Part 9: Preliminary thoughts on my ongoing vaping experience survey

I published a survey that looks tiny, but has proven to be quite fruitful. Even more than I thought too. A couple hundred answers in now and a big picture is already emerging and I'm finding it truly fascinating. English and Finnish versions of the survey here :)

I had my suspicions on the progression and reasons for the apparent efficiency of the vaping habit and experience, based on my own experience I have been outlining a bit in this blog already. This is a very illuminating exercise and is intended to build upon my existing knowledge from the literature and user reports, focusing on an aspect that is very often overlooked in scientific discussions:
The experience itself as a social phenomenon.

Addiction has a weird status in the current society, it's a sort of "I'll know it when I see it" kind of thing and all the current attempts at defining it fail to adequately make any distinction between the supposed pathological patterns and simply just continuous behaviour. The former is included, but not necessary for the determination, which makes the whole exercise rather pointless.

I think a more comprehensive understanding of the behaviour is necessary, before the concept of addiction can be solidly defined, in a sense of determining what it's not. And this is what I am attempting to establish and solidify. Deeper understanding and knowledge.
Even if only for myself, though obviously I'm hoping I can make an impact past that as well.

But, for now.. As I obviously did not participate in they survey myself, I'll just give my answers here:

1. I smoked for around 17 years, with the last decade being a bit over 20 cigarettes a day.

2. What I would miss the most is the enjoyment I get from the experience, the sense of community, all the little fiddling with juices, coils and so on.. And being a part of something far greater than just e-cig advocacy. The emergence of vaping is not just a new technology and consumer product, it's a social phenomenon that highlights a lot of the failings of conventional wisdom around nicotine and addiction. I don't think I'd honestly stop doing research even if I'd quit vaping.

3. What got me vaping was a desire to decrease the distress caused by smoking while knowing it was harmful to not only in terms of health, but economical issues as well. Money did play a big part in the choice.

4. I continue vaping because of it's many benefits which I outlined above. Flavors are a integral part of that and the huge variety is something that keeps the novelty alive, the experience fresh and enjoyable.

5. I would like to thank everybody who is taking part in this quest of mine and hopefully you too will have realizations of new things along the way while thinking about these things. I love the community and the sheer enthusiasm that exists within vapers.

To be continued :)

Part 8: Some thoughts on morality, disease and addiction

Getting back to more personal views on the issues, I've been thinking a lot about the classifications surrounding vaping and nicotine use. It basically all starts with morality.

To me, the question of morality is very simple. A moral act is something that increases wellfare and well-being or decreases harm. A rather straight-forward risk-benefit analysis. I realize this is a somewhat nihilistic position on the concept, but to me it seems to be the only definition that really matters in a pragmatic sense.

Most importantly, this does preclude statements of immoral behaviour simply on the basis of what is and suggests that the consequences are the primary consideration, whether or not the net benefit of an action or behaviour is positive or negative. In a sense, it seems to me that being moral is the result of evolutionary processes that has led to us as a species being extremely social, the existence of empathy and acting on that impulse.

This is exemplified in the principle of harm reduction. What we should do is determined by evaluation if an action is likely to cause more harm or reduce it.

Ascribing meaning beyond these simple terms is usually an addition of personal bias, subjective views and the dilution of objective consideration. What matters, is well-being and welfare and not what some people might consider offensive or "unwanted", absent any considerations into evidence of actual harms and often at the expense of well-being and welfare of other people. The problem with most claims of morality in different ideologies is that the concepts are too varied, so things need to be boiled down to the core to have a coherent definition, so discussions about the same thing are even possible.

The problem with the concept of disease in the context of my interests, is that it gets muddled with inconsistent notions of morality. There seems to be a concentrated effort to redefine nicotine use to be a chronic disease, instead of voluntary exposure and behaviour. 

It's a sort of dehumanizing practice, treating the symptom instead of the person kind of thing, that is rightfully frowned upon in medical practice.

Defining use as a disease that needs treatment completely takes out major factors, choice and preference, leaving behind the notion that it's all involuntary and forced upon the "victims" by things like advertising, flavor options, even exposure to the mere sight of nicotine use which are all orchestrated by amorphous and malicious entities like "big tobacco" and the like.

I don't know why this happens, but often it does seem that there's a necessity to bypass personal freedoms and rights, in order to promote their preferred brand of "morality" under the guise of protecting the people. Seems to me like an illusion of grandeur. The pretense of power to know what is correct behaviour to other people, while ignoring that they are in fact people.

Addiction is the other side of this coin. It's a concept that instantly invokes concepts of compulsory actions, involuntary behaviour and inevitably results in the injection of a moral duty because the people are "unable" to stop. 

