Where There's Vape, There's Fire: E-Cig Hype, Harm, and Hope??

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1:03What a deal. Your new morning groove. Ice coffee from McDonald's, any size for just 99 cents to 11 a.m. Pricing participation may vary. Cannot be combined with any other offer. Welcome to Unbiased Science. Where we bring scientific method to the madness. We're your hosts, Dr. Jess Steyer and Dr. Sarah Scheinman. And this week we are tackling a topic that is really near and dear to to my heart, the topic of e-cigarettes, electronic cigarettes, vapes, lots of different ways that we describe these things. So we're going to get into it. We have a very special guest who has lots of expertise on this topic and I think we'll learn a lot from him. Before we introduce our special

2:08guest and before we get into it, just a quick public health update that there was big news last week. So we're recording this March 23rd, but last week there was a very big update in the federal case of the AAP, the American Academy of Pediatrics versus RFK Junior. There was this big lawsuit surrounding the ASIP. I always forget what this acronym means or what it stands for. The Advisory Committee on Immunization Practices. That's the federal committee that makes decisions around vaccines in the United States. And so the federal judge ruled that here, let me just say, that basically what has transpired the last year is not okay. So in terms of what the the ruling actually was at what it means for us. So the 13 ASIP members that a Kennedy appointed after firing all of the qualified experts on the committee are effectively sidelined. So they

3:12cannot meet in any official capacity. And every vote that they cast is seemingly nullified. And this is really, really interesting. So what this means is that some of the decisions that they made, like the hepatitis B birth dose recommendation, which they eliminated, that is now restored. The changes to the entire vaccine schedule. So if you recall back in January, the childhood schedule went from a recommendation of 17 routine vaccines down to 11. That is now reversed. So in terms of what we as Americans and families will experience, we likely we won't see an immediate change in what insurance covers. So if you remember, major insurers had already committed to honoring the pre-change schedule through 2026. But this ruling stops the damage from compounding. So this is big. I'll say candidly, you know, this is a win, but it sort of wrapped

4:14in a caveat. There was an interesting article that came out of the Atlantic that called this vaccine purgatory, because this is a win for public health and for vaccines and for preventative health. But we know that it will be appealed. We were already caught when that the committee will be reconstituted. So yes, this was a victory, but does not mean that there won't be challenges that lie ahead. Last thing on that is that we did do a deep dive on this. So if you want to read more, you could check out our substack at the unbiasedsiapod.substack.com. All right, without further ado, we'd love to introduce today's guest, Dr. Mike Siegel. We're going to let him introduce himself in just one moment. He is a really impressive background, but I wanted to give a little context. So Mike, if I can, if I can call you Mike, I hope that's okay, Dr. Siegel. Mike reached out to me after I published a piece on substack that was called the call I

5:14didn't want to take. I lost my dad to cigarettes, and then I took a call from the vape industry. So in this article, I talk about what I've spoken about a lot on the podcast. I lost my father in an emphysema to COPD. My research beginnings were in tobacco control. I have very strong feelings about cigarettes smoking. I understand the harms of cigarettes smoking. And transparently, I have been quite critical of e-cigarettes in the past, for reasons we'll talk about in a moment, but at a high level, I'd say concerns that the marketing of e-cigarettes to youth in particular might get a generation of young folks addicted to nicotine, which could potentially lead to smoking combustible cigarettes. Anyway, we'll talk more about it, but I shared how my thinking changed a bit. So I took a random message from an e-cigarette consultant who reached out to me on LinkedIn,

6:18and he said, can we talk? And I had this moment of internal struggle where I was like, do I get on this phone call? Am I selling my soul by getting on this phone call? But I got on the call, and he was lovely, and we talked, and he was sharing some research with me that really, it was quite eye-opening to me. And the research was about how e-cigarettes are actually very helpful for many current smokers to help them quit the habit. So I'll put a pin in what I'm saying right now, but I'll just say that that prompted Mike to reach out. So Mike, can you introduce yourself, and maybe just give us a little bit of background and why we're having this conversation today? Yeah, so I'm a physician by training, but I've spent the last 30 years or so as a public health researcher and professor, and I have done much of my work has been in the area of tobacco control.

