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Our society's tendency to moralize or rationalize issues has made it tough to talk about harm reduction. Moralizers focus on the corrosive elements of addictio

Our society's tendency to moralize or rationalize issues has made it tough to talk about harm reduction. Moralizers focus on the corrosive elements of addiction and rationalizers say that e-cigs are still harmful but they miss the point that many people who smoke e-cigs are better off than they would be if they used cigs to get their nicotine. E-cigs offer a better path to cessation through better control of the nicotine concentrations than cigs do, and e-cigs are probably one of the least harmful ways to get nicotine (and they're certainly cheaper than gum and patches). I was very disappointed that the Obama administration tried to apply such heavy-handed regulations to the industry, it has its place and I think we'd be better off tolerating e-cigs. Give people an alternative to caffeine. I think most productive people are dependent on some stimulant or at least most people find their productivity is enhanced through stimulation. Whether it's coffee, nicotine, or amphetamine, we should be honest about why people use it and focus on access that doesn't cause undue suffering.

aphextron 9y ago
>E-cigs offer a better path to cessation through better control of the nicotine concentrations than cigs do, and e-cigs are probably one of the least harmful ways to get nicotine (and they're certainly cheaper than gum and patches). Alternatively, e-cigs have made nicotine consumption cheaper, faster, more convenient, more socially acceptable, and available at much higher concentrations than tobacco. The aggregate being that nicotine addiction could very well increase overall, even if smoking rates drop. Most people don't realize that it's not really the smoke and lung cancer that leads to a majority of smoking deaths. It's the cardiovascular effects of nicotine leading to heart disease. Equating that to caffeine is ridiculous.
- mistercow 9y ago
  Do you have a source on that claim? I'm pretty sure you're thinking of the cardiovascular effects of smoking, and attributing all of those effects to nicotine, which is incorrect. Everything I've read on the subject indicates that nicotine's role in cardiovascular disease is quite minor.
  - QAPereo 9y ago
    Sadly... http://www.onlinejacc.org/content/29/7/1422 http://www.onlinejacc.org/content/29/7/1422 Edit: To clarify, there is still no contest at all between potential long term harm from smoking, and massively reduced potential for harm from vaping. Sorry for my lack of responsibility in making that point clearly, or at all.
    - mistercow 9y ago
      That source appears to back up what I said.
    - j0rd 9y ago
      "Clinical trials of NRT in patients with underlying, stable coronary disease suggest that nicotine does not increase cardiovascular risk. At worst, the risks of NRT are no more than those of cigarette smoking. The risks of NRT for smokers, even for those with underlying cardiovascular disease, are small and are substantially outweighed by the potential benefits of smoking cessation." NRT: nicotine replacement therapy
      - mistercow 9y ago
        Yeah, they discuss various mechanisms by which nicotine could increase risk, but unless I missed something, every time they look for an actual long term impact, there's no demonstrated risk from nicotine alone.
      - QAPereo 9y ago
        I’m not arguing that vaping isn’t massively better than smoking, but harmless? That’s a high bar. Edit: you’re correct about my irresponsibility, I apologize and have edited my post.
        mistercow 9y ago
        But you were replying to my comment questioning the outrageous claim that smoking's chief risk is cardiovascular disease caused by nicotine. You replied with only a link to a journal article, which could easily, at a glance, appear to back up that claim, although upon further reading, it certainly does not. Do you see how that's kind of irresponsible?
whipoodle 9y ago
Yes, there is so much public material implying that e-cigs are basically just as bad. It seems so irresponsible to me. I think in part it's driven by how low-status smoking is these days, to the point that some people even hate the optics of it. It looks like smoking so it must be just as bad, or close.
- grasshopperpurp 9y ago
  >Yes, there is so much public material implying that e-cigs are basically just as bad. It seems so irresponsible to me. Which material are you referring to? This is an outrageous claim.
  - whipoodle 9y ago
    Public service billboards, ads on buses, things like that. They don't claim it directly- they imply it by saying that smoking is bad, but so is vaping, so don't let your kids vape. Things like that. Look at this: http://stillblowingsmoke.org/ http://stillblowingsmoke.org/ I mean right off the bat they're calling it smoke. That is so obviously an attempt to link e-cigs to tobacco. Hell, they even use the word tobacco on the page.
    - grasshopperpurp 9y ago
      My apologies. I misread your original statement.
tlb 9y ago
I didn't think the regulations were heavy-handed. Such devices should be tested and certified to make sure they aren't, for example, leaching heavy metals into the liquid and vaporizing it. Devices sold with cadmium-plated heating coils or lead solder joints could easily poison millions of people, so I think it's reasonable to require safety testing.
- j0rd 9y ago
