Monthly Archives: July 2013

Biking harm reduction

by Carl V Phillips

I just got done talking to two reporters about e-cigarettes and THR.  In one of those I had the nice rare opportunity to be able to reply to the comments of the apparently mandatory interviewee for these stories: a medic who seems to understand neither the products nor humanity, but insists on opining on them anyway.  Re the lack of understanding of humanity, I pointed out to the reporter that — contrary to the views of that physician — people care about things other than just minimizing health risks (something I almost always have to do, in spite of the fact that most people I talk to are people, and so should already know this).

Of course, the entire “public health” iron triangle[*] (not to be confused with real public health) is premised on the notion that the only thing people care about is maximizing their longevity.  Or perhaps their view is that people owe their lives to The State or to The Community (dare I say, to The Collective), and thus only productivity and costs-savings — not pesky little matters of happiness — matter.  Either way, they never defend their position.  They just take it as a premise and run with it, perhaps knowing that it is indefensible but trying to make people forget that they have no foundation by creating a huge edifice without one.

[*For those who do not know, “iron triangle” is the generalization of Eisenhower’s “military-industrial complex”, as applied to self-perpetuating, self-enriching special-interest industry/government/academia institutions other than the military.]

But having gone through that thought process, I came out the other side thinking about where “public health” people, along with those medics who think of patients as their serfs rather than their customers, recognize that maximizing longevity is the only thing that matters.  I do not recall — in all my years of hanging out with people who engaged in these activities –ever hearing about a physician or “public health” type advising them to give up mountain climbing or commuting by bicycle.  Each of these activities is far more dangerous than using low-risk tobacco products.  The former (among those who do it seriously) is more dangerous than smoking.  And yet not a peep from those who would ban large sodas or whose attitude toward THR is that (even if they acknowledge that is healthier than smoking) it is a poor substitute for the always-better choice of avoiding the behavior entirely.

Of course, I can hear the inevitable response to that, “but they are good exercise”.  Trust me, you only hear that from people who have not done those activities.  They are certainly exercise, and as such better than no exercise at all.  But they are fairly lousy as exercise (which is clearly not the main motivation to do them), with a lot of fitness-inefficient starting and stopping, brutalization of tendons and other body parts that you might discover that you need later, and furious inhalation of bad air (either not enough of it or far too high a concentration particulate matter and toxic gasses from burned gasoline and diesel).  That is to say nothing of the trauma risk.  But can you even imagine a medic advising someone, “instead of commuting by bike, you would be better off driving to the gym, riding the stationary bike there for half an hour (during which you can get some reading done for the good of The Collective, something you cannot due while commuting), and then continuing on to work.”  By “better off”, they of course mean healthier — what else matters after all?

If you actually had this discussion with a “public health” type special interest activist, you could count on them also responding that just commuting by bike, rather than switching to that reduced-harm version, is better for the environment.  To which I say: Aha!  So even if you do not care about people’s pleasures, health concerns do not trump all other human wants, do they!?

To head off some of my experience from my last post, of comments and nasty notes from people who know nothing of my work, I will point out that I am aware that “public health” types and activist physicians are generally authoritarian elitists who think of the plebs (and the environment) as helpless kittens who need to be protected.  That is the charitable interpretation; the less charitable version being that they think of the plebs as savages who need to be civilized into proper moral behavior so they can be good members of The Collective.  The people who they encounter who commute by bike and climb tend to be fellow elites, who can be trusted to make their own decisions, while the peasants who use tobacco need to be civilized.  (What about the people who commute by bike — sans carbon fiber, lycra, and helmet — because they cannot afford to drive to their jobs, often on particularly unsafe roads?  The “public health” types do not really care because that highly unhealthy activity is not “immoral”, and the physicians who are willing to see them understand that they probably have bigger health concerns.)

Still, we can ignore all that subtext and perhaps find a vein of good rhetorical fodder.  When responding to an authoritarian who takes the “you would be better off not doing it” attitude, whether in an interview or personally, perhaps it would be useful to ask “so, do you recommend that people give up hobbies/sports that are just as hazardous in favor of just riding a stationary bike?  Why not?”

E-cigarettes are a tobacco product, so please stop wasting time arguing otherwise

by Carl V Phillips

CASAA’s Kristin Noll-Marsh just posted an excellent analysis of why it is a bad idea to try to argue that e-cigarettes should not be considered a tobacco product.  If you are reading this post, you will definitely want to go read it.