The huge issue though is that there is no coherent definition of addiction, much less "nicotine addiction" and thus the ability to even pretend to measure it is largely invalid. It suffers from the exact same problem morality does, it means different things to different people and most of them cannot agree with each other what it is, what to do about it and even if anything should be done about it. Unfortunately, it's a very complex phenomena, so making a simplistic statement about it is likely not going to be correct or useful, without including things that are not problematic. The conventional wisdom seems to be far too broad and leads to statements like "half the population is addicted". If such a systemic issue exists, surely we can at least pretend defining the term so we can discuss it?

For now, I can only leave this consideration hanging with questions that everybody should be asking themselves:

"Is the continued use of nicotine by somebody any of my concern to begin with?"

"What evidence is there to support my views, do I have a right to impose my views on others and above all, what are the predicted impacts of doing so?"

Translation: Finnish TPD implementation draft was updated

The TPD implementing legislation is currently going rounds with expert statements in various committees in Finland at the moment, their thoughts on whether or not things need to be changed should be out soonish. But in the mean time, here's what's on the table right now as far as national additions to the directive are concerned, all of which are derived from existing cigarette regulation and the asserted "need to regulate them in exactly the same way" (which ofcourse fails spectacularly due to TPD itself):

- Only allowed flavor in liquids (nic and non-nic) is tobacco. Specifically the ban on "characterizing flavors" was extended to electronic cigarettes. This is based on the assertion that the measure would reduce appeal among youth, but still leave the products available for adults who choose to use them.
This has also led to opponents arguing that "but we are not criminalizing ecigs!".

- Ban on cross-border and distance sales to consumers, including domestic sales. Justification stated is that internet-based market cannot be adequately overseen, particularly when it comes to checking age.

- A shop employee must be present at all times at a sales event and must be able to keep an eye on the products at all times. Also only 18+ can sell any products under the tobacco legislation.

- Age limit 18 years for buying and possession of electronic cigarettes and nicotine liquids. Also illegal to give under-aged persons electronic cigarettes or nicotine liquids.

- Ban on usage anywhere smoking is prohibited (more or less anywhere indoors that's not a home and outdoor events if there are stationary bystanders), this includes vape shops. The law also includes provisions for housing companies to ban usage on balconies, without requiring evidence of harm to health of bystanders. The only exception is that vaping cannot be banned inside apartments.

- Import limit of 10ml nicotine liquids for products that do not have warning labels in finnish and swedish. This is a straight implementation of the restriction on cigarettes. They justify the amount by asserting that 200mg maximum content is equal to maximum nicotine yield of 200 cigarettes. This, of course, is a nonsensical and absurd calculation. The original restriction of 200 cigarettes is in place to control the prevalence of imported products so finnish and swedish warning labels stay atleast at a constant level.

- Sales require a permit. Oversight fee for each point of sale 500 euros per year. The permit is the same as for cigarette sales, but the fee is separate for each.

- Point of sale display ban on products. Customers can be shown a printed catalog if they request it, that includes a picture of the products and their prices (not known at this point if it can include anything else). The catalog must be hidden otherwise.

EDIT 22.03.: An amendment was just proposed, that would ban smoking in a private vehicle when a 15 year old or younger was present. It was reasonably well argued and does make sense, although unenforceable for the most part. But, the legislation draft includes a statement on electronic cigarette emissions, extending ANY ban enacted on smoking to apply to vaping as well. So, basically vaping in a car when a child is preset would also be banned, on the basis of the hazards of cigarette smoke without ever specifically mentioning vaping. Whether or not such a ban is a good idea is certainly a legitimate discussion, but it should definitely be done so on it's own merits.

Reverse quote mining, or just random thoughts.

A rather major issue in communicating matters of science is the sentiment "that is not only not right, it is not even wrong". To be specific, it's an issue of lacking falsifiability. What this means is that for any scientific hypothesis to be worthy of any consideration, it has to be presented in a way that can be tested and includes the possibility of being shown to be wrong.
Or to put it simply, a claim can only be shown to be right if there is a way to show it is not.

