How We Know Vaping Opponents are Driven by Ideology and Not Science

I have presented many examples on this blog over the past months demonstrating the fact that vaping opponents are being driven by ideology rather than science. But there is one observation I made which is dispositive. In legal terminology, dispositive meansevidence that unqualifiedly brings a conclusion to a legal controversy.” This observation brings a conclusion to any controversy about whether the position and actions of vaping opponents have been science-based or ideology-based.

The Rest of the Story

The observation is actually quite simple:

Not a single anti-tobacco or health group or agency which has warned the public about the risks of “popcorn lung” from vaping has warned smokers about the risks of popcorn lung.

Let us assume, for a moment, that it is true that vaping puts people at risk of developing popcorn lung because it contains diacetyl, a chemical which was found to cause popcorn lung in several popcorn factory workers. Well, it turns out that cigarettes deliver hundreds of times more diacetyl to smokers than vapers get from e-cigarettes. Given the exposure difference, if diacetyl poses a risk of popcorn lung to vapers, then it certainly poses a much larger risk of popcorn lung to vapers.

Yet I am unable to find a single web site of a health or anti-tobacco group that warns smokers about the risk of popcorn lung from smoking, based on the presence of high levels of diacetyl.

It seems to me that if the actions of vaping opponents were science-based, then they should be plastering the headlines with warnings about the risks of popcorn lung to smokers. But they’re not. They are only telling the public that e-cigarettes poses such a risk, not real cigarettes. This can only be explained by ideology: a huge bias against vaping. Without realizing it, these groups are actually defending smoking by not calling out the risks of popcorn lung.

Now the truth is that there is no evidence that vaping is associated with popcorn lung. While cigarettes deliver much higher levels of diacetyl, cigarette smoking itself has not been associated with popcorn lung. So the hysterical claims about the relationship between vaping and popcorn lung have little basis in science. But if we assume that there really is a risk of developing popcorn lung if you vape, then certainly these health groups should be warning smokers, who would face a much larger risk.

As an example, take the American Lung Association. They have a web page entitled “Popcorn Lung: A Dangerous Risk of Flavored E-Cigarettes.” The first problem with this page is that it isn’t true. There is no reason to believe that popcorn lung is a dangerous risk of flavored e-cigarettes. As far as I know, despite millions of e-cigarette users, there has not been a single documented case of popcorn lung caused by vaping. 

But the second problem is that even if we assume that the risk is real, the American Lung Association nowhere warns smokers of this risk. Shamefully, while the American Lung Association demands that “FDA act quickly to require that diacetyl and other harmful chemicals be removed from e-cigarettes,” the Lung Association is not calling on the FDA to require that diacetyl be removed from real cigarettes.

Is this really about health, or is it just about demonizing e-cigarettes?

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Critical Thinking 101: Source Evaluation

I think we live in an unscientific age in which almost all the buffeting of communication and television–words, books, and so on–are unscientific. As a result, there is a considerable amount of intellectual tyranny in the name of science.

~ Richard Feynman, 1966

Refuting unscientific anti-e-cigarette commentaries takes a lot of work these days. These articles pull facts from thin air, make specious arguments, cherry-pick evidence, and manufacture conclusions to support the personal biases of the author. Analyzing one of these articles with an eye to separating fact from fiction takes time–time most people don’t have or are unwilling to devote to the process. However, sometimes an author unknowingly makes it easy for you. Just a small amount of effort, perhaps just a few minutes, is all you need to determine whether the piece is credible. An infamous example of this is the Margaret Cuomo video. She has some fame, speaks with great confidence, and appears to know what she’s talking about. Most critics focused on her outrageously unscientific claims but ignored a much more fundamental problem: She had no legitimacy to speak authoritatively about e-cigarettes in the first place. This lack of legitimacy should have been obvious but was missed by many people because of a basic critical thinking error known as poor source evaluation.

The reality of poor source evaluation was demonstrated by a recent series of studies by Stanford researchers Sam Wineberg and Sarah McGrew. They assessed students’ ability to judge the credibility of online sources of information and were taken aback by the glaring mistakes the students made when coming to their conclusions. Students trusted the search engine to place the most reliable sources first. They readily accepted all sources as being equally reliable, failing to properly distinguish between established and respected scientific organizations and extremist political front groups with lofty sounding names. They were routinely fooled by sponsored links (essentially advertisements), mistaking them for legitimate news articles. All of this, despite the fact that these students were free to make a few extra clicks and learn some critical information that would have at least raised skepticism about the reliability of some sources. That is, they engaged in no source evaluation.

