By Clark Miller

Published August 23, 2018

Updated April 6, 2021

Like Suboxone for the opioid crisis, promotion of e-cigarettes to address tobacco use as “harm reduction” has been supported by establishment Medicine citing signs of decreased rates of both tobacco and e-cigarette use by youth, but more recent data point instead to worsening effects: booming rates of vaping by kids, increasing their risk of smoking tobacco, and through the known action of nicotine helping to fuel a diabetes epidemic.

In the failure to provide medical treatments with benefit, or identification of medical causes, or progress against a substance use epidemic despite decades and hundreds of billions in research dollars and public funding dedicated to “addiction medicine” and the invalidated medical model of addiction, the medical industry protects control of resources and appearance of legitimacy by promoting “harm reduction” strategies – those approaches  having the appearance  and  branding of medical or medication fixes for the medically-generated epidemics. Look, we’re fixing this with medications, or with drugs to replace the more dangerous ones.

It’s not working, in case we haven’t noticed.

Suboxone and Medication-Assisted Treatment (MAT) for the opioid crisis, for example, are seemingly universally embraced by the medical healthcare industry and popular media as the fix for the crisis. It goes without saying (that is, without the protective scrutiny of critical examination) that MAT is an  established as effective medical fix for the medically-generated opioid crisis. The research however, critically examined, does not support effectiveness of MAT as currently implemented if at all, recent studies pointing to overall treatment failure and with continuing drug abuse in MAT programs.

Endorsement of the FDA plan in JAMA cited a small downward shift in vaping by youth over just one year- 2016. But as described in new reports . . .  more recent data point to booming use of e-cigarettes among youth, that use increasing likelihood of young people starting to smoke (tobacco) cigarettes. 

What about Nicotine Replacement Therapy (NRT)

and prescribed medications to quit smoking?  This – they don’t have significant benefit for smoking cessation, may likely be worsening the problem, more about that later. But they work well for keeping patients coming back for medical visits, creating the appearance of legitimacy and control in the area of problem substance use for an industry that created the opioid crisis. Those expensive medical visits unfortunately provide no benefit because NRT is not supported by research(1-4) as providing significant benefit for tobacco cessation.

Effects for positive outcomes with NRT have always been small, e.g. “Number Needed to Treat” NNT to achieve one positive outcome = 29 = 97% failure rate:


Newer research including meta-analysis point to no tobacco cessation benefit (no difference in cessation rates compared to no treatment) from NRT:




5. Herd, N., Borland, R. and Hyland, A. (2009), Predictors of smoking relapse by duration of abstinence: findings from the International Tobacco Control (ITC) Four Country Survey. Addiction, 104: 2088–2099

The large, naturalistic (realistic, data coming from natural community settings) survey by Herd, Borland and Hyland (5) adds to evidence that urges per se to use substances, specifically tobacco, do not predict return to problem use (“relapse”), instead other factors, notably decreased self-efficacy – a person’s belief that she is effective in making important changes by her own choices and actions. Self-efficacy is inversely related to belief in the invalidated disease model of addiction, instilled in patients by the medical industry and addiction treatment programs. That falsified model, internalized by trusting and vulnerable patients, predicts disinvestment in personal efforts and changes – what’s the point of making big changes when my problem is a “chronic disease of the brain”? – and is a key predictor of relapse. The incorrect and invalidated effectiveness of medications and NRT for tobacco cessation is based on the assumption that urges drive relapse.

Two strikes so far against medical fixes for problems – compulsive behaviors driven by inner distress – that are entirely non-medical, those failed approaches predictable, like the opioid crisis.

Girls walking and vaping

Now we have endorsement by medical public health authorities in the nation’s premier medical journal

of a Food and Drug Administration (FDA) plan to address the half million annual deaths and additional costs due to smoking by encouraging use of e-cigarettes, or “vaping” – delivery of addictive nicotine in cigarette-like devices, with the nicotine but not tobacco, reducing risk of illness and death due to the combustion products of tobacco.

Endorsement of the FDA plan in the Journal of the American Medical Association (JAMA) cited a small downward shift in vaping by youth over just one year- 2016. But as described in new reports in the online news source Vox, more recent data point to booming use of e-cigarettes among youth, that use increasing likelihood of young people starting to smoke (tobacco) cigarettes.  Additional takeaways from the 2018 report on e-cigarette use by the National Academies of Sciences, Engineering, and Medicine include:


long term health effects are not known

the evidence is not clear as to whether use of e-cigarettes actually reduces tobacco use

use of e-cigarettes may or may not decrease prevalence of tobacco use among adults – leaving the question of effectiveness and wisdom of the e-cigarette harm reduction strategy unanswered.

young woman smoking a cigarette

Remarkably, the esteemed Academies and Medical Industry reviews and recommendations along with media analyses of results, policy, and implications for public health have not yet addressed the concurrent public health epidemics directly impacted by proposed use of an FDA vaping promotion campaign – childhood obesity epidemic and childhood and adult diabetes epidemic fueled partly by nicotine use.

The missing, potentially lethal, epidemic links – missing from the scientific reviews, medical industry recommendations, and media accounts – are the:

1) direct effects of nicotine on risk of onset of type 2 diabetes and worsening of diabetes,

2) normalization and  worsening (increase) of nicotine use in youth and adults by trends in e-cigarette use, encouraged by harm-reduction strategies, and

3) the diabetes public health epidemic described as posing the greatest risk to public health , looming and fueled by increased latent risk from a childhood obesity epidemic.

A meta-analysis found that current smokers had a 45% increased risk of developing diabetes compared with nonsmokers.”

Nicotine, acknowledged as the major pharmacologically active chemical in tobacco, is responsible for the association between cigarette smoking and development of diabetes.”

That’s not good.

Strike three. But no worries, for their side the batter’s never out.

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.

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