": "fb-680922957812", "service": "fb", "text": "On nicotine itself, as opposed to smoking: \"One of the reasons tobacco became so popular in the 1600s, along with tea & coffee (for their caffeine), was that nicotine is a powerful stimulant. Obvious enough; it affects tons of systems. Less obvious is that nicotine has many beneficial effects (and these benefits may be related to anomalous smoking results); the infamous deadliness of smoking would seem to be almost solely from the smoke, not the nicotine.\" -- http://www.gwern.net/Nicotine", "timestamp": "1409338601"}, {"author": "Vivian", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680923132462", "anchor": "fb-680923132462", "service": "fb", "text": "A 2014 review of what science knows about e-cigarettes:
http://circ.ahajournals.org/content/129/19/1972.long
A few quotes relevant to this thread:
\"As of late 2013, there was wide variability in e-cigarette product engineering, including varying nicotine concentrations in the solution used to generate the nicotine aerosol (also called e-liquid), varying volumes of solution in the product, different carrier compounds (most commonly propylene glycol with or without glycerol [glycerin]), a wide range of additives and flavors, and battery voltage. Quality control is variable[...] These engineering differences result in variability in how e-cigarettes heat and convert the nicotine solution to an aerosol and consequently the levels of nicotine and other chemicals delivered to users and the air pollution generated by the exhaled aerosol.\"
Results are mixed in the section \"Effects on Cessation of Conventional Cigarettes\" - it is not yet clear whether e-cigarettes help compared to other ways to quit smoking.
The \"policy recommendations\" section - \"E-cigarettes deliver lower levels of some of the toxins found in cigarette smoke. Main concerns about the potential of e-cigarettes to make a contribution to reducing the harm caused by cigarette smoking arise from effects on youth, dual use with cigarettes resulting in delayed or deferred quitting (among both adults and youth), and renormalization of smoking behavior.
The ultimate effect of e-cigarettes on public health will depend on what happens in the policy environment. These policies should be implemented to protect public health: [...]\"
I personally hope this review's policy recommendations work out, because secondhand e-cig vapor is bad for me yet much less bad than secondhand cigarette smoke.", "timestamp": "1409338701"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680923566592", "anchor": "fb-680923566592", "service": "fb", "text": "@Hollis: \"as someone who has chemical sensitivities to many of those things and often has to go home from work because of people's deodorants and perfumes, I have an interest in not adding more of those things to my environment\"
I can see why this would make you dislike e-cigs, but unlike deodorants and perfumes e-cigs are probably saving lives. So maybe it would be better to work to get fragrances banned?
\"If you're going to argue with me that vape-smoke isn't possibly a drug because...\"
I'm definitely not saying this. I'm saying that the idea that we should call the smoke from second-hand vaping a \"drug\" because it's not a food, and therefore we should treat it like other things we also label \"drugs\" is not a good way to approach the world. The link I gave has more detail, but it's kind of like people who respond to someone saying \"MLK was a hero, with the way he championed non-violent civil disobedience and successfully dismantled the worst parts of segregation\" with \"but MLK was a criminal!\". Technically, yes, MLK was a criminal in that he broke and advocated breaking segregation laws. But we think those were unjust laws and that they were right to break them in the way they did, which means the label \"criminal\" is just confusing things. The idea is, you shouldn't take an element of a class that is very atypical for the class, and then try to argue you should treat it like a typical member of the class just because of shared class membership.", "timestamp": "1409339111"}, {"author": "Hollis", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680925637442", "anchor": "fb-680925637442", "service": "fb", "text": "Nicotine is a drug. It doesn't become a non-drug just because I'm breathing it after someone else runs it through their lungs and absorbs part of it.", "timestamp": "1409340724"}, {"author": "Erik", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680925956802", "anchor": "fb-680925956802", "service": "fb", "text": "Isaac, thanks for the link. One of the better mainstream pieces I've read, as most are horribly biased. There is so much propaganda on the topic, a lot of