[gringoDan]

I wonder how good it is for public health if Juul is able to grow this market. Do the health benefits from cigarette smokers switching to e-cigarettes offset the young people who never would have dreamt of smoking cigarettes heavily, but regularly use Juul?

I had no idea how pervasive Juul was for college students until my sister told me that multiple people were "Juul-ing" in all of her classes. Highly recommend this New Yorker article to understand the cultural phenomenon: https://www.newyorker.com/magazine/2018/05/14/the-promise-of...

[wtvanhest]

Absolutely not good for public health long-term. Their recruiter reached out to me last December and it was a hard no for me based on what I understood about the industry.

People use them for starting to smoke just as much as stopping and they are also heavily used for non-nicotine products as well. I don't hold any moral judgements on the brand, or customers, but I was not going to spend my effort helping that become a bigger company.

[awakeasleep]

Tobacco kills 7 MILLION PEOPLE A YEAR

You confused your personal morality, which seems more based on "would this rule benefit everyone applied universally" with the question you were asked, which is of the "does this provide the greatest good to the greatest amount of people" variety.

It's _possible_ that in the end, ecigs are not a net positive for humanity. But that is a belief without firm proof. They could be twice as addictive, but if they kill only 1/3 of us that cigs did, they'll be a net benefit. And 1/3 the lethality of cigarettes seems to be a drastic overestimation of their harm from the evidence we have right now.

[flyingcircus3]

You, in fact, conflated the original question with a essentialized, worst case scenario that shoehorns a multivariate determination into a binary proposition. There are, after all, other methods of smoking secession beyond nicotene alternatives.

In fact, there are some methods of quitting an addictive substance that work by actually stopping the ingestion of the addictive substance in the first place.

Nicotene alternatives are akin to advertisers recommending you to take a break from Facebook when it's too overwhelming, instead of just deleting your account entirely, like a person with self control and agency might do when products and services continually make you regret ever starting to use them in the first place.

[seanmcdirmid]

You misunderstand what is really bad about cigarettes. It isn’t the nicotine, but the tar (the burning of it). Heck, nicotine gum has long been used as a safe smoking cessation aide. Not to mention it is present in many new works vegetables.

Getting rid of the burning tar is a HUGE win for smokers, healthwise.

[arkades]

(1) nicotine gum is used as a weaning assist, not an ongoing alternative

(2) you chose to overlook his point that vapes are also an on-ramp to smoking, not just an off-ramp.

(3) people really oversell the whole “vape isn’t combustion” bs. Both the solvent and the flavors form toxic aldehydes when vaped, and their long term safety has not been assessed.

[strathmeyer]

The only reason you could want a smoking-cessation product to not be available is because it causes big tobacco to lose money. Why are you telling lies that other people have to be paid to tell? Why are you doing it for free?

[lotsofpulp]

The really bad thing about cigarettes is that it harms other people. If people want to exchange a little bit of their future for some pleasure now, then I don't think that's so bad. Some do it with alcohol, some do it with adrenaline rushing activities, some with sugary desserts, or unhealthy sitting and lounging around habits, etc. Everyone's just trying to get that hit of dopamine or whatever in their brain. But just do it without causing inconvenience to others, as much as possible.

[flyingcircus3]

I, in fact, possess no such misunderstanding. I can certainly appreciate that holding the tar up as the boogieman, to give coverfire to nicotene, makes good marketing material for up and coming businesses looking to disrupt established tobacco companies. However, there is a faulty assumption in your copy. And that's to defang addiction as a problem, and to anchor all of the negative effects of smoking to the respiratory system.

Of course tar is bad for lungs. It turns out that products such as tobacco can have multiple health hazards. I do not besmirch people for improving the health of others. I simply detest marketing that acts as if addiction is something to strive for.

[seanmcdirmid]

I tried to quit smoking with earlier vapes and failed because I wasn’t really addicted to the nicotine at all. I eventually figured out how to quit, but it was the burning plant matter that had me hooked more than what you can get in a bunch of tomatoes.