7:20So really, for 30 years, I've been a very strong anti-smoking researcher and advocate. I've played a role in lobbying for smoke-free bar and restaurant laws throughout the country and throughout the world, actually. I also testified in, I think, about 10 different lawsuits against big tobacco, including the angle case, which resulted in a $145 billion punitive damage award against the tobacco industry, which is the largest in history, and have just been really a part of the tobacco control movement for all this time. I've worked with many, many organizations and health agencies in the field. I also spent two years at the office on smoking and health at CDC working as an epidemiologist there, providing technical assistance to the states on trying to reduce smoking. So my background is

8:21really strongly anti-smoking, and I come to it as a researcher and epidemiologist looking at the data and the evidence. So Mike, suffice to say that you've got a great deal of expertise in this topic. So maybe we can kind of set the stage, because today we're here to talk about e-cigarettes. So maybe we could just start by defining what we mean when we say e-cigarettes. And like, just mentioned, it's often referred to as like an electronic cigarette or this term vape gets thrown around or like vaping. A lot of people are vaping these days. What exactly is that? And how is it distinct from smoking? So an electronic cigarette is basically a device that heats a liquid and turns into an aerosol. It basically aerosols creates an aerosol and allows the user to inhale that aerosol. The e-liquid typically contains propylene glycol or and or glycerin. And then nicotine is in

9:29there. And so when the liquid is aerosolized, the user inhales nicotine. But the philosophy behind vaping or e-cigarette use is that there's no tobacco in there and there's no combustion. So what makes smoking so incredibly harmful? The two things, one, the fact that it's using a tobacco leaf and second, the fact that it's combusting it. And so when you take any kind of organic matter, but especially tobacco and you burn it at extremely high temperatures to about 900 degrees Fahrenheit, you get all kinds of toxic byproducts. There are literally 10,000 or more chemicals in smoke, in tobacco smoke, and over 60 known human carcinogens. So the philosophy behind electronic cigarettes is people are many people are addicted to nicotine, addicted to smoking. So what if we

10:30are able to give them that nicotine to satisfy their addiction, but take away all the toxic components. And so an entrepreneur named Han Leek from China, who had lost his father to smoking, decided to invent this device. And he invented what is now known as the electronic cigarette. The most important thing that I think people need to understand about these devices is number one, there's no tobacco involved. So they're not a tobacco product. Many people call this a tobacco product and a lot of organizations say that this is, you know, vaping is now the top form of tobacco use. It's not tobacco use. There's no tobacco in it whatsoever. It's just nicotine and there's no combustion. So it's not smoking. There's no smoke. It's just aerosol, you know, aerosol. Just as if you used like when you use an inhaler for asthma, that's just aerosolizing a liquid solution. So that's what electronic cigarettes are. So I want to lay some cards out on

11:34the table. And I'm curious how you'd respond to this. So for me, in an ideal world, no one would, certainly no one would smoke combustible cigarettes, but also no one would smoke e-cigarettes. Like if we could avoid it altogether, that would be fantastic, right? The reality though is that we do have folks who are highly addicted to combustible cigarettes. And so what we're really talking about now is is this a viable cessation tool for those folks. But taking a step back, you know, to your point, no, we're not using tobacco. No, it's not burning, right? Which is a very big part of why it's harmful. But nicotine isn't great for us, right? It is highly addictive. It does my understanding, this is really not my, you know, my expertise is that it has some negative physiological biological effects like impairs, immune function, things like wound healing. So again, nicotine is not great. What we're talking about now is harm reduction, right? Would

