FDA Why Isn't Vaping the FDA Center for Tobacco Product's Biggest Ally?

[Jman8]

Okay imagine the world before vaping. Look at the quitting rates before vaping. Roughly 5% of smokers have quit annually, via counselling, cold turkey, NRT etc.

Now look at the quitting rates among vapers. If it turns out that those quit rates aren't lower, then you have at least the same if not a higher percentage of vapers who are still smoking. That's correlation. Now the public health people will identify various kinds of causal links by surveys. For example, the perception of reduced risk among dual users. (Which, if we believe Siegel, is false insofar as mortality goes.)

You have the Dr. S. belief incorrect, and this is the third or forth time I've seen you allude to it. From my reading, you have it precisely backwards.

If this bogus claim can be established - namely that vaping supposedly causes less quitting, then the public health people can argue that vaping is the indirect cause of more deaths.

The public health people (who lean in the ANTZ direction) will be arguing that vaping is the cause of more deaths. They'll try to argue that vaping causes less quitting. They are trying that now. They look very foolish each time they float that claim out there. Cessation is clearly occurring, surveys are backing this up, and they look foolish each time they try and downplay this.

It seems like you are trying to help them out of the hole they dug, but it appears to this pro-vaper, like you just jumped right there in the hole with them.

Now fast-forward to a time when the FDA might be able to reject an application and pull a product off the market (after the window closes). If they were to pull all the vaping products, the ANTZ would say "Hey, we're saving lives, because we're taking away these products that reduce quit rates. Because more quitting means fewer smoking-related premature deaths."

These products are not going away, and there will always be a market for them. ANTZ has a moral choice of determining whether this product ought to be legal and as safe as possible (within reason), or allow another market to control distribution whereby safety is not foremost among buyers and sellers.

Now if we could beat the argument that someone who smokes one cigaratte a week has the same mortality as someone who smokes 5 PAD, it would be a different situation.

You mean like the way Dr. S. beat that argument?

But as long as reduced smoking is no better than continued unabated smoking in terms of morbidity (premature death rates), then then the only thing that matters is cessation, right?

I dunno, let's see what Dr. S. has to say:

The major problem with Dr. Glantz's argument is that he is considering only smoking-related mortality. The literature he cites deals with mortality only. However, there is more to life than simply its length. The quality of life is also important (although apparently not for smokers, according to Glantz). And cutting down the amount you smoke substantially improves the quality of life by reducing respiratory morbidity.

*Bold emphasis mine

 

[Kent C]

From Siegel's blog:



Siegel goes on to argue that respiratory morbidity may be improved, but doesn't cite anything. The key issue here is that he is basically conceding the overall morbidity arguemnt to Glantz (because respiratory issues are only one of many "smoking related illnesses").

If vapers have a lower quit rate than the general population of smokers (as Glantz falsely claims) then vapers may die more often from smoking-related illnesses than smokers who do not vape - despite having a higher quality of life than smokers who do not vape.

I.e. vaping leads to more smoking-related deaths, because dual users are less likely to quit than smokers who do not vape. (But of course this is false, which is my point. Vaping leads to cessation.)

What part of that do you dispute?

Roger:"the key issue here is that he(Siegel) is basically conceding the overall morbidity arguemnt to Glantz "

Siegal:"The study that Glantz cites as showing no health benefits of smoking reduction actually found a 34% decline in lung cancer risk associated with smoking reduction."

I was similarly stunned with your original remark.

 

[Jman8]

From Siegel's blog:

Siegel goes on to argue that respiratory morbidity may be improved, but doesn't cite anything. The key issue here is that he is basically conceding the overall morbidity arguemnt to Glantz (because respiratory issues are only one of many "smoking related illnesses").

Siegel cites his experience as a doctor and downplays Glantz's propaganda by citing that Glantz is not a medical doctor. Everything about this linked piece is explaining how wrong Glantz is to be making this claim.

What part of that do you dispute?

All the parts where you are spinning it incorrectly, or pretty much your entire basis for introducing this into the discussion.

Just little things like that.

 

[Roger_Lafayette]

Roger:"the key issue here is that he(Siegel) is basically conceding the overall morbidity arguemnt to Glantz "

Siegal:"The study that Glantz cites as showing no health benefits of smoking reduction actually found a 34% decline in lung cancer risk associated with smoking reduction."