College students aren’t especially more prone to making this error than anyone else. Everyone who prowls the internet looking for reliable and trustworthy information is prone to making this mistake. As a lesson in source evaluation, we’ll take a look at a recent op-ed written by Sudip Bose, MD, published at the Huffington Post. I read widely in the field of nicotine and tobacco research, not just articles in the press, but the research reports they refer to. After decades of being in this field as a scientist and researcher, I’m fairly confident I know the major players in the field. Even so, I’d never heard of Sudip Bose. Because he’s writing on a topic in my field, the natural reaction was to think, who is this guy? Doing what most of the Stanford students failed to do, I did a Google search of his name, and it returned this bio. Looking it over, I learned Dr. Bose is a practicing emergency care physician, Iraq war veteran, leadership speaker, CEO, and a guest and consultant for The Dr. Oz Show. He seems to enjoy a modicum of fame and respect by engaging in these and many other pursuits. However, Dr. Bose’s bio also indicates he has absolutely no experience, training, scholarship, or practical knowledge about e-cigarettes and related fields like tobacco use or addiction. Those extra few clicks raised a puzzling question: Just what, exactly, qualifies him to be offering his opinion about e-cigarettes?

I won’t spend much time on the specific content of Bose’s article; it’s unmitigated junk from start to finish. He commits striking errors of fact, demonstrates a fundamental lack of understanding of the basic concepts, makes unsupported claims, and engages in feeble logic to arrive at his conclusions. A reader, even without any deep understanding of the topics Dr. Bose pontificates about, should suspect his piece could hardly be anything other than unmitigated junk. This comes from a rough assessment (from his bio) of what knowledge base he likely does have expertise in, the nature of how genuine expertise is acquired, and how it is unrealistic to expect that having expertise in one field confers expertise in another.

To become truly expert in a specialized area of knowledge takes long, hard years of study, practical experience, synthesizing research findings, and basically eating, sleeping, living, in the complex world of a specialized area of knowledge. Along the way, one would naturally pick up a survey-course level of knowledge in closely related fields, but this doesn’t qualify as expertise. For example, an electrical engineer is likely acquainted with the basics of civil engineering, but no one would hire them to develop a plan for building a flood wall. Likewise, there’s nothing about the process of becoming an accomplished emergency care physician (or writing a book about cancer survivorship) that would confer a trustworthy level of expertise in the unrelated fields of tobacco use, nicotine, or addiction. This is not to say they couldn’t have developed expertise in these areas. It’s just highly unlikely because it takes a herculean amount of time and effort to become proficient in two different bodies of knowledge. In the case of Drs. Bose and Cuomo, there is zero evidence from their bios that they’ve made even the barest attempt to do so.

Just to be clear, source evaluation is not some royal road to truth. It’s merely a first critical step one typically might take to arrive at a confident judgment of truth or fiction. Moreover, it’s a step too easily omitted when you agree with the main thrust of the commentary. Most of the time source evaluation doesn’t tell you enough, and you need to analyze the content of the article. But sometimes doing a little source evaluation can sharpen your critical eye and save you a lot of work. When there’s a complete mismatch between an author’s background, training, education, and current field of expertise and the topic they’re writing about, then you can dismiss them as inexpert and give their opinion no more weight than you would your drunk uncle’s view on international trade. Although it makes sense to consider what Bose has to say about emergency medicine or tap Cuomo’s views on cancer survivorship, it simply makes no sense to trust they know what they’re talking about when it comes to e-cigarettes.

Dr. Brian Carter

CASAA Director of Scientific Communications

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New Study in Pediatrics Shows How Anti-Vaping Researchers are Trying to Fool the Public

A new study published online ahead of print in the journal Pediatrics purports to provide evidence that e-cigarettes are encouraging youth to smoke. According to the article, “youth who initiate use with e-cigarettes are more likely to start smoking conventional cigarettes.” An accompanying press release concluded that “E-cigarettes are encouraging – not discouraging – youth to smoke…”. 

(See: Dutra LM, Glantz SA. E-cigarettes and national adolescent e-cigarette use: 2004-2014. Pediatrics 2017. DOI: 10.1542/peds.2016-2450.)

