Cliff Douglas

Veteran investigative journalist @MarcGunther examines one of public health's most consequential controversies: why some leading tobacco control organizations continue to resist or fail to accurately communicate the evidence on tobacco harm reduction and the FDA's rigorous review of authorized smoke-free products. Having worked closely with @LungAssociation over many years, I contributed to his investigation not as an adversary, but as someone who deeply respects ALA's mission to prevent lung disease. That's why I'm genuinely puzzled and disappointed by its position. Millions of lives depend on public health policies and communications reflecting the best available science.

@Bludn_Gore Agreed. Combine that with clear, accurate, digestible information and guidance, and you have a formula for success.

A smoker who reduces their exposure to toxic smoke has not failed. They have begun. The measure of a compassionate society is not whether it demands perfection from people. It is whether it offers them a safer path when perfection feels impossible.

When I read this, it struck a chord, for reasons that many people here will understand: “Malynnda Stewart, PhD, BCPA recently wrote in Health Management on the techniques that doctors can use to help their patients change. They don’t just change because someone tells them to, she writes; in fact, that often has the opposite effect. What Stewart suggests instead is good advice not just for doctors, but for everyone. ‘Change rarely happens because we push harder. More often, it happens because we build a bridge strong enough for someone to cross, and then we get out of the way and let them walk.’” From: How to deal with the (inevitable) jerks in your life, medium.com/blog/how-to-de…

You're correct: Gross generalizations about targeting youth and the role of the so-called "tobacco industry" -- most of the vaping product market does not come from tobacco companies -- are unhelpful and promote rather than correct misunderstanding. This contributes to poor public health policy decisions, which in turn can result in greater, not less, harm.

How do we explain these two contradictory things? (1) the blanket assumption that "they target teens" (2) the MASSIVE 74% drop in teen nicotine vaping How can this contradiction be called out for what it is: a standard prohibitionist propaganda tactic. e.g., If it's red, it is "brighly colored to lure teens." If it's black, it is "designed for kids to keep it hidden."

Researchers at the Rutgers Center for Rapid Surveillance of Tobacco (@RutgersINTS) report their surveillance of marketing activities for Geek Bar, the highly popular #ecig that has not been authorized by @FDATobacco, “showed frequent product releases and marketing targeting young people." They also find that “About 25 % of 16–19 year olds who vaped in the past 30 days and reported having a usual brand, reported Geek Bar as their preferred brand, making it the number one brand reported.” #bb0150" target="_blank" rel="nofollow noopener">sciencedirect.com/science/articl… This highlights again the urgent need to legitimize and strengthen the market for reduced-risk nicotine alternatives for adults who need and wish to use them. Effective regulation is essential. This means FDA accelerating its evidence-based review and authorization of products that are “appropriate for the protection of the public health.” Cigarettes cannot continue to dominate the marketplace for nicotine delivery if we truly want to reduce preventable death and suffering.

@RepDebDingell Deepest condolences to your entire family. Wishing you peace in such difficult circumstamces.

Today I am returning home to be with my family during an incredibly painful and deeply personal time. Our family’s 12-day-old daughter, granddaughter, and great-granddaughter has returned home to God this afternoon. We have been in God’s hands throughout all of this.

Please, please, #FixIt, @elonmusk @x @Support. @Algore09algor has had his X account capriciously suspended for weeks. This denies this community the wisdom and heartfelt emotions of his writing. See attached for a moving paean to his wife, @Bludn_Gore. 🙏 1/2

Regarding modern (versus your parents’ or grandparents’) marijuana use, this cautionary discussion with the well-informed physician @DrLizaMD is worth a listen. And, of course, with any substance, it is better to use noncombustible forms if you have a choice.

@ChaunceyGardner I would add that, based on my query, this journal is often utilized by medical students, residents, and researchers looking for a legitimate, indexed platform for case reports and studies.

@ChaunceyGardner Likely, yes. On the other hand, one *could* take the time to consider the research based on its objective merits, as was presumably done in the independent peer review process.

Pleased to share some important findings from a new analysis on the benefits to cardiovascular health of switching from combustible tobacco use (smoking) to alternative forms of nicotine delivery. The authors conclude that:“Supporting the complete displacement of cigarettes with the use of NGPs (next‑generation tobacco and nicotine products) has the potential to reduce CVD (cardiovascular disease) risk and improve both individual and population health.” Specifically, they report: 1) In vivo and in vitro modeling studies demonstrate the potential for NGPs to reduce CVD risk compared with cigarette smoking. 2) Switching to the exclusive use of these products leads to reductions in biomarkers of exposure to cardiovascular toxicants and favorable changes in CVD risk-related biomarkers of potential harm. 3) Population‑level data show that switching to the exclusive use of both electronic vaping products and heated tobacco products is associated with reduced risk of CVD and related comorbidities compared with continued smoking. 4) Regulators are increasingly using science‑based evidence when approving marketing authorizations and the use of consumer‑facing reduced exposure claims. pubmed.ncbi.nlm.nih.gov/42389254/

