4 ms·

Isn't it more the delivery mechanism than the drug itself?

by mahyarm 10y ago

taneq 10y ago
Away with your nuances, we must stay 'on message' and the message is 'psychoactive substances are always bad'. :P
rabidrat 10y ago
After lung disease, the second largest consequence of tobacco smoking is heart disease, which is due to the nicotine itself.
- dkbrk 10y ago
  That hasn't been unequivocably established. For example, a 2016 review article "Cardiovascular Toxicity of Nicotine: Implications for Electronic Cigarette Use" published in Trends in Cardiovascular Medicine (http://sci-hub.cc/10.1016/j.tcm.2016.03.001 http://sci-hub.cc/10.1016/j.tcm.2016.03.001) concluded: > Studies of the pharmacology and toxicology of nicotine in animals and some epidemiologic studies in people support the biological plausibility that nicotine contributes to acute cardiovascular events in smokers with underlying CVD, and exerts pharmacologic effects that could contribute to accelerated atherogenesis. Short-term nicotine use, such as nicotine medication to aid smoking cessation, appears to pose little cardiovascular risk, even to patients with known CVD. Longer term nicotine use, such as in ST users, appears not accelerate atherogenesis, but may contribute to acute cardiovascular events in the presence of CVD. "may contribute to acute cardiovascular events in the presence of CVD" is a far cry from being the sole (or even principle) cause of smoking-related cardiovascular disease.
- iak8god 10y ago
  It looks like about 1/3 of smoking-related deaths are due more to the nicotine than the smoke: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/ https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal... That's much higher than I'd assumed, and bad news for those who want to claim that e-cigarettes are essentially safe. EDIT: DanBC points out below[1] that it's wrong to assume the cardiovascular disease is caused primarily by nicotine, which is how I came to think it was about 1/3. So I retract this interpretation, but leave it up for posterity :) [1] https://news.ycombinator.com/item?id=13467235 https://news.ycombinator.com/item?id=13467235
  - jdietrich 10y ago
    I couldn't find that evidence anywhere in your link. A report by Public Health England estimated e-cigarettes to be at least 95% less harmful than combustible tobacco. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/457102/Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Health_England_FINAL.pdf https://www.gov.uk/government/uploads/system/uploads/attachm...
    - iak8god 10y ago
      The report you linked does not explain the 95% number, and following their citations bottomed out in articles that don't contain that number either. I'd need to spend more time looking through those before I'd feel comfortable saying that no existence for the 95% harm reduction claim can be found in the tree of citations spinning out from the PHE report, but please be aware that as of now you have not provided evidence for that claim. I'd be pleased if you would, since it would probably save me a lot of time later.
      - jdietrich 10y ago
        https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/456704/McNeill-Hajek_report_authors_note_on_evidence_for_95_estimate.pdf https://www.gov.uk/government/uploads/system/uploads/attachm...
        iak8god 10y ago
        Thanks, this is more clear and straightforward about where they got that number, though the relevant citation ends up being the same as in the longer document. The evidence cited in that summary is the study 'Estimating the Harms of Nicotine-Containing Products Using the MCDA Approach'[1]. If you read that paper, I guarantee you will find yourself much less confident in the 95% harm reduction claim. Briefly, here's the method they employed: * Convene a panel of "international experts" in a two day workshop. * Ask each participant to separately rate how harmful they believe each type of nicotine-containing product is, on a scale of 0 (no harm) - 100 (cigarettes). * Weight/average the scores and publish the results In case anyone is inclined to think that counts as "evidence", be aware that the authors of that study don't: "A limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria" They fail to mention in particular the lack of long-term evidence for some of the products, which have not been available long enough to properly measure. In any case, I am aware that vaping nicotine is much safer than combusting tobacco (though I think the latter is a lot yummier). However, I found this to be an interesting case study in how a report can pull out precise and scientific-looking numbers like 95% and trust that people for the most part will take that at face value without looking into the scientific validity of the claim. [1] http://www.karger.com/article/FullText/360220 http://www.karger.com/article/FullText/360220