For those who do not know, approximately once every five minutes in some forum somewhere, someone who is new to vaping or otherwise unfamiliar with the THR debate and regulatory issues declares that if e-cigarette advocates only pushed back against the categorization, or even the name “electronic cigarettes” itself, then…  Well, actually I am not quite sure.  Then something wonderful and positive would happen, though it is never quite clear what or why it would happen.

Noll-Marsh does a good job of explaining how if this succeeded, it would accomplish nothing in terms of improving regulatory prospects, and indeed is almost certain to make them worse.  She also points out how e-cigarettes so obviously occupy the exact same niche as other tobacco products that it is perfectly accurate to call them tobacco products for any practical purpose.  It is not even misleading about risk, since smokeless tobacco is the proof that smoke-free tobacco is not substantially harmful.  (And for those who are merely obsessed with the literal meaning of words, every tobacco product contains part, but not all, of the tobacco plant, just like e-cigarettes do.)

She does not go into much detail about another good reason to not pursue this fight:  It cannot be won.  Regulators will declare e-cigarettes to be tobacco products if they want to — and if you are a vaper who lives somewhere this is happening (e.g., the USA), count your blessings, because the leading competing alternative is to regulate them as medicines.

As for changing the name “e-cigarettes”, there are several reasons why the current name is good and the proposed alternatives have serious flaws, but those are moot because the ship has long-since sailed on that one.  I cannot think of any example where a political effort to change the name of a popular consumer product succeeded, other than with the intention of slandering the product (e.g., “alco-pop”)  Do you really want “e-cigarettes” to be officially called ENDS?  Because if the name were really put in play, that is the likely landing point.

Apart from some vague (and clearly incorrect) notion that somehow a re-categorization would lead to more consumer-friendly regulation, why is there so much interest in this?  I think a lot of it comes from smokers learning to accept the characterization of themselves as pathetic or evil — a very typical pattern among those who are the victims of systematic abuse by those who hold power over them — and so wanting to declare, after switching to vaping, that they are no longer that.  It is understandable, and if you need to personally declare that you no longer use tobacco because you use e-cigarettes, then you can do so (just do not expect most of the world to agree with you).  But if instead you were to fight back against the self-perception that your abusers inflicted, and declare that you are a willing, knowledgeable, and happy tobacco user, you might feel better still.  And if not for yourself, consider doing that for the good of the cause and others who practice or might practice THR.  Because it seems that proud and happy self-declared tobacco product users, united rather than divided, are much more likely to have a positive influence than what — to the outside observer — mostly comes across as apologetic.

 

Tuesday Testimonial (3)

Another example of the excellent testimonials collection.  Add yours!  (see the first post in the series if you do not know how)

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Tish

I began smoking when I was 12 years old. My friend and I would get her older brother to buy them for us. We thought we were so cool and grown up. As I progressed into high school, my habit became more severe and by sophomore year I was up to a pack a day. I told myself I was going to quit before I graduated. Near the end of my senior year, I quit for the first time. My first attempt was cold turkey. That lasted about a month and I quickly discovered that much of my addiction was psychological, not just the physical dependance on nicotine. As soon as my home life got difficult I was back smoking cigarettes.

My second attempt at quitting was a disaster. at 19 years old I decided to try nicotine patches, which resulted in dizziness, rapid heartbeat, and severe insomnia. I was back to smoking within two weeks. My third attempt was with nicotine gum, which again resulted in dizziness and rapid heartbeat, with the added bonus of making me nauseous as well.

My fourth attempt at quitting was when I was 24. I learned that I was pregnant and again decided to quit on my own, without any smoking cessation aids. I was actually fairly successful in that I stayed smoke free for the duration of my pregnancy, and for about 6 months after my daughter was born. Unfortunately, stress once again got the better of me and I was back to smoking again.

From the ages of 25 to 32, I smoked anywhere from 5 or 6 cigarettes a day to as much as a pack. Then, two years ago, my sister and her husband quit their occasional clove cigarette habit using an e-cigarette. They let me try it, and I enjoyed it but was not really convinced. After all, in my mind they weren’t really smokers. I figured it was just too good to be true. So another year went by, and my brother came to town for a visit. He told me he had quit smoking using e-cigarettes. He was using a Provari, which was the first large, advanced personal vaporizer I had ever seen. It looked like a monster. He had been a two pack a day smoker for many years and was now no longer smoking. I was surprised that it had worked so well for him and it convinced me to give it a try.