This is a well thought out response to the question of what are the main factors driving the public's broadly irrational & intolerant perceptions of nicotine vaping and tobacco harm reduction in general. H/T @camjenglish

Cam, I think the double standard boils down to a few things: * The unscientific demonization of nicotine * Widespread misunderstanding of relative risk * The conspiratorial portrayal of tobacco harm reduction as an industry plot * The exaggerated prioritization of concerns about youth to the exclusion of all else * Extraordinary global funding in support of the perpetuation of the above by an extremely wealthy, aggressive, and ideologically driven media magnate

@cdoug @brentstafford @RegWatchCanada @DrLizaMD @By_CJewett @nyahphengsitthy @Clive_Bates @RushmoreExt23 @GrimmGreen Cliff, what do you think explains the double standard?

I’ve just enjoyed this popular mini-can of beer at a family restaurant by Lake Michigan. It naturally reminded me of the controversies related to the marketing of nicotine vaping products. The “Lil Buddy” can looks like it was decorated with crayons. But there is no controversy involved. None of this is to suggest that there is not a serious problem involving illicit vaping products, some of which have appeal to young people. Nonetheless, there seems to be a disconnect in how some folks have singled out vaping as a unique risk for our youth, even as youth vaping continues to plummet.

All of those examples can be seen as versions of harm reduction. None of them eliminates risk or illness. Each of them reduces risk and provides evidence-based protection for consumers. But acting with hubris and elitism —and without realistic regard for scientific and real-world evidence — too often results in increasing risk.

Simon Chapman’s latest polemic is not an essay it’s a sprawling ideological screed that conflates nearly every public safety regulation ever enacted with prohibition, in an attempt to defend Australia’s failed nicotine policies. 150 Regulations Are Not an Argument Against Prohibition Failure. His latest essay attempts to ridicule the phrase “prohibition doesn’t work” by presenting a list of 150 public health laws and regulations that have improved safety and quality of life in Australia. The problem is that most of his examples aren’t prohibitions at all. Seat belt laws are not prohibition. Swimming pool fences are not prohibition. Food safety standards are not prohibition. Building regulations are not prohibition. Professional licensing is not prohibition. These are examples of regulation, standards and risk management. Almost nobody disputes their value. Critics of Australia’s vaping and illicit tobacco policies are making a very different argument. They are pointing to situations where governments attempt to severely restrict or prohibit access to products that remain in demand, creating opportunities for black markets and organised crime. History shows this can happen. US alcohol prohibition generated illicit supply networks. The war on drugs has fuelled global criminal enterprises. Australia’s illicit tobacco market has generated billions of dollars for organised crime and has been linked to hundreds of firebombings. You can believe these policies had good intentions while still recognising that they produced unintended consequences. Chapman’s article avoids this distinction by creating a straw man. He implies that anyone questioning prohibition must also oppose seat belts, clean water, pool fencing and food standards. That simply isn’t the argument being made. There is also an irony here. Chapman himself now openly acknowledges that cheap illicit cigarettes threaten decades of tobacco control progress. In other words, he accepts that when a prohibited or highly restricted market emerges, people adapt their behaviour in ways policymakers didn’t anticipate. That is precisely the concern critics have been raising. The question isn’t whether all regulations work. Of course it does. The question is whether certain forms of prohibition, under certain conditions, can create harms that outweigh their intended benefits. On that question, Australia’s experience with illicit tobacco and vapes suggests the answer is at least sometimes yes. Public health should be willing to learn from unintended consequences, not dismiss them by equating pool fences with prohibition.

@JeromeAdamsMD Love this - and my shirt!

From our pastor today: There is no heaven just for Americans. We will all be immigrants in heaven… if we make it there. And we will be asked, did you welcome others to your home/ land when on earth… or did you turn them away…🤔

76% of the global vape market is now illicit, and the U.S. is the largest player. This is not a black-market problem. It's policy failure. @DrMtyndall explains. @cdoug @ChaunceyGardner @alli_vapes @VaporTechAssoc @INNCOorg @GFNicotine @GrimmGreen @LegionVaping x.com/RegWatchCanada…

From @MarcGunther's outstanding new Substack piece: open.substack.com/pub/marcgunthe… By email, @cdoug, a lawyer and lifelong anti-smoking activist who now favors tobacco harm reduction, described the misinformation from health authorities as “a problem of epidemic proportions.” He said: