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Acute Effects of Electronic Cigarette Aerosol Inhalation on Vascular Function

203 points by mzs 7y ago

bobwaycott 7y ago
> ... on healthy non-smokers ... That’s unlikely to be surprising. Would really love to know what the impact is in smokers versus an actual cigarette. Isn’t nicotine already known to have this effect?
- ceejayoz 7y ago
  It seems clear that e-cigs are better than smoking. It also seems clear that e-cig manufacturers are hoping to hook young non-smokers to expand their market. Both are valuable bits of info, but "e-cigs do confirmed damage" is extremely important info from a public health perspective.
  - d1zzy 7y ago
    That's correct but I worry that all this will result in banning e-cigs (in my state at least), based on the idea that cigarettes (and many other things) wouldn't have been legal/popular if they appeared today but we tolerate them because they are already a thing. The last thing I want is for my SO to go back to smoking real cigs because e-cigs become unavailable here :(
    - ceejayoz 7y ago
      I'd like to see them made available via a prescription for smoking cessation.
      - dennisnedry 7y ago
        I don't understand why making them available via a prescription would solve anything. I do not smoke or vape, but I have a friend who stopped smoking because vaping was accessible without going to a doctor. He just tried it because he wanted to see if it would work, and it did. He no longer vapes or smokes.
        ceejayoz 7y ago
        The stated concern is e-cigs becoming unavailable to smokers looking to quit. Making it available via a prescription permits that use, while limiting access for recreational uptake by kids.
        bobwaycott 7y ago
        No, it means every smoker has to go to a doctor just to try to use vaping to quit! Fuck that. That’s insane. No adult should have to go to a doctor for permission to use an e-cig. It’s not medicine. Let the state go after the businesses promoting and selling e-cigs to kids—and levy astronomical fines against them. Sponsor PSAs that scare kids away from doing it. Educate everyone on the potential risks. If these “kids” are 18, they’re adults, so let them do as they please. Cigarettes don’t require a prescription to get hooked on them. Adults should be free to recreationally use e-cigs just as much as cigarettes, weed, alcohol, and plenty of other substances. It’s their body. Increase taxes on them to try and discourage it and pay for PSAs against vaping. Whatever. But let’s dispense with the think-of-the-children crap, and let adults be adults.
        deleted 7y ago
        [deleted]
      - EpicEng 7y ago
        Sure. While you're at it, please ban red meat. I eat far too much of it and need to be protected.
        ceejayoz 7y ago
        If someone starts selling nicotine-laced steaks, I'll be the first to advocate for an FDA crackdown on it.
        EpicEng 7y ago
        Nicotine is in the same drug class as caffiene. Want to ban coffee as well?
        ceejayoz 7y ago
        Plenty of drugs are in the same class with substantially differing impacts - take heroin vs. morphine vs. fentanyl vs. oxycodone as an example, or ask someone taking antipsychotic psych meds if they're all the same. Or try taking some strychnine because it's an alkaloid like nicotine and caffeine and see how well that works out. Since you picked coffee as an example, most of the studies I've seen indicate probably health benefits from it. Nicotine it's not.
        EpicEng 7y ago
        I guess I shouldn't have used the word "class" as you're not the only person to come back with that. I mean that it's generally recognized as safe (GRAS) by the FDA. I think you know that comparing heroin to nicotine is just silly and, as far as I'm aware, there's no data that shows that nicotine is any more or substantially more harmful than caffeine. So back in reality where we're talking about banning e-cigs; why should they be subject to a prescription?
        ceejayoz 7y ago
        "So back in reality" GRAS does not mean what you think it means. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664775/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664775/ > Despite scientific uncertainty regarding the safety of inhaling aerosol and flavorant substances from electronic cigarettes (e-cigarettes) relative to inhaling smoke from traditional cigarettes, some consumers and vape shop employees suggest that the U.S. Food and Drug Administration’s (FDA) “generally recognized as safe” (GRAS) designation of constituents provides clear evidence of overall e-cigarette safety. > Although the Flavor and Extract Manufacturers Association (FEMA) has clarified that the GRAS program only assesses product safety for ingestion in food, not inhalation, public confusion appears to continue. Nicotine isn't even on the GRAS list at all. Some of the additives (like glycerol) and flavorants are. https://www.accessdata.fda.gov/scripts/fdcc/index.cfm?set=GRASNotices&sort=GRN_No&order=DESC&startrow=1&type=basic&search=nicotine https://www.accessdata.fda.gov/scripts/fdcc/index.cfm?set=GR...
    - sawjet 7y ago
      There are tons of resources for building your own DIY e-cigarette. it might not be as slim and sleek as a Juul, but it will perform better, be cheaper to maintain and produce much less waste.
  - tinus_hn 7y ago
    It should also be clear that not using electronic cigarettes is better than using them.
    - ceejayoz 7y ago
      The industry is going to fight that conclusion tooth and nail, though, so solid evidence of it is valuable.
      - throwaway5752 7y ago
        Younger users might not have context like https://en.wikipedia.org/wiki/Operation_Berkshire https://en.wikipedia.org/wiki/Operation_Berkshire or the acrimony leading up to https://en.wikipedia.org/wiki/Tobacco_Master_Settlement_Agreement https://en.wikipedia.org/wiki/Tobacco_Master_Settlement_Agre....
    - oarabbus_ 7y ago
      I've never seen anyone argue they are harmless, just that they are less harmful than actual cigarettes. The problem is that places are banning e-cigs, which presumably drives people back to smoking. Which is worse for everyone.
      - redisman 7y ago
        Less harmful than tobacco is a very low bar. Especially for non-smokers. If it was treated like methadone then cool, but seems like these days most of the vapers are young, new users. Not recovering cigarette addicts.
      - aketchum 7y ago
        Anecdotally, I hear many friends say they are harmless. Surprisingly a nurse friend of mine vapes Juuls and isn't worried about the health impacts. I think plenty of people actually take it that since they are not cigarettes and are "just nicotine" they don't worry about their safety.
        7y ago
  - jforman 7y ago
    It seems clear that e-cigs are better than smoking. How can this be clear without long-term usage data?
    - ceejayoz 7y ago
      Well, that's the seems part. It certainly stands to reason that inhaling vaporized nicotine will be better than inhaling vaporized nicotine plus ash and tar and pesticides and whatnot.
      - jforman 7y ago
        Fair enough. Although I think a researcher would say our bags of meat often surprise us.
  - bobwaycott 7y ago
    > It also seems clear that e-cig manufacturers are hoping to hook young non-smokers to expand their market. This is mentioned a lot, but I find it questionable. I’ve never seen an ad that made me feel like Joe Camel or the Marlboro Man did when I was a kid. My teenagers haven’t ever thought vaping was cool based on ads or plenty of people doing it. This sounds too much like a general truism of capitalist enterprise—always find ways to expand your markets—while combining it with a direct accusation that it’s being done perniciously to “hook” them. Everyone who is selling anything is trying to hook people on their product, if that’s the terminology we’re using—new clothes, new cars, new TVs, the latest deals ... every company is using advertising to hook people on their products. People go into financial ruin for cars and homes and stupid stuff. Maybe we should just ban advertising to people so no company can try to hook young people on their products to expand their markets.
    - ceejayoz 7y ago
      Do you think Juul’s school curriculum - which they paid schools to accept - was genuinely well-intentioned? https://www.nytimes.com/2019/07/25/health/juul-teens-vaping.html https://www.nytimes.com/2019/07/25/health/juul-teens-vaping.... > In April 2017, a Juul representative visited the Dwight School in New York City to meet with students — with no teachers present — and told them the company’s e-cigarettes were “totally safe.”
      - bobwaycott 7y ago
        Do you really think I would argue that is well-intentioned—no matter what company it is? Did my comment really leave the impression I’d give that a thumbs up? Companies shouldn’t be permitted to do that, regardless of their product—so fine them exorbitantly, and let’s do the same to the morons who accepted such a proposal while we’re at it. What I’m pointing out is this is standard behavior for corporations, and nobody does a thing to go after them or their profits when they behave badly—instead, people use this for lame think-of-the-children arguments against the products, calling for public bans, suggesting we force adults to get prescriptions for an e-cig, when what we ought to do is aggressively go after the bad corporate behavior—or make it illegal to manufacture and sell things if we don’t like them. But in the case of e-cigs, let’s start with cigarettes first, or admit we aren’t going to ever do that, move onto more productive conversations, and stop acting like e-cigs and actual tobacco products are at all equivalent—aside from the very narrow category of nicotine-delivery device.
- mzs 7y ago
  The vascular effects are very similar to prior research on cigarette smoke. It's precisely the same initial effects thought to lead to heart disease in smokers. edit: You my have edited your comment while I was relying. The second of two sentences under Background (first section) mentions that this was a nicotine free study unlike earlier ones.
- refurb 7y ago
  Yes, nicotine itself is known to have this impact on the vascular system. Not surprising you see it with nicotine vaping.
program_whiz 7y ago
Many people seem to believe that vaping is harmless, this is good to make the point clearly that vaping, while not as harmful as smoking cigarettes, isn't a "cost free" activity. I personally didn't realize that it could have these effects either.
- redisman 7y ago
  Yes and we still don't know the long term effects of heavy use for a decade or two. Cigarettes were great and good for you for decades too.
- mruts 7y ago
  I’m not sure there exists a cost free activity as far as people are concerned.
  - kuiper0x2 7y ago
    Sex is pretty cost free. Meditation is cost free. Unless you are defining time usage as a cost which is absurd.
    - umvi 7y ago
      > Sex is pretty cost free Not sure if you are joking or not, but I would wager the costs of sex are actually enormous even compared to drugs. Look no further than the costs and issues surrounding the following: adoption, foster care, abortion, child support, single parent welfare rates, STDs, etc. In theory sex is a "cost free" recreational activity, but in practice it isn't.
      - jolux 7y ago
        well, if you’re super careful with your contraception and have easy access to abortion...also lots of queer sex runs no risk of reproducing accidentally. STIs, on the other hand, are definitely a risk.
        7y ago
charliesharding 7y ago
I'm a little confused - can someone knowledgable in the area help out? In the introduction they assert: "Once inhaled, ultrafine particles and the oxidant species located on their surface can translocate into the vascular space (13), resulting in a state of chronic vascular inflammation and oxidative stress noxious to endothelial function." However in the conclusion they state: "Inhaling nicotine-free electronic cigarette aerosol transiently impacted endothelial function in healthy nonsmokers" It sounds like in the introduction they are aware of studies that concluded the aerosol inhalation causes chronic issues with endothelial function, but they concluded that it only has a transient effect. Are they refuting those claims? Did I miss something?
- zaptheimpaler 7y ago
  Maybe the duration of the study is too short to definitively conclude a chronic effect, even though they suspect it is there.
- onemoresoop 7y ago
  While I don't think e-cigarettes are completely harmless, anything can be proved (fudged in a way) if there is an intention to. Yes, we don't know what the effects of vaping are but they appear to be a decent (and possibly more addictive) alternative to tobacco smokers who can't quit.
- close04 7y ago
  Transient in healthy nonsmokers. Since most vapers do it regularly it's a fair to assume that they are in a "permanently transient" state. A permanently acute state is basically a chronic state.
  - filoleg 7y ago
    Imo permanent === persisting after whatever was causing this state in the first place is gone. If those "transient" effects are gone after a chronic user is done using after a long time, then I would still consider the effect to be transient rather than permanent.
deleted 7y ago
[deleted]
dumbfoundded 7y ago
If you believe E-Cigs are harmless, there's an easy experiment you can do for yourself. Go on a run, time yourself. The next day, vape for 30 min and then go on the same run. This is what got me to personally switch away from E-Cigs. Vaping would add an additional 30-sec to 1-min per mile on my runs. I try to only use patches or gum now. Still not great but it's a lot better if you're trying to stay in shape. That being said, if you're only two choices are cigarettes and vaping. Obviously, choose vaping.
- jack_h 7y ago
  Similarly try running when you're a smoker vs a vaper. I'd say vaping is a very good harm reduction path for smokers that hopefully leads to quitting altogether. It is definitely not harm free though. I just hope our society and laws don't go in a direction where people are pushed back into smoking.
- mzs 7y ago
  Careful, in addition to constricting/hardening blood vessels that is thought to lead to heart disease nicotine has other long term effects as seen in in this study of angiogenesis: >In a series of experiments, the researchers found that nicotine could enhance new blood vessel growth in mice whose hind limbs were artificially starved of oxygen. They also found that lung cancer cells implanted into mice grew more quickly when the mice consumed nicotine in their drinking water. Mice susceptible to developing plaque in the arteries of their hearts also experienced more rapid plaque growth when exposed to nicotine than mice who were not exposed. >The researchers believe nicotine works by binding to a receptor on the surface of endothelial cells that recognizes acetylcholine -- a chemical that nerve cells use to communicate with each other. Endothelial cells line the interior of blood vessels throughout the body. … https://news.stanford.edu/news/2001/july11/nicotine.html https://news.stanford.edu/news/2001/july11/nicotine.html
  - mikelyons 7y ago
    Nicotine is also, itself, a known carcinogen.
sharadov 7y ago
Why don't ecigs come with the same warnings that regular cigs do?
- umvi 7y ago
  Regulation hasn't caught up. Think of Juul as the Uber of nicotine.
- 83457 7y ago
  Because nicotine doesn't kill you, the way it is delivered does. Tobacco products are the most popular delivery method and is especially harmful due to level of carcinogens and other elements. Essentially no one cared much about nicotine as a chemical specifically much more than they did about caffeine.
- filoleg 7y ago
  I don't know where you live, but in my jurisdiction they do (WA state). Same big black or white paper with giant print saying the same stuff that is said on cig packs.
Medicalidiot 7y ago
The number one controllable risk factor for stroke and heart attack is smoking. By far. Not diet, not exercise, smoking. A significant part of that is because nicotine will constrict blood vessels leading to hypertension[1], this leads to destruction of the surface of an artery, leading to atherosclerosis formation. One day the atherosclerotic plaque ruptures and then you see me. We once thought that atherosclerosis is an old persons disease, where health habits later in life lead are what predicates plaque formation. The Army started noticing fatty streak formation(first stage of atherosclerosis)[2] in arteries of dead soldiers during autopsy, which now leads us to believe this starts in youth and progresses from there. 1) https://www.ingentaconnect.com/content/ben/vdp/2005/00000002/00000002/art00006 https://www.ingentaconnect.com/content/ben/vdp/2005/00000002... 2) https://media.jamanetwork.com/news-item/autopsy-based-study-examines-prevalence-of-atherosclerosis-among-u-s-service-members/ https://media.jamanetwork.com/news-item/autopsy-based-study-...
- LinuxBender 7y ago
  Have any of your patients tried reversing the plaque with k2/d3/magnesium. It works for lowering CAC scores, just curious if it also helps with any of the other buildup beyond calcium. Or perhaps serrapeptase/natto.
  - amelius 7y ago
    Look up Linus Pauling's therapy.
    - LinuxBender 7y ago
      I actually ran across his studies some time ago. I've always been curious if the testing to validate his work used real vitamin-C or ascorbic acid. I will dig deeper into that now that you bring it up.
    - JanSt 7y ago
      https://www.quackwatch.org/01QuackeryRelatedTopics/pauling.html https://www.quackwatch.org/01QuackeryRelatedTopics/pauling.h...
magashna 7y ago
One of the frustrating things about ecig studies is that they always use the worst quality hardware and puff really hard on them. The "Epuffer" looks like one of those "cig-a-like" which are notoriously worse than the much more expensive hobbyist mech mods. The cig-a-likes usually don't get enough juice to the heating element so when you're puffing a lot (16 consecutive 3s pulls) you end up burning the wick.
- epmaybe 7y ago
  Out of curiosity, are most people that use ecigs going for the expensive mods, or are they going for the more popular brands that are closer in quality to the epuffer?
  - travelton 7y ago
    I don't have any science to back up this, just an opinion. Epuffer is like a conversion product. Once you try it, you likely invest in better equipment. This is what happened to me... Started with a cheap gas station stick, then quickly upgraded to a decent set up. Was able to get my dad to stop smoking by buying him a cheap puffer to test it out. Now he has a full set up.
cr0sh 7y ago
So I take it, should these results be replicated and validated as scientifically sound, that smoke machines will be banned? Because it's the same kind of aerosol with virtually the same ingredients. I'm also curious - and maybe I missed it; it's a dense paper - that while they mentioned the primary ingredients in "bare" vape liquids, they didn't seem to mention the concentrations of each used in the study? Again, maybe I missed it... If it wasn't mentioned, I would be curious how different percentages of each affect the outcome. For that matter - I would also be curious how "vaping" something similar - say perhaps atomized distilled water in a nebulizer - what kind of results are seen there, too. While it may be that vaping liquids are "bad" (and any metals from the heating coil, as the study noted), how they compare to other similar liquids might be important in determining their relative danger. Also - whether this reported danger is warranted or not? That is, when compared to other things in day-to-day breathing, where does this fall in terms of "danger"? Is it worse than being around a camp fire or fireplace? Is it worse than breathing air in a working kitchen? Is it worse than breathing the air while taking a hot shower? Sure - the numbers can be made to look scary - but what is the objective truth, beyond the idea that "yes, vaping even base liquids is worse than just breathing" - I think we can agree that breathing in something more than clean air is worse for you, no matter what it is. But for all we know, we're constantly breathing in microparticles of plastic and other pollution in greater rates and more often than even a heavy vaping device user. Lots of questions and avenues that could be pursued in follow-up research on this topic, certainly. It was interesting to read about, especially as someone who occasionally vapes a caffeine-based (non-niccotine) liquid.
- fuzz4lyfe 7y ago
  > smoke machines will be banned Do people put smoke machines up to their mouths and inhale it many times a day over many years?
  - bushido 7y ago
    No. But that might be an unfair comparison. People vape by choice. Smoke machines on the other hand have more in common to going to a restaurant or bar back in the day and being subjected to other people's second hand smoke. You go to a venue for music or something similar, and get exposed to smoke machines. Never have I ever heard anyone say, we should go to a concert or night club because - smoke machines!
aphextim 7y ago
I would be curious to compare this to smoking an actual cigarette to see if there is any difference. Inhaling any vapor/smoke that isn't meant for your lungs is going to cause damage and it would be neat to see a comparison between the two. Anecdotal story time: My grandfather who is currently 81, has been smoking since he was 12. He grew up in a very small town, and had 6 people in his graduating class other than himself. Around January of this year, during a visit he seemed inquisitive as to the vaping device I was using. He still at this time was smoking 1.5-2 packs a day of roll-your-own cigarettes. The reason he still was smoking so much is he has severe health issues from being legally blind from diabetes, and having extreme back pain since he returned from the service. In his hold age the only place he can sit and relax is this very old chair that sits on his porch that for whatever reason the angle on it relieves his back pain. He sits on that porch, smoking I would say 85% of his time, and the habit of playing with cigarettes while sitting there was the biggest factor. After inquiring about my device and having me explain it to him he wanted to buy one right away and get on the e-cig bandwagon. I was skeptical as he has a whole multitude of health issues and if I were to switch him without consultation and something were to happen the guilt would be very great and I could not live with that. I went with him to one of his visits to the V.A. and he brought up the subject of e-cigs to his