bad science, and mostly a shit pile of ignorance. Ecigs come in many shapes, sizes and designs, but they all operate as follows. A battery heats a resistance coil that is in contact with e-liquid. The heat vaporizes the liquid (makes an aerosol) which the user inhales. There is some danger in over heating PG, so it is important that the user maintains their hardware to avoid this. The vape tastes bad when this happens, so there's built in motivation to vape safe. I have read articles about heavy metals being found.", "timestamp": "1409340885"}, {"author": "Maureen", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680926211292", "anchor": "fb-680926211292", "service": "fb", "text": "I worked in a small office with two e cig smokers and would have terrible headaches from the esmoke--don't want to be any closer to that than cig smoke.", "timestamp": "1409341060"}, {"author": "Erik", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680926999712", "anchor": "fb-680926999712", "service": "fb", "text": "Heavy metals may come from the heating coil, or perhaps from the metal \"cartomizer\" that contains the coil, wicking material and liquid. More advanced user hardware is user serviceable. I wrap and replace my coils and wicks in all of the devices I use. Contamination can be in the form of machine oils used in making the stainless steel parts. You've got to clean these things made in China before they are put into service. So when contaminants are found, do they investigate where they came from? So many articles and studies, so little good science.", "timestamp": "1409341523"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680928950802", "anchor": "fb-680928950802", "service": "fb", "text": "(I'm entirely in favor of regulations that e-cigs can't emit heavy metals and e-juice can't contain toxic chemicals.)", "timestamp": "1409342876"}, {"author": "Hollis", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680929150402", "anchor": "fb-680929150402", "service": "fb", "text": "If these things are getting into the hands of consumers without being cleaned and are therefore putting out toxic things, it doesn't matter whether it's innately toxic or accidentally toxic. It doesn't really matter whether it's a design feature or a design flaw. I shouldn't have to sit next to you and breathe it.", "timestamp": "1409343029"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680929424852", "anchor": "fb-680929424852", "service": "fb", "text": "@Hollis: The difference between \"toxic because of bad design\" and \"toxic because that's the product\" is important for figuring out how regulation should work.
\"I shouldn't have to sit next to you and breathe it.\"
You also shouldn't have to sit next to me and breathe my synthetic chemical perfume. If we can get e-cigarettes to where they're generally about as dangerous to others as common perfumes, then I think we should restrict their consumption the way we currently restrict perfume use. (Fragrance-free places and events, social censure for excessive use, you choose who you spend your time around, etc.)", "timestamp": "1409343345"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680933082522", "anchor": "fb-680933082522", "service": "fb", "text": "@Hollis: \"Nicotine is a drug. It doesn't become a non-drug just because I'm breathing it after someone else runs it through their lungs and absorbs part of it.\"
I agree. Nicotine is a drug regardless, and calling it one and asking it to be treated like one is not an application of the non-central fallacy. But you wrote:
\"Whatever is in vape-juice, we can safely call it 'drugs' because it's designed to have an effect on the body and it ain't food. Some of it comes back out of the vaper's mouth and into the air, which you can tell because (a) you can smell it and (b) you can see it.\"
What you see and what you smell are not the nicotine. You see the vapor from the PV/VG and you smell the artificial flavorings. I had read you to be saying PV, VG, and artificial flavoring were drugs. That was why I said \"noncentral fallacy\", because they might be \"drugs\" by your definition but they're very different from nicotine and other prototypical drugs.", "timestamp": "1409343688"}, {"author": "Hollis", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680933376932", "anchor": "fb-680933376932", "service": "fb", "text": "So you're arguing that 100% of the nicotine load gets absorbed within the lungs, such that none of it gets exhaled? All my statement says is that some of what goes in comes out, and there's visible and olfactory evidence. If you're arguing that what comes out of a vaper's lungs has no drug content, I think the burden is on you to prove 100% absorption, not on me to prove that it's impossible.