I was similarly stunned with your original remark.

Okay point taken. But if that's all we're doing, then we still have a tradeoff. Reduced lung cancer morbidity versus reduced quitting overall. The only way to win that one is to say that vaping leads to more cessation - otherwise we're trying to balance one type of reduced morbidity (lung cancer) and quailty of life versus many other kinds of moribidity such as heart disease, diabetes, etc.

That's messy and complicated at best. (And probably ineffective.)

This is why even Siegel wants to argue for cessation as well:

A final, important benefit of smoking reduction is that it helps facilitate the possibility that a smoker will subsequently be able to quit. It reduces the level of smoking addiction. It is easier to quit from a level of 5 cigarettes per day than it is to quit from a level of 30 cigarettes per day.

We can win this argument. We can show that vaping leads to more cessation. Why wouldn't we want to do that?

Why ignore our most powerful argument? It's really simple. Nonsmokers/nonvapers think people should quit smoking - doesn't matter whether they're in public health or they are policy makers, or anyone else.

So-o, now we can show that vaping helps smokers quit. Simple, easy, effective.

 

[aikanae1]

I think one of the first questions is how are they used? I see that as a problem since many of the convienence store kits are used as complimentry to smoking, dual use. Whereas the more advanced devices are used to replace smoking. Pretty much any data set is going to be weakened if those two are not seperated out. I know that's not "popular" and that's not why it's mentioned. It's going to confused study results. The only way that can change is if the FDA can find a way to include the results of both in a single category and so far they are expecting one or the other - seperating them into two categories is a way to get both useages recognized.

I quickly looked at the legal brief linked to earlier and noted the judge commenting on Congress' intent. I wonder if Congress really intended to make Modified Risk Products nearly impossible to satisfy. If vaping devices say they lead to cessation, that makes them a drug. And if they reduce combustional smoking without leading to cessation then they aren't considered safer. It doesn't seem like there's anywhere that the FDA can accept reduced harm from using non-combustional products and that's where vaping exists.

I think we need to stick to harm reduction which doesn't always include cessation from nicotine.

Practical reality is to pick the path of least resistance and contort vaping into that. The fewest boxes we have to check, the easier we fit into narrow categories as they define them and the less thinking they will have to do for approval. They get to go home by 5pm. That's what is liked.

 

[Kent C]

Okay point taken. But if that's all we're doing, then we still have a tradeoff. Reduced lung cancer morbidity versus reduced quitting overall. The only way to win that one is to say that vaping leads to more cessation - otherwise we're trying to balance one type of reduced morbidity (lung cancer) and quailty of life versus many other kinds of moribidity such as heart disease, diabetes, etc.

That's messy and complicated at best.

This is why even Siegel wants to argue for cessation as well:



We can win this argument. We can show that vaping leads to more cessation. Why wouldn't we want to do that?

Why ignore our most powerful argument? It's really simple. Nonsmokers/nonvapers think people should quit smoking - doesn't matter whether they're in public health or they are policy makers, or anyone else.

So-o, now we can show that vaping helps smokers quit. Simple, easy, effective.

And dual use does not kill. As a smoker advocate, as much as I applaud those who took the 'harm reduction' path, some were instrumental in tightening the screws - the 'no smoking path' - as you delineate in one of your posts above. Many forwarded the false notions of second hand smoke.

 

[Roger_Lafayette]

I think one of the first questions is how are they used? I see that as a problem since many of the convienence store kits are used as complimentry to smoking, dual use. Whereas the more advanced devices are used to replace smoking. Pretty much any data set is going to be weakened if those two are not seperated out. I know that's not "popular" and that's not why it's mentioned. It's going to confused study results. The only way that can change is if the FDA can find a way to include the results of both in a single category and so far they are expecting one or the other - seperating them into two categories is a way to get both useages recognized.

I quickly looked at the legal brief linked to earlier and noted the judge commenting on Congress' intent. I wonder if Congress really intended to make Modified Risk Products nearly impossible to satisfy. If vaping devices say they lead to cessation, that makes them a drug. And if they reduce combustional smoking without leading to cessation then they aren't considered safer. It doesn't seem like there's anywhere that the FDA can accept reduced harm from using non-combustional products and that's where vaping exists.

http://www.fda.gov/downloads/Tobacco.../UCM297751.pdf is what the FDA says about a modified risk product. But remember it still has to be approved by one of the other pathways first, so MRTP is something that happens afterwards.