I bought a Joyetech E-Go kit at the local shop in my hometown. I told myself that if I really wanted a real cigarette I could have it. When I bought the e-cigarette I had 4 cigarettes left in my pack. I smoked one cigarette each day before I went to bed, and on the fifth day I decided not to buy any more. I haven’t smoked since. It has been 13 months since I had my last cigarette. I have upgraded from my original kit and now have an assortment of E-Go Twists, Vision Spinners, an Apollo VTube and a Vamo V2. I usually use my Vamo. I also mix my own e-liquids. It has become not just a smoking cessation device, but also a hobby that I enjoy.

I have converted quite a few people to using e-cigarettes, many of whom have also quit using traditional tobacco with them. This includes friends, co-workers and family members. These devices have been a blessing in my life. After almost 20 years of smoking, I can proudly say that I am not a smoker. I can breathe better. I can smell and taste again. I don’t smell like smoke. And, most importantly, my daughter isn’t being exposed to second-hand smoke anymore. And I will get to be around, and be healthy, when she grows up and has kids of her own. I truly believe that e-cigarettes are saving my life, and the lives of thousands of others.

Thank you for taking the time to read my story, and thank you to CASAA for all the important work you do for all of us ex-smokers and future ex-smokers.

American Legacy Foundation – lying via hypothetical research methods

by Carl V Phillips

I have spent a lot of my career pointing out how the choice of research methods and statistical models — in particular, the choice of which to report among the many that were tried — create bias in the epidemiology literature.  It is easy to create a study that is designed to get a particular result, especially if the desired result is to fail to observe a phenomenon (in the days before e-cigarettes, I was baffled that the anti-ST people never ran an intended-to-fail intervention to “show” that THR did not work).

It seems that the American Legacy Foundation has taken this one step further.  In a comment on the ECLAT study, which found that many smokers who were forced to try e-cigarettes for a while (as study participants) decided to switch to them, they basically described the designed-to-fail methodology they would have used and criticized the honest researchers for not using it.  Mike Siegel summed it up (emphasis in original):

According to the press release: “The researchers reported that e-cigarettes decreased some smokers’ cigarette consumption and that 8.7% quit smoking 40 weeks after the intervention ended. Unfortunately, they also found that smokers quit rates were not statistically different whether given e-cigarettes with or without nicotine –thereby causing a placebo effect. … We cannot conclude from this study that e-cigarettes promote cessation. While the study showed that some smokers quit, it does not show that the product itself had any role in the behavior change. In fact, the results merely show that sucking on an empty cigarette holder (a placebo) would likely accomplish the same thing.”

This press release misses the whole point. And in doing so, it ends up misleading the public.

There is no true “placebo” effect involved with electronic cigarettes because the mimicking of smoking with the use of a cigarette-like device is the main point of the product. We do not want research to control for this effect. We want research to measure this effect.

Obviously Legacy is wrong about a cigarette holder being the same experience as an e-cigarette.  But they did figure out that if you want to design your study to show a null result — to minimize the apparent effect of e-cigarettes on smoking cessation — you should compare nicotine e-cigarettes to non-nicotine and claim that this is the contrast of interest.  Based on that insight, they went back and pretended that this existing study had such a design flaw and reinterpreted the results accordingly.

Part of the problem is the entire notion of using clinical trials to study complicated learning- and socially-influenced processes like THR.  You might be able to argue that testing medicalized nicotine products (the way NRTs are marketed) can be done reasonably in a clinic because they are used in a very clinical way.  But that is not true of most ways of quitting smoking.  In fairness to the ECLAT authors, that methodology has some advantages, and they were not actually doing a standard cessation trial.  But the RCT fetish that is common among medics who only half-understand scientific research makes it very easy to design a study to fail and claim that it must be a good study because it is an RCT.

RCTs usually have net advantages compared to observational studies when (a) the assigned protocol is a realistic version of what someone would experience in real life and (b) the mere act of having people in a clinical setting and assigning them something does not affect the outcome.  This makes them nice for examining medical procedures or treatment drugs, where these conditions are pretty much met.  But they are quite bad for studying behavioral phenomena, especially those where, in real life, people fiddle with the details of the methods and act on their own without the artificial pressure of being in a study.