12:39you agree with that or would you push back on anything I just said? No, that's exactly right. I mean, in an ideal world, we would not want anyone to be smoking. We wouldn't want anyone to be vaping. We wouldn't want anyone to be using nicotine. So we certainly wouldn't want anyone to be addicted to any drug. The problem is we don't live in an ideal world. We live in a world where adolescents are risk takers. You know, they are independence and autonomy and rebellion are core values of adolescents. And as long as we have adolescents, we're going to have risk taking. And it can't be avoided. And I think that the, the effort to try to say, you know, we're not going to allow youth to be at any risk of anything is it's not only unrealistic, but I think it actually backfired. Because the more we tell youth what not to do, the more they're going to, they're going to do it. So I think that in that world, which is the world that I'm in,

13:43which is public health, you know, that's what public health is about. It's about balancing the risks and the benefits of different behaviors. And it's not about trying to achieve perfection. It's about trying to deal with these problems realistically. And that's where harm reduction comes in to the picture. One more thing. And sorry, Sarah, I know I'm talking a lot, but I could talk about this for days without stopping. So candidly, I'll say that the feedback I got on this article that I wrote was not all positive. I actually got a lot of blowback from the public health community who felt like I was terrible that I was even considering talking about e-cigarettes in a positive light. And we'll link to this article. I want to say, and something we haven't talked about, but of course we're going to talk about is this predatory marketing and, you know, and getting youth started, right? When we're when we're trying to to hook non-smokers

14:50on this product. But what I was talking about was what we're just saying is harm reduction, living in a realistic world where we do have smokers, is this a safer alternative to combustible smoking cigarettes? And Mike, we did speak briefly before this. And my understanding is you've also experienced similar pushback from the public health community. Is that right? Yeah, absolutely. I think that for some reason, and I can talk a little bit about what I suspect, but for some reason, there is really a reluctance in the public health community, especially in the tobacco control movement, to accept the idea of harm reduction when it comes to nicotine. And, you know, I want to make it clear that we accept harm reduction for many, many other issues in public health, including other addictions. I mean, nobody argues that we should take buprenorphine off the market because youth are going to start using it, right? It's, we know that for heroin users, and nobody

15:53ideally thinks that somebody should be addicted to any opiate. It's not an ideal situation, but would we rather have people, you know, on heroin, shooting up heroin and using dirty needles and all of that? Or would we have them having a safe drug that's administered in a clinic and is not, even it's still an opiate, but it's not, it doesn't carry the other risks associated with, say, heroin use or fentanyl use. But for some reason, the tobacco control field has not embraced harm reduction for nicotine. And I guess I should start by really being honest in saying that when I first heard of electronic cigarettes, I first heard of these products in 2009. And when they first came on the market, I, my reaction, as a long-time anti-smoking advocate was, oh my gosh, the tobacco industry's added again, big tobacco. And I thought, what a cunning idea, you know, what a great ploy to come up with this product that they could,

16:54that, you know, they could say is safer, but in reality is just more of the same. The tobacco industry at one point had introduced light cigarettes and it was the same thing. They said, all of these are much safer. And of course, light cigarettes aren't any safer. In fact, you might hail more, right? So it might even be worse. But, so I just assumed this was another big tobacco ploy. But over the course of two years, I started looking at the research, I started studying the, the issue, I started looking at the companies, I started talking to some of the CEO's of these companies. But most importantly, I started to talk to the vapors, people were actually using these products. And what I found out was very different from what I originally imagined. So first of all, big tobacco was not a fault at all in this product. It was not, the tobacco companies did not create electronic cigarettes and start marketing it. This was independent, as I said, this Chinese entrepreneur who created them. And then it was independent companies that started

17:58selling them. Tobacco companies didn't even get involved in the picture until 2011 when they saw how successful they were and they decided, okay, well, we made it, we'll make some money off of people who are quitting since we're not going to make any money if they just quit and leave our product. So they got into the market. But prior to that, they weren't involved at all. So this was not a big tobacco ploy. Freightrail does more than move goods. It drives America's economy. Every dollar invested generates another $2.50 in economic activity, spurring growth from farms to factories. And here's the best part. Freightrail roads fund their own infrastructure, saving taxpayers billions while powering the economy forward, from reducing highway congestion to delivering goods safely and efficiently. Freightrail keeps America moving. Learn more at ar.org slash America's engine. Listen, we've seen what's out there for patio furniture and what you've been paying is outrageous. But that was last season you before you ditch the specialty stores and started saving more at home