Isn't it more the delivery mechanism than the drug itself?

by mahyarm 10y ago

Isn't it more the delivery mechanism than the drug itself?

taneq 10y ago

Away with your nuances, we must stay 'on message' and the message is 'psychoactive substances are always bad'. :P

rabidrat 10y ago

After lung disease, the second largest consequence of tobacco smoking is heart disease, which is due to the nicotine itself.

dkbrk 10y ago
That hasn't been unequivocably established. For example, a 2016 review article "Cardiovascular Toxicity of Nicotine: Implications for Electronic Cigarette Use" published in Trends in Cardiovascular Medicine (http://sci-hub.cc/10.1016/j.tcm.2016.03.001 http://sci-hub.cc/10.1016/j.tcm.2016.03.001) concluded: > Studies of the pharmacology and toxicology of nicotine in animals and some epidemiologic studies in people support the biological plausibility that nicotine contributes to acute cardiovascular events in smokers with underlying CVD, and exerts pharmacologic effects that could contribute to accelerated atherogenesis. Short-term nicotine use, such as nicotine medication to aid smoking cessation, appears to pose little cardiovascular risk, even to patients with known CVD. Longer term nicotine use, such as in ST users, appears not accelerate atherogenesis, but may contribute to acute cardiovascular events in the presence of CVD. "may contribute to acute cardiovascular events in the presence of CVD" is a far cry from being the sole (or even principle) cause of smoking-related cardiovascular disease.
iak8god 10y ago
It looks like about 1/3 of smoking-related deaths are due more to the nicotine than the smoke: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/ https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal... That's much higher than I'd assumed, and bad news for those who want to claim that e-cigarettes are essentially safe. EDIT: DanBC points out below[1] that it's wrong to assume the cardiovascular disease is caused primarily by nicotine, which is how I came to think it was about 1/3. So I retract this interpretation, but leave it up for posterity :) [1] https://news.ycombinator.com/item?id=13467235 https://news.ycombinator.com/item?id=13467235
- jdietrich 10y ago
  I couldn't find that evidence anywhere in your link. A report by Public Health England estimated e-cigarettes to be at least 95% less harmful than combustible tobacco. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/457102/Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Health_England_FINAL.pdf https://www.gov.uk/government/uploads/system/uploads/attachm...
  - iak8god 10y ago
    The report you linked does not explain the 95% number, and following their citations bottomed out in articles that don't contain that number either. I'd need to spend more time looking through those before I'd feel comfortable saying that no existence for the 95% harm reduction claim can be found in the tree of citations spinning out from the PHE report, but please be aware that as of now you have not provided evidence for that claim. I'd be pleased if you would, since it would probably save me a lot of time later.
    - jdietrich 10y ago
      https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/456704/McNeill-Hajek_report_authors_note_on_evidence_for_95_estimate.pdf https://www.gov.uk/government/uploads/system/uploads/attachm...
      - iak8god 10y ago
        Thanks, this is more clear and straightforward about where they got that number, though the relevant citation ends up being the same as in the longer document. The evidence cited in that summary is the study 'Estimating the Harms of Nicotine-Containing Products Using the MCDA Approach'[1]. If you read that paper, I guarantee you will find yourself much less confident in the 95% harm reduction claim. Briefly, here's the method they employed: * Convene a panel of "international experts" in a two day workshop. * Ask each participant to separately rate how harmful they believe each type of nicotine-containing product is, on a scale of 0 (no harm) - 100 (cigarettes). * Weight/average the scores and publish the results In case anyone is inclined to think that counts as "evidence", be aware that the authors of that study don't: "A limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria" They fail to mention in particular the lack of long-term evidence for some of the products, which have not been available long enough to properly measure. In any case, I am aware that vaping nicotine is much safer than combusting tobacco (though I think the latter is a lot yummier). However, I found this to be an interesting case study in how a report can pull out precise and scientific-looking numbers like 95% and trust that people for the most part will take that at face value without looking into the scientific validity of the claim. [1] http://www.karger.com/article/FullText/360220 http://www.karger.com/article/FullText/360220