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Comment by maehwasu | Hacker News Reader

"Smoked a cigarette in the last 12 months" is an incredibly low bar, to the point where I'd guess the study had a desired outcome.

The important question isn't "were vapers more likely to smoke 1+ times"--it's "how many cigarettes (from 0 to n) would the average vaper have smoked in the absence of vape options?"

The latter is a counterfactual, and thus much harder to study. It's almost as if valuable research is hard, and you can't just slap together a few variables and toss the "Science!" label on it.

Edit for context: I'm an ex 1-2 packs-a-day smoker, and vaping definitely helped me substitute a less harmful behavior. I smoke 5-30 cigarettes per year still, and vape about the same number of times per year. Having substitute options definitely helps avoid slipping back into cycles of addiction, to the point where I don't worry about that at all now.

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The question wasnt even about "vapers". The qurstion was about underage vapers.

I've known vapers that would pick up a pack for the blizzard when they expect to get snowed in for days on end. Some of them quit vaping (and smoking) by the end of digging themselves out.

Ive known vape shop owners who were regular daily cigarette smokers in between vaping 0 nic. That's the most damaging thing possible - give that sticky tar glycerin to attach to in new ways. Give that glycerin new ways to get stuck in tar. And layer it up!

I may not like it, but I respect Britain's cutoff for tobacco leaf products. If you were born 2000 or later, you will only ever get to buy vapes. Not cigars, not cigarettes, not hookah nor dojah. They're banned from you.

Where the US is close to banning the cleaner nicotine option (salt nic vapes aside), Britain chose to ban the stuff that seriously clogs lungs.

> I may not like it, but I respect Britain's cutoff for tobacco leaf products. If you were born 2000 or later, you will only ever get to buy vapes. Not cigars, not cigarettes, not hookah nor dojah. They're banned from you.

Wait, what? I Googled pretty extensively and it appears that was just a vote between doctors with no legal binding. Did it actually become law?

No, this is absolutely not the case in the UK.

I submitted this partly to see how people would explain away the result.

4.78 RR for smoking one year after vaping for non-smokers is pretty huge. That’s definitely a clinically significant result. Smoking itself is the highest OR for lung cancer and therefore mortality of any behavior (in the 60s for Americans), and using cigarettes really dooms you to that outcome.

Nicotine patches, as transdermal delivery, don’t get people as high as Juul does, and that’s the likely reason you don’t observe either recreational use of them nor people becoming smokers from using them.

You've used some jargon here that I don't understand, so I'm probably just missing it, but I don't see where any of this addresses the claim that, "Smoked a cigarette in the last 12 months" is a strikingly low bar.

On the one hand, I don't want to condescend. Relative risk and odds ratio are best explained on Wikipedia.

If you want to get advice on smoking cessation, ask a doctor. There have been no clinical trials for Juul or any e-cigarette product. No doctor following the letter of what they're supposed to be doing is going to recommend an e-cigarette product to a person seeking smoking cessation.

The strikingly low bar thing... People here defend Juul like people defended Theranos. Nobody wants to accept that the Juul guys are liars. Not yet anyway.

If e-cigarette companies had a study, much like Theranos, they'd publish it. They'd compare it to nicotine patches. They just don't. There's no secret, it's really just an agglomeration of personal experiences and unfortunate but real stories quitting addiction masquerading as a positive public health development.

This study shows pretty unequivocally that vaping can't possibly just substitute for cigarette smoking. If it did, we'd observe zero cigarette smokers in the vaping-only population. Correlation versus causation, whatever logic puzzles commenters invoke, it just distracts from both the evidence presented here and the total lack of a rigorous trial from e-cigarette sellers.

> This study shows pretty unequivocally that vaping can't possibly just substitute for cigarette smoking. If it did, we'd observe zero cigarette smokers in the vaping-only population.

What an absolutely insane claim.

> There have been no clinical trials for Juul or any e-cigarette product.