Using annual, cross-sectional data from the National Youth Tobacco Survey, the study found that the rate of decline in youth smoking from 2009-2014 was no different than the rate of decline in youth smoking from 2004 to 2009. Based on this finding, the authors conclude that experimentation with e-cigarettes did not contribute to the observed decline in smoking.

The ultimate study conclusion is that e-cigarettes have led to an increase in the “tobacco market” by attracting youth to “smoke.”

The Rest of the Story

There’s a major flaw in the study conclusion. And once you’re aware of it, you’ll realize that the study is really trying to pull the wool over the eyes of the public.

The best way I can demonstrate the trick the study is playing is through an analogy. Suppose we are interested in whether the acquisition of Al Horford led to a decline in the performance of the Boston Celtics. Controlling for a number of psychosocial variables that might affect the Celtics’ performance, we find no change in the record of the Celtics from before to after Horford joined the team (this is a hypothetical example because I think they’re actually playing better this year).

OK – it’s time for our conclusion. And here it is:

The acquisition of Al Horford has led to an improvement in the performance of the Boston Celtics.

But wait one second. How can you conclude that the acquisition improved the Celtics’ record when your analysis demonstrated that the acquisition was not associated with any change in the team’s performance?

You can’t. Unless you are trying to fool people.

This is exactly what is happening with this study. The researchers showed that experimentation with e-cigarettes did not lead to a decline in smoking. But that’s only half the story. The rest of the story is that experimentation with e-cigarettes did not lead to an increase in smoking.

You see – it works both ways. You can’t tell just the half of the story that you happen to like. If this study provides evidence that e-cigarettes didn’t result in a decline in youth smoking because there was no change in the rate of decline then the study also provides evidence that e-cigarettes didn’t result in an increase in youth smoking.

And that’s not consistent with the authors’ conclusion that e-cigarettes are encouraging youth to smoke and thereby increasing the tobacco market.

The study actually demonstrates the opposite of what the authors are telling the public. It provides evidence that e-cigarettes are not attracting kids to smoke. If that were the case, one would have expected to see lower rates of decline in youth smoking following the drastic proliferation of vaping among young people.

There is a more technical flaw with the analysis as well. The investigators choose a split point of 2009 to test the before and after trends in smoking. But there was little difference in youth smoking as measured by the NYTS between 2009 and 2011. Thus, using 2009 as the split point creates an artificially low estimate of the decline in youth smoking from 2011 to 2014. You can see from Figure 1 in the paper that there was a substantial increase in the rate of decline in youth smoking from 2011 to 2014, compared to the period from 2004 to 2011. That the model used in the paper doesn’t fit the data is clear from how far off the 2011 data point is from the trend line.

The truth is that there does appear to have been an acceleration in the rate of decline in youth smoking from 2011 to 2014. This observation is consistent with results from other national surveys, including the Youth Risk Behavior Survey and the Monitoring the Future study. This doesn’t mean that e-cigarettes are the reason for this accelerated decline, but it does suggest that the study has obscured the actual trend by choosing an inappropriate split point. Since e-cigarettes were not at all popular among youth in 2009 and only used by a small fraction of youth in 2011, it doesn’t make sense to place the split point at 2009. Unless you’re out to show that there was no change in the trend line.

The rest of the story is that by providing only half of the story, this study fools the public into believing that this research is providing evidence that e-cigarettes are encouraging kids to smoke. The truth is just the opposite. The paper also shows that e-cigarettes have not led to an increase in the youth smoking trend. There is no support for the study’s conclusion that e-cigarettes are encouraging kids to smoke and thereby expanding the use of tobacco among our nation’s youth.

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Battery Safety – Making Peace With Power

CASAA has produced a comprehensive guide to battery safety for those who use vapor products. The guide discusses how batteries are made, how they work, and what damages them. From this understanding, users can formulate some pretty clear rules to keep them and their batteries living together peacefully.

  • Download the complete guide here.
  • CASAA battery cases are available here.