[wtvanhest]

I made my own assumptions and came to the conclusion that this was net negative not net positive.

I guess we will find out in 30 years.

[awakeasleep]

Well I am interested in what other features you considered in your analysis (not to disputed them, just curious about what elements spoke to you).

[toomuchtodo]

Kudos for the ethics.

[TimTheTinker]

That’s a great article, and rather eye-opening.

Juul may help cigarette smokers get away from tobacco, but wow — stories about teens and young adults taking Juul hits every 10-15 minutes are something else. That’s just plain addiction, taking them far beyond the threshold of diminishing returns, even for caffeine-like self-medication.

There’s definitely a lot of money in creating addictions... this can’t be a long-term, net good to society the way it’s heading now.

[EpicEng]

And when I was in school half the kids smoked cigarrettes. I have no idea what the numbers are, but you have to consider that fewer kids are using tobacco, which is a good thing.

[trentlott]

Well, it depends.

As far as I remember, the vehicle is propylene glycol. It isn't biologically inert, and I'm not sure how much work has been done to study buildup within the lungs or combustion products. Combine that with dodgy sourcing allowing metal contamination.

It seems more or less the definition of trading the devil you know for one you don't.

[tonypace]

There are a lot of studies about inhaling PG in the context of smoke machines (in bars, generally). It reduces lung function, but not permanently. No more serious harm seems to be indicated.

[EpicEng]

Also, PG has been used in ventilation systems as an air sanitizer for decades. Not a 1:1 comparison given the massively increased volume papers get, but it's something.

[singingfish]

There's literature back to the 1930s about workers inhalation of VG and PG vapour in volume in an industrial setting. From memory, there are consequences but not associated with the chronic degenerative health conditions associated with cigarette smoking. An examination of the molecular biology of VG and PG suggests its quite difficult to find bad things they would do that would be associated with the chronic degenerative health conditions associated with smoking.

[pdpi]

False dichotomy. Tobacco smoking was on a downwards trend before vaping anyhow (it just plain stopped being “cool”) so clearly you don’t need vaping as alternative to reduce tobacco usage.

[pssflops]

My younger brother, over 18, is rather fond of his Juul and I don't quite understand why. My parents smoked while raising my sister and I, which I believe contributed to our fascination and addiction to cigarettes; but they had quit long before having him. I've worked my way off but after seeing what vaping has done to my brother from what appears to be social (peer) pressure, I'm not certain if it has provided any net benefit to this point.

[ShabbosGoy]

To be honest, nicotine has cognitive enhancing effects. Nicotine alone does not have detrimental effects (aside from vasoconstriction, but it’s a stimulant); the main risk comes from the unknown effects of long term exposure to inhaled chemicals like propelyne glycol/vegetable glycerin.

These chemicals are approved as food additives, though.

[TimTheTinker]

> Nicotine alone does not have detrimental effects

I think it’s normal to consider dependency and major withdrawals when stopping as pretty detrimental effects, whether or not any other symptoms are involved.

Not that everyone is bothered by that, but folks needing to vape every 10 minutes have a severely lowered quality of life (or the risk of having one), in my opinion — if only because their habit gets in the way of other things, or perhaps they forget their pod pack and have an incredibly bad day. I think that could be a whole lot worse than not having one’s morning cup of coffee.

[jjeaff]

Not to mention the very questionable morality of selling a product engineered to hopelessly addict your customers.

[stefan_]

Kids taking Juul hits every 10-15 minutes are not driving and are not drinking alcohol, so there is your public health benefit already, mostly in the former.

If you're gonna be opposed to some fidget spinner infatuation on "think about the kids" public health concerns, start at what actually kills kids.

[Splines]

If you're going to pick something to say "Kids doing X don't drink a drive", vaping would probably be pretty low on that list.