And the manufacturer is not arguing anything to the public - it's an argument to the FDA. Cessation potential need not be cited as part of this appication.

 

[toddkuen]

Okay imagine the world before vaping. Look at the quitting rates before vaping. Roughly 5% of smokers have quit annually, via counselling, cold turkey, NRT etc.

....

All the rest of this goes on to convince people vaping is equivalent on many planes to smoking.

Yet NRT (patches, gum) is out in the market for three decades with FDA regulation and big pharma support.

Vaping at best from the regulatory perspective IS NRT even if it looks like smoking.

That's what its equivalent too, not smoking, yet on and on goes the same argument all designed to reenforce doom and failure.

We've lost all the vaping arguments because there is no public face to vaping for exactly the reasons Rodger uses.

Call it "smoking" (as he implicitly does in his post) even if it isn't and people will hate it.

Now let's look at what might happen if you were to call "vaping" something else.

Proponents of gay marriage have done exactly this.

In PA, a state with a DOMA law on the books, proponents got the law chucked out wholesale with this comment from the Judge: “We are a better people than what these laws represent. It is time to discard them into the ash heap of history.”

How was this accomplished?

But putting a human and discriminatory face on something that was unpopular and previously illegal.

Poof - law chucked out. Just like that.

But no one I can see, not CASAA, not Rodger, not anyone else attempts to put a different face on vaping.

At worst (or best) its NRT, not smoking.

But, as with the example above, bigotry against vapers is okay because they happen to "look" like they are smoking.

Another reason? Smokers are "addicts" - a CODE WORD for something bad.

I, a non-smoker have vaped (gasp) nicotine for 6 months, and I don't like it and I simply stopped without any withdrawal or side effects - none.

Try that with drugs derived from certain flowers grown in Afganistan.

Two different types of addiction, apparently.

But if we call it "addiction" it becomes addiction whether it is or is not.

And of course its the addicts fault.

How about calling anti-smoking bigots what they really are, bigots, instead of just being nice.

 

[Roger_Lafayette]

And dual use does not kill. As a smoker advocate, as much as I applaud those who took the 'harm reduction' path, some were instrumental in tightening the screws - the 'no smoking path' - as you delineate in one of your posts above. Many forwarded the false notions of second hand smoke.

Yes, the second-hand smoke thing was largerly garbage. But if you believe Siegel, reduced smoking has all the risks of smoking other than a 1/3 reduction in lung cancer risk (and maybe some other other respiratory benefits).

Dual use doesn't kill if it leads to cessation. But permanent dual use is basically just reduced smoking, right? (Reduced smoking plus one other activity, namely vaping - which itself is not 100% "safe.")

So if we support vaping because it promotes reduced smoking whilie conceding the false argument that vaping decreases cessation, then we are basically saying that reduced smoking among a lot of smokers is better than cessation among a few extra smokers (i.e.the extra smokers who would supposedly quit if they weren't vaping, according to the false claims made by Glantz and his ilk).

We can't concede that ground - we have to show that vapers quit at least as much if not more than smokers who do not vape. (And preferably more.)

The West toolkit shows that we can prove this. And we're probably going to have to, if we want to stop the FDA proposed rule from either becoming final, or from being devasting in its impact if it does become final - via advoacy in the public policy arena.

We won't be able to make that case, if all we're saying is that vaping lets smokers cut down, while either unwisely conceding the false claim that vapers quit less, or simply ignoring this bogus argument.

 

[aikanae1]

http://www.fda.gov/downloads/Tobacco.../UCM297751.pdf is what the FDA says about a modified risk product. But remember it still has to be approved by one of the other pathways first, so MRTP is something that happens afterwards.

And the manufacturer is not arguing anything to the public - it's an argument to the FDA. Cessation potential need not be cited as part of this appication.

Thx.

No matter how this is looked at, it's still coming to the same conclusion; vaping is banned and smoking is frozen at 2007.