Practical Battery Safety Tips

  1. Know your device. Every device has specific power requirements and the batteries for the device should meet or exceed those requirements.
  2. Do NOT make modifications to the device including those which could block any ventilation holes or slots. Those holes or slots remove heat and/or allow venting gas to escape safely.
  3. Buy high-quality batteries from a known source – cheap batteries and seconds have poor internal quality and could fail sooner.
  4. Buy only batteries rated for your device. Beware of re-branded batteries claiming to have ‘High Output’ – many of these are counterfeit and will fail. If in doubt seek well-known brands like Sony, LG, Samsung, etc.,  and buy from a dealer that knows where they came from.
  5. Store batteries in a protective case or sleeve, to prevent them from shorting or being damaged. CASAA has battery cases available in our store here.
  6. NEVER exceed the rated capacity of the battery – pulse ratings are high-stress ratings, batteries are meant to rest after stress.
  7. Do not drop batteries. If they are dropped they should be inspected very carefully. Any sign of damage on the outside could mean damage on the inside.
  8. Do not subject batteries to extremes of temperature. Leaving them in your car could freeze the electrolyte causing it to crack. Overheating the electrolyte will cause it to dry out prematurely and crack. Cracked electrolyte is a key point of failure for thermal runaway.
  9. If, when using a battery, it gets hot, STOP! Batteries may get warm to touch, but they should never get hot. Immediately put the battery in a fire-safe place such as a dry sink or outdoors away from people or pets.
  10. Use a quality charger designed for lithium batteries – using cheap chargers can result in overcharging batteries, or charging them too fast. This weakens the separator and causes the electrolyte to dry out and crack making the battery unsafe.
  11. Batteries should be replaced after at least 1 year of use – more often under high-stress applications like vaping. If you notice that the battery is taking longer to charge, seems warmer while using, or doesn’t seem to hold a charge as long, it is time to replace it.
  12. Never use a battery whose wrapper is damaged! The opportunity for shorts is higher, and damaged wraps may indicate internal damage.

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Nurses Get Into the Act: Smoking is No Worse than Vaping! Don't Commend Patients for Quitting Smoking Using E-Cigarettes

Apparently, irresponsible medical advice being given to smokers about quitting is not restricted to physicians. Nurses are getting in on the act and publicly making the most reckless medical recommendations to smokers. Two egregious examples highlight the incompetent and ill-considered information being disseminated to the public in the nursing literature.

1. Smoking is No Worse than Vaping

According to an article in the current issue of the journal Nursing, two instructors at the Georgetown University School of Nursing and Health Studies claim that smoking may be no more hazardous than vaping. According to the article:

“Because e-cigarettes don’t contain tobacco, they’re purported to be “less toxic” than traditional tobacco products, but the lack of long-term research and the variability among available products makes this claim unsubstantiated to date.”

This is complete nonsense. There is abundant evidence that vaping is much safer than smoking. Even the most ardent opponents of vaping agree that although not absolutely safe, vaping is much safer than smoking. There is abundant research which demonstrates this. But it is also common sense, as electronic cigarettes contain no tobacco and do not involve combustion. How could they be as dangerous as tobacco cigarettes, which we know kill more than 400,000 Americans each year? There is no legitimate scientific dispute over the fact that vaping is much safer than smoking.

Spreading this kind of misinformation demonstrates both incompetency and a lack of responsibility. Medical practitioners should not be disseminating false health information, especially about something so important as the severe hazards of smoking. To undermine the public’s appreciation of the severity of smoking’s hazards by comparing real cigarettes to fake ones is doing a huge disservice to the public and to smokers in particular. 
 
2. Smokers Who Quit Using E-Cigarettes Should Not be Commended

According to an article in the Journal of the American Association of Nurse Practitioners, nurses discourage patients who smoke from trying to quit using e-cigarettes and furthermore, they should not commend patients who have already quit smoking using e-cigarettes!

According to the article: “Currently,itisneitheradvisableforpractitionerstorecommende-cigarettesforsmokingcessation,nor isitrecommendedtocommendpatientsformakingthe switchtoe-cigaretteuseovertraditionalcigarettesmoking.”

It is certainly inappropriate medical advice to discourage smokers from using e-cigarettes in a quit attempt, especially if they are highly motivated about the idea of e-cigarettes and have not had success with traditional approaches. But it is insane to recommend that nurses not commend patients who have successfully quit smoking just because they happened to achieve success using e-cigarettes.

Have we completely lost our mind? 

I just cannot understand how a nurse could possibly be advised not to commend a patient who successfully quit smoking. It is an amazing accomplishment and the patient deserves the highest commendation for such an achievement. To withhold such a commendation simply because you don’t happen to like the methods the patient used is, frankly, sick. It suggests that the health of the patient doesn’t matter. What matters is that the patient quits the way this particular nurse thinks is best.