doctor. We all had a conversation that pretty much came to the conclusion that continuing to smoke cigarettes wouldn't be any better than e-cigs, and there is always a chance that the e-cig could be worse but there was nothing definitive. I was able to get him to transition to smoking 0% nicotine juice, with a higher PV/VG ratio (from what I've gathered online in smoker forums high VG juice tends to inflame those with asthma more than the PG). He did use nicotine patches for two weeks when he came off the cigarettes. He slipped up and did smoke about 3 cigarettes during this transition, but starting the beginning of February he has been nicotine free and smoking the e-cig. He recently had a lung test or something where they measure your 02 etc. He had said when he was smoking his 2 packs a day that his 02 was at 65% or so, and that it had gotten up to 78% at his last test. Now I'm not a doctor and there are probably a billion variables that are unaccounted for, however he said that his breathing is much easier and doesn't have a hard time sleeping when it is hot and humid out as much as before. For him the switch seems to be working with regards to his lungs/breathing. As far as other issues becoming more exacerbated because of this, only time will tell I guess. He does want to quite completely, I suggested switching to sugar free candies or something to keep his oral fixation at bay while he sits in his chair. He seemed open to the idea, but like most smokers it really is a mental game and trying to get him to change his ways is pretty tough as he is a stubborn old man.
ozzmotik 7y ago
sorry if this comment is against the spirit of the community (i don't think it is, but I have been blocked from posting in the past oblivious to the fact that I wasn't contributing anything meaningful), but that being said... am I the only one who isn't surprised that someone managed to find that if you introduce something into the body that isn't generally there, that there is obviously going to be an acute response of some sort? seems sort of like a simple "you introduce a thing to your body, your body responds to it" type thing, though perhaps I misunderstood the nature of the acute systems that were measured? they just didn't seem too horribly negative to me from my reading of it. granted, that being said, im all for further testing and gathering of further evidence, as a vaping enthusiast myself i think it's quite important that science keeps studying it so that we know exactly what it does, especially over long term exposure. and perhaps maybe I'm just being unnecessarily reactive against some imagined people that might take this and say "hey look it's proof that vaping is bad for you because things happen when you do it!"
- ozzmotik 7y ago
  sometimes i really wish that people would actually tell me why they downvote what I have to say, rather than just silently doing so and condemning me to the bottom of the comments. i can't really really do the revision part of performance, feedback, revision without any actual feedback of substance to inform me as to what it is that I did wrong in the first place.
  - mturmon 7y ago
    Downvotes usually equilibrate "correctly" over time. Best response to downvotes is to re-read and see if anything said was wrong or inflammatory, and if not, just wait it out. In general, I'd say that using proper capitalization and avoiding walls of text - stripping down to your actual point - would help your comments.
    - ozzmotik 7y ago
      oh interesting, i never seem to find mine to equilibriate over time; they generally get zero engagement. i honestly did not realize that people really put that much import into proper capitalization; i figured most people understand that, given the heavy market share of mobile users, that most of the time, all lowercase text is more often an intentional choice and not necessarily one made of intellectual laziness. as for the wall of text thing, that certainly makes sense to me. i always have a tendency to write those, and i could understand why others would find them cumbersome to parse. all in all, good advice, and i highly thank you for sharing it with me. i suppose i may have to rethink how i present myself here, esp wrt the whole orthography of my posts :)
MayeulC 7y ago
Are there good comprehensive guides out there regarding vaping? My mother has been a smoker for a long time, and she bought a "myblu" on a whim. However, she is concrned about the need to buy small recharges, as it is obviously not environment-friendly. Moreover, she had issues with the battery (I think it's not charging anymore, or maybe charged but not producing vapor) after a couple months of extremely light use. As she finds the product unreliable (battery capacity, etc), she always have cigarette "backups". I do not know anything about the mechanical parts used, nor the chemicals (for DIY liquid), or even the various vapes on the market. Are there good, reputable and independent review sites or wikis on this topic? Preferably not with toxic kitchen recipes. I think a good vape could accept either standard or homemade products, with a standardized battery, and as much replaceable parts as possible.
- ogwh 7y ago
  I started with a myBlu and ended up going through 6 different devices before finding one that doesn't suck. There is a huge quality problem in the market at the moment. The device I settled on, and which I've had zero problems with, is the "Smok Nord AIO 19". It's about 25GBP. Note that I had also bought a "Smok Novo" and DID have problems with that, it leaked everywhere, so even within the same brand quality varies dramatically. The reviews on YouTube aren't useful because they don't usually use a device long enough for problems to become apparent. I've been using the Nord AIO 19 for several weeks now and swear by it. And it's not to be confused with the regular Nord... Which looks like the Novo and also has leaking problems. If you're in the UK, Totally Wicked are a company that, while expensive, can be trusted. They only sell quality devices, but they're all rebranded versions of other manufacturers. They've recently struck a deal with WHSmith who will also be selling their kits (that's how trustworthy they are).
pcj-github 7y ago
Increases my conviction that vaping products should only be available by prescription, which any primary care physician would be more than happy to prescribe for a smoker hoping to quit. As for the ~40% of 7th and 8th graders that are vaping at my kids middle school, well, that number would hopefully decrease.
rkimmel 7y ago
I’m tired of vaping companies claiming it’s safe. Glad the truth is finally getting out. The only safe alternative to cigarettes is to not smoke at all.
- glloydell 7y ago
  Can you point me towards any advertising campaigns or promotional material claiming that vaping is "Safe"? Not safer, but safe.
carbocation 7y ago
I readily buy their conclusions, but this really should be placebo controlled. MRIs are loud and obnoxious and upleasant. If you told me that this result (observed on MRI#2) was entirely the consequence of having done MRI#1, I would find it plausible.
billfruit 7y ago
Is there a theoretical model for the effect of ecigs on the effect on the human body? What would such a model say about their safety in comparison to normal cigarettes.
xyst 7y ago
While I have no doubts or reservations about the ill effects of E-cigarettes, can a sample size of 31 people provide a definitive conclusion?
denkmoon 7y ago
Very frustrating that there is so much attention around e-cigarettes and so little around cannabis vaporisers.

