Study: E-cigs more effective than patches, gum for quitting cigarettes

Three studies came out in one day about e-cigarettes, two very, very negative and the third one with positive news.

It sort of sums up the mixed bag that are e-cigs, and sums up the quandary about them.

First, the good news. A recent study by Queen Mary University in London, published by the New England Journal of Medicine shows that e-cigarettes are far more effective than nicotine gum or patches in getting people to quit cigarettes.

The study involved 886 smokers, half were given the option to quit using e-cigs and the other half were given the option to quit through patches, gum or other nicotine replacement therapies.

After one full year, 18 percent of the e-cig group was able to quit smoking, while just 9.9 percent of the patches and gum group quit.

Those percentages may not sound good, but it’s widely known that nicotine replacement treatments have a pretty high failure rate. Most smokers, it takes four or five tries or more to actually quit.

From a CNBC article:

Doctors have been wary of recommending people use e-cigarettes as a way to wean themselves off conventional cigarettes, citing both the lack of evidence showing they work and lack of data on the long-term health effects of using the products. The new study may quell some of those concerns. However, the study is also likely to receive some pushback because it was conducted in the United Kingdom, which has embraced and even encouraged e-cigarettes as an alternative for adult smokers.

Here’s another flaw with the study, I think. The point of patches and gum is to eventually wean people off of addictive nicotine. However, that’s not how very many people really use e-cigs. They remain addicted to the nicotine, and in my opinion, as long as they remain addicted, they remain at risk at falling back onto cigarettes.

From the same article:

“While e-cigarettes are ‘safer’ than traditional cigarettes, they are not without risks,” Boston University professors Belinda Borrelli and George O’Connor said in a statement.

They also pointed to the finding that at the one-year mark, 80 percent of people in the e-cigarette group were still using the devices. So while people stopped smoking cigarettes, they were still using e-cigarettes. The study’s authors also noted this finding, saying it “can be seen as problematic if e-cigarette use for a year signals ongoing long-term use, which may pose as-yet unknown health risks.”

Huge numbers of teens using the products — particularly one brand, Juul — have soured perceptions about e-cigarettes in the U.S. Even Food and Drug Administration Commissioner Scott Gottlieb, who has championed the devices as a way to help adult smokers, says the industry is at a tipping point.

That final paragraph about Juuls explains the condundrum about e-cigarettes. While they appear to have a very valid and genuine value in helping some people quit smoking, the down side is their use among teens has exploded in the past five years … and these are kids who have never smoked a cigarette in their lives. They’re not using e-cigs to get off cigarettes, they’re using them to get addicted to nicotine to begin with.

The FDA has started talking tough about e-cigs the past couple of months, even going so far as saying it might just outright ban e-cigs. If 18 percent of the people who try e-cigs to get off cigarettes are successful, I think that’d be a terrible step in the wrong direction.

But, they gotta stop the teen epidemic of vaping. If that means banning fruity e-cig flavours, so be it. I personally would like to see e-cig marketing more strictly regulated. I liked the idea the FDA came up with a few weeks ago (and quickly dropped, unfortunately), of only allowing e-cig sales in tobacco shops, where you have to show an ID just to walk into the door. The FDA came up with some odd idea of only allowing e-cig sales in adult areas … but still allowing them to be sold in convenience stores. How could that even work?

Anyway, an interesting study showing the other side of the e-cig debate and showing that it’s not a black and white issue.

FDA chief threatens to completely remove e-cigs from the market

The war between FDA chief Scott Gottlieb and the e-cig industry continues to escalate with Gottlieb last week threatening to just say “Fuck it” and completely take e-cigs off the market.

To wit, the Food and Drug Administration has come out harshly against the e-cig industry beginning about six months ago because of the skyrocketing increase in teen vaping rates.

So, the FDA came out with a series of rules regarding e-cigs, including some restrictions on fruity flavours and the requirement that e-cig products only be sold in areas open to adults. The FDA didn’t get into marketing of e-cig products.

These rules weren’t as strong as what *I* had hoped for, at the very least, I liked an idea that was floated to restrict e-cig sales strictly to tobacco shops, but that got dropped, likely because of pressure from the industry.

Anyway, Gottlieb said he has met with industry representatives and he remains unimpressed with their response so far.