A further complication is what Siegel alluded to: RCTs tend to work better only if (c) it is obvious what to compare the intervention to.  Comparing nicotine to non-nicotine e-cigarettes is not an interesting comparison.  In any case, despite the rhetoric you hear about placebos, most proper RCTs do not compare a treatment of interest to a placebo, but to the realistic alternative.  To see if a new method for performing an appendectomy produces fewer complications, you do not assign half of the subjects to the placebo of being anesthetized but their appendix left in.  That would be insane.  You compare the new method to the best available old method.

This further emphasizes the importance of point (b).  Who do you compare the group assigned to use e-cigarettes to?  Should they be given a placebo treatment of just being handed a quit smoking pamphlet that is known to have no effect?  If so, you are still looking at people who agreed to participate in the trial (not representative of the population) and are comparing people who were asked to take a major step to those who just throw away a piece of paper and forget the whole thing.  To merely control for the entire Hawthorne effect (the effect of feeling like you are being studied) the alternative may need to be more aggressive than that.  To control for any placebo effect it would be necessary to give people pills that are inert but described as being a satisfying substitute for smoking (not a “cure” for it), because everyone knows that e-cigarettes are about substitution.  That fiction is unlikely to hold up very long.

Basically, the more thought you give to trying to do the science right, the more clear it becomes that there is no particularly good way to do the RCT.  Thus, the advantages of observational research over RCTs start to predominate.

—–

As an aside for those who click through and read that Siegel post:  You will notice that the thesis of the post is about Legacy failing to disclose that they receive funding from the pharmaceutical industry, which stands to lose sales as a result of e-cigarettes.  I have to say that it seems like rather a stretch to demand that a large corporation disclose their relatively modest pharma funding on everything they write.  It is kind of like asking FDA to do the same.  (Perhaps the more relevant disclosure would be that Legacy was created and funded by a sales tax on cigarettes, the MSA.)

The impact of pharma funding on the anti-THR attitudes of Legacy and other pseudo-health corporations is somewhere between zero and trivial.  Part of the reason is that there are much stronger self-interested motives for being anti-THR.  More important still, people do not adopt these semi-religious beliefs because of funding.  Many gravitate to where there is funding that supports the mission they have adopted, but that is causation in the other direction.  Finally, the amount of money at stake is trivial to the pharmaceutical industry.  They give grants to keep a hand in things and get inside information, certainly.  But it is very difficult to believe that they are so concerned about relatively modest erosion of the tiny tiny corner of their business that is smoking cessation that they would exert pressure on those they fund to attack e-cigarettes.

Recall that yesterday I pointed out that holding an unrealistic view of your enemies’ motives is a recipe for adopting bad tactics.  While this case is not quite as dramatic as the one I was discussing, it is another example.  It is a mistake to think that pharma cares so much about THR that they are throwing around bribes to try to discourage it (even if you are willing to assume they would be willing to take such actions), and also a mistake to think that those funds play a major role in the decisions of anti-THR actors.  It is probably safe to say that the impact is not exactly zero, but there are much more important forces afoot.  If we focus on the red herring of donations rather than the major social forces and other base interests, we are likely to be rather less effective.

Sunday Science Lesson: Some basic economics of tobacco use

by Carl V Phillips

Yesterday I pointed out how out of touch the tobacco control industry, and “public health” people in general, are with respect to basic consumer economics. Today I will expand a bit on their key failure.  For more on this and its specific implications for THR, see my recent paper (which is rather longer and more detailed than a blog post, or ten, of course, but worth your time if you really want to understand this stuff; it is intended to be accessible to those with only a newspaper-reader level of familiarity with economics, and will be no more difficult than blog reading if you took an econ class or two).

Economics tells is that, in the ideal, everyone is presented with a choice of which goods to consume and they choose the combination, subject to their budget, that makes them happiest.  This is a pretty good starting point, and is fairly useful for population-level analysis, though it is clearly too idealized to provide much of a bedrock for analyzing each person’s decisions (e.g., none of us are aware of all of our choices).  But take a thin slice of that and you are on much firmer ground:  For each choice about consuming a particular good and paying the costs of doing so versus not consuming it, people choose whichever of those makes them happier.  (If you want to split hairs about the choice of words, you could elaborate “happier” into “whichever makes them better off” or “whichever makes them and those they care about better off”, but you get the idea.)