203 points by mzs 7y ago

> ... on healthy non-smokers ... That’s unlikely to be surprising. Would really love to know what the impact is in smokers versus an actual cigarette. Isn’t nicotine already known to have this effect?

ceejayoz 7y ago
It seems clear that e-cigs are better than smoking. It also seems clear that e-cig manufacturers are hoping to hook young non-smokers to expand their market. Both are valuable bits of info, but "e-cigs do confirmed damage" is extremely important info from a public health perspective.
- d1zzy 7y ago
  That's correct but I worry that all this will result in banning e-cigs (in my state at least), based on the idea that cigarettes (and many other things) wouldn't have been legal/popular if they appeared today but we tolerate them because they are already a thing. The last thing I want is for my SO to go back to smoking real cigs because e-cigs become unavailable here :(
  - ceejayoz 7y ago
    I'd like to see them made available via a prescription for smoking cessation.
    - dennisnedry 7y ago
      I don't understand why making them available via a prescription would solve anything. I do not smoke or vape, but I have a friend who stopped smoking because vaping was accessible without going to a doctor. He just tried it because he wanted to see if it would work, and it did. He no longer vapes or smokes.
      - ceejayoz 7y ago
        The stated concern is e-cigs becoming unavailable to smokers looking to quit. Making it available via a prescription permits that use, while limiting access for recreational uptake by kids.
        bobwaycott 7y ago
        No, it means every smoker has to go to a doctor just to try to use vaping to quit! Fuck that. That’s insane. No adult should have to go to a doctor for permission to use an e-cig. It’s not medicine. Let the state go after the businesses promoting and selling e-cigs to kids—and levy astronomical fines against them. Sponsor PSAs that scare kids away from doing it. Educate everyone on the potential risks. If these “kids” are 18, they’re adults, so let them do as they please. Cigarettes don’t require a prescription to get hooked on them. Adults should be free to recreationally use e-cigs just as much as cigarettes, weed, alcohol, and plenty of other substances. It’s their body. Increase taxes on them to try and discourage it and pay for PSAs against vaping. Whatever. But let’s dispense with the think-of-the-children crap, and let adults be adults.
      - deleted 7y ago
        [deleted]
    - EpicEng 7y ago
      Sure. While you're at it, please ban red meat. I eat far too much of it and need to be protected.
      - ceejayoz 7y ago
        If someone starts selling nicotine-laced steaks, I'll be the first to advocate for an FDA crackdown on it.
        EpicEng 7y ago
        Nicotine is in the same drug class as caffiene. Want to ban coffee as well?
        ceejayoz 7y ago
        Plenty of drugs are in the same class with substantially differing impacts - take heroin vs. morphine vs. fentanyl vs. oxycodone as an example, or ask someone taking antipsychotic psych meds if they're all the same. Or try taking some strychnine because it's an alkaloid like nicotine and caffeine and see how well that works out. Since you picked coffee as an example, most of the studies I've seen indicate probably health benefits from it. Nicotine it's not.
        EpicEng 7y ago
        I guess I shouldn't have used the word "class" as you're not the only person to come back with that. I mean that it's generally recognized as safe (GRAS) by the FDA. I think you know that comparing heroin to nicotine is just silly and, as far as I'm aware, there's no data that shows that nicotine is any more or substantially more harmful than caffeine. So back in reality where we're talking about banning e-cigs; why should they be subject to a prescription?
        ceejayoz 7y ago
        "So back in reality" GRAS does not mean what you think it means. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664775/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664775/ > Despite scientific uncertainty regarding the safety of inhaling aerosol and flavorant substances from electronic cigarettes (e-cigarettes) relative to inhaling smoke from traditional cigarettes, some consumers and vape shop employees suggest that the U.S. Food and Drug Administration’s (FDA) “generally recognized as safe” (GRAS) designation of constituents provides clear evidence of overall e-cigarette safety. > Although the Flavor and Extract Manufacturers Association (FEMA) has clarified that the GRAS program only assesses product safety for ingestion in food, not inhalation, public confusion appears to continue. Nicotine isn't even on the GRAS list at all. Some of the additives (like glycerol) and flavorants are. https://www.accessdata.fda.gov/scripts/fdcc/index.cfm?set=GRASNotices&sort=GRN_No&order=DESC&startrow=1&type=basic&search=nicotine https://www.accessdata.fda.gov/scripts/fdcc/index.cfm?set=GR...
  - sawjet 7y ago
    There are tons of resources for building your own DIY e-cigarette. it might not be as slim and sleek as a Juul, but it will perform better, be cheaper to maintain and produce much less waste.
- tinus_hn 7y ago
  It should also be clear that not using electronic cigarettes is better than using them.
  - ceejayoz 7y ago
    The industry is going to fight that conclusion tooth and nail, though, so solid evidence of it is valuable.
    - throwaway5752 7y ago
      Younger users might not have context like https://en.wikipedia.org/wiki/Operation_Berkshire https://en.wikipedia.org/wiki/Operation_Berkshire or the acrimony leading up to https://en.wikipedia.org/wiki/Tobacco_Master_Settlement_Agreement https://en.wikipedia.org/wiki/Tobacco_Master_Settlement_Agre....
  - oarabbus_ 7y ago
    I've never seen anyone argue they are harmless, just that they are less harmful than actual cigarettes. The problem is that places are banning e-cigs, which presumably drives people back to smoking. Which is worse for everyone.
    - redisman 7y ago
      Less harmful than tobacco is a very low bar. Especially for non-smokers. If it was treated like methadone then cool, but seems like these days most of the vapers are young, new users. Not recovering cigarette addicts.
    - aketchum 7y ago
      Anecdotally, I hear many friends say they are harmless. Surprisingly a nurse friend of mine vapes Juuls and isn't worried about the health impacts. I think plenty of people actually take it that since they are not cigarettes and are "just nicotine" they don't worry about their safety.
      - 7y ago
- jforman 7y ago
  It seems clear that e-cigs are better than smoking. How can this be clear without long-term usage data?
  - ceejayoz 7y ago
    Well, that's the seems part. It certainly stands to reason that inhaling vaporized nicotine will be better than inhaling vaporized nicotine plus ash and tar and pesticides and whatnot.
    - jforman 7y ago
      Fair enough. Although I think a researcher would say our bags of meat often surprise us.
- bobwaycott 7y ago
  > It also seems clear that e-cig manufacturers are hoping to hook young non-smokers to expand their market. This is mentioned a lot, but I find it questionable. I’ve never seen an ad that made me feel like Joe Camel or the Marlboro Man did when I was a kid. My teenagers haven’t ever thought vaping was cool based on ads or plenty of people doing it. This sounds too much like a general truism of capitalist enterprise—always find ways to expand your markets—while combining it with a direct accusation that it’s being done perniciously to “hook” them. Everyone who is selling anything is trying to hook people on their product, if that’s the terminology we’re using—new clothes, new cars, new TVs, the latest deals ... every company is using advertising to hook people on their products. People go into financial ruin for cars and homes and stupid stuff. Maybe we should just ban advertising to people so no company can try to hook young people on their products to expand their markets.
  - ceejayoz 7y ago
    Do you think Juul’s school curriculum - which they paid schools to accept - was genuinely well-intentioned? https://www.nytimes.com/2019/07/25/health/juul-teens-vaping.html https://www.nytimes.com/2019/07/25/health/juul-teens-vaping.... > In April 2017, a Juul representative visited the Dwight School in New York City to meet with students — with no teachers present — and told them the company’s e-cigarettes were “totally safe.”
    - bobwaycott 7y ago
      Do you really think I would argue that is well-intentioned—no matter what company it is? Did my comment really leave the impression I’d give that a thumbs up? Companies shouldn’t be permitted to do that, regardless of their product—so fine them exorbitantly, and let’s do the same to the morons who accepted such a proposal while we’re at it. What I’m pointing out is this is standard behavior for corporations, and nobody does a thing to go after them or their profits when they behave badly—instead, people use this for lame think-of-the-children arguments against the products, calling for public bans, suggesting we force adults to get prescriptions for an e-cig, when what we ought to do is aggressively go after the bad corporate behavior—or make it illegal to manufacture and sell things if we don’t like them. But in the case of e-cigs, let’s start with cigarettes first, or admit we aren’t going to ever do that, move onto more productive conversations, and stop acting like e-cigs and actual tobacco products are at all equivalent—aside from the very narrow category of nicotine-delivery device.
mzs 7y ago
The vascular effects are very similar to prior research on cigarette smoke. It's precisely the same initial effects thought to lead to heart disease in smokers. edit: You my have edited your comment while I was relying. The second of two sentences under Background (first section) mentions that this was a nicotine free study unlike earlier ones.
refurb 7y ago
Yes, nicotine itself is known to have this impact on the vascular system. Not surprising you see it with nicotine vaping.