  I personally think ecigs are an interesting experiment in free markets. A bunch of like minded people who had a habbit which was the leading cause of preventable death coming together to figure out a way to kill themselves less. Have there been things in the industry which were poisonous and could kill you over the course of it's history. Yes. Lots. Have those been slowly fased out as concerned consumers voice opinions, yes. Ni200 wire is a good example. Battery mooch is another. The lack of regulation has certainly led to it being more dangerous for uninformed consumers, but it has also lead to lots of independent entrepreneurs innovating fast in the space. Personally I see it as a great example of free markets vs. regulation. I also think it's only been able to exist because it's in a market which of its own is hazardous to health. Also this entire industry as I understand it came from China.
  - craftyguy 9y ago
    So your argument is that because e-cig users are coming from one harmful product, that we should do nothing to prevent the new product from causing undue harm, and that eventually (decades?) e-cigs will become safer because someone (who?) will eventually phase out the harmful ones? Why not stop wasting time and lives, and prevent the harmful ones from being produced/released?
    - snuxoll 9y ago
      I think regulations are certainly warranted, but the ones the FDA has implemented are heavy handed. I don't think anyone in the industry is opposed to common sense regulations.
    - 9y ago
hwillis 9y ago
Counterargument: I have seen vaping be MUCH more popular among people who would not otherwise smoke, and relatively little impact among people who do smoke. That's anecdotal obviously, but I think its pretty clear that the less noxious and more convenient nature makes vaping way more popular among younger people, potentially starting lifelong addictions. There isn't a whole lot of reason to believe these products are particularly safer, either. The heating coils are in direct contact with the fluid and get easily hot enough to decompose it. Glycerine is food-safe and very probably alright to inhale- the other products used in vape fluid and the unwanted side-products from overheating them are reactive unknowns. E-cigs and vaporizers are/have the potential to be way more popular among people who wouldn't otherwise use them and they are not as simple or safe as just nicotine (which itself isn't as simple or safe as just being a stimulant). Because of those two factors and the current and past massive negative effects of smoking, it's an extremely good idea to regulate them carefully or even heavily. We already know how hard it is to get the genie back into the bottle from cigarettes.
- Obi_Juan_Kenobi 9y ago
  I find it very disappointing that people resort to anecdote when data is available. Granted, it's a new area and there hasn't been enough time for proper longitudinal studies, but what data we do have generally supports EC's for smoking cessation, and also functioning as a replacement for young people that would likely otherwise start smoking cigarettes. https://www.ncbi.nlm.nih.gov/pubmed/25301815 https://www.ncbi.nlm.nih.gov/pubmed/25301815 https://www.ncbi.nlm.nih.gov/pubmed/25888354 https://www.ncbi.nlm.nih.gov/pubmed/25888354 https://www.ncbi.nlm.nih.gov/pubmed/26597453 https://www.ncbi.nlm.nih.gov/pubmed/26597453 As for the safety of the vapor itself, it's a little tricky. Some studies faced a lot of criticism because the 'vaping' method did not reflect actual usage. In one protocol (unfortunately I can't recall the article) it was found they basically burned up the coil and reported combustion products as the vapor profile. Similarly, this study appears to be reasonably executed, at least at first: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961046/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961046/ A few takeaways from the article: no long-lived free radicals present, and short-lived radicals in the range of 100 to 1000 fold less than cigarettes. Their estimates for a typical 'vaper' would be about a 10-fold higher dose than typical air pollution exposure for a 24 hour period (200 puffs/day). This certainly represents a real potential hazard, but is also a clear improvement over cigarettes (especially because this isn't the major hazard in cigarette smoke). However, the protocol uses 5 second 'puffs' on a 1.5 ohm coil with an absolutely pathetic 500ml/min flow rate. For reference, 500ml is the typical breath volume for a human at rest, with >10,000ml/min being typical breathing for a person at rest (https://ehjournal.biomedcentral.com/articles/10.1186/1476-069X-8-48 https://ehjournal.biomedcentral.com/articles/10.1186/1476-06...). In actual use, a puff is usually larger than the typical breath and taken in a span of 2-4 seconds. A flow rate of 20,000-40,000 ml/min is much more representative. It's no surprise that a coil with such a low flow rate would get far hotter than what is seen in actual use. Worth noting that high flow rates make for more comfortable and pleasant vaping, so are common in actual use. Some good work has looked at variation in vaping protocol https://www.ncbi.nlm.nih.gov/pubmed/24832759 https://www.ncbi.nlm.nih.gov/pubmed/24832759 These findings show just how drastic the differences are when you start to use higher power levels in ECs. The data clearly show that high-power vaping likely presents a significant risk, but to date I've yet to see data that is convincingly representative of anything like normal use.