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20:04One iced coffee. 99 cents please. For real? No way. Hmm. What a deal. Your new morning groove. Ice coffee from McDonald's, any size for just 99 cents to 11 a.m. Pricing participation may vary. Cannot be combined with any other offer. Second of all, what I found out is that they are safer than cigarettes. This wasn't, you know, light cigarettes was a scam. It was a fiasco. But it was marketing, right? It was a marketing tactic. Yeah. But this is not a scam. I mean, this is true. Electronic cigarettes are much safer than cigarettes. There's no question about it. And smokers who switch to electronic cigarettes experience immediate improvement in their health, especially in their respiratory health. And they greatly reduce their risk of cancer and lung disease. I talked to vapors and they, many of them, said that there's so only way they could quit. They had tried many, many other ways to quit.

21:08And nothing worked for them until they tried electronic cigarettes. And then finally, I looked at the data. And the data basically showed that as of this point, there's been over 5 million smoke ex-smokers who quit because of switching to vaping. So you're talking about 5 million people who essentially saved their lives because of this product. And so, you know, when I see data, when I see the evidence change, I change my mind. The beauty of science. Like any good scientist. So I mean, given all of this positive data, pointing to, you know, the relative safety of e-cigarettes compared to tobacco, combustible tobacco smoking, why is it that there's so much pushback from the public health community, do you think, with regards to e-cigs? I'm curious, Mike, you'd say, although I think

22:09you did sort of touch on it. I think for many of us in public health, there was this association with Big Tobacco. And I have a funny anecdote, I'll share in a second, but Mike, you're the one who informed me that actually Big Tobacco, they were not the originators, as you've just described, if e-cigarettes, but once they saw the dollars flowing, of course, they went with it. But, and sorry, Mike, I don't know if you want to jump in, but can we? Actually, sorry, go, go for it. Did you want to jump in there? Anything else to add? In response to Sarah's question, I think a major reason for this is that people tend to make assumptions, and they try to put things into boxes, into containers. And so, when something new comes on the market, we try to place it in a, in a comfortable area, something that we already know. And I did the same thing, right? I just admitted, I was guilty of that when the first came on the market, before I even started looking at what they were, I immediately placed them into

23:14this bucket of, okay, this is just another Big Tobacco ploy. And I think that's what happened to everyone in the Tobacco Control and Public Health Movement. And I don't have a problem with that, because I did it myself, right? Right? Right. You naturally are going to make some assumptions. The problem is, in science, when the data changes, the whole point of science is that you change your opinion, and that's what didn't happen, that I changed my up mind a number of other scientists changed their mind when they saw the data, but the mainstream tobacco control groups and a lot of the health agencies did not. They just stuck with that same, and they're not willing to reconsider their opinions, no matter how much evidence comes out showing how much safer these products are. So, but there is one thing that we've danced around a bit, but I just want to really go there. The marketing of e-cigarettes. I think that's another reason, and over 100% understandable reason, I think, why Public Health has had qualms with e-cigarettes. So the flavors, of course,

24:19you know, that's the big thing. You got bubblegum, peach flavored e-cigarettes. It feels predatory, not it feels it is predatory, and I would argue, you know, it sounds like that story you shared about how it was a Chinese entrepreneur who lost his or her father, right? Is that what you were saying, that sort of spurred the idea, while that original, like the origin story, was likely coming from a good place. I think we could agree that now it is, this is a very profitable industry, and I don't think the majority of e-cigarette companies are doing this out of the goodness of their hearts. I think this is making them a lot of money. So I just, I want to talk about that a little bit, and whether, in my piece, I guess I was saying, is there a way to acknowledge that e-cigarettes can be a very powerful cessation tool, but is there a way to regulate them more, or put up, I don't know, we constrain a little, like for example, I think is it in the UK,