This is a quote from a Gottlieb tweet:

I still believe e-cigarettes present an opportunity for adult smokers to transition off cigarettes and onto nicotine delivery products that may not have the same level of risks. However, if the youth use continues to rise, the entire category will face an existential threat

Also, from an NBC News article:


“I’ll tell you this. If the youth use continues to rise, and we see significant increases in use in 2019, on top of the dramatic rise in 2018, the entire category will face an existential threat,” Gottlieb told a meeting.
“It will be game over for these products until they can successfully traverse the regulatory process.”

Gottlieb said he has met repeatedly with the vape industry. “I find myself debating with tobacco makers and retailers the merits of selling fruity flavors in ways that remain easily accessible to kids,” he said.

Last November, Gottlieb said he was starting the process to limit sales of flavored e-cigarettes, as well as to ban menthol in combustible cigarettes.

“I have questions about whether they are living up to the very modest promises that they made,” he said. “It matters if the e-cig makers can’t honor even modest, voluntary commitments that they made to the FDA.”

I’m curious if the industry is taking these threats seriously? Juul very quickly shut down its social media presence, but it might be too little, too late to slow down teen vaping use … or to satisfy the FDA.

Gottlieb said the dramatic rise in e-cigs is sabotaging the success public health advocates have had in cutting the teen smoking rate.

From a Yahoo article:

“This progress is being undercut — even eclipsed — by the recent, dramatic rise in youth vaping. A few years ago, it would have been incredible to me that we’d be here, discussing the potential for drug therapy to help addicted youth vapers quit nicotine,” he said Friday.

Gottlieb cited statistics about the large use of e-cigarettes by young people, saying that between 2017 and 2018 there was a 78 percent increase in e-cigarette use in high school students, and a 48 percent increase among middle schoolers. That means the total number of middle- and high-school students using e-cigarettes rose to 3.6 million — 1.5 million more than used the product the previous year. He added that more than a quarter (27.7 percent) of high-school-age e-cigarette users use the product regularly, and more than two-thirds (67.8 percent) are using flavored e-cigarettes. 

“Youth use of e-cigarettes has become an epidemic,” Gottlieb said, adding, “It could be ‘game over’ for some [of] these products until they can successfully traverse the regulatory process. I think the stakes are that high.” Gottlieb also noted that e-cigarettes can be a helpful tool for adults trying to quit smoking traditional cigarettes, and said he hopes to avoid removing e-cigarettes from the market because of the good they can serve in that regard. 

Stay tuned. Gonna be a rocky year on this issue likely.

It’s official, Juul is now a subsidiary of Philip Morris, ie Altria

The tobacco industry will sell you the disease and now will sell you the cure.

This came out a couple of weeks ago and apparently this week it became official. Juul, those cutesey little e-cigs that plug into laptop computer and look just like a flash drive, came to completely dominate the e-cig industry incredibly quickly, eating up 75 percent of the market in less than two years.

Altria just invested $13.5 BILLION into Juul, taking ownership of 35 percent of the company.

Juuls sort of advertised themselves as an indie company against the tide of Big Tobacco. No more. Juul IS BIG TOBACCO now, baby. Altria, formerly known as Philip Morris, makers of Marlboro cigarettes.

Here’s the shit that actually pisses me off. From an AP story:

Juul will remain an independent company, but it gains access to Altria’s massive infrastructure and reach. Namely, Altria will help Juul secure space on store shelves beside traditional cigarettes. It will also help Juul reach smokers via cigarette pack inserts and mailings.

Yeah, fuck you, Juul. You’ve been one of the biggest guilty parties, if not THE biggest guilty party, in marketing e-cigs to kids. Now that you’ve got these teenagers hooked on nicotine, you get Altria’s [quote] “massive infrastructure and reach.”

Surgeon general labels teen vaping an “epidemic”

More harsh rhetoric toward e-cigarettes and the explosion of e-cig use by teenagers over the past seven years.

U.S. Surgeon General Dr. Jerome Adams joined the head of the FDA this week in denouncing e-cigarettes, going so far as to call teenage e-cigarette use an “epidemic.”

From an NPR article:

“I am officially declaring e-cigarette use among youth an epidemic in the United States,” Adams said at a news conference. “Now is the time to take action. We need to protect our young people from all tobacco products, including e-cigarettes.”