It would be one thing to suggest that nurses caution smokers that e-cigarettes are not effective for everyone. But if a smoker has tried e-cigarettes and succeeded in quitting smoking, then what is there not to like? What is the problem with that? I’d call that a public health miracle. 

It is like a spit in the face to the estimated two million Americans who have successfully quit smoking using electronic cigarettes.

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National Park Service Withdraws E-Cigarette Rule

The National Park Service (NPS) has withdrawn its proposed rule that would add vapor products to the existing regulation that allows superintendents to prohibit smoking in locations and areas at their discretion.  Although this may be regarded as a positive move by the NPS, the agency states that “[t]he withdrawal is based upon a need to engage in additional interagency coordination and review of the proposal.” There will likely be opportunities to comment on proposed rules regarding the use of vapor products in the future from the NPS and other agencies within the Department of the Interior.

 

  • You can read the withdrawal announcement here.
  • The proposed regulation that is being withdrawn is available here.

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Episode 35: Music CastHey Listeners!Welcome to the Culture of…

Episode 35: Music Cast

Hey Listeners!

Welcome to the Culture of Clouds Podcast, Episode 35! In this week’s show, Ruby admits to liking Sarah McLughlan, and Nick reminds us that he was once in a little band we like to call CREED!!!

Our main topic this week is all about MUSIC!!! We go over everything from our days as young high school band kids, to Nick’s adventures in adolescence, to Ruby’s robotic climb into becoming a professional, classically trained flutist. We also gush over our favorite bands, albums, and songs of all time. ENJOY!

Thanks for listening everyone!

Ruby & Grimm

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E-Cigarettes May Cause Kids to Break into Homes and Turn to a Life of Street Crime, Physician Warns

An emergency medicine physician has warned that e-cigarettes may lead to kids breaking into homes and turning to a life of street crime in order to feed their addictions to serious drugs.

In a Huffington Post column, he claims that due to e-cigarette experimentation: “teenagers — and even younger children — are getting addicted early, which could lead to smoking, and e-cigs can easily become a gateway to trying and developing an addiction to more serious drugs. Addiction correlates to crime. People need to feed their habit, they break into homes to steal things to resell, they commit robberies on the streets, all to get money to feed their addiction.”

In the column, the physician also claims that vaping causes popcorn lung: “We know that when inhaled, diacetyl causes a type of bronchitis known as “popcorn lung” — a scarring of the tiny air sacs in the lungs resulting in the thickening and narrowing of the airways.”

To put the icing on the cake, he claims that smoking may not be any more hazardous than vaping: “The act of “vaping” is often thought of as a safer alternative to smoking, but that’s not necessarily the case.”

The Rest of the Story

Not a day has passed in 2017 that an anti-tobacco group or health professional hasn’t lied to the public about the health risks of e-cigarettes. The contestants for the 2017 Lie of the Year Award are already lining up in huge numbers, and it’s only early January.

Just to set the records straight, there is no current evidence that e-cigarette experimentation leads to an addiction to smoking or any other drugs. There isn’t even evidence that e-cigarette use causes nonsmoking youth to become addicted to vaping itself. The overwhelming majority of nonsmoking youth who have experimented with e-cigarettes have not become regular vapers. The proportion of nonsmoking youth who report having vaped in the past 30 days is substantial, but the percentage of those who vape daily – a pattern suggesting addiction – is very small. So it’s a bit of a stretch perhaps to argue that a kid who tries an e-cigarette today will tomorrow be breaking into homes to feed a serious drug addiction.

There is also no evidence that vaping causes popcorn lung. Despite of the fact that there are millions of vapers in the U.S., there has not been a single reported case of popcorn lung among this population. Moreover, smoking itself has not been associated with popcorn lung, and cigarette smoking exposes users to levels of diacetyl that are hundreds of times higher than with vaping.

Finally, there is abundant evidence that smoking is far more hazardous than vaping. This is hardly surprising, since e-cigarettes do not contain tobacco and there is no combustion or smoke.

I’m sure this physician is well-intended and is just trying to protect kids from potential risks; however, I don’t think we need to lie to kids or greatly exaggerate the risks. Not only is it inappropriate to lie to and mislead youth, but this strategy has been shown many times over not to work.