25:24and you know a lot more about this than I do, I believe there are limits on the amount of nicotine that could be an e-cigarette. Here are levels fluctuate more, and that upper level is far higher, and please correct me if I'm mistaken. Could it be, and I don't know, just thinking, are there ways to really market this, really market it as a cessation tool, or have like require a prescription, for example? I mean, obviously that would set up a barrier, and I'm sure it's another consideration, but what do you think? Do you think there's a better way, like recognizing that this is a valuable tool, but is there a better way to go about it? There is, there absolutely is, and you know, this is what public health does, public health regulates risks, you know, that's that that's what we do, that's the art of public health, it's balancing the cost and benefits, right? There's, there's many, many products that are used that have a benefit to society, but which also have, have drawbacks, and what we do in public health is we try to balance those, we try to regulate

26:28the risks so that we maximize the benefit and minimize the harm, and there is a way to do that with electronic cigarettes. The problem is that because the, a lot of these health groups and tobacco control groups have been unwilling to even acknowledge that these are safer than, than cigarettes, and that we actually prefer that people, if you had a choice between smoking and vaping, we'd rather that people choose to vape. The fact that they haven't even been able to, to acknowledge that is really what's standing in the way of regulating the product, because the approach that they've taken is, you know, these things are horrible, it's a big tobacco ploy, we need to get them off the market, and so they've taken essentially a prohibition approach. Let's just ban all, e-cigarettes, or at least let's ban all flavored, all flavors of e-cigarettes. And that's not a public health approach that works, you know, we know from prohibition of alcohol, that just, it doesn't work, what it does is it creates a black market and you end up with,

27:31you know, illegal moonshine that actually it's going to kill people. So, it seems a little narrow-minded. It is, it's very narrow-minded, and it just, that approach is not, doesn't work. So, what we need is to regulate the products, and regulating the products means, regulating the marketing, you know, right, regulating some of the flavors, saying, okay, you cannot have gummy bear, you know, there's no, there's no need for gummy bear, you know, flavor. So, that's not going to help you quit smoking anymore, if it's flavored, it's like candy. It doesn't have to be that kind of, you know, candy, right? And so, there are limits, you could limit the nicotine levels, you could regulate the battery safety and the quality of these products. The problem is, we're not doing that because the approach that we as a country have taken, and it's largely because of the reaction of a lot of the public health groups, is a prohibitionist approach. So, we basically, in this country, have decided that we're going to outlaw all cigarettes, sorry, we're going to outlaw all e-cigarettes, except for ones that get

28:36FDA approval, and to get FDA approval, they have to submit these complex applications that cost hundreds of thousands of dollars. And so far, only 32 products have been approved. And so, what that means is that 70% of the e-cigarette market right now is illicit. Most electronic cigarettes on the market now are illicit. 75% of people who are buying e-cigarettes are buying essentially an illegal product. And that doesn't help anyone because what that means is that they're buying products that are not regulated. And that is a problem. So, what, you know, I think the better way to approach this is just to acknowledge, yes, these products are going to help many smokers quit. So, yes, we do want to keep them available, but at the same time, we're going to try to minimize the risks to youth and to, you know, other non-smokers. And so,

29:36to do that, let's regulate this. Let's put marketing limits. Let's, you know, make sure that nobody under H-21 can access the products. Let's make sure that they're as safe as they can be by, you know, let's regulate the temperature so that they don't get chemicals in there that shouldn't be in there. But that's not the approach that we've taken in the United States. Right. I'm going to go on a little tangent, but, you know, I am raw, raw public health. I am Mrs. public health. I love public health. And I think people are quite hard on public health, in particular, like COVID response stuff. And there's been a lot of criticism, maybe some warranted, not all of it. So, with that in mind, I will tell you that I am frustrated with this aspect of public health. And I've written, I wrote this other piece, like I said, this is a tangent, but it's somewhat related. I wrote this article on masks. And how I as a public health scientist