If what you're arguing is that vape-juice is not a drug because only the nicotine is a drug, that's fine, and we can go back to talking about how it's not guns that kill people, it's bullets, and how it's not sex that causes pregnancy, it's sperm and eggs.", "timestamp": "1409343941"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680934469742", "anchor": "fb-680934469742", "service": "fb", "text": "@Hollis: \"you're arguing that 100% of the nicotine load gets absorbed within the lungs, such that none of it gets exhaled?\"
No. That would be ridiculous. I'm claiming that the \"visible and olfactory evidence\" is about ingredients other than the nicotine. For example, when someone drinks coffee they smell like coffee, but as far as I know they're not actually exhaling appreciable amounts of caffeine.
A good parallel here is alcohol. If you drink alcohol, or have a glass next to you, you release some alcohol fumes into the room. When you walk into a room where a lot of people are drinking you can smell it. But outside of a few places like the cellar of a winery you're not going to be intoxicated by the fumes. Similarly, when people worry about secondhand smoke they're worrying about the chemicals like formaldehyde that are released from tobacco combustion, not that they will be affected by the nicotine. We can do some math on the dispersion, but the nicotine exposure is just not going to be that high.
\"If what you're arguing is that vape-juice is not a drug because only the nicotine is a drug, that's fine, and we can go back to talking about how it's not guns that kill people, it's bullets, and how it's not sex that causes pregnancy, it's sperm and eggs.\"
I'm not sure what you're getting at here.", "timestamp": "1409344756"}, {"author": "Erik", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680935767142", "anchor": "fb-680935767142", "service": "fb", "text": "If I read that fried eggs should be avoided because they have machine oil in them, I would question how they were cooked. It shouldn't be there, nor should it be in the vapor produced by an ecig. BTW, the levels of metals reported were basically benign. Hollis. Please wash your brand new frying pans before you use them.", "timestamp": "1409345696"}, {"author": "Chris", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680935777122", "anchor": "fb-680935777122", "service": "fb", "text": "It appears that Hollis is expressing his unwillingness to inhale any amount, no matter how small, of nicotine as it gets exhaled by vapers. It looks like nicotine *is* exhaled, but it's approximately 10 times less than a traditional cigarette. (0.82 to 6.23 \u00b5g/m3, see: http://ntr.oxfordjournals.org/.../ntr.ntt203.abstract.html). Couldn't find a followup study on measuring impact of such chemicals.", "timestamp": "1409345719"}, {"author": "Hollis", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680935876922", "anchor": "fb-680935876922", "service": "fb", "text": "Thanks, Chris--will check that out!", "timestamp": "1409345825"}, {"author": "Chris", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680935976722", "anchor": "fb-680935976722", "service": "fb", "text": "I will add, however that the abstract didn't indicate a human subject (at least at first glance). A \"smoking machine\" may have different absorption properties than lungs.", "timestamp": "1409345946"}, {"author": "Wayne", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680978810882", "anchor": "fb-680978810882", "service": "fb", "text": "", "timestamp": "1409370698"}, {"author": "Erik", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=680993102242", "anchor": "fb-680993102242", "service": "fb", "text": "The above is a great example of how ridiculous the public debate is on this topic. People raise legitimate \"sounding\" questions from a basis of zero knowledge.The sad part is many are our public officials or are in the medical community.", "timestamp": "1409398727"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=681006575242", "anchor": "fb-681006575242", "service": "fb", "text": "@Wayne: \"do we know that e-cigarettes are actually replacing real cigarette usage, as opposed to creating new usage?\"
We don't know this. There are lots of e-cig users who are former cigarette users (ex: Erik) but all the actual studies on this are really bad.
I'd like to see a study that tried to get a large sample of e-cig users, perhaps by interviewing people buying refills, and just asked them whether they currently/used to/have never smoked cigarettes. This wouldn't be great, but it's a lot better than what we have now.", "timestamp": "1409406331"}, {"author": "Penelope", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=681008456472", "anchor": "fb-681008456472", "service": "fb", "text": "Wayne http://www.techtimes.com/.../uk-has-two-million-e...