The rest of the story: Just remember, the kid you see blowing vape rings today in the school courtyard at recess will soon be a street criminal who is breaking into homes to feed an insatiable addiction to heroin. It’s bubble gum and cotton candy vapes today, but it’s smack tomorrow.

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Tennessee Department of Health: E-Cigarettes Create the Threat of Date Rape, Cause Popcorn Lung, and are as Addictive as Heroin

According to a new warningissued by the Tennessee Department of Health (TDOH), use of electronic cigarettes puts youth at risk of date rape. Date rape is just one of numerous devastating consequences that the Tennessee Department of Health is linking to electronic cigarette use, including “popcorn lung” (i.e., bronchiolitis obliterans) and addiction to nicotine that is just as strong as heroin addiction.

According to a “Public Health Advisory” issued by the TDOH:
“ENDS can be delivery systems for incapacitating agents such as gamma butyrolactone, GBL, more commonly known as the date rape drug. According to the U.S. Drug Enforcement Association, victims of date rape drugs are frequently not aware of ingesting the drug, which is a central nervous system depressant and may cause drowsiness, dizziness, nausea, loss of inhibition, memory loss and visual disturbance. High doses will cause unconsciousness, seizures, severe respiratory distress, coma and death. Due to induced memory loss, a victim may not be aware of an attack until many hours after it occurred.”
The Tennessee Department of Health also warns that e-cigarette use may cause “popcorn lung,” stating: “The Occupational Safety and Health Administration has warned about the association of inhaling diacetyl with a debilitating condition known as bronchiolitis obliterans (also known as popcorn lung).”
The Department also warns that e-cigarette use is as addictive as heroin: “People should remember that the primary ingredient of ENDS devices is nicotine, an addictive drug that … is the most common form of chemical dependence in the United States; research suggests it is as addictive as heroin, cocaine or alcohol.”
The Rest of the Story
The Tennessee Department of Health would have us believe that experimentation with electronic cigarettes is turning our kids into a generation of nicotine-addicted junkie rapists whose lungs are rapidly obliterating and who are facing imminent death.
Of course, the TDOH is telling a tall tale. The truth – and the rest of the story – is that there is no evidence that e-cigarettes are associated with any of these outcomes.

Date rape

Despite the use of e-cigarettes by millions of youth, there are no confirmed reports of youths sneaking gamma butyrolactone into e-liquids and then using e-cigarettes to drug peers in order to rape them. There is merely one unconfirmed report that this may have occurred once. If the Tennessee Department of Health were truly interested in preventing date rape, why is it not warning that there have been many more confirmed reports of real cigarettes being used to perpetrate date rape (although even that is not a recognized public health problem)? Is the TDOH actually trying to prevent date rape, or is it merely trying to demonize electronic cigarettes? I think the answer is quite obvious.

Popcorn lung

There is no evidence that e-cigarettes cause popcorn lung. Despite millions of e-cigarette users, there has not been a single confirmed case of popcorn lung caused by e-cigarettes. Moreover, since the level of diacetyl in cigarettes is 750 times higher, on average, than in e-liquids, why isn’t the Tennessee Department of Health warning kids that smoking can cause popcorn lung? The rest of the story is that popcorn lung has not even been associated with smoking. There is absolutely no evidence that vaping causes popcorn lung. 

Nicotine addiction

There is actually no evidence at the current time that experimentation with e-cigarettes causes nicotine addiction among youth who are not already tobacco users. We do know that despite the high percentage of youth who are trying e-cigarettes, very few are progressing to regular use and most of those who do are kids who were already smoking or using other tobacco products. The jury is still out, but there is not evidence at this time to support the contention that e-cigarettes are causing nonsmoking youth to become addicted to nicotine.

In my opinion, there is no need for the Tennessee Department of Health to lie to the public. The truth should be enough. The end result of the Department’s actions are to trivialize serious problems, including date rape, actual lung disease, and smoking of real cigarettes. The Department also undermines its own credibility, risking the loss of the public’s trust. Finally, even if e-cigarettes were a serious public health threat, these hysterical scare tactics have been shown not to work. 

If anything, the Tennessee Department of Health is incredibly irresponsible because publicizing that e-cigarettes can be used to perpetrate date rape will probably lead some youth to actually try it. And that will result in more cases of e-cigarette use for date rape than have actually occurred.

For this reason, I am today demanding that the Tennessee Department of Health immediately retract these claims.

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