Usually this issue only happens in metaphysical matters, where falsifiability is not possible by definition, but unfortunately it seems to be creeping into discussions that seem scientific on the surface. Here though, an additional layer of masquerading as science usually blurs the fallacy, by leaving out rather important bits.
Consider the following:

"Electronic cigarettes may be a gateway to tobacco use"

What does gateway even mean? Is it defined in a way that can be tested and shown wrong?
Most of the time it really cannot. The vast majority of comments including a proposed gateway-effect only mentions it's existence, without any sort of justification why it might exist, what mechanisms it contains and what would be a reasonable test to see if such an effect even exists in the first place. The comment is more or less worthless, has no real substance to consider or be concerned about. It is a legitimate question, but only in the context of actually trying to define what it means and how it might happen.
(more on this here, it's a rather complicated subject)

Then, what about this:

"Electronic cigarettes have formaldehyde in them"

Formaldehyde is infamous for being an embalming agent and a carsinogen, so this evokes fear and doubt about the safety of vaping.. But is it even wrong? Sure, it's technically falsifiable.. But the existence of anything is meaningless without comparisons.
Human breath also has formaldehyde, but that doesn't exactly tell us anything relevant. Is the amount of the substance enough to be a part of any meaningful discussion? Is there an actual hypothesis hiding in that statement? Do we gain any real information from that statement?
So let me fix it:

"Electronic cigarettes have formaldehyde in them, but mostly in amounts that are unlikely to cause any concern to users and even less to bystanders"

And now we get something that has something relevant that can be tested, analyzed and shown to be wrong. And most importantly, can actually tell us something that IS useful information.

And a bit of analytical brilliance from my beloved country, Finland (though I don't think level of absurdity can be really fixed without abolishing the limit):

"The import limit of 10ml is based on the fact that it contains a maximum of 200mg of nicotine, which is the same amount of nicotine a person gets from 200 cigarettes when smoking them"

This is about as vacuous as one can get. Comparing the nicotine content of e-liquid to nicotine yield of cigarettes and pretending that this is somehow a reasonable calculation to base restrictions on.

"Electronic cigarettes are harmless"

No, they are not. No such thing exists. In pragmatic terms, they are practically mostly harmless as far as we know, but stating that absolutely is very much absurd as it's impossible. And this gets (rightly) used against us. So:

"Electronic cigarettes are not likely to have risks on any meaningful level, which makes them harmless enough to be reasonably safe"

Unfortunately the discourse is full of these kinds of things, on both sides sometimes even.
I really wish at least the pro-vaping side would start also being pro-science as a whole.

Don't play their game. We will lose that one.

Part 7: Thoughts on the logic of dissenting opinions

"It has toxic substances in it"

"We don't know what the long term effects are"

"There is already a decline, so they are not needed"

"They contain formaldehyde"

"They contain antifreeze"

"They are not 100% safe"

"They can cause harm"

"They exist to earn more money to the industry"

And so on. Sound familiar, right?
Obviously these comments are made about vaping, right?
This is the stuff that gets thrown at vaping advocates on a daily basis more or less, so it's obvious what they are talking about, right?

You'd be wrong. These come from the anti-vaccination crowd.
The undercurrent of anti-science that is going on right now is seeping into a lot of areas right now and it seems clear to me that the vehement opposition to electronic cigarettes is an unfortunate symptom of that sort of mindset. Although, it is not clear why certain people manage to endorse electronic cigarettes and still oppose vaccines, as these are essentially different manifestations of the same philosophy that is also the basis for the medical profession and promotion of health in general, harm reduction.

Harm reduction is thought of as a sort of ideology, but the practices and ideas embedded in it are not something novel or new. They have much further reach than that. The basis for promoting HR is quite simply the fact that risk-benefit analysis is an essential part of modern societies, since everything inherently has some level of risk. There is always a consideration of "is this likely to be a net benefit, or in other words are the rewards worth the risk" and a way to reduce those risks while retaining the benefits. This includes things like bicycle helmets, seat belts, condoms, needle exchanges and obviously I think also electronic cigarettes.

While the role of ecigs is very much under disagreement, the basic science is rather clear and sound. Smoke is something societies strive to get rid of by introducing better alternatives, across the board, just not in nicotine use. This is because the health effects of combustion are rather well known and switching to non-combustion options is likely to be a real net benefit, but somehow this doesn't seem to register with the anti-vaping crowd.

This leads me to wonder, why is that?
Well, it seems there's a train of thought behind it that is reminiscent of some arguments I mentioned in my last blog post. Specifically considering this issue, they could be formatted something like this (and PLEASE, do correct me if these are way off base):

1. Nicotine in cigarettes is highly addictive

2. Electronic cigarettes have nicotine

3. Therefore electronic cigarettes are highly addictive

and

1. Exposure to nicotine from cigarettes leads to smoking

2. Electronic cigarettes have nicotine

3. Therefore electronic cigarettes lead to smoking

and

1. Cigarettes are designed to make nicotine use as highly addictive as possible

2. Electronic cigarettes are designed and have nicotine

3. Therefore electronic cigarettes are designed to be as highly addictive as possible

Now, I'm not aware of anybody who would say these things outright.. But the first one is something very clearly implied in the discourse globally. The second one seems to be a basis for the insistence of gateways. The latter is implied in the accusations of tobacco industry involvement, in the sense that "we can't trust these things".