aphextron 9y ago

>E-cigs offer a better path to cessation through better control of the nicotine concentrations than cigs do, and e-cigs are probably one of the least harmful ways to get nicotine (and they're certainly cheaper than gum and patches). Alternatively, e-cigs have made nicotine consumption cheaper, faster, more convenient, more socially acceptable, and available at much higher concentrations than tobacco. The aggregate being that nicotine addiction could very well increase overall, even if smoking rates drop. Most people don't realize that it's not really the smoke and lung cancer that leads to a majority of smoking deaths. It's the cardiovascular effects of nicotine leading to heart disease. Equating that to caffeine is ridiculous.

mistercow 9y ago
Do you have a source on that claim? I'm pretty sure you're thinking of the cardiovascular effects of smoking, and attributing all of those effects to nicotine, which is incorrect. Everything I've read on the subject indicates that nicotine's role in cardiovascular disease is quite minor.
- QAPereo 9y ago
  Sadly... http://www.onlinejacc.org/content/29/7/1422 http://www.onlinejacc.org/content/29/7/1422 Edit: To clarify, there is still no contest at all between potential long term harm from smoking, and massively reduced potential for harm from vaping. Sorry for my lack of responsibility in making that point clearly, or at all.
  - mistercow 9y ago
    That source appears to back up what I said.
  - j0rd 9y ago
    "Clinical trials of NRT in patients with underlying, stable coronary disease suggest that nicotine does not increase cardiovascular risk. At worst, the risks of NRT are no more than those of cigarette smoking. The risks of NRT for smokers, even for those with underlying cardiovascular disease, are small and are substantially outweighed by the potential benefits of smoking cessation." NRT: nicotine replacement therapy
    - mistercow 9y ago
      Yeah, they discuss various mechanisms by which nicotine could increase risk, but unless I missed something, every time they look for an actual long term impact, there's no demonstrated risk from nicotine alone.
    - QAPereo 9y ago
      I’m not arguing that vaping isn’t massively better than smoking, but harmless? That’s a high bar. Edit: you’re correct about my irresponsibility, I apologize and have edited my post.
      - mistercow 9y ago
        But you were replying to my comment questioning the outrageous claim that smoking's chief risk is cardiovascular disease caused by nicotine. You replied with only a link to a journal article, which could easily, at a glance, appear to back up that claim, although upon further reading, it certainly does not. Do you see how that's kind of irresponsible?

whipoodle 9y ago

Yes, there is so much public material implying that e-cigs are basically just as bad. It seems so irresponsible to me. I think in part it's driven by how low-status smoking is these days, to the point that some people even hate the optics of it. It looks like smoking so it must be just as bad, or close.

grasshopperpurp 9y ago
>Yes, there is so much public material implying that e-cigs are basically just as bad. It seems so irresponsible to me. Which material are you referring to? This is an outrageous claim.
- whipoodle 9y ago
  Public service billboards, ads on buses, things like that. They don't claim it directly- they imply it by saying that smoking is bad, but so is vaping, so don't let your kids vape. Things like that. Look at this: http://stillblowingsmoke.org/ http://stillblowingsmoke.org/ I mean right off the bat they're calling it smoke. That is so obviously an attempt to link e-cigs to tobacco. Hell, they even use the word tobacco on the page.
  - grasshopperpurp 9y ago
    My apologies. I misread your original statement.

tlb 9y ago

I didn't think the regulations were heavy-handed. Such devices should be tested and certified to make sure they aren't, for example, leaching heavy metals into the liquid and vaporizing it. Devices sold with cadmium-plated heating coils or lead solder joints could easily poison millions of people, so I think it's reasonable to require safety testing.