program_whiz 7y ago

Many people seem to believe that vaping is harmless, this is good to make the point clearly that vaping, while not as harmful as smoking cigarettes, isn't a "cost free" activity. I personally didn't realize that it could have these effects either.

redisman 7y ago
Yes and we still don't know the long term effects of heavy use for a decade or two. Cigarettes were great and good for you for decades too.
mruts 7y ago
I’m not sure there exists a cost free activity as far as people are concerned.
- kuiper0x2 7y ago
  Sex is pretty cost free. Meditation is cost free. Unless you are defining time usage as a cost which is absurd.
  - umvi 7y ago
    > Sex is pretty cost free Not sure if you are joking or not, but I would wager the costs of sex are actually enormous even compared to drugs. Look no further than the costs and issues surrounding the following: adoption, foster care, abortion, child support, single parent welfare rates, STDs, etc. In theory sex is a "cost free" recreational activity, but in practice it isn't.
    - jolux 7y ago
      well, if you’re super careful with your contraception and have easy access to abortion...also lots of queer sex runs no risk of reproducing accidentally. STIs, on the other hand, are definitely a risk.
      - 7y ago

charliesharding 7y ago

I'm a little confused - can someone knowledgable in the area help out? In the introduction they assert: "Once inhaled, ultrafine particles and the oxidant species located on their surface can translocate into the vascular space (13), resulting in a state of chronic vascular inflammation and oxidative stress noxious to endothelial function." However in the conclusion they state: "Inhaling nicotine-free electronic cigarette aerosol transiently impacted endothelial function in healthy nonsmokers" It sounds like in the introduction they are aware of studies that concluded the aerosol inhalation causes chronic issues with endothelial function, but they concluded that it only has a transient effect. Are they refuting those claims? Did I miss something?

zaptheimpaler 7y ago
Maybe the duration of the study is too short to definitively conclude a chronic effect, even though they suspect it is there.
onemoresoop 7y ago
While I don't think e-cigarettes are completely harmless, anything can be proved (fudged in a way) if there is an intention to. Yes, we don't know what the effects of vaping are but they appear to be a decent (and possibly more addictive) alternative to tobacco smokers who can't quit.
close04 7y ago
Transient in healthy nonsmokers. Since most vapers do it regularly it's a fair to assume that they are in a "permanently transient" state. A permanently acute state is basically a chronic state.
- filoleg 7y ago
  Imo permanent === persisting after whatever was causing this state in the first place is gone. If those "transient" effects are gone after a chronic user is done using after a long time, then I would still consider the effect to be transient rather than permanent.

deleted 7y ago

[deleted]

dumbfoundded 7y ago

If you believe E-Cigs are harmless, there's an easy experiment you can do for yourself. Go on a run, time yourself. The next day, vape for 30 min and then go on the same run. This is what got me to personally switch away from E-Cigs. Vaping would add an additional 30-sec to 1-min per mile on my runs. I try to only use patches or gum now. Still not great but it's a lot better if you're trying to stay in shape. That being said, if you're only two choices are cigarettes and vaping. Obviously, choose vaping.

jack_h 7y ago
Similarly try running when you're a smoker vs a vaper. I'd say vaping is a very good harm reduction path for smokers that hopefully leads to quitting altogether. It is definitely not harm free though. I just hope our society and laws don't go in a direction where people are pushed back into smoking.
mzs 7y ago
Careful, in addition to constricting/hardening blood vessels that is thought to lead to heart disease nicotine has other long term effects as seen in in this study of angiogenesis: >In a series of experiments, the researchers found that nicotine could enhance new blood vessel growth in mice whose hind limbs were artificially starved of oxygen. They also found that lung cancer cells implanted into mice grew more quickly when the mice consumed nicotine in their drinking water. Mice susceptible to developing plaque in the arteries of their hearts also experienced more rapid plaque growth when exposed to nicotine than mice who were not exposed. >The researchers believe nicotine works by binding to a receptor on the surface of endothelial cells that recognizes acetylcholine -- a chemical that nerve cells use to communicate with each other. Endothelial cells line the interior of blood vessels throughout the body. … https://news.stanford.edu/news/2001/july11/nicotine.html https://news.stanford.edu/news/2001/july11/nicotine.html
- mikelyons 7y ago
  Nicotine is also, itself, a known carcinogen.