Rubbish. Just 10 seconds on PubMed found me this:

Rahman et al. E-cigarettes and smoking cessation: evidence from a systematic review and meta-analysis. PLoS One. 2015. https://www.ncbi.nlm.nih.gov/pubmed/25822251

"Six studies were included involving 7,551 participants. … Use of e-cigarettes is associated with smoking cessation and reduction."

> No doctor following the letter of what they're supposed to be doing is going to recommend an e-cigarette product to a person seeking smoking cessation.

Also rubbish. Even if there were no studies, absence of data of effect is different from data of absence of effect. There are good reasons to believe (even pre-hoc) that vaping is safer than cigarettes.

As a student doctor and I would happily council a patient to consider vaping instead of smoking as a harm minimisation intervention.

> If e-cigarette companies had a study, much like Theranos, they'd publish it

Will this do? "In a nutshell, best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes, and when supported by a smoking cessation service, help most smokers to quit tobacco altogether."

From the extensive Public Health England study: https://www.gov.uk/government/news/e-cigarettes-around-95-le...

E-cigarettes are now available on prescription in the UK as one of the smoking cessation aids available to doctors.

No idea about Juul, they're not in the UK yet.

E-cigarettes companies are in business of selling product, not doing research for once. Another thing you might be missing is that the only reason you can buy vape products with pocket change unlike the "researched" things like patches, gum etc. is that they do not sell them as any kind of medical treatment. If they tried to claim anything to that effect they would have been dealing with FDA and doing whatever expensive procedures FDA demands and their product would be as expensive as patches etc and they would have been out of business since their $100 per 10 ml "researched" juice would not stand a chance against the same compound but not researched and sold at $20/100ml. So, even if they had a study they would not publish it if they had any sense.

As for people you suspect being uninformed and defending a fraudulent business, all I can see people who actually quit smoking saying they did it through vaping. We don't know if they are just unique rare cases but, on the other hand, you rarely see people claiming this with patches and gum. Most mentions of these in relation to quitting smoking I've seen were "I tried patches/gum, they did not work". I am lazy to look up research but from what I remember, patches and gum are amazingly inefficient in any prolonged smoking cessation. So pushing patches might appear more similar to shilling for Theranos than you might have suspected.

You do know that both nicotine replacement users and people prescribed Champix, both well studied and proven to work sometimes smoke? Your bar means literally any and all things other than pure abstinence will fail. That’s ridiculous.

The other side of the abstinence issue is that it's difficult to find good information about the relative risks of different smoking behavior. Nearly all smoking advice and all smoking regulations are based on the notion that literally no amount of exposure is acceptable -- full stop, end of story, do not inquire further.

Even the CDC uses that kind of hysterical, unscientific language to describe the risks of secondhand smoke: "There is no risk-free level of secondhand smoke exposure." [0] That's a religious claim, not a scientific one.

[0] https://www.cdc.gov/tobacco/data_statistics/fact_sheets/seco...

What these studies show is that kids who are likely to try smoking are also more likely to try vaping. That's it. That's the whole thing. It's correlation, and doesn't speak in any way to anything like a "gateway drug" phenomenon - and that has also been recognised in studies that bother to consider the possibility.

Oh, right, yeah. Because this line totally isn't directly from the paper's conclusion:

> These results contribute to the growing body of evidence supporting vaping as a one-way bridge to cigarette smoking among youth.

I'll see that study and raise you the UVic cohort study that found the opposite[0], among others if you're willing to look. The "growing body of evidence" is all about correlations in interview studies.

[0]http://www.uvic.ca/research/centres/carbc/assets/docs/report...

That link just goes to their homepage.

That line honestly just makes it sound like they already knew what their opinion was before doing the study

The easy social explanation for this is that people who vape are more likely to be around smoking anyways, and thus are far more likely to bum a cig off someone in a party than your average 19 year old. The only clinical result you can pull from this is 'people who vape are more likely to smoke >1 cigarette a year', and the fact that they couldn't produce a more significant result with any sort of correlation tells you the paucity of the data.

From personal experience, the gum and the sprays definitely do get you a “buzz”.

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