Friday, 30 May 2014

E-cigarette regulations in Norway: A status update

Will we see vape-shops like this in Norway soon?
Even though Norway is not part of the EU, most EU directives are implemented here as we are part of the EEA. The TPD is no exception and unless the Norwegian Government decides to apply for an exception (which is very unlikely) the TPD will be implemented here as well during 2016.

However, until then several member states are working on their own regulations that might be implemented before the TPD. In Wales they are talking about banning e-cigarettes in public, there are debates on regulating advertising in the UK and Spain has already implemented a ban on use in public places with devastating effects:

Apparently governments see the need for making their own regulations prior to the TPD. The reasons for this might be that they want regulations in place earlier, maybe to ensure control of the market and the money involved at an earlier point, but the TPD also leaves a lot up to the member states so some of these regulations can co-exist with the TPD when this is implemented. For example the TPD allows member states to decide that they want to regulate e-cigarettes as medicines, something that was pointed out by a Norwegian health official in a recent TV-debate on the subject. Some governments might also expect changes to the TPD and are not sure how it will affect them in the end, as the war is by no means over yet. The EU even states that they will monitor the development and that changes might occur. As more and more evidence is stacking up and scientist are engaging in the battle, putting their careers at risk criticizing the WHO's stance on e-cigarettes for being counter-productive and undermining public health (read the Asthray blogs post on the matter:, who knows where this will end? And economic crisis and general scepticism towards the EU might even have left some members unsure of the future of the EU.

So what about Norway? What is happening here? I asked Research Director Karl Erik Lund what the Norwegian government is doing about it right now. The Ministry of Health and Care Services has now asked underlying agencies for reports on the matter:
  • The Norwegian Institute of Public Health will assess the potential harm from e-cigarettes.
  • The Norwegian Medicines Agency will look at whether electronic cigarettes can be considered to be medicinal products.
  • The Norwegian Directorate of Health has been asked to come up with possible regulation models and has in turn asked SIRUS (The institute for Alcohol and Drug research) for assistance.
These reports will be submitted before the end of this year. Lund says it is difficult to say whether the government will implement it's own politics before 2016 or not. "They are just as concerned with figuring out what limits they have to maneuver within under the EU directive, as they are with creating their own politics in the area", says Lund.

I'm happy to see that SIRUS is asked for assistance concerning the regulation models, as in my opinion they are very focused on harm reduction. Karl Erik Lund was also one of the 52 signatories that just wrote a letter to the WHO asking them to start consider harm reduction alternatives (such as e-cigarettes) as a solution, not part of the problem:

Lund says it will be interesting to see what perspective the Institute of Public Health will chose to use when assessing potential harm. Lund mentions three different potential perspectives:
Traditionally the government has used a bio-chemical reductionist perspective regarding snus and e-cigarettes, meaning they look at chemical contents, acute physiological effects and potential long term physiological effects. If they then find any reason to believe that the e-cigarettes are not totally risk free they can use that to defend a restrictive policy based on the non-harm principle (we should not facilitate something that has potential harm), precautionary principle or loss-of-autonomy principle (risk of nicotine addiction).
Alternatively they can choose a comparative perspective where the harm potential is compared to the harm of cigarettes. Because the two products have the same consumer groups one could defend such perspective. However the Ministry of Health has explicitly stated that the harm potential from cigarettes should not be used as comparison when assessing the harm potential from SNUS (Swedish smokeless tobacco). We might expect the same for e-cigarettes? This will amputate the institutes risk assessment.
The third perspective is the public health perspective that looks both the risk differences between cigarettes and e-cigarettes and at the relative recruitment and use among smokers and non-smokers. For SNUS it is obvious that easy access to the product has led to a net gain in public health, but this is a fact that is difficult to admit for the government. The tobacco-hostile norm climate makes rational approaches difficult.
Although I think it is a positive think that SIRUS has been asked to assist in the work on regulation models I do feel they should be listened to when it comes to the harm potential assessments as well. I fear that the Institute of Public Health will choose the first perspective when doing the assessment, and that they will come up with something that shows some kind of potential harm, or at least something that says we can't rule it out. And traditionally they love the precautionary principle, something that in this case could prove a danger to public health. I think 2014 will be a year where we will see a lot more debates on the topic, and most people here are now aware of e-cigarettes, and will start making up their opinions on them if they don't have them already. Hopefully more and more scientists will speak up and may manage to get some positive media coverage. I guess we have to expect some negative media coverage as well, so I hope the good work of SIRUS and the Norwegian vaping community in commenting and ripping these stories apart will continue. But, as I have stated over and over again, the vapers stories will be crucial to how the general public's views on the matter. A lot of vapers are doing a great job already, and hopefully more will join. Let's try to make 2014 the year everyone was talking about vaping.

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Wednesday, 21 May 2014

Switching from cigarettes to e-cigarettes puts you at less risk from MRSA

After Laura E. Crotty Alexander and her team released a study on how e-cigarette vapour affects MRSA ( on the 18th of May ( the media has been throwing headlines at us that makes it look like e-cigarettes will cause these bacteria to mutate and take over the world. Not very surprising looking at how Crotty Alexander presents her research herself:
Vapour from e-cigarettes makes MRSA bacteria more aggressive
Doesn't look good now does it? The media of course, eager to attract readers by reporting another scandal, makes this even worse. Just have a look at this headline from the Daily Mail:
Are e-cigarette smokers at risk from superbugs? Vapour helps deadly bacteria to thrive, say scientists
First of all there is no such thing as an "e-cigarette smoker". It's just no smoke involved, so stop it! To make it even worse, they add this in the sub-header:
"However new study shows users are more at risk from superbugs"
Looks like we're dead then. Keep vaping and you'll get eaten alive by MRSA, right? NO! Cause there is something missing from the statement in that sub-header. They should have added this: "compared to non-smokers." Because this is what the scientists actually found: E-cigarette vapour makes the bacteria more aggressive, and the human defence system less effective, but smoking cigarettes will have the same effect... only 10 times stronger. So a more reasonable headline would have been something like this:
Are e-cigarettes the solution to fighting MRSA in smokers? Smoke makes bacteria 10 times more aggressive than vapour, say scientists.
You see it all comes down to what perspective you view the data from, and which parts you choose to promote. If you're against e-cigarettes, and like the nicotine gum and patches better, it's pretty obvious that you can present this data to make e-cigarettes look bad. It's all about which findings you focus on and which ones you tone down. The fact that cigarettes are far worse in this matter is just mentioned at the end of the Daily Mail article: "However, the study also failed to give real cigarettes a clean bill of health. In fact, they were found to fuel MRSA even more than the electronic versions." They even fail to mention the magnitude of the whole thing.

Another thing they fail to mention, and that Crotty Alexander just barely mentions herself, is this: "We have not yet pinpointed the components of e-cigarette vapour that trigger these effects, but preliminary findings suggest that the nicotine in e-juice (the liquid used in e-cigarettes that is vapourised and inhaled) is a significant contributor." This would mean that not only cigarettes and e-cigarettes would make MRSA worse, but also nicotine patches and gum... and even tomatoes and eggplant might have an effect. Why don't Crotty Alexander give her lab-mice some nicotine gum instead of letting them breath in e-cigarette vapour if she suspects nicotine is the problem?

The fact that Crotty Alexander, despite the results she has published here, still won't recommend e-cigarettes for her asthma-patients is beyond me. It really makes me wonder if the disclosure statement printed below her author info on is even remotely true. We've seen studies lately ( kicking the gateway argument out the window and that makes the really important truth discovered in her research this:  
Switching from cigarettes to e-cigarettes puts you at less risk from MRSA.

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Friday, 16 May 2014

Alexis Petridis tells his vaping story

The stories that vaping ex-smokers tell are the best proof there is that vaping works. And these stories saves lives by making more and more smokers able to do the switch. The most effective stories are the ones shared between people who know, love and trust each other, stories told by friends and family. But stories told in public by journalists, celebrities and politicians are also effective in making people aware of the benefits of switching. I really enjoyed reading music journalist Alexis Petridis' (the Guardian) story:

He reflects around some really important questions in his story, the most important one being why he started smoking. Alexis says he started because it was cool, or actually because he thought he'd look as cool as his idols with a cigarette in hand. I'm guessing I'm not the only one who can recognize myself if this. Smoking has an aura of cool surrounding it, says Alexis, and he also gives the gateway argument some proper kicks in the nuts:
Even so, the life of the vaper isn't without minor privations. If the argument that e-cigarettes will ultimately lure kids into smoking seems specious, I suspect that's largely because the one thing that smoking an e-cigarette definitely doesn't do is make you look good. Quite the opposite: whatever the health benefits, it feels faintly pathetic whipping out an e-cigarette when the people around you are smoking the real thing, like turning up at the Giro d'Italia on a bike with stabilisers.
Love that Giro d'Italia analogy. And I like how he points out how horrible a cigarette tastes after you've been vaping for a while. This is why only never-smokers clings to the gateway argument. To a vaper who has successfully quit smoking completely, it's just ridiculous.

As I said, I really enjoyed reading Alexis' story, but it also made me think that some vapers have to think twice before going public with their story. I'm thinking about stars and celebrities. Their stories have the potential to influence a lot of people if published. These people have to remember that they are the idols of thousands, in some cases maybe millions of teens. If told in the right way they could possibly help a lot of smokers make the switch, but told wrongly, without making it very clear that this is not a habit you should pick up if you're not already a smoker, they can easily recruit non-smoking teenagers as well. I'm not pointing fingers here, in fact I've not seen any examples of such stories coming out in the wrong way, it was just a thought. And a reminder to any teen idol that reads my blog :) Actually, when I think about it, it might be a good reminder to all of us, especially parents, cause even though you're not on TV your story might influence your kids (or their friends) so make sure they get the correct version. You might be someones idol without even knowing it.

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Monday, 12 May 2014

E-juice review: Vapourlites Blueberry, Vanilla Pod and Strawberry

A little while ago Vapourlites contacted me and asked if I wanted to review some of their new E-liquids, and I agreed to sharing my honest opinion on these. They sent me 3 flavours free of charge for the purpose of this review. (I am not affiliated with Vapourlites in any other way).

Vapourlites Pharma + E-liquids are produced by Vapourlabs (, and they've opted for 80/20 PG/VG. They have a strong focus on safety, all e-liquid are delivered in child safe 10 ml bottles, with a proper list of ingredients and warnings. They make a point out of the fact that their liquid is manufactured in their UK laboratories using the best ingredients including pharmaceutical grade nicotine.

All juices were 18mg/ml nicotine.

Tested on: Hellfire Hybrid
Opening the bottle the smell of this one is pretty good. As expected from an 80/20 liquid the throat hit was good as well. When it comes to flavour it's pretty good and pretty strong as well. There's a good deal of sweetness added, and I think that makes me feel it tastes a bit artificial. More like blueberry candy than pure blueberry. I haven't got too much to compare with when it comes to blueberry, as the only other one I've tried is Scopes, which is a much more complex juice that could just as well have been called blueberry-cinnamon-muffin or something like that. Vapourlites I'd say is more blueberry candy, which probably would hit the spot for quite a lot of people, but personally I like it more natural and I think it could be more balanced when it comes to sweetness.

Vanilla Pod
Tested on: Hellfire Mega
Good throat hit and decent vapour production. A pretty good vanilla flavour but I also get the feeling the sweetness could be balanced a bit better on this one as well. But then again, for some reason I tend to get quickly bored by vanilla e-liquid. I do love vanilla ice cream, vanilla custard and vanilla syrup in my coffee but as an e-liquid it doesn't really work for me, at least not as an all day vape. Vanilla custard on the other hand could easily be, don't really know why. Taste is personal I guess :)

Tested on: Hellfire Mega
This on kind of takes me back to my childhood as the taste reminds me of a strawberry milkshake they used to sell here in Norway like 20 years ago. To me this was the best of the 3, and although this one is also pretty sweet I think it suits the flavour better. It still has kind of a candy feeling about it, but there is still a distinct strawberry taste, which is a good thing. And even though it does have that candy feeling it still doesn't feel that artificial.

To sum up
The juices vapourlites sent me are by no means bad juices. Actually they are pretty good, and I wouldn't mind recommending them to someone looking for reasonably priced, safe e-liquid. I've tasted better blueberry, better vanilla and better strawberry juices than these, but then the price is also quite a lot higher. These you get 3 for £10. You probably also noticed that I've "complained" about sweetness balance a bit. This I guess is a matter of personal preference. I recommend trying them out to make up your own opinion, after all the price is quite affordable so you won't get ruined trying them out:

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Wednesday, 7 May 2014

The ASH study covered in Norwegian Media

On Tuesday, Norwegian newspaper VG published a story ( on the ASH study I've written about earlier ( The article sums up the results of the study, which you can read more about in my previous post, and also has a couple of interesting sub-headings:
  • Norwegian expert rejoice in the development
  • Can expect the same development in Norway
The expert in question is of course again Research Director for the SIRUS (Norwegian institute for drug and alcohol research) tobacco unit, Karl Erik Lund. He says to VG that he thinks we will see the same development here in Norway if the ban on over-the-counter sales is lifted. Today there is around 50.000 e-cigarette users in Norway.

"Despite the fact that some people are worried that e-cigarettes will re-normalize smoking, we have not found anything that supports this. On the contrary the use of e-cigarettes can help people quit smoking as many use them to help quitting.", Robert West, professor and head of The Smoking Toolkit Study, is quoted. And Karl Erik Lund supports this. He says the development is undoubtedly positive from a public health view, and he adds that we have studies indicating that the use of e-cigarettes is not harmful at all from a physiological perspective.

Lund is very negative towards todays ban on over-the-counter sales in Norway. He says there has been observations of some products that contains toxins that can be harmful in high concentrations and over time, and therefore it is urgent to get regulations in place that will ensure a higher grade of consumer safety. However, "it is the long term effects of keeping the ban that will prove fatal", he says.

In Denmark, the use of e-cigarettes has also exploded, and their minister of health, Nick Hækkerup, has said that he wants to intervene, mainly because he is worried about the rising popularity among children and young people. (Read my post on this here: Commenting on this Lund says that "all user surveys - in Norway as well - shows that e-cigarettes has little appeal to non-smokers. But as the use of e-cigarettes increases, we have to expect that a segment of young non-smokers will be recruited." And he goes on to make a very important point that I've mentioned a lot of times on this blog: "The question is if the experience these young people has with e-cigarettes will increase their desire to switch to conventional cigarettes. There is not much that suggests this. Why should someone abandon the e-cigarette in favor of conventional cigarettes that tastes rancid compared to e-cigarettes, is perceived as a lot more dangerous, are a lot more expensive, has a negative symbolic effect and can only be used outdoors?"

photo credit: MonicaGrigsby via photopin cc 

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Tuesday, 6 May 2014

What does ASH Scotland really think about e-cigarettes?

Last week I wrote about the survey YouGov ( have done on behalf of ASH UK. YouGov also did a similar survey ( for Scotland, and the results are pretty much the same: A dramatic rise in both use and awareness of e-cigarettes but almost no non-smokers use them. The conclusion, again: E-cigarettes are NOT a gateway to smoking traditional cigarettes.

On April 28th ASH Scotland commented on the results: There you will also find a summary of the results. Although the numbers are a bit lower than in the UK survey the trends are exactly the same: More and more smokers try e-cigarettes and more people believe that they will be good for public health (31%) than not (23%). The most important finding however, as in the UK survey: "Current use of e-cigarettes amongst those who have never smoked is negligible (zero or nearly zero) and only around 1% of never-smokers report ever trying e-cigarettes."

ASH Scotland Chief Executive Sheila Duffy then comments on the results:
"Our interest is in helping people improve their health and so we welcome harm reduction as a principle. We believe that ‘vaping’ will prove to be less harmful than smoking – but not harmless, as some supporters suggest."
That's good. Even if most unbiased studies do conclude that e-cigarettes are pretty much harmless, there are in fact some that conclude that there may be some dangers from some products. And of course we cannot say that we are 100% sure there will be no long term negative effects from use. What we do know however is that they are a lot less harmful than cigarettes (and maybe even totally harmless or even beneficial ... we'll know more as time goes). And this is the important question to ask when we are talking about harm reduction: How much safer is it? Not: Is it totally 100% safe? From this statement it looks like Shiela Duffy and ASH Scotland has that right.
"We are calling for regulation of the market in e-cigarettes - and other new nicotine delivery devices - because nicotine is a highly addictive substance and the companies involved are under strong commercial pressure to recruit young people into using it.
To minimise the risk of drawing the next generation into nicotine addiction, we also want an under-18 age restriction on the sale of e-cigarettes in Scotland, as is already being planned for England and Wales, and we need restrictions on how these products are promoted."
I find it a bit strange that this is mentioned in a response to the results of this survey that clearly shows that non-smokers show very little interest in the products in today's regulations. I read this as a call for stronger regulation of advertising of e-cigarettes, which I think must be handled with care. Over-regulating in this area, for example by not allowing advertisers to say that the products are healthier than smokers and effective tools to quit smoking, dangerous. This means advertisers are forced to play other cards, mainly marketing them as cool lifestyle products, which would be more appealing to young people. I've written about this earlier: However some careful regulations could be reasonable to prohibit advertising that targets children. The age limit, of course, is something we all want, and that most of the industry already has in place by self regulating.
"However, including e-cigarettes in the smoke-free enclosed public spaces legislation would require scientific evidence that harm from ‘second-hand’ e-cigarette emissions is likely. This is not the situation to date. But we support venues that have banned vaping to protect smoke-free environments."
This one is confusing. They say that there is no evidence that supports vaping harms anyone around the vaper, and they do not want it included in the smoke-free enclosed public spaces legislation for that reason. But then in the next sentence they support venues that bans them? The survey shows an enormous growth in e-cigarette use among smokers, and I believe one of the most important reasons for this is that smokers see vapers vaping around them, often in places where smoking is not allowed, like bars and restaurants, and then get inspired to try it themselves. Venues that allow vaping will be areas where adult smokers are directly targeted by the best advertising for e-cigarettes there is: The vapers story. Supporting venues that ban e-cigarettes will only work against this. Yes, someone might misunderstand from time to time, and light up a cigarette where they are not allowed to, but the staff on the venue can just tell them that only e-cigarettes are allowed, and that might even trigger another switch.
"There are particular concerns with the growing involvement of tobacco companies in this market because of their history of prioritising profits over people and misleading consumers. It is not in their interest for people to become free of nicotine addiction. We must defend Scotland’s vision for creating a generation free from tobacco and ensure that e-cigarettes work for this, not against it."
If they are really concerned about the tobacco industry winning the e-cigarette market, they should be really careful with calling for strict regulations, especially when it comes to advertising, but also regarding premarket authorization. As I commented on the proposed FDA regulations (, expensive premarket authorization and ridiculous restrictions on advertising will hand the whole market over to the tobacco industry, and kill most innovation that could have made e-cigarettes even better and safer than they are today.

From these comments, I must say I'm a bit unsure what ASH Scotland actually wants. It seems to me they kind of see the potential and they want the e-cigarettes to keep getting smokers rid of the cigarettes. But on the other hand they seem to call for regulations that will work against this. To be honest they look like they are very sceptical, but the numbers of the survey makes them unsure on what stance to take. Guess I'll have to do some more reading to get a better view of where they really stand.

Friday, 2 May 2014

My comments on CDC Director Frieden's explanation to what he hates with e-cigarettes

I just finished reading this article in the Los Angeles Times where CDC (Centers for Disease Control and Prevention) Director Tom Frieden explains what he hates about electronic cigarettes, and I just can't resist the urge to comment on it. I know I'm a bit late but what the hell. How this man got this job is beyond my understanding.
“I’ve treated so many adults who are desperate -- desperate -- to get off tobacco. They all started as kids,” Frieden said. “I see the industry getting another generation of our kids addicted. To me, as a physician, when 1.78 million of our high school kids have tried an e-cigarette and a lot of them are using them regularly … that’s like watching someone harm hundreds of thousands of children.”
When the anti-e-cigarette movement is out of arguments, this is what they turn to. Think about the children. And Frieden even wants us to think about 1.78 million of them. Of course with no reference to any evidence whatsoever. To be honest I'm a bit surprised he didn't mention puppies and kittens while he was at it. Now dr. Frieden - how many patients have you treated that was desperate -- desperate -- to get off e-cigarettes? Well at least he kind of confirms that e-cigarettes gets these people off tobacco. Then he adds:
“people have a misconception that the tobacco epidemic is a thing of the past. Tobacco still kills more Americans than any other cause. It still kills more than 1,000 people a day. As a doctor, I can tell you it kills them in really unpleasant ways -- gasping for breath with emphysema, with cancer, with heart disease.” 
What on earth does that have to do with e-cigarettes? We all know cigarettes kills people in rather nasty ways, but why should that make one hate e-cigarettes? Again, he feels the need to mention he's a doctor, to give people the impression he knows what he's talking about. Some probably fall for that too and it is such statements that will keep your patients gasping for breath with emphysema and dying from cancer or heart disease, dr. Frieden.

I'm glad the journalist felt the same way that I did about the statement above and asked the obvious question next:
"What does that have to do with e-cigarettes?"
"E-cigarettes are a tobacco product,"
Frieden answers.
Oh really? By what logic? That the nicotine can be extracted from tobacco? That would also make nicotine gum and patches tobacco products. But maybe it's because it looks like you are smoking tobacco when you use them? By that logic however you also have to assume that electric cars are oil-products that lets out just as much CO2 as a regular car, right? I mean in some cases you can't really see the difference. Actually, when I think more about it, e-cigarettes does have something to do with this; they have the potential to shorten dr. Frieden's line of emphysema, cancer and heart disease patients. Maybe that's his problem?

Then there is the five reasons Frieden rattled off to why e-cigarettes are as dangerous as tobacco cigarettes:
--“If they get another generation of kids more hooked on nicotine and more likely to smoke cigarettes, that’s more harm than good”
--“If they get smokers who would have quit to keep smoking instead of quitting, more harm than good.
--“If they get ex-smokers who have been off nicotine to go back on nicotine and then back to cigarettes, more harm than good.
--“If they get people who want to quit smoking and would have taken medicines to think e-cigarettes are going to help, but they don’t, more harm than good.
--“If they re-glamorize smoking, it’s more harm than good.”
This makes it pretty obvious that Frieden actually has no reason to hate e-cigarettes, but has decided to do it anyway. And these are just a list of reasons he wish he had, that's why he put "if" in front of them. Well here is why I hate dr. Frieden and why he is as dangerous as a mass murderer:
-- "If he buys a machine gun and kills a bunch of people, he would do more harm than good".
Actually I've got another, more plausible one as well:
-- "If he takes advantage of his position to make sure smokers are deprived of a healthier alternative and hence keep on smoking, he would to more harm than good"
Just for good measure, Frieden threw in two more problems with e-cigarettes: People who use them can expose kids, teens and pregnant women to nicotine via secondhand smoke; and enterprising smokers can put marijuana or hallucinogens in an e-cigarette “tank.”
First of all there is no smoke involved in vaping. This just shows ignorant and uneducated this man is. Then there is a bunch of ways to consume marijuana and hallucinogens. Do you hate ovens since it can be used to bake hash cookies? And by the way Frieden, you missed another opportunity to throw in puppies and kittens. Stay focused please.
Frieden acknowledged that “stick to stick, they’re almost certainly less toxic than cigarettes" and that many people have quit smoking tobacco cigarettes with the help of e-cigarettes. However, he said, “the plural of anecdote is not data.”
So the fact that millions of people have quit with the help of e-cigarettes are just funny anecdotes and not data? If you ask everyone who quit smoking how they did it, the means they used are just irrelevant then? This argument just crumbles under it's own weight.
“If the e-cigarette companies want to market these to help people quit, then do the clinical trials and apply to the FDA,” he said, in a reference to the Food and Drug Administration. “But they don’t want to do that. They want to market them widely.”
Another example of how little common sense this man shows/has. This has nothing to do with whether or not e-cigarette companies want to apply to the FDA or not, it has to do with what they can afford and how long it would take to get a new product to the market. I would like to believe that Frieden understands this in his position, but based on his statements, sadly I don't.
“The challenge that the FDA has is that they will be challenged by the tobacco industry, as they have been at every step of the way,” he said. The federal agency “tried to regulate e-cigarettes earlier, and they lost to the tobacco industry. … So the FDA has to balance moving quickly with moving in a way that’s going to be able to survive the tobacco industry’s highly paid legal challenge.” 
You think the tobacco industry's lawyers will fight regulations that will effectively wipe out all their competition? The FDA's challenge is to balance between moving quickly and moving in a way that will convince the general public that their regulations are reasonable. And the tobacco industry will applaud every successful step the FDA takes in this direction.

Since I started this blog, I've read tons of articles about, and interviews of, anti-e-cigarette advocates, but never before have I come across any that managed to reel off this many contradictions and this much, excuse my language, bullshit in so few words.

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