j0rd 9y ago
I personally think ecigs are an interesting experiment in free markets. A bunch of like minded people who had a habbit which was the leading cause of preventable death coming together to figure out a way to kill themselves less. Have there been things in the industry which were poisonous and could kill you over the course of it's history. Yes. Lots. Have those been slowly fased out as concerned consumers voice opinions, yes. Ni200 wire is a good example. Battery mooch is another. The lack of regulation has certainly led to it being more dangerous for uninformed consumers, but it has also lead to lots of independent entrepreneurs innovating fast in the space. Personally I see it as a great example of free markets vs. regulation. I also think it's only been able to exist because it's in a market which of its own is hazardous to health. Also this entire industry as I understand it came from China.
- craftyguy 9y ago
  So your argument is that because e-cig users are coming from one harmful product, that we should do nothing to prevent the new product from causing undue harm, and that eventually (decades?) e-cigs will become safer because someone (who?) will eventually phase out the harmful ones? Why not stop wasting time and lives, and prevent the harmful ones from being produced/released?
  - snuxoll 9y ago
    I think regulations are certainly warranted, but the ones the FDA has implemented are heavy handed. I don't think anyone in the industry is opposed to common sense regulations.
  - 9y ago

hwillis 9y ago

Counterargument: I have seen vaping be MUCH more popular among people who would not otherwise smoke, and relatively little impact among people who do smoke. That's anecdotal obviously, but I think its pretty clear that the less noxious and more convenient nature makes vaping way more popular among younger people, potentially starting lifelong addictions. There isn't a whole lot of reason to believe these products are particularly safer, either. The heating coils are in direct contact with the fluid and get easily hot enough to decompose it. Glycerine is food-safe and very probably alright to inhale- the other products used in vape fluid and the unwanted side-products from overheating them are reactive unknowns. E-cigs and vaporizers are/have the potential to be way more popular among people who wouldn't otherwise use them and they are not as simple or safe as just nicotine (which itself isn't as simple or safe as just being a stimulant). Because of those two factors and the current and past massive negative effects of smoking, it's an extremely good idea to regulate them carefully or even heavily. We already know how hard it is to get the genie back into the bottle from cigarettes.

Obi_Juan_Kenobi 9y ago
I find it very disappointing that people resort to anecdote when data is available. Granted, it's a new area and there hasn't been enough time for proper longitudinal studies, but what data we do have generally supports EC's for smoking cessation, and also functioning as a replacement for young people that would likely otherwise start smoking cigarettes. https://www.ncbi.nlm.nih.gov/pubmed/25301815 https://www.ncbi.nlm.nih.gov/pubmed/25301815 https://www.ncbi.nlm.nih.gov/pubmed/25888354 https://www.ncbi.nlm.nih.gov/pubmed/25888354 https://www.ncbi.nlm.nih.gov/pubmed/26597453 https://www.ncbi.nlm.nih.gov/pubmed/26597453 As for the safety of the vapor itself, it's a little tricky. Some studies faced a lot of criticism because the 'vaping' method did not reflect actual usage. In one protocol (unfortunately I can't recall the article) it was found they basically burned up the coil and reported combustion products as the vapor profile. Similarly, this study appears to be reasonably executed, at least at first: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961046/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961046/ A few takeaways from the article: no long-lived free radicals present, and short-lived radicals in the range of 100 to 1000 fold less than cigarettes. Their estimates for a typical 'vaper' would be about a 10-fold higher dose than typical air pollution exposure for a 24 hour period (200 puffs/day). This certainly represents a real potential hazard, but is also a clear improvement over cigarettes (especially because this isn't the major hazard in cigarette smoke). However, the protocol uses 5 second 'puffs' on a 1.5 ohm coil with an absolutely pathetic 500ml/min flow rate. For reference, 500ml is the typical breath volume for a human at rest, with >10,000ml/min being typical breathing for a person at rest (https://ehjournal.biomedcentral.com/articles/10.1186/1476-069X-8-48 https://ehjournal.biomedcentral.com/articles/10.1186/1476-06...). In actual use, a puff is usually larger than the typical breath and taken in a span of 2-4 seconds. A flow rate of 20,000-40,000 ml/min is much more representative. It's no surprise that a coil with such a low flow rate would get far hotter than what is seen in actual use. Worth noting that high flow rates make for more comfortable and pleasant vaping, so are common in actual use. Some good work has looked at variation in vaping protocol https://www.ncbi.nlm.nih.gov/pubmed/24832759 https://www.ncbi.nlm.nih.gov/pubmed/24832759 These findings show just how drastic the differences are when you start to use higher power levels in ECs. The data clearly show that high-power vaping likely presents a significant risk, but to date I've yet to see data that is convincingly representative of anything like normal use.