sharadov 7y ago

Why don't ecigs come with the same warnings that regular cigs do?

umvi 7y ago
Regulation hasn't caught up. Think of Juul as the Uber of nicotine.
83457 7y ago
Because nicotine doesn't kill you, the way it is delivered does. Tobacco products are the most popular delivery method and is especially harmful due to level of carcinogens and other elements. Essentially no one cared much about nicotine as a chemical specifically much more than they did about caffeine.
filoleg 7y ago
I don't know where you live, but in my jurisdiction they do (WA state). Same big black or white paper with giant print saying the same stuff that is said on cig packs.

Medicalidiot 7y ago

The number one controllable risk factor for stroke and heart attack is smoking. By far. Not diet, not exercise, smoking. A significant part of that is because nicotine will constrict blood vessels leading to hypertension[1], this leads to destruction of the surface of an artery, leading to atherosclerosis formation. One day the atherosclerotic plaque ruptures and then you see me. We once thought that atherosclerosis is an old persons disease, where health habits later in life lead are what predicates plaque formation. The Army started noticing fatty streak formation(first stage of atherosclerosis)[2] in arteries of dead soldiers during autopsy, which now leads us to believe this starts in youth and progresses from there. 1) https://www.ingentaconnect.com/content/ben/vdp/2005/00000002/00000002/art00006 https://www.ingentaconnect.com/content/ben/vdp/2005/00000002... 2) https://media.jamanetwork.com/news-item/autopsy-based-study-examines-prevalence-of-atherosclerosis-among-u-s-service-members/ https://media.jamanetwork.com/news-item/autopsy-based-study-...

LinuxBender 7y ago
Have any of your patients tried reversing the plaque with k2/d3/magnesium. It works for lowering CAC scores, just curious if it also helps with any of the other buildup beyond calcium. Or perhaps serrapeptase/natto.
- amelius 7y ago
  Look up Linus Pauling's therapy.
  - LinuxBender 7y ago
    I actually ran across his studies some time ago. I've always been curious if the testing to validate his work used real vitamin-C or ascorbic acid. I will dig deeper into that now that you bring it up.
  - JanSt 7y ago
    https://www.quackwatch.org/01QuackeryRelatedTopics/pauling.html https://www.quackwatch.org/01QuackeryRelatedTopics/pauling.h...

magashna 7y ago

One of the frustrating things about ecig studies is that they always use the worst quality hardware and puff really hard on them. The "Epuffer" looks like one of those "cig-a-like" which are notoriously worse than the much more expensive hobbyist mech mods. The cig-a-likes usually don't get enough juice to the heating element so when you're puffing a lot (16 consecutive 3s pulls) you end up burning the wick.

epmaybe 7y ago
Out of curiosity, are most people that use ecigs going for the expensive mods, or are they going for the more popular brands that are closer in quality to the epuffer?
- travelton 7y ago
  I don't have any science to back up this, just an opinion. Epuffer is like a conversion product. Once you try it, you likely invest in better equipment. This is what happened to me... Started with a cheap gas station stick, then quickly upgraded to a decent set up. Was able to get my dad to stop smoking by buying him a cheap puffer to test it out. Now he has a full set up.

cr0sh 7y ago

So I take it, should these results be replicated and validated as scientifically sound, that smoke machines will be banned? Because it's the same kind of aerosol with virtually the same ingredients. I'm also curious - and maybe I missed it; it's a dense paper - that while they mentioned the primary ingredients in "bare" vape liquids, they didn't seem to mention the concentrations of each used in the study? Again, maybe I missed it... If it wasn't mentioned, I would be curious how different percentages of each affect the outcome. For that matter - I would also be curious how "vaping" something similar - say perhaps atomized distilled water in a nebulizer - what kind of results are seen there, too. While it may be that vaping liquids are "bad" (and any metals from the heating coil, as the study noted), how they compare to other similar liquids might be important in determining their relative danger. Also - whether this reported danger is warranted or not? That is, when compared to other things in day-to-day breathing, where does this fall in terms of "danger"? Is it worse than being around a camp fire or fireplace? Is it worse than breathing air in a working kitchen? Is it worse than breathing the air while taking a hot shower? Sure - the numbers can be made to look scary - but what is the objective truth, beyond the idea that "yes, vaping even base liquids is worse than just breathing" - I think we can agree that breathing in something more than clean air is worse for you, no matter what it is. But for all we know, we're constantly breathing in microparticles of plastic and other pollution in greater rates and more often than even a heavy vaping device user. Lots of questions and avenues that could be pursued in follow-up research on this topic, certainly. It was interesting to read about, especially as someone who occasionally vapes a caffeine-based (non-niccotine) liquid.

fuzz4lyfe 7y ago
> smoke machines will be banned Do people put smoke machines up to their mouths and inhale it many times a day over many years?
- bushido 7y ago
  No. But that might be an unfair comparison. People vape by choice. Smoke machines on the other hand have more in common to going to a restaurant or bar back in the day and being subjected to other people's second hand smoke. You go to a venue for music or something similar, and get exposed to smoke machines. Never have I ever heard anyone say, we should go to a concert or night club because - smoke machines!