To claim otherwise — that people are making a choice that makes them worse off, all things considered, and their revealed preference somehow does not represent their true preferences — requires some strong arguments.  The tobacco control people implicitly claim otherwise, since a key bit of their subtext is that people must be worse off if they use tobacco/nicotine.  But they do not even attempt to make the necessary arguments, let alone make a legitimate case.  Indeed, the fact that they bury it in their subtext rather than making the claim explicitly is a good indication that they know they cannot really defend it.

One legitimate reason that someone’s choice might not really reflect their preferences is that they do not actually know the real costs and benefits, and if they knew the truth they would make a different choice.  This argument can certainly be made about smokers half a century ago, and perhaps some people today in highly uneducated populations (who have rather bigger problems to worry about).  Half a century ago, smokers make their decision based on a huge underestimate of the (health) costs.  But this can no longer be said about tobacco users in any educated society.  Indeed what evidence we have suggests that smokers somewhat overestimate their risk.  Smokeless tobacco users grossly overestimate their risk in most populations (with Swedes and other aficionados of snus understand the truth more often).  Casual empiricism suggests that e-cigarette users may slightly underestimate their risks as compared to a best educated guess about the real risks, but since both the popular and best scientific estimates are that the risk is low (and e-cigarette users are basically all recent ex-smokers, so they chose smoking over abstinence) this hardly seems likely to affect consumption decisions.

So the tobacco control industry has no safe haven from economics there.  Of course, they still try to vaguely insinuate that people do not understand the risks, but no one other than some of the clueless useful idiots actually makes that claim.  Indeed, most of the time when there is an insistence that more must be done to “educate young people about the risks” or whatever, it is clearly a rationalization for producing propaganda that does not actually educate, but rather is intended to create a racism- or homophobia-like irrational hatred of tobacco users and similar disdain for the products.

Failing this semi-rational explanation (that people are making a rational choice, but based on incorrect beliefs), the task becomes rather more difficult.  One argument is that people tend to discount their welfare in the far future compared to immediate gratification more than is rational (based on other measures of how the make comparisons across time).  This is a defensible argument that is made by legitimate scholars and researchers who look at risk in general, and can apply it to smoking in particular.  (There are no longer any legitimate scholars and researchers in tobacco control as far as I can tell, but this point is made by those outside that industry.)  This is possibly a legitimate argument for not believing that smokers are really making the welfare-maximizing choice, though it does not seem to apply to tobacco products like snus or e-cigarettes that have such low risk that there is very little long-term consequence.  Moreover, even to the extent that it applies, the scientific argument needs to be made, and there needs to be the additional argument that aggressive intervention is ethical based of this.

Instead of making one of the potentially legitimate arguments, tobacco control hides behind an unstated notion that the choice to use tobacco products is some sort of involuntary tic that people stumble into for no explicable reason (or perhaps because of pretty packaging) and just keep doing.  This allows them to pretend that they are not attacking a choice that people are making for some legitimate reason, and thus lets them pretend that they are attacking some inanimate force, not the people that they claim they are trying to help.  But such fictions are not without costs to those who believe them.  It is difficult to formulate effective tactics when your view of what you are dealing with departs so substantially from reality.

Bottom line:  The main reasons tobacco control consistently fails to meet its own expectations are a matter of basic economics (people make choices based on preferences) and basic warfare strategy (if you have no understanding of what motivates your enemies, you will have a difficult time defeating them via any method other than obliteration).

 

[…”what about addiction?” some of you are asking.  Well, what about it?  Whatever it means, does it change the basic economic principles?  Comments welcome, but more on that later…]

The Lancet does not know the first thing about economics

by Carl V Phillips

The Lancet recently editorialized that medics should stick to what they are expert in, diagnosing and treating individual disease cases, because when they venture beyond their expertise they tend to say really stupid things.  Well, actually that is not quite true, as you might guess.  Instead they wrote an editorial that demonstrated that medics should stick to what they are expert in, diagnosing and treating individual disease cases, because when they venture beyond their expertise they tend to say really stupid things.

When physicians venture into epidemiology they are generally pretty bad at it, but at least they have the advantage of being consumers of the science and so are not completely illiterate.  When they venture into other fields, say economics, they are not only not nearly as expert as they think (medics are basically trained to pretend they know everything when dealing with patients, and many of them come to forget that they are pretending) but are completely oblivious to even the basics of the field.