\"Of these, close to two-thirds of the users are smokers, and one third are former smokers, with the latter said to have increased as opposed to the previous years. Meanwhile, self-reported non-smokers who currently use e-cigarette only account for 0.1 percent and never smokers who report trying e-cigarette were only one percent.\"", "timestamp": "1409407887"}, {"author": "Erik", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=681360171632", "anchor": "fb-681360171632", "service": "fb", "text": "Thank you Penelope . There are dozens of good studies on use, dangers, etc., that are out there, but they are getting little play in the media. Tons of miss information, conjecture, bad science, and and other clumsy scare tactics. There is a massively disproportionate fight to be had. The little e-cig guys don't have much of a chance against big tobacco and big pharmaceutical.", "timestamp": "1409418551"}, {"author": "Laura", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=681859396182", "anchor": "fb-681859396182", "service": "fb", "text": "E-cigarettes are clearly a win over tobacco. My concern about them is that I have seen a lot of people in my community who were not smokers deciding to start smoking e-cigs because they are tech-cool and saying things like 'nicotine isn't the problem, it's the carcinogens.' While e-cigs are *less* problematic, nicotine has direct negative effects on the circulatory system, and is still very addictive. I would not say they are safe. I also know one ex-smoker who had quit who began smoking e-cigs because so many people in the community were and then went back to regular cigarettes since they are cheaper. I also personally dislike inhaling the second hand e-cig vapor, which makes me nausoeous and light-headed, and people don't seem to think its a problem to smoke them indoors, which is aggravating.", "timestamp": "1409482404"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=681859989992", "anchor": "fb-681859989992", "service": "fb", "text": "@Laura: \"who began smoking e-cigs because so many people in the community were and then went back to regular cigarettes since they are cheaper\"
That's weird; I thought regular cigarettes were much more expensive than e-cigs. In NYC a pack is ~$14 [1] or $0.70/each. You can make e-cigs extremely cheap if you mix your own e-juice, but let's say you're using Blu and buying their refills: those are ~$0.12 per cigarette equivalent.
[1] http://www.theawl.com/.../what-a-pack-of-cigarettes-costs...", "timestamp": "1409483831"}, {"author": "Laura", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=681860144682", "anchor": "fb-681860144682", "service": "fb", "text": "That is what she told me. It's possible costs have come down in a year.", "timestamp": "1409484379"}, {"author": "Lisa", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=681861971022", "anchor": "fb-681861971022", "service": "fb", "text": "Brett Terpstra did an interesting podcast that included a matter-of-fact discussion of vaping, I believe it was this one: http://5by5.tv/systematic/98", "timestamp": "1409487977"}, {"author": "Luke", "source_link": "https://plus.google.com/115294324243294509069", "anchor": "gp-1409535460385", "service": "gp", "text": "Jeff, I'll give you that there are some potential benefits of e-cigarettes for current smokers; but I'd much rather see a lot more regulation than we currently have, because e-cigarettes are catching teens who have never smoked.\n
\n
\nhttp://www.cdc.gov/media/releases/2014/p0825-e-cigarettes.html?s_cid=cdc_homepage_whatsnew_002\n
\n
\nI think they should be regulated and taxed like cigarettes. They should explicitly forbidden for sale to minors, and forbidden from marketing to minors.\n
\n
\nI think if you want to harness some of the possible health benefits for smokers, then set up a program where smokers with a history of smoking (either receipts from past cigarette sales or medical history from doctor) can apply for a refund of the tax portion of the cost of e-cigarettes (up to some cap). If you want to help the folks currently smoking, incentivize it for them not everyone.\n