aphextim 7y ago

I would be curious to compare this to smoking an actual cigarette to see if there is any difference. Inhaling any vapor/smoke that isn't meant for your lungs is going to cause damage and it would be neat to see a comparison between the two. Anecdotal story time: My grandfather who is currently 81, has been smoking since he was 12. He grew up in a very small town, and had 6 people in his graduating class other than himself. Around January of this year, during a visit he seemed inquisitive as to the vaping device I was using. He still at this time was smoking 1.5-2 packs a day of roll-your-own cigarettes. The reason he still was smoking so much is he has severe health issues from being legally blind from diabetes, and having extreme back pain since he returned from the service. In his hold age the only place he can sit and relax is this very old chair that sits on his porch that for whatever reason the angle on it relieves his back pain. He sits on that porch, smoking I would say 85% of his time, and the habit of playing with cigarettes while sitting there was the biggest factor. After inquiring about my device and having me explain it to him he wanted to buy one right away and get on the e-cig bandwagon. I was skeptical as he has a whole multitude of health issues and if I were to switch him without consultation and something were to happen the guilt would be very great and I could not live with that. I went with him to one of his visits to the V.A. and he brought up the subject of e-cigs to his doctor. We all had a conversation that pretty much came to the conclusion that continuing to smoke cigarettes wouldn't be any better than e-cigs, and there is always a chance that the e-cig could be worse but there was nothing definitive. I was able to get him to transition to smoking 0% nicotine juice, with a higher PV/VG ratio (from what I've gathered online in smoker forums high VG juice tends to inflame those with asthma more than the PG). He did use nicotine patches for two weeks when he came off the cigarettes. He slipped up and did smoke about 3 cigarettes during this transition, but starting the beginning of February he has been nicotine free and smoking the e-cig. He recently had a lung test or something where they measure your 02 etc. He had said when he was smoking his 2 packs a day that his 02 was at 65% or so, and that it had gotten up to 78% at his last test. Now I'm not a doctor and there are probably a billion variables that are unaccounted for, however he said that his breathing is much easier and doesn't have a hard time sleeping when it is hot and humid out as much as before. For him the switch seems to be working with regards to his lungs/breathing. As far as other issues becoming more exacerbated because of this, only time will tell I guess. He does want to quite completely, I suggested switching to sugar free candies or something to keep his oral fixation at bay while he sits in his chair. He seemed open to the idea, but like most smokers it really is a mental game and trying to get him to change his ways is pretty tough as he is a stubborn old man.

ozzmotik 7y ago

sorry if this comment is against the spirit of the community (i don't think it is, but I have been blocked from posting in the past oblivious to the fact that I wasn't contributing anything meaningful), but that being said... am I the only one who isn't surprised that someone managed to find that if you introduce something into the body that isn't generally there, that there is obviously going to be an acute response of some sort? seems sort of like a simple "you introduce a thing to your body, your body responds to it" type thing, though perhaps I misunderstood the nature of the acute systems that were measured? they just didn't seem too horribly negative to me from my reading of it. granted, that being said, im all for further testing and gathering of further evidence, as a vaping enthusiast myself i think it's quite important that science keeps studying it so that we know exactly what it does, especially over long term exposure. and perhaps maybe I'm just being unnecessarily reactive against some imagined people that might take this and say "hey look it's proof that vaping is bad for you because things happen when you do it!"

ozzmotik 7y ago
sometimes i really wish that people would actually tell me why they downvote what I have to say, rather than just silently doing so and condemning me to the bottom of the comments. i can't really really do the revision part of performance, feedback, revision without any actual feedback of substance to inform me as to what it is that I did wrong in the first place.
- mturmon 7y ago
  Downvotes usually equilibrate "correctly" over time. Best response to downvotes is to re-read and see if anything said was wrong or inflammatory, and if not, just wait it out. In general, I'd say that using proper capitalization and avoiding walls of text - stripping down to your actual point - would help your comments.
  - ozzmotik 7y ago
    oh interesting, i never seem to find mine to equilibriate over time; they generally get zero engagement. i honestly did not realize that people really put that much import into proper capitalization; i figured most people understand that, given the heavy market share of mobile users, that most of the time, all lowercase text is more often an intentional choice and not necessarily one made of intellectual laziness. as for the wall of text thing, that certainly makes sense to me. i always have a tendency to write those, and i could understand why others would find them cumbersome to parse. all in all, good advice, and i highly thank you for sharing it with me. i suppose i may have to rethink how i present myself here, esp wrt the whole orthography of my posts :)

MayeulC 7y ago

Are there good comprehensive guides out there regarding vaping? My mother has been a smoker for a long time, and she bought a "myblu" on a whim. However, she is concrned about the need to buy small recharges, as it is obviously not environment-friendly. Moreover, she had issues with the battery (I think it's not charging anymore, or maybe charged but not producing vapor) after a couple months of extremely light use. As she finds the product unreliable (battery capacity, etc), she always have cigarette "backups". I do not know anything about the mechanical parts used, nor the chemicals (for DIY liquid), or even the various vapes on the market. Are there good, reputable and independent review sites or wikis on this topic? Preferably not with toxic kitchen recipes. I think a good vape could accept either standard or homemade products, with a standardized battery, and as much replaceable parts as possible.

ogwh 7y ago
I started with a myBlu and ended up going through 6 different devices before finding one that doesn't suck. There is a huge quality problem in the market at the moment. The device I settled on, and which I've had zero problems with, is the "Smok Nord AIO 19". It's about 25GBP. Note that I had also bought a "Smok Novo" and DID have problems with that, it leaked everywhere, so even within the same brand quality varies dramatically. The reviews on YouTube aren't useful because they don't usually use a device long enough for problems to become apparent. I've been using the Nord AIO 19 for several weeks now and swear by it. And it's not to be confused with the regular Nord... Which looks like the Novo and also has leaking problems. If you're in the UK, Totally Wicked are a company that, while expensive, can be trusted. They only sell quality devices, but they're all rebranded versions of other manufacturers. They've recently struck a deal with WHSmith who will also be selling their kits (that's how trustworthy they are).

pcj-github 7y ago

Increases my conviction that vaping products should only be available by prescription, which any primary care physician would be more than happy to prescribe for a smoker hoping to quit. As for the ~40% of 7th and 8th graders that are vaping at my kids middle school, well, that number would hopefully decrease.

rkimmel 7y ago

I’m tired of vaping companies claiming it’s safe. Glad the truth is finally getting out. The only safe alternative to cigarettes is to not smoke at all.

glloydell 7y ago
Can you point me towards any advertising campaigns or promotional material claiming that vaping is "Safe"? Not safer, but safe.

carbocation 7y ago

I readily buy their conclusions, but this really should be placebo controlled. MRIs are loud and obnoxious and upleasant. If you told me that this result (observed on MRI#2) was entirely the consequence of having done MRI#1, I would find it plausible.

billfruit 7y ago

Is there a theoretical model for the effect of ecigs on the effect on the human body? What would such a model say about their safety in comparison to normal cigarettes.

xyst 7y ago

While I have no doubts or reservations about the ill effects of E-cigarettes, can a sample size of 31 people provide a definitive conclusion?

denkmoon 7y ago

Very frustrating that there is so much attention around e-cigarettes and so little around cannabis vaporisers.