 

[toddkuen]

In case the above isn't clear (Wikipedia definitions):

"Bigotry is the state of mind of a bigot: someone who, as a result of their prejudices, treats or views other people with fear, distrust or hatred on the basis of a person's ethnicity, evaluative orientation, race, religion, national origin, gender, gender identity, sexual orientation, disability, socioeconomic status, or other characteristics..." (like nicotine usage?)

Bullying is the use of force, threat, or coercion to abuse, intimidate, or aggressively impose domination over others. The behavior is often repeated and habitual. One essential prerequisite is the perception, by the bully or by others, of an imbalance of social or physical power.

 

[aikanae1]

Yes, the second-hand smoke thing was largerly garbage. But if you believe Siegel, reduced smoking has all the risks of smoking other than a 1/3 reduction in lung cancer risk (and maybe some other other respiratory benefits).

Dual use doesn't kill if it leads to cessation. But permanent dual use is basically just reduced smoking, right? (Reduced smoking plus one other activity, namely vaping - which itself is not 100% "safe.")

So if we support vaping because it promotes reduced smoking whilie conceding the false argument that vaping decreases cessation, then we are basically saying that reduced smoking among a lot of smokers is better than cessation among a few extra smokers (i.e.the extra smokers who would supposedly quit if they weren't vaping, according to the false claims made by Glantz and his ilk).

We can't concede that ground - we have to show that vapers quit at least as much if not more than smokers who do not vape. (And preferably more.)

The West toolkit shows that we can prove this. And we're probably going to have to, if we want to stop the FDA proposed rule by advoacy in the public policy arena.

How can they prove dual use deters cessation efforts? I think that's a very weak concept. If anything those are the user least likely to obtain abstinence (which from what you've stated is the FDA's definition of cessation).

Maybe one of our objectives should be getting the FDA to look at a wide range of peer reviewed published studies rather than just the ones they invent.

 

[Roger_Lafayette]

How can they prove dual use deters cessation efforts? I think that's a very weak concept. If anything those are the user least likely to obtain abstinence (which from what you've stated is the FDA's definition of cessation).

Maybe one of our objectives should be getting the FDA to look at a wide range of peer reviewed published studies rather than just the ones they invent.

FYI - when I say cessation I mean (combustible tobacco cigarette) cessation, not nicotine cessation. There isn't any claim yet that vaping by itself has mortality for a specific user who just vapes and never does anything else.

But Glantz and his pals have churned out a number of junk studies which make this very argument - vapers are less likely (than smokers who don't vape) to quit smoking (combustible tobacco cigarettes). They do it via surveys.

Their latest 'review' crunches five different other junk studies, to get more "garbage" out of the "garbage" that they put in there in the first place

This is why the West Toolkit is such a game-changer - it show that in the UK, vaping helps smokers quit, and more effectively than the alternatives.

Therefore vaping doesn't just improve the quality of life, or reduce the mortality due to lung cancer by 1/3, in fact it saves lives because it helps smokers quit more effectively than NRT and so forth. Take vaping out of the equation, and more people would still be smoking. That's the most powerful argument that we have.

 

[Kent C]

Roger_Lafayette:Yes, the second-hand smoke thing was largerly garbage. But if you believe Siegel, reduced smoking has all the risks of smoking other than a 1/3 reduction in lung cancer risk (and maybe some other other respiratory benefits).

Yeah, I don't believe Siegel on that point. Correlation isn't causation. If it were, then more people would be dying.

Dual use doesn't kill if it leads to cessation. But permanent dual use is basically just reduced smoking, right? (Reduced smoking plus one other activity, namely vaping - which itself is not 100% "safe.")

You're really starting to sound like 'them'.

So if we support vaping because it promotes reduced smoking whilie conceding the false argument that vaping decreases cessation, then we are basically saying that reduced smoking among a lot of smokers is better than cessation among a few extra smokers (i.e.the extra smokers who would supposedly quit if they weren't vaping, according to the false claims made by Glantz and his ilk).

That is so convoluted I don't even want to address it. I understand it, it's just not worth addressing. I have to say, many here seem to enjoy your rantings, I'm not one of those, but good for you. The problem is, you argue along the same lines they do - pragmatic - and you can never win that argument no matter how many studies you have, because they will have just as many showing the opposite. Your only hope is that yours is more convincing and........................(not worth continuing).

The reason I am a smoker and vaper advocate is that it is a person's prerogative to do actions that harm no one. Hence my aversion to the second hand smoke fallacies. Not saying it doesn't smell bad or could cause redeye or that it causes people to fake cough, just that it doesn't harm anyone in places I would smoke, and places that people who don't like it, shouldn't patronize.

 

[sonicdsl]

Keep in mind when glANTZ & the other ANTZ say "quit smoking" they are really saying "quit tobacco nicotine".



Also, my eyes hurt. oO

 

[tombaker]

What part of "it has already been done to no effect" do you not understand?

I do not understand why one would give up. Especially under the new environment that the Deeming proposal is out and the FDA is asking for comments. Asking. It would seem that you are suggesting, tried and failed, never try again. Is a paradigm of success.

Its not. Consult Winston Churchill's graduation speech. Its rather famous.

 

[tombaker]

So if we support vaping because it promotes reduced smoking whilie conceding the false argument that vaping decreases cessation, then we are basically saying that reduced smoking among a lot of smokers is better than cessation among a few extra smokers (i.e.the extra smokers who would supposedly quit if they weren't vaping, according to the false claims made by Glantz and his ilk).

That is so convoluted I don't even want to address it. I understand it, it's just not worth addressing.

Exactly correct. The only thing worth addressing is how easily the argument is defeated. Glantz's meta-study is taking people who are continuing THEIR OWN program of path of cessation, and potentially dual using at that point....and he puts those people into a bucket of Not Cessation. He then argues that Cessation is the only measure. And concedes that E-Cigs cause a significant reduction of Analog usage in the "dual use" mode.

Glantz even has a measure of "quit attempts" This is because there is a theory that X attempts will equal a full cessation. Again corollary without causation "science"

The simplest way of removing Glantz's false conclusions is to reflect that "Dual usage" is an ongoing Quit Attempt. Its not failed. Why can we show this? Because 80% of the people trying E-Cigs say they are doing it TO QUIT.

 

[Kent C]

Exactly correct. The only thing worth addressing is how easily the argument is defeated. Glantz's meta-study is taking people who are continuing THEIR OWN program of path of cessation, and potentially dual using at that point....and he puts those people into a bucket of Not Cessation. He then argues that Cessation is the only measure. And concedes that E-Cigs cause a significant reduction of Analog usage in the "dual use" mode.

Glantz even has a measure of "quit attempts" This is because there is a theory that X attempts will equal a full cessation. Again corollary without causation "science"

The simplest way of removing Glantz's false conclusions is to reflect that "Dual usage" is an ongoing Quit Attempt. Its not failed. Why can we show this? Because 80% of the people trying E-Cigs say they are doing it TO QUIT.

Quit attempts are meaningless.

Yoda:Try not. Do... or do not. There is no try.

 

[tombaker]

Quit attempts are meaningless.

Yoda:Try not. Do... or do not. There is no try.

Grasshopper inquires, Is there DOing?

 

[Jman8]

Yes, the second-hand smoke thing was largerly garbage. But if you believe Siegel, reduced smoking has all the risks of smoking other than a 1/3 reduction in lung cancer risk (and maybe some other other respiratory benefits).

Why do you keep saying this about Siegel without providing quotes to back up your assertions? I have 2 quotes on this thread that say exact opposite of what you are espousing. He does not say it has all the risks and has said it has significant health benefits, as already quoted on this thread, or as I'm quoting right now:

There is no question that the best advice to smokers is to quit completely. But for those who are unable to do so, the use of electronic cigarettes to try to quit is sound advice. Clearly, if they quit completely with electronic cigarettes, they have accomplished a huge task in terms of improving their health. But even if they are still dual using, they may have substantially improved their health. And, they may have made it easier to quit completely at a later time.

But the truth is much too inconvenient for zealots who have adopted an abstinence-only, quit-or-die mentality. The lives and health of smokers are expendable when compared to the principle that addiction is evil and smoking is immoral. So when the truth gets in the way, anti-smoking fanatics simply lie.

*Bold emphasis mine. (Third time on this thread I've posted a quote that essentially says this same thing.)

It seems to me that where he says "the truth is much too inconvenient for zealots who have adopted an abstinence only" mentality, he could be speaking directly to the path you are advocating that eCigs stay on. How bout we go ask Siegel if it is best for a person to completely quit eCigs or stay on them for life? As if that is an either-or decision and nothing in the middle will suffice? I'm guessing he'd go with 'quit eCigs completely' between those 2 choices. And even if he wouldn't, ANTZ surely would. Likely most non-vapers would. They'd be like, 'really cool that you stopped smoking, now when you going to stop vaping (nicotine)?' Thus, if we go in direction you are advocating, THAT absolutely has to be part of the overall message. It has to be 'completely ceased smoking and we have collective plan to get all vapers off of vaping, for purpose of public health.' Otherwise, we are literally digging our own hole, for no politically sane doctor is going to advocate for vaping forever, unless user is saying, "if I don't vape, I absolutely will smoke," which then becomes a psychiatric issue.

Dual use doesn't kill if it leads to cessation. But permanent dual use is basically just reduced smoking, right? (Reduced smoking plus one other activity, namely vaping - which itself is not 100% "safe.")

So if we support vaping because it promotes reduced smoking whilie conceding the false argument that vaping decreases cessation, then we are basically saying that reduced smoking among a lot of smokers is better than cessation among a few extra smokers (i.e.the extra smokers who would supposedly quit if they weren't vaping, according to the false claims made by Glantz and his ilk).

No, if we say that vaping promotes reduced smoking, it doesn't mean we concede on the cessation claim. Both are at work, and the cessation claim, when thought through, becomes a matter where cessation from vaping absolutely must occur, otherwise your logic is easy to see through as heavily biased towards perpetual use on something you acknowledge isn't 100% safe, nor does anyone claim it is. Cessation has to be something that an individual wants, and the more the merrier. But for people outside the individual to argue that this is the best/only path for public health, then it sets up a paradigm where all cessation must be sought (including vaping).

Thus, very good for individuals to let the world know, "I quit smoking with great assistance from vaping." Very good to participate in studies that track this, the longer term the study, the better. But when groups or industry is going for the cessation path as 'best for public policy' or 'for the children,' they are in politically dangerous territory. I would say that on the surface, their intention is noble, but the reality is, they will lie, to help that cause (easily demonstrated) and because of those lies, or because of the inherent claim that 'everyone ought to cease use' it will have the opposite effect. Think 'war on drugs' if you have trouble understanding how the heck the opposite effect could occur from the noble intention. It is because of the deception that is at work, and comes from the omission of telling the whole truth. User (who is new or minor) learns immediately about the deception and proceeds on path of occasional to regular use to discover just how much were they being deceived.

The West toolkit shows that we can prove this. And we're probably going to have to, if we want to stop the FDA proposed rule from either becoming final, or from being devasting in its impact if it does become final - via advoacy in the public policy arena.

We won't be able to make that case, if all we're saying is that vaping lets smokers cut down, while either unwisely conceding the false claim that vapers quit less, or simply ignoring this bogus argument.

Then, let's not 'only' say that vaping lets smokers cut down. This isn't either-or from the other side of the equation. I as a dual user am very happy that smokers who wanted to quit were able to cease their usage. I'm glad that story is being told in mass numbers. But less happy when righteous vaper like yourself becomes yet another ex-smoking anti-smoking zealot and says, 'now everyone must quit' or if they don't they aren't 'really one of us' and we should keep them out of the equation when it comes to public health advocacy. Especially now with FDA regulations looming.

We can say both messages. Siegel does this in the item you linked. Most politically aware vapers say this same message. Yet, you spin it as if one is 'good for the cause' and the other is ultimately harming us. Why? Because ANTZ can use it as a tool against us. But you seem to think ANTZ will stop there once we win on this point. Check that thought a few times before you truly go in that direction. Cause in a world where smoking no longer exists in anyone, but vaping nicotine does, then ANTZ will, without any doubt, advocate for complete cessation from vaping, otherwise it deserves to be treated on par with what smoking was, and harmful to public health, and to the children.

As long as vaping exists (hopefully forever), ANTZ will have a mission. Point, from politically aware vaper perspective, is to make them irrelevant, or just let them keep peddling false scientific data that allows them to show up irrelevant all on their own.