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\nI'll freely admit to a knee-jerk reaction of intense dislike and distrust of tobacco companies. They've callously and systematically manipulated and lobbied for their bottom line. I've known recovering addict who say that nicotine was harder to give up than heroin, so I want to give those folks a path off cigarettes, but I REALLY don't want a surge in addiction for another generation.", "timestamp": 1409535460}, {"author": "Jeff Kaufman", "source_link": "https://plus.google.com/103013777355236494008", "anchor": "gp-1409571951411", "service": "gp", "text": "@Luke\n\u00a0\"e-cigarettes are catching teens who have never smoked\"\n
\n
\nIf e-cigs didn't exist, how many would instead be smoking cigarettes now? \u00a0The CDC post presents this as if e-cigs are bringing in new people to nicotine use who otherwise wouldn't have tried it, but their survey can't tell the difference between that and substitution.\n
\n
\nThe CDC article also says \"Among non-smoking youth who had ever used e-cigarettes, 43.9 percent said they intended to smoke conventional cigarettes within the next year, compared with 21.5 percent of those who had never used e-cigarettes.\" which is presented as an attempt to answer this question, a psuedo-control, but it's a really bad one. \u00a0The factors that make kids smoke cigarettes and e-cigarettes are likely related.\n
\n
\n\"I think they should be regulated and taxed like cigarettes. They should explicitly forbidden for sale to minors, and forbidden from marketing to minors.\"\n
\n
\nThey should definitely be regulated to make sure they contain what they're supposed to. \u00a0Forbidding sale and marketing to minors is also reasonable. \u00a0But I \ndon't\n think they should have the high taxes of cigarettes. \u00a0E-cigarettes are currently much cheaper than regular cigarettes, and lower taxes are a lot of this. \u00a0Undermining the cost incentive to switch to something much healthier sounds really bad.\n
\n
\n\"if you want to harness some of the possible health benefits for smokers, then set up a program where smokers with a history of smoking (either receipts from past cigarette sales or medical history from doctor) can apply for a refund of the tax portion of the cost of e-cigarettes (up to some cap). If you want to help the folks currently smoking, incentivize it for them not everyone.\"\n
\n
\nThis sounds complicated and like people mostly wouldn't actually take advantage of it, especially poorer people. \u00a0Compare it to a system MA has, where in order to make public transit cheaper they offer a refund on your state taxes for documented public transit usage. \u00a0It's not widely used, especially among the people who need it most. \u00a0Much better would just be lower fares.\n
\n
\nHow much we should worry about people taking up e-cigs who've never smoked depends on how much worse e-cigs are than not smoking. \u00a0For example, if e-cigs are less than half as bad as smoking then I'm in favor of e-cigs even if one never-smoker starts using them for every smoker. \u00a0And I think the ratio is much less than half, maybe 1:50. \u00a0(Where would you put the ratio?) \u00a0Which means I'm much less concerned about people starting e-cigs from nothing than I am about preventing people from switching to them from smoking.", "timestamp": 1409571951}, {"author": "S.", "source_link": "https://plus.google.com/106111921562196141993", "anchor": "gp-1409632216477", "service": "gp", "text": "Totally anecdotal, but I was approached by a sales person marketing e-cigarettes in a bar recently (I interrupted her and informed her that I'm a med student, and she basically acted like she couldn't run away fast enough, but now I'm wishing I had listened to the whole pitch/told her I'm not a smoker to see what she said).\u00a0 The experience certainly raises my concern about people who would otherwise not smoke starting because of e-cigarettes.", "timestamp": 1409632216}, {"author": "Will", "source_link": "https://plus.google.com/115623320734956550423", "anchor": "gp-1409687552401", "service": "gp", "text": "@Sarah\n Sounds like the e-cig rep was just following the tobacco industry practices.\n
\nhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447091/", "timestamp": 1409687552}, {"author": "Erik", "source_link": "https://www.facebook.com/jefftk/posts/680888761342?comment_id=684316532062", "anchor": "fb-684316532062", "service": "fb", "text": "Here is an example of the sort of \"science\" being put forth, trashing e-cigs. http://www.ecigarette-research.com/.../2013.../2014/179-coc", "timestamp": "1409858554"}]}