By Clark Miller

Published February 20, 2020

Updated April 15, 2021

When the American Medical Association in its leading journal JAMA endorsed the “innovative” plan by the Food and Drug Administration to promote vaping as a form of harm reduction, there was no more than preliminary evidence by which to evaluate safety and public health outcomes. The plan and endorsement were generated without critical thought and analysis of the most relevant factors: the psychology and behavior of compulsive substance use. Instead, the institutional-media branding and promotion as harm reduction were driven by concrete, reductionist thinking that focused on the claim of overall reduced risks of harms to health due to avoidance of the combustion products of tobacco in smoking versus vaping.
That promotion of vaping by America’s mass media and healthcare collusion hasn’t worked out well.


Just like cigarettes and vape devices, the new, sleek Iqos devices deliver the addictive substance nicotine to users, in the case of vaping, often at higher levels than in cigarettes.

And just as with vape devices, Iqos is designed and marketed to target the psychological vulnerability that represents need for novelty, joining a social trend, possession and use of products to signal and identify users as having esteemed social attributes and status. That is, it’s new and cool and signals adult behavior = irresistible to youth.


From the CNN BUSINESS piece:

The timing couldn’t be better for the new nicotine product, as scrutiny grows around smokeless alternatives like e-cigarettes.

Iqos is a futuristic-looking device that looks like an e-cigarette. But don’t call it a vape. It heats tobacco sticks at a much lower temperature compared to a cigarette and delivers a “full and more authentic taste,” according to its website, without as many toxins. It also requires a charge after several uses.Iqos has been on sale in 49 countries since 2014, and now its opening its first US location in an Atlanta area mall on Friday. Altria (MO) said it plans to expand sales of the “heatsticks” to other retailers like Circle K and Speedways.

Customers will have to buy the Iqos device at its stores to ensure sales are limited to people over 18 years old. It plans to “expand expeditiously” with stores, an Altria spokesperson told CNN Business. The company is using Atlanta as a testing ground on how to grow elsewhere in the United States.

. . .

The opening follows the Food and Drug Administration’s approval of Iqos in April. The agency allowed the Iqos to go on sale because it produces “fewer or lower levels of some toxins than combustible cigarettes.” Regulators also “placed stringent marketing restrictions” on the product, including FDA approval of its ads.


Yahoo Finance and Fox Business News don’t want to be left out of introducing the important trend to a public already primed to believe that vaping is less harmful than smoking and provides benefit for stopping use of cigarettes.




From the Yahoo piece:

“With innovative UVT (Ultrasonic Vaping Technology) applied to their products, the ultrasonic vaping seems an alternative method of nicotine delivery, while avoiding most of the toxic emission from heating.”


What could possibly go wrong?

Just the predictable:

Vaping was called safe and effective for cessation of tobacco smoking, endorsed as “innovative” in the nation’s top medical journal. What happened?

Let’s review.

Late in 2017 the nation’s top medical journal – Journal of the American Medical Association, JAMA – featured endorsement of an “innovative” plan by the U.S. Food and Drug Administration (FDA) for use of electronic cigarettes, “vaping”, to substitute for that of tobacco cigarettes as a form of medical harm reduction. The message was clear and came from one of the America’s most trusted and authoritative medical institutions: vaping is a much safer alternative to smoking. That message targeted, through mass media dissemination, a vulnerable and trusting public trapped in arguably this culture’s most costly and lethal compulsive substance use problem, the annual half-million deaths due to tobacco use eclipsing those related to alcohol, opioids, and other street drugs combined.

The message would also have been taken as authoritative by America’s medical professionals,

who encounter smokers routinely in primary care and other settings and advise them on interventions to help stop smoking.

Institutions including top medical journals, medical regulatory agencies, and media have powerful influence on American medical practice, their cultural fabrication of a new medical gold standard  for treatment of chronic pain, for example, substituted for clinical and ethical judgment and responsibility and resulted in runaway, medically inappropriate dispensing of Schedule II opioids for the established non-medical condition of common chronic pain generating a lethal public opioid crisis. But that’s another story.

That JAMA-endorsed medical harm reduction flipped within months, predictably,  to a child nicotine abuse and dependence problem, now widely recognized as another public health epidemic.

The public disinformation campaign worked, providing for booming sales and use of vape products. Worked, that is, apart from the worsening child nicotine dependence epidemic.

And apart from the emerging adult vaping illness epidemic.