30:41without question, high quality masks are incredibly effective at reducing disease transmission. From that perspective, absolutely, they're an incredible tool. But the reality is that there are other factors that we weigh when deciding whether or not to wear a mask, right? Like for me, I have a daughter who has some speech challenges and it's very important for her to see my mouth as it moves. There are other downsides. I've heard people say, you know, they don't, they don't like wearing that candid layer. It might interfere with social interactions. So the answer is for me, I take a harm reduction approach where I do mask any time on a doctor's office or a clinical setting where I know I'm going to be around sick people. I mask, if someone asks me to mask, I mask if I'm around individuals who, you know, identify as immunocompromised understanding that not we can't always see whether a person is immunocompromised, which is 100%

31:45an issue, right? And so people, that tends to be the argument I hear. But my point is that I think public health needs to get with the program and understand that we're not always, like we see things through a very specific lens, but we have to understand these other things that are happening and impacting decision making and our behaviors. And until we do that, it feels like it's we're going to be so polarizing and we're going to miss a real opportunity to to help people. So sorry, that was a little bit of a tangent soap box, but I'm frustrated by that. Sounds like you are too. Yeah, and I guess I would say that I don't, you know, I don't think that actually is a tangent. I think that is the central issue. I think the central issue is that we have to be better in public health about acknowledging the reality of people's lives and in giving people autonomy to make choices. But in doing that, what we, what is absolutely essential

32:47is that people are informed with the truth. You know, it's it's not autonomy. People can't be autonomous if they don't have the correct information. And so what we've done, I think, is given people a lot of misinformation in public health. And, you know, the original, remember in March 2020, when masks went when the CDC first talked about COVID, they said, don't wear masks. That was their first, their very first message was don't wear a mask because it doesn't, it doesn't work. And that ended up being very damaging because you can't, you know, once you tell the public one thing, you can't backtrack on that or you're going to, you're going to lose trust. And I think that's what happened. So I would argue that with respect to the vaping issue, you know, people have to make their own minds. Smokers have to have autonomy to decide like, you know, if they can't quit using any other method and the cigarettes are available, that, you know, they can make an informed decision. But what people do need to know is the truth. And right now, the public health groups are not

33:52telling the public the truth. They're basically saying in many groups have said that vaping is just as harmful as smoking, that it doesn't help you to quit smoking. And they're actually discouraging people from quitting smoking by switching to vaping. And so that is going too far because that is not being truthful. And so people, that's actually taking people's autonomy away, not giving them autonomy. So I think, you know, what you're mentioning here is really the central issue, which is that we have to understand what what people's lives are, that there are competing risks that people make decisions about every day. And they have to have autonomy to make those decisions, but to do that, they need the truth and hiding the truth and just forcing them into a, you know, kind of either or situation where there's no nuance and no middle ground is usually not the best approach.

34:52So I know we're going to get ready to wrap in just a couple of minutes, but I think we'd be remiss if we didn't acknowledge that there are other cessation, smoking cessation tools out there. There's, you know, Nicarat gum, there are patches that people wear. There's chantics, right, which is a prescription medication that can help with cessation, although I know that also comes with it with its own risks, right? There's in also the little pouches you could put in your lip and and, you know, like chewing tobacco like that. Do you know that there's a whole Zinfluencer culture now? Do you have you heard that term? Yeah, it's a whole thing. And my understanding, and I really want to hear from you, Mike, I'm sure there have been studies sort of comparing these cessation tools. My thinking is that I'm sure there's something about, and if you're not watching on video, I'm modeling smoking cigarettes, something about the act of smoking, of drawing the, you know, the cigarette to your back, just because it mimics that same

35:53motion of cigarette smoking. I would think that's part of why maybe it's more effective, but I'm curious, have you seen research on that? Yeah, so basically the research is pretty clear that the most effective way, you know, outside of, say, cold turkey quitting, which is always the best method. But outside of that, if you're going to use some sort of cessation aid, by far, the most effective is actually electronic cigarettes vaping. The long-term success rate with vaping over about a four-year period can be as high as about 50%. Even in clinical trials, the success rate for vaping, switching to vaping is about 20%, and for nicotine replacement therapy, it's only 10%. So using these cigarettes is actually twice as effective as any other method for quitting, and so it's not that we, you know, obviously we wouldn't discourage people from