“We have never seen use of any substance by America’s young people rise this rapidly,” Health and Human Services Secretary Alex Azar said at the briefing. “This is an unprecedented challenge.”

Officials at this press conference largely blamed Juul for the epidemic, though to be fair, the increase in teen vaping was already happening before Juuls hit the market about two years ago.

Less than 2 percent of teens were vaping in 2011. In 2018, that figure has increased to 21 percent.

At the same time, there’s been a big decrease in teens smoking, which is great.

Teens getting addicted to nicotine, not so great.

I debated with a few vaping advocates on this story. They keep harping on two really false and lame narratives.

One: Who cares if teens are vaping … would you rather they be doing crack or meth?

Well, no, of course, that’s just stupid. I’d rather they not do ANY addicting substances. It’s not an either/or situation. It’s not either they vape or they do meth. I’d rather they do NEITHER.

And the second lame point: “Well, e-cigs don’t have the toxins of cigarettes, and they’re much safer than cigarettes.”

Yes, probably. And I emphasize “probably,” big time. Because the jury is still out about that. No one is totally sure everything that is in e-cig vapour. Yes, e-cigs don’t contain the Polunium-210 and carbon monoxide and benzene that cigarette smoke does, but it still contains formaldehyde and most of all … nicotine, which is incredibly addictive. And studies have shown that a higher percentage of teens who vape eventually take up smoking to get their nicotine fixed filled, than teens who never vaped to begin with.

Anyway, I’m going to get into these weak-ass arguments in a little more in-depth in a later post about libertarian fake journalist and tobacco industry apologist stooge John Stossel (again … this isn’t my first go-around with Stossel, who seems to really have a thing about tobacco issues.).

Anyway, to try and combat the increase in teen vaping, the FDA has proposed putting limits on where e-cigarettes can be sold, ruling that they must be sold in an area closed off to minors. The FDA pulled up just short of flat out banning e-cigarette sales in minimarts and convenience stores, which was being proposed.

Strong language, for sure from the surgeon general. It’s going to be really interesting what will happen with the e-cigarette industry in the next two or three years.

Here’s a good article from the Verge about what Adams’ proclamation actually means. It means e-cigarettes are squarely in regulators’ sites:

From the Verge:

The Surgeon General’s power is more about influence, and less about enforcement: the real regulatory power over vaping comes from the Food and Drug Administration. So this advisory doesn’t have any legal force, Micah Berman, a professor of health services management and policy at The Ohio State University, tells The Verge in an email. “They are a tool used by the Surgeon General to call attention to an issue and to provide guidance to the public,” Berman says. “They are only issued rarely, when immediate action is called for — which is what makes them so noteworthy.”


That’s why it’s particularly significant that the Surgeon General is using the word “epidemic,” says Kathleen Hoke, a professor specializing in public health law at the University of Maryland: “Using the e-word, epidemic, takes it to a higher level. From a public health perspective, we try not to use that word unless it’s warranted — otherwise you have the boy cried wolf,” she says. But she says, according to these health officials, youth vaping has reached that level: “It’s broad, vast in its impacts, and of deep concern about its lasting effects.”




California lawmakers propose ban on flavoured e-cig products

Yeah, those are actually e-cigarette flavours, not actual candy. Nope, not marketing to kids at all!

The headline to this article is slightly misleading. They aren’t talking about just a ban on flavoured tobacco in California, they’re talking about a ban on flavoured tobacco and flavoured e-cigarette products. I still think it’s important to differentiate between the two.

This is all part of a recent crackdown on e-cigarettes and their fruity, sugary flavours. The e-cigarette industry isn’t really fooling anyone when they claim they aren’t marketing to kids when they make flavours like “Smurf grape” and bubble gum.

Juul has apparently agreed to stop sales of some of its sweet flavours. Candy-flavoured cigarettes were banned some time ago, but Swisher sweet cigars, a long-established product and menthol cigarettes were still allowed.

Now, the FDA is moving to ban all flavoured tobacco products and menthol cigarettes. That move could be tied up in courts for a while, because menthol cigarettes are BIG business (roughly about 10 percent of cigarette sales) and the tobacco industry simply isn’t going to go down without a fight.

The City of San Francisco banned the sale of flavoured e-cig products and several state legislators in California are proposing a similar statewide ban.