But it’s not just advertising at work, when e-cigarette use is endorsed as an innovative harm reduction approach in the nation’s leading medical journal, and the same journal endorses a research report – disseminated to American medical practitioners – with claims that vaping is an effective method for stopping cigarette use, repeated in authoritative media outlets.

As reported in JAMA and published in another leading medical research journal, the New England Journal of Medicine (NEJM) the landmark study, a “seminal study” according to medical authorities, establishes that vaping of nicotine is effective for stopping use of tobacco by smoking, affirming vaping as a new medical gold standard for smoking cessation. It’s even more effective than nicotine replacement treatment (NRT), based on critical evaluation of the research study by medical professionals, leading authorities, and major mass media. (Coincidentally, NEJM is the top medical research journal that published another seminal study not long ago – the study establishing that Schedule II opioids were safe and effective to use for all pain, including chronic pain.)

What happened?

It’s just that – the study in question establishing vaping as a new medical gold standard actually provides no evidence at all of benefit for smoking cessation from either NRT or e-cigarette use, instead points to no benefit. And it turns out that the demonstrably false, unvalidated claims of benefit (of about 10 percent and 20 percent cessation success rates for NRT and vaping, respectively), were based on errors in experimental design and interpretation of the most elementary and demonstrable types.

And now – to add to opioid, alcohol, and other substance use epidemics, and to youth obesity and diabetes epidemics – a youth vaping epidemic with poor prognosis.

And an American Mass Media-Public Health collusion promoting a new nicotine delivery device while that epidemic worsens.

And the same Media-Medical collusion keeping public attention focused on headline-worthy distractions – the rare instances of acute, lethal lung disease, prior to that, of exploding vape devices, meanwhile –


Mounting and alarming evidence  links trends, risks and harm:

Inhalation of nicotine by vaping is booming among young people

Driven by popularity of shrewdly advertised, designed, and marketed devices to deliver nicotine

In concentrations comparable to or higher than delivered in cigarettes

As often preferred by users

The retained dependence on nicotine driving compulsive, durable use of delivery devices

Without convincing evidence of benefit as cessation aid for use of cigarettes

Instead evidence of “gateway” effect, or prediction of initiation of cigarette use

Including new evidence of reversal of years of declining cigarette use among youth with cigarette smoking now trending up in the U.S., Canada, and France

The presumed net benefit of vaping substituted for cigarette use not established, with long-term population effects of increased prevalence of nicotine dependence unknown

And alarming in the context of known health risks of nicotine regardless of delivery system, including contribution to incidence of type 2 diabetes, increasing in youth

Girl vaping

The significance and potential public health threat

of these trends, which may include nicotine use by youth increasingly by mutually reinforcing routes of administration – vaping and return to cigarette smoking – is heightened by concurrent increases in incidence of type 2 diabetes and a primary risk factor for its onset, obesity.

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 vaping “harm reduction” promotion campaigns – 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.”

In that context, new warnings about diabetes risk for kids

That confluence of risk factors potentially contributing to a latent epidemic of type 2 diabetes in youth comes with new warnings about the severity of T2DM in children and their vulnerability:

“Research has indicated type 2 diabetes appears to be more aggressive in youth than in adults, with a faster rate of deterioration of β-cell function and poorer response to glucose-lowering medications,” said lead author Silva Arslanian, MD, Scientific Director and Principal Investigator of the Center for Pediatric Research in Obesity and Metabolism, UPMC Children’s Hospital of Pittsburgh, and the Richard L. Day Endowed Professor of Pediatrics at the University of Pittsburgh School of Medicine. “Furthermore, there is a higher risk for complications in people with earlier-onset type 2 diabetes, which is possibly related to prolonged lifetime exposure to hyperglycemia and other atherogenic risk factors, including insulin resistance, dyslipidemia, hypertension, and chronic inflammation. Thus, we must continue to make strides in recognizing the specific needs of youth and adolescents who are at-risk or diagnosed with type 2 diabetes.”


Compulsive use of nicotine, like that of any other mood-altering substance including food, is a behavioral health, not medical, condition with indicated, evidence-based treatments established by longstanding bodies of evidence for psychotherapies and related psychosocial supports and prevention strategies guided by ACE-informed, developmental and psychosocial understanding of risk factors and inner and environmental stressors driving the compulsive behaviors.

It may be time to consider allocation of healthcare system focus and public healthcare funds to evidence-based therapies and strategies rather than diverted to additional medical industry fixes for a non-medical condition. 

teenaged boy vaping

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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