[TimTheTinker]

> start at what actually kills kids

Sounds like you’re categorically ignoring whatever negative things don’t directly kill people... well-being encompasses a lot more than not dying.

[83457]

All I know is that I vastly prefer hanging around people that vape vs smoke. I am middle aged and wasn't that familiar with it but started running events with older teens and young adults with vaping being somewhat common (small fraction overall). For some events a dozen people go outside to smoke and then come back stinking the entire place up. Vapers on the other hand just take some puffs in the room and no one even notices or go out and come back smelling normal. Of course the highly scented or large clouds are annoying but not what most vapers I know do. Not sure how "juuling" figures in here but wanted to share my experience. Growing up annoyed with a mom who smoked and generally hating it, vaping has been a bit of a relief as compared to cigarette smokers.

[magissima]

High schools too, it's amazing how many kids use juul. I think a lot of them aren't even aware it's nicotine.

[GW150914]

They know, they don’t care. It was hard enough to convince people, especially kids, that smoking was bad for you and that was with something that made you hack up yellow slugs, and stank. I would guess that convincing people that vaping nicotine is harmful decades before the harm is readily apparent, in ways that are not well studied will be essentially impossible.

Juul is just the perfect intersection of portable, concealable, and apparently consequence-free. Kids will use it, and I don’t see a way around it. Good luck to the poor little bastards.

[wycs]

There is startlingly little evidence that pure doses of nicotine are harmful without smoke.

[Jonovono]

Everyone in here is caught up in the physical harm of smoking. Celebrating moving from cigarettes to eCigs. I'll admit that's important. But for me, most of the harm cigarettes have (and also eCigs) is not how bad is it on your physical health.

[hazz99]

Legitimate question - if most of the harm of eCigs is not on your physical health, what is it?

[Jonovono]

It's the mental addiction. The physical health is not really something you deal with every day - usually doesn't get super serious until you get older. But when you are addicted to smoking (cigs or ecigs), it changes you. It interferes with how you live your life. You are now thinking about smoking a lot, when the next time you smoke will be. You will be doing something and then you will think "I wish I had a cigarette" and then that will consume you until you find one. You are less productive because of this. You are less in the moment because of this. You become controlled by the addiction. To me this is much more serious. You might die 10-20 years earlier, sure, that's bad, but if you aren't living to your greatest extent right now, I think that's much worse.

I actually think ecigs are worse than normal cigarettes for this reason. It's now socially acceptable to smoke them, easier to smoke them (you can just hop into a bathroom stall and take a hit).

[justin]

What is it?

[_Schizotypy]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553893/

[hazz99]

Is nicotine bad for you? I thought it was just what made cigarettes addictive, and all the other stuff is what made them unhealthy. Happy to be proved wrong -- I'll let some eCig friends know ;)

[Alex3917]

The main problem with nicotine is that it increases your risk for heart disease. It’s also somewhat carcinogenic.

[throwaway5752]

It's also extraordinarily addictive. That's an ethical problem in and of itself.

[Nursie]

e-cigs have been proclaimed as between 95 and 99% less harmful than smoking, by some health charities.

If these figures are well grounded in evidence then... probably yes.

[kenning]

One thing that bugs me about ecigarettes is that the flavoring chemicals are totally untested. Vegetable glycerin is essentially harmless and is even used in asthma inhalers, and nicotine is way less harmful as well. However it's already been shown that certain flavoring agents like a particular butter flavoring are harmful (https://www.theatlantic.com/health/archive/2017/11/e-cigaret...). I know a couple "juice" makers and they basically just throw in random flavoring chemicals that are meant to be ingested.

It's possible to get unflavored e-cigarette juice, and when I was using an e-cigarette (i switched to gum) i tried to get it as often as I could. But it's really uncommon, most shops don't even have one, and the one i went to was often sold out.

[nyolfen]

The 'popcorn lung' bit is BS. There are no known instances of ecig users contracting it. People also fail to mention that the levels of the chemical in question (diacetyl) is >700x higher in traditional cigarettes.