Case in point is the editorial, which is entitled “Tobacco control: when economics trumps health”.  A little rearrangement of the words would actually make this an insightful observation:  Tobacco control: when health does not trump economics.  That rearrangement pretty much sums it up if (in contrast with the authors) you actually understand what the word “economics” means.

The thesis of the editorial seems to be that the reason tobacco control continues to fail is that  manufacturers make money selling the products.  I say “seems to be” because they kind of wave their hands in that direction but never actually argue it.  They seem most worried about the recent UK decision to not mandate plain packaging for tobacco products.  Never mind that there is no reason to believe such a rule would have any effect on health.  More important, never mind that the campaign against the proposal came more from the public than from business who stood to lose profit due to the resulting hassle and black market.

Why would the public object?  Economics.  Not business finance — that is not what the word means.  “Economics” is basically the science of limited resources and making tradeoffs among them to fulfill preferences, and so includes business finance, but also individual preferences and welfare, which I would argue is the far more interesting and important part of the field.  It seems that consumers do not like the government mandating what their cigarette packs look like.  Surprise!

More important, of course, is that people get benefits from using tobacco and nicotine.  That is the critical fact that the tobacco control industry pretends is not true, and that “public health”-type medics like those who wrote the editorial apparently do not even understand.  Preferences — not some contrived conspiracy — is why tobacco control continues to fail.  The most charitable interpretation of the dismissal of real preferences (and there are many others that are rather less flattering still) is that they think health concerns should trump all other human wants: anything that might benefit health, no matter how trivially, should be done, no matter how great the costs it imposes on people.

This is an utterly absurd position.  Those who exercise police powers to force such absurd priorities on others certainly do not behave that way in their own lives.  Do you think that they never eat anything unhealthy and avoid leisure travel, to name just a couple of activities that create risk?  You do not have to view yourself as a libertarian to believe that government should pay attention to economics (i.e., to what people want and to the actual costs and benefits of a policy) before acting.

But when this happens, and health concerns are not allowed to trump everything else, and the “public health” types whine that they are being trumped.  They are not, of course.  They are just being forced to put their personal preferences into the marketplace of ideas and political process, where it just might be that others’ personal preferences win the day.

They are right about one thing:  Economics is not on their side, they just do not know what that statement actually means.

Tuesday Testimonial (2)

Continuing the posting of selected contributions to the CASAA THR success stories testimonial collection (more info about that in the previous post)…

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Daniel

Like most people, I picked up the habit of smoking cigarettes at a young age while still at school. Call it peer pressure, call it wanting to look cool, call it anything you want but for me it was the start of a long battle to quit.

I always said to myself that this will be the last pack and sometimes I even went as far as throwing a 3/4 full packet of smokes in the bin vowing never to smoke again. Sometimes I would last a day but most times it was only a couple of hours.
At 18 years of age I joined the army. Just before I joined I thought to myself If anything is going to make me quit it will be this, I will need to be fit, and in order to be fit I will need to quit. Well once enlisted I found myself head deep in a culture of smokers, It seemed like every second soldier was a pack a day smoker and I found it even harder to kick the habit.

My first real attempt at quitting came at the age of 23. The army sent a message out stating that if anyone wanted to give up the smokes they would supply NRT in the form of patches or gum so I jumped at the chance and took up the offer. To my surprise it didn’t work, in fact I just ended up smoking while taking the NRT. This cycle continued on and off for the next few years.

I left the army when I was 26, still a smoker and moved back home. Over the next couple of years I tried hypnosis, acupuncture, Champix, patches, nicotine gum, nicotine lozenges and continued to smoke on all of these. Nothing I tried worked.

When I was 30 years old my father was diagnosed with smoking related lung cancer and upon hearing this news, I went outside and lit a cigarette to calm myself down. As soon as I finished it, I threw the 3/4 pack of smokes in the bin once again vowing never to smoke another one. This lasted about a day and a half.