Here’s my attitude about the sweet flavours. If e-cigs are really designed to help get smokers off cigarettes, then the draw should be the nicotine, not the flavour of the steam. By having strawberry and lemon-lime and what have you flavours, this to me is pretty clearly just part of the e-cig’s craven tactic of making their products appealing to kids — who are not using e-cigs to get off cigarettes, they’re using e-cigs to get addicted to nicotine to begin with.

Anyway, I hope the bill passes and in California, it probably has a good chance to pass. The day of reckoning for the e-cig industry has arrived, I think.

Altria now trying to buy into Juuls

Well, this was as predictable as the day is long.

I wrote a few days ago about how Altria is expanding its business to marijuana. Altria, which already owns the e-cigarette brand MarkTen, is now making a move to buy into the biggest e-cigarette brand out there, Juul.

It’s interesting. A lot of people think e-cigarettes and cigarettes are somehow in competition. Nothing could be further from the truth. They’re really two sides of the same coin, doing a cutesy little dance around each other.

At one time, Big Tobacco controlled about 80 percent of the e-cigarette market. Altria had MarkTen, RJ Reynolds controlled Blu for a while, then Blu was sold to and controlled by Imperial Brands, a subsidiary of Philip Morris. Meanwhile, RJ Reynolds kept control of Vuse. Those three brands constituted about 80 percent of the e-cigarette market.

So, no, e-cigarettes were not competing with Big Tobacco. E-cigarettes WERE Big Tobacco. All those people usuing e-cigarettes to get off cigarettes. All those people using e-cig to say “F U” to the tobacco industry. Hey, you were giving your money to the same CEOs. Big Tobacco was selling you both the disease and the cure.

Then, along came Juul to overturn the apple cart. Juul is a relatively new player in the e-cigarette market and sometime around 2017, this company started dominating the e-cig industry, pushing down Big Tobacco’s share in the market. Juul’s share got up to 75 percent. They did this in about two years.

Now, Altria is following the Big Tobacco playbook. When you can’t beat them in the marketplace, simply buy them out. 

Juuls are incredibly convenient. They look exactly like a computer flash drive. They can charge up by plugging them into a laptop. And the flavour viles are little and easy to use.

Juuls are controversial with a lot of people in the tobacco control industry because the company, much like Blu, was pretty fucking brazen about marketing to teens. Juul relied heavily on social media to market itself and they got themselve in the crosshairs big time not only of the tobacco control community, but of the FDA. After the FDA started suggesting that it was cracking down on e-cigs because of the explosion of e-cig use by teenagers, Juul very quickly abandoned all of its social media accounts and announced that it would no longer sell many of its fruity and surgary flavours.

Along comes Altria to save the day. Altria, the parent company behind what used to be known as Philip Morris, is abandoning its failed MarkTen product.

According to this CNBC article, Altria is looking at buying a “significant” share of Juul. And again, we follow the same pattern as Blu and MarkTen and Vuse.

Now, this news came out around the same time as the FDA announced that it was cracking down on e-cigs, mostly by requiring that e-cigs be sold in areas closed off to minors, and Juul shut down its social media accounts. We all know Altria has a long, long history of playing cutesy with the “Marketing to teens? Moi? Never!” game that Juul and every other e-cig brand has copied from.

I see this as Altria evolving and trying to stay an active player in the nicotine addiction game, via e-cigs and international marekts. (And my concern about Altria getting involved in marijuana is over the company cooking up schemes to add nicotine to marijuana to make it more addictive). This is a multi-billion dollar corporation that has no plans of simply slinking off into the sunset.

I toldja! Big Tobacco looks to get into the pot business

The Marlboro Head

I toldja! I toldja!

I knew this would happen. In fact, to be honest, I’m surprised it took this long.

As marijuana becomes legal in more and more of the U.S., I knew sooner or later Big Tobacco would look to get into the game. 

Sure enough, a bunch of huge stories came out this week that Altria … the parent company of Philip Morris, makers of Marlboros, is investing $1.8 billion in Cronos, a Canadian marijuana company. And as we all know, marijuana was legalized across ALL of Canada a couple of months ago.

About 80 million people in the U.S. live in states where marijuana is now legal. Add that to the 36 million of so people in Canada … that’s a lot of legal marijuana users. And that number is just going to continue to grow as more and more states figure out that keeping pot illegal is not just stupid but also a waste of a BIG potential tax source.

So, tobacco sales in the U.S. have been in decline for decades. Big Tobacco is being forced to diversify … by pouring more energy in developing tobacco markets in the Third World, by investing in e-cigarettes (though the future of e-cigs is now in doubt with new FDA regulations being proposed) and now pot. It was totally predictable.

My biggest concern about Big Tobacco getting their beak wet in the pot industry is my fear that they’ll pull the same underhanded, amoral crap with pot that they’ve pulled with marijuana for decades. For instance, I could totally see Big Tobacco artificially adding nicotine into marijuana to make it physically addictive like cigarettes. (And then acting all “Moi? Not us!” before Congressional committees about it). Think of it. The pure, amoral genius of it. The most addictive substance in the world added … to marijuana. They would do it, too. They totally would.

One of the biggest worries about legalizing pot was allowing big corporations to take over the pot industry. I remember an article from a year or two ago worrying that the beer industry would get involved in pot. Honestly, that doesn’t scare me nearly as much as Altria or any tobacco company getting their paws on it. 

Something to keep an eye on.

Juuls, menthols and e-cigarettes, oh my — the FDA cracks down finally

Big update today because there’s a LOT to talk about.

Well, the FDA did it, they came down fairly hard on e-cigs. And not just e-cigs, but finally came down on menthol cigarettes and flavoured cigars like Swisher sweets.

I keep scratching my head and asking myself … wait, this is the Trump Administration? The incredibly anti-regulatory and pro-business Trump Administration imposing a whole bunch of new regulations on e-cigs and cigaretttes.

The FDA is making its move as new figures from the Centers for Disease Control show a 78 percent increase in the use of vaping among teenagers since 2011.

E-cig use by teens went up from 1.5 percent of teens in 2011 to 20.8 percent of teens in 2018, according the CDC. The industry has played coy and cutesy about

From an NBC story:

“These data shock my conscience: From 2017 to 2018, there was a 78 percent increase in current e-cigarette use among high school students and a 48 percent increase among middle school students,” said FDA administrator Scott Gottlieb.

We’re not telling the retail stores you can’t sell them,” Gottlieb said. “If the establishments want to continue to sell these fruity flavored products, they’re going to have to put into place measures that will make sure they are not going to get into the hands of kids,” Gottlieb told NBC News.

OK, this is a big story that kept getting bigger, so let’s start with e-cigs.

Restrictions on sales of e-cigs and e-cig flavours

The new e-cig policy is confusing and I’m still trying to parse it.

Tthe FDA’s proposal would limit the sale of these products in retail stores to closed-off areas that are inaccessible to minors.”

I’m not positive what these means, because I don’t think I’ve ever seen an “adults only” area in a minimart. So, I guess that means no more e-cig sales or fruity flavours on display on the counters of minimarts and convenience stores. This seems slightly watered down from the proposed rules that were leaked last week, which flat out said a ban on sales in minimarts and convenience stores.

The Campaign for Tobacco-Free Children also wonders what “adults only” actually means.

From NBC News:

Anti-smoking advocates praised the moves, while questioning how easy it would be to enforce them. For one thing, vape products are sold in a variety of outlets, said Matthew Myers, president of the Campaign for Tobacco-Free Kids. “It’s a loophole big enough for a truck to go through,” Myers told NBC News.

“(Gottlieb) doesn’t define age-restricted, in-person locations. For this to have any effect, that has got to be a very vigorous definition.”

Gottlieb told NBC that measures might include a curtained-off section where vapes are sold. Online sales will need age verification protocols, he said.

The FDA is also imposing new rules on online sales of e-cig products, requiring better age verification measures from companies (Right now, literally all a kid has to do is click on “Are you 21?” Seriously, that’s all they have to do.)

Maybe this ultimately accomplishes the same thing as a flat-out ban, but it remains to be seen. The FDA might have totally wimped out here.

Juul feels the heat

Juuls have quickly grabbed up 70 percent of the e-cigarette market and this company came to realize it was seriouly in the crosshairs because its products are very popular with teens.

Juul announced a number of steps this week to try and restrict sales to minors, I’m sure realizing that if it didn’t take actions, the FDA might do worse.

Juul said it is voluntarily restricting the sales of some fruity flavours only to businesses that invest in technology to verify the age of customers, such as scanning IDs.

Juul also completely shut down all of its social media accounts — Instagram, Facebook and others. Though, now that Juul has 70 percent of the market, some people would argue that this is too little, too late.

From a New York Times article

Caroline Renzulli, a spokeswoman for the Campaign for Tobacco-Free Kids, called Juul’s announcement too little too late. “Juul’s social media marketing fueled its popularity with kids,” she said. “Now that it has captured 75 percent of the e-cigarette market, Juul no longer needs to do social media marketing because its young customers are doing it for them.”

Maura Healey, the attorney general for Massachusetts, echoed that sentiment. “Unfortunately, much of the damage has already been done,” she said. “Our investigation into Juul’s practices, including if it was knowingly selling and marketing its products to young people, will continue.”

Myers agrees:

“Juul is smart enough to try to use FDA actions to falsely create an impression of it as a caring, responsible company,” he said.

Juul now dominates the e-cigarette market with its small, sleek, pod-based product that delivers a far heftier dose of addictive nicotine than other vape devices.

“Having used social media to gain market dominance among young people, Juul can step back now because it no longer needs to pay for social media. Its young, addicted customers are doing it for them. It’s stunning to me,” Myers said.

“It is so completely out of the Big Tobacco playbook it is unbelievable,” he added.

Juul defends itself, using lame corporate-speak.

From an Associated Press article:

Its products are meant to help adult smokers quit regular cigarettes, CEO Kevin Burns said in a statement.

“We don’t want anyone who doesn’t smoke, or already use nicotine, to use Juul products,” Burns said. “We certainly don’t want youth using the product. It is bad for public health and it is bad for our mission.”

Menthol cigarettes, flavoured cigars BANNED

No if ands or but(t)s. Unlike some of the slightly milquetoast measures taken toward Juuls and e-cigs, menthol cigarettes will be simply BANNED. Sugary or candy-flavoured cigarettes were banned by the FDA a few years ago, but the agency allowed menthols to continue.

Well, no more, the FDA announced it will ban all sales of menthol cigarettes and sugary cigars like Swisher Sweets.

(As an aside, my parents smoked menthols, mostly Kool brand. Most menthol smokers are black.)

However, don’t expect menthols to disappear any time soon. The tobacco industry has vowed to fight the ban and it could be tied up in the courts for years.

From the NBC story:

Tobacco companies signaled they would fight efforts to ban menthol.

“We continue to believe that a total ban on menthol cigarettes or flavored cigars would be an extreme measure not supported by the science and evidence,” Altria, which makes a range of tobacco products, said in a statement. “We expect that establishing product standards on menthol cigarettes and flavored cigars will be a multi-year, deliberative process, and we will be fully engaged throughout.”

FDA to ban flavoured e-cig products from minimarts

Well, this is progress, I wonder if it will have any effect.

The FDA announced that it will soon ban the sale of e-cig flavourings at minimarts. This is in response to the rapid rise of e-cig use by teenagers. The FDA warned a few weeks ago that it was cracking down on e-cigs because of the epidemic of teen e-cig use. So, this is apparently step one.

Also, cartridge-based e-cig products like Juuls will no longer be allowed to be sold at convenience stores. Sales will be limited to tobacco and vaping shops. Juuls are relatively news, they’ve only been around a year or two, but their use has exploded (not literally) among teens.

That seriously limits the venues that e-cig flavours and Juuls will be sold at — basically from millions of convenience stores around the country to about 10,000 estimated tobacco and vaping stores. It won’t stop kids from trying to buy them, but will make it harder. And tobacco and vaping stores are more regulated than convenience stores.

The FDA, and this is a big one I think, is also going to impose more rules and regulations on online sales of vaping products, requiring stricter standards for age verification. Today, any kid with their own debit card can just click on “yes, I’m 18” on most of these sites.

Will these be enough to stop the epidemic of kids using e-cigs? Only time will tell, but the FDA suggested this is just the beginning of the steps that it plans to crack down on the industry and its lax attitude toward teen vaping.

From an NBC News article on the FDA’s move:

The Centers for Disease Control and Prevention reported Thursday that adult smoking rates have dropped to their lowest level yet, at 14 percent. But the CDC found that 47.4 million U.S. adults , or 19 percent of the adult population, uses any tobacco product, including cigarettes, cigars, or e-cigarettes.

Public health experts have been complaining that the fruity, candy-like flavors found in e-cigarettes are targeted directly at children and teenagers, and rates of teen cigarette use have soared.

The FDA has also expressed concern about online sales to teens. In September, the FDA made an unannounced visit to Juul headquarters to look for evidence about the company’s marketing practices. In April, the agency launched what it called a “blitz” to stop retailers from selling vaping products to underage children. And it has warned several online sites about sales.

“We’re also going to restrict online sales only to sites that put in place specific age verification measures and limit access to kids that we are going to specify in guidance,” the official said.

Immune therapy breakthrough for cancer wins Nobel

Two medical researchers, James Allison of the U.S. and Tasuku Honjo of Japan, were awarded the Nobel Prize for medicine this week for their breakthrough research in harnessing the body’s own immune system to fight cancer.

Allison and Honjo’s breakthroughs came way back in the 1990s. Their research eventually led to the production of immunotherapy drugs such as Yervoy in 2011 and later the well-known drug Keytruda.

Immunotherapy unleashes the body’s own immune system to attack cancer cells rather than chemotherapy. It tends to not have as many side-effects as chemotherapy and for certain kinds of cancers, such as melonoma, it has provided astounding results. Keytruda is most famous for being known as “The Jimmy Carter” drug because Carter was given the drug on an experimental basis several years ago when he had advanced melanoma and brain cancer. And Jimmy is still around today to talk about it.

Keytruda has shown success in treating certain kinds of small cell lung cancer (if patients have certain gene markers). While there are some reports that people with melanoma have been literally cured by Keytruda, it’s not a cure for lung cancer. However, for some patients, they live much longer on the average than with traditional chemo and have much better quality of life.

From a Scientific American article:

Allison, a professor at The University of Texas M. D. Anderson Cancer Center in Houston, discovered that a molecule called CTLA-4 (cytotoxic T-lymphocyte antigen 4) acts as a “brake” on the immune system; remove the brake and—in many cases—immune cells are unleashed to fight the cancer. Allison spent 17 years convincing others that this approach could work, leading to approval in 2011 of the drug Yervoy, which showed near-miraculous results for a fraction of patients with a lethal form of skin cancer.

The pharmaceutical industry is vigorously pursuing immunotherapy, and hundreds of trials are currently underway based on CTLA-4, PD-1 and other immune approaches.

For decades researchers had been trying to figure out effective ways to use the body’s own immune system against cancer. They tried vaccines and other approaches for ramping up immune activity. Allison’s insight, Perlmann said, was to trigger the brakes instead. “It represents a completely new principle because, unlike the previous strategies, it is not based on targeting the cancer cells but rather the brakes, the checkpoints of the host immune system,” he said. “It represents a paradigmatic shift and a landmark in the fight against cancer.”

Honjo’s research was completely separate from Allison’s, but used a similar approach.

From the article:

Meanwhile Honjo, of Kyoto University in Japan, was studying a different immune brake called PD-1 (programmed cell death 1), according to Thomas Perlmann, secretary general of the Nobel Committee, who spoke about the findings amid the prize announcement early Monday. Allison’s success with CTLA-4 in cancer persuaded Honjo to consider his molecule in cancer as well—and he found PD-1 therapy was even safer and more effective against a number of cancers, including lung cancer, which kills about 150,000 Americans a year. Drugs based on his findings also work in combination with Yervoy against a number of types of cancer.

Keytruda is not quite a miracle drug, unfortunately. Not everyone has the gene markers for it, but it has gained a massive reputation thanks to Jaimmy Carter. From a Times Now article:

While in theory it should work for most forms of cancer, it’s most effective on those with the highest numbers of mutations such as melanomas, lung cancer and smoking, he added.

And it has sometimes been met with too much enthusiasm by patients. In the US, some have reportedly asked their doctors to immediately use immunotherapy instead of traditional treatments like chemotherapy, even when they are more effective.

After his big win on Monday, Allison warned that immunotherapy will not replace all other cancer treatments. Instead, it is “going to be part of therapy that potentially all cancer patients will receive in five years,” he told a press conference in New York. Honjo, meanwhile, said he wanted to continue his research “so that this immune therapy will save more cancer patients than ever”.