36:59using, I wouldn't discourage someone from using shantyx or using nicotine replacement therapy. So, but that's what we're doing in public health. We're actually public health people are telling people only use NRT to not use vapes, and that makes no sense because many people just can't quit with, with, with those products, and why would you tell people to use something that's actually less effective? I mean, what we need to do is we need to have as many off-ramps as we can for people who smoke. It is deadly, and we've all seen loved ones die from smoking, and we're still losing about 300,000 people a year to smoking. So we need to open up every possible off-ramp, and for somebody to come in and say, no, we're not going to allow you to use that off-ramp, or we're going to tell you, you know, we're blocking that off-ramp, makes no sense whatsoever. We need to allow all those off-ramps to exist. Now, we can we put

38:01guardrails on the off-ramps to make sure that people don't, yes, that's fine. We need to put guardrails up, but that's not the approach we're taking. And this is such deadly, you know, smoking is such a deadly thing that I think part of the problem is that people have lost sight of that because smoking rates have gone down so far that people think that, oh, you know, I don't see anyone smoking the problem is over. The problem is not over because among adults, you know, we still have about 17% of adults who smoke, and so, you know, we can't throw those people under the bus. It's just not fair to do that. And I just saw something really upsetting that I'm seeing smoking, combustible smoking is actually on the rise in young people, which is her just terrible news. So we're coming up on time here. I just want to sort of recap where I think we landed and then Mike, if you have any like last, you know, last last thoughts, please feel free to chime in. In an ideal world, people wouldn't smoke combustible cigarettes. They also would not smoke

39:04e-cigarettes, right? E-cigarettes are one of several possible cessation tools for smokers, and you should do what works best for you. Smoking is brutal, you know, I watched my father die slowly and painfully for almost 15 years. It was horrific. And so my goal as a public health scientist is to have fewer people smoke cigarettes, right? That being said, right now, the e-cigarette industry is running wild, right? There is no regulation. And they are, there is 100% predatory marketing to youth. And we should not have children and teenagers and young adults starting this habit. That's a problem. So it sounds like we need to really regulate e-cigarettes. We need to maybe limit the amount of nicotine that is in these e-cigarettes. We need to absolutely have guardrails on marketing. But we do need to do better about presenting this as one viable

40:11off-ramp, as you said, Mike. Any like last thoughts or what, what did we not? Anything we didn't say? Well, no, I think the way that you described it is perfect. I mean, in an ideal world, we wouldn't want anyone vaping. We wouldn't want anyone using nicotine. We don't live in an ideal world. And so what we do in public health is we regulate in order to try to maximize benefits and minimize risks. And, you know, we can regulate these products. There's no reason why we can't. But we haven't chosen to do that. Instead, we've chosen a path that has led to a situation where 70% of products on the market, of vaping products, are completely unregulated. There is an illicit market. And then it's there. It's the wild west, right? It's anything goes. That's where you get your predatory marketing that you can't control. That's where you get cotton candy flavors, which are just irresponsible. So we need to embrace e-cigarettes so that we can

41:11regulate them. And to do that, we need to embrace harm reduction. And that's what hasn't occurred in public health. Here, here. All right, Sarah, do you want to take us home? Dr. Mike Siegel, thank you so much for joining us today. And also, Jess, thank you for sharing your expertise with us today. I don't know if she mentioned, but Jess actually did her dissertation on this stuff. So it's super, super knowledgeable. So I really feel like I did a lot of listening today, but I learned a ton from both of you. So thank you so much. And thank you all for tuning in. We hope you learned a thing or two. Please join us next week on your trusted source for no nonsense, just science. You won't see the engineer that slams the Nissan Rogue Store 13,920 times. Or the corrosive chamber that simulates 15 years of life in five months. Or the Rogue Heat

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