I'm not much of a conspiracy theorist but I have to wonder if tobacco company PR agencies have anything to do with the proliferation of that particular talking point.

[_Schizotypy]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553893/

[_Schizotypy]

Actually it recently was discovered that the metabolites of nicotine itself are a likely carcinogen, so not quite so harmless.

[slg]

Oxycontin is likely a safer drug than heroin. That doesn't mean we should be working on growing the Oxycontin market on the assumption that every new user is someone who might have otherwise used heroin.

[varjag]

Methadone is safer than heroin and is widely used in substitution therapy.

Either way, the bulk of health damage from smoking was from the complimentary products of burning. You ain't getting lung cancer from nicotine.

[slg]

I am not aware of any doctors that would recommend using methadone permanently and and it is only legally available to be prescribed for ongoing substitution therapy by federally certified abuse recovery centers. So my analogy still stands. No one should be actively campaigning to grow the methadone market the way that people are for e-cigarettes.

[malkuth23]

The metaphor is somewhat flawed, but methadone is unfortunately often considered a life long way to manage an addiction.

[bfuller]

You'd be wrong. Opiate maintenance with suboxone or methadone is often understood to be a lifelong thing.

[nasredin]

AFAIK any MD can write a script for methadone.

[mjcl]

Only for pain, not as a part of detox/treatment. Source: https://www.deadiversion.usdoj.gov/faq/prescriptions.htm#rx-...

[_Schizotypy]

Actually, you just might get cancer from nicotine.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553893/

[tigershark]

As far as I remember you are getting cancer, although at a lower risk, at least accordingly to some study posted here in the past that I can’t pinpoint right now.

[_Schizotypy]

Here's one :) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553893/

[Nursie]

If being addicted to Oxy was 95-99% less harmful than being addicted to heroin, I think we'd be OK with a small rise in Oxy users as heroin use fell off.

But as these are not in any way analagous to the current situation, it seems silly to talk about them.

[blowski]

Is it better to have 10 kids smoking traditional cigarettes, or 1000 using Juul? But perhaps that's a false dichotomy. My worry is that by creating new addictions, we will end up with 1000 using Juul AND 100 kids smoking traditional cigarettes.

I don't see how anyone gains from this, other than Juul's investors.

[gervase]

Given the existing socioeconomic patterns of smoking [0], I think this is the most likely scenario. Given a Venn diagram of people who smoke (low socioeconomic status) and people who "Juul" (high socioeconomic status [1]), the overlap in users is likely quite small.

It doesn't seem like they're cannibalizing an existing market, as much as they are forging a new one.

[0]: https://www.ncbi.nlm.nih.gov/pubmed/22092035 [1]: https://www.newyorker.com/magazine/2018/05/14/the-promise-of...

[Nursie]

Your worry is unfounded, apparently. So far there's no evidence of e-cigs being a gateway to regular ones.

[tigershark]

I never heard of this Jool-thingy before, but when I was smoking I switched to e-cig for a while and after a couple of month I had to stop altogether because one night I managed to smoke the equivalent of 2 packs of cigs in something like 4/5 hours. After that night I didn’t smoke for 8/9 months I think because the effect that it had on me was so awful. After some huge stress at work I started again and after a couple of years I finally stopped for good, I hope. Now it’s 3 years that I don’t touch a cig or an e-cig, and I really hope that the new generation doesn’t fall on the new and glamorous nicotine trap, although I’m not really optimistic...

[singingfish]

I'm not sure how you'd manage to "smoke the equivalent of 2 packs of cigs in something like 4/5 hours". Firstly you're not inhaling any combustion products, so that's not equivalent to start with. Secondly the absorbance of nicotine from ecig vapour is much lower than when nicotine is inhaled in the form of smoke such equivalence is not really measurable.

[homero]

I was a heavy smoker, 2 packs a day, Juul was the only thing that helped me quit. Nothing else worked.