If you state them out loud though, do they make sense? Are the assumptions of equivocation required plausible?

Do the anti vaccination arguments make sense if you consider the science?

To me, these seem like very classic type 1 observational errors, or false positives. In this sort of case the two razors should likely be at the forefront of thinking:
"Among competing hypotheses, the one with the fewest assumptions should be selected"
"That which can be asserted without evidence, can be dismissed without evidence"

Ultimately, does rational opposition to electronic cigarettes even exist at all?

Part 6: The children, sort of.

The new tobacco law draft was presented to our national parliament yesterday, including some discussion with very outlandish claims and assumptions.

 - "It's not vapor, it consists of 10-300 nanometer size solid particles"

Which has to be, by far, one of the most absurd claims I have ever seen in the discourse. And the fact that it came from the vice chairperson of the social and health affairs committee that's going to handle the finalized details of the law just makes it so much worse. But.. she didn't stop there.

- "It's clear that the tobacco industry does not want electronic cigarettes under medical regulations, because they would not get on the market in any country"

Except, that's not.. really.. true.
It's well established that's clearly not the case, since BAT already has a product that is approved and it seems that would be the easiest way for tobacco companies to avoid the restrictive tobacco regulation. I'm starting to be seriously worried about the future of health policy here, because if this kind of person is on the committee, there's no way legislation is based on sound science or even factual information.

She drops "tobacco industry" into the discussion regularly and eventually goes on to claim that because it's a nicotine product, it's also a tobacco industry product and their aim is to produce lifetime addiction. The obvious implication, although not explicitly stated, is that electronic cigarettes are a bad thing by default and should be restricted simply because they are made by the "tobacco industry".

As a whole, the discourse is centered on children. Claims of "well, we are not criminalizing these products, only restricting the flavor options to tobacco so that they are not appealing to children, so adults can still choose to use them if they want to do so" go around.

The reasoning behind forcing electronic cigarettes under the identical regulation as regular cigarettes (although in reality, ecigs have much more stringent restrictions due to TPD) is nicotine, specifically gateways and a "new generation of nicotine addicts". So, I started digging on that gateway issue as presented here and it seems it's based on some very glantzian logic:

- A person starts with an electronic cigarettte, learning "how to smoke"
- (remember, only flavor would be tobacco. I can't reconcile how that is a logical way to reduce this "learning" that supposedly happens)
- When the person feels like they are not getting enough nicotine from vaping, they move on to conventional cigarettes

Which has to be a non sequitor on a level only things like discussions on deities achieve, namely cosmological and teleological arguments. The fact is, this discourse really does remind me of religions. Science and logic are used as a smokescreen to lend credibility to hollow arguments with no real substance. I think the resemblance is really striking:

- Because X causes Y, Z also causes Y
and
- Because Y is caused by X, Z also causes Y

Insert terms relevant to the discussion at hand. The assumption, although again technically unstated, is that electronic cigarettes and smoking cause the exact same level of dependence and addiction. And that because cigarettes are designed to cause maximum amounts of addiction (though not entirely sure if many of these people actually realize this), surely electronic cigarettes are as well.

Obviously these things start to break apart when actual science is considered, namely the fact that it's absolutely untenable to claim tobacco addiction and nicotine dependence are in any way the same thing and that smoking is somehow "better" as a method of nicotine delivery.
Cigarettes do deliver the dose more quickly and efficiently, being designed that way. But it is far less enjoyable in other respects in my opinion, making it's benefits noticeably inferior.
But the fact is that a vaper never needs to turn to smoking to get more nicotine, since they can just use a stronger liquid and enchance their existing behavior instead of taking on another.

The reality is that vaping or smoking is just not something you can reduce to simply being a nicotine delivery method, although many "health" officials seem to think that's somehow justified.
This is both why NRT exists and why it's not very effective.

Sometimes I'm really at a loss, how does one explain the major difference between these products to people who don't understand the mechanics, have any experience in the behavior and have already decided a stance based on nothing more than their personal prejudices.
Incidentally, she claimed that there's only one meta-analysis on the issue of smoking cessation with ecigs and that showed they are less effective than "real" smoking cessation methods.

In short, the discussion is not just reminiscent of religion.. It's more or less exactly the same problem, forcing personal fallacies and fantasies into public policy.