Dad fought strong for a while, and at one point the doctors thought they were winning the battle but only 6 months later I was holding his hand as he passed away peacefully in hospital. Again, I stepped outside and had a cigarette to calm myself and threw out the 3/4 packet of smokes – lasted 2 days this time.
32 days ago I was driving home when I saw a sign on a shop – “Electronic Cigarettes” so I pulled over and went inside. The guy who runs the shop spent about half an hour talking to me, showing my some gear that he had and explaining things to me in great deal. I ended up buying a start up kit which included a clearomizer, two batteries, some 12mg Nicotine E-liquid and some accessories. He told me that I should continue to smoke cigarettes for the first week while slowly transitioning into using just the E-cigarette.

Well 2 days later I was using nothing but the E-cigarette and loving it. I was amazed how it completely took away the craving. I threw out another 3/4 packet of cigarettes. This time its been 30 days and I’m still going strong. I honestly can’t imagine ever buying another packet of those cancer causing death sticks.

In the month that I have been vaping I have converted my best friend, my mother in law and 2 work colleagues and am more that happy to convince others to give it a shot as this is the ONLY thing that has worked for me. I have upgraded to a VAMO VW VV device and am still on the 12mg nicotine liquid. My plan is to slowly drop down in nicotine strength over the next 12 months but I feel at ease knowing that I am not inhaling 4000 chemicals while I do it.
I feel as though the vendor that I spoke to 32 days ago has saved my life, without seeing his shop while driving home I would still be smoking today, so thanks Phil. I feel better, I smell better, I am sleeping better and waking up easier and its only been 1 month! I cant wait to see how much better I feel in 6 months!

This is my story.

Tuesday Testimonial (1)

As many of you know, CASAA has been collecting testimonials from people who have succeeded with THR, quitting smoking (or cutting waaay down) by substituting e-cigarettes, smokeless tobacco, or other low-risk alternatives.  These are people’s own stories, in their own words, and provide a powerful testament to the benefits and effectiveness of THR.  This collection has already been used in policy advocacy and we expect that it will play an important role in future efforts to defend THR — stories like these are real scientific evidence, and are just a lot more compelling than statistics in policy debates.

[For those who do not know about this collection, and have such a story, please go to http://fluidsurveys.com/s/THR-testimonial-CASAA/ and add your story to the collection.  And if you have already done so or are not someone who personally benefited from THR, please consider taking a minute and pointing people toward this post or that link — we have nearly 600 testimonials so far, but our goal is 1000.]

We will make the whole collection browsable, but we realize that few are going to want to just thumb through hundreds of stories.  So we have decided to start posting about one a week here.  Today’s was chosen because its content is typical of a lot of the stories, and also because it is short but still very compelling (some are ten times as long, and go into amazing and fascinating detail — again, we want whatever version of the story someone wants to tell).  For those of you who have hesitated to contribute your story because it seemed too daunting to try to tell it all, this should demonstrate how you can tell a compelling story in just a few paragraphs.

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Gabe from Los Angeles

Short and sweet: I started smoking when I was 16. By the time I was 18 I was good and hooked. I smoked a pack a day, give or take, since then. I started trying to quit seriously in my late 20’s — I tried every single doctor recommended product on the market. Chantix, Bupropion, the patch, the gum, the inhaler, cutting down, cold turkey, juice cleanses, counseling, everything. Nothing worked.

About 2 years ago, I got one of the first e-cigarettes on the market. It wasn’t great, and after it broke I gave it up as another failure. I had come to terms with the fact that I was hopelessly addicted to nicotine, and that I was going to likely end up with a shortened life span and serious health problem. I couldn’t afford patches or more medical interventions that didn’t work in the long term. When I found out that a new generation of e-cigarettes were on the market that delivered better results, I figured I would try them without much hope of success.

After a few weeks of mainly smoking cigarettes and using the e-cigarette just a bit, I switched over to mainly using the e-cigarette. After a few weeks of switching back and forth with primarily the e-cigarette, I decided to cut out cigarettes even further. For the first time in my life, I was able to do so without anxiety, deep depression, mood swings, and an extreme feeling of “fuzziness” in my thinking. Over the past 3 months, I’ve smoked 3 cigarettes. I’m healthy, I feel great, and I’m finally done with the tobacco.

This is a wonderful product, one that actually works in reducing harm substantially, and one that has helped me to personally stop smoking cigarettes. I know that people want to regulate them or just don’t have the information to make a good choice on it. I implore anybody who wants to have a knee jerk regulatory reaction or judgement to please, think of the people like me who have not been able to quit any other way. We’re real, we’re being helped daily by this. It’s life changing.