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Real Talk About Nicotine
How CDC propaganda leads to bad medicine and kills people
There is no greater public health failure of this century than the CDC’s approach to nicotine messaging. Not only is the public misinformed about cigarettes, vapes, and the good and bad effects of nicotine, the public continues to get more and more misinformed over time. That misinformation is killing people, the CDC is doing it on purpose, and the only way to counteract it is to spread the scientific truth through unofficial channels.
Herein, we will discuss in scientific, objective terms the good and the bad about nicotine, the good and bad of tobacco, the good and bad of vaping, the very awful things the CDC are doing to hide all of this, the number of people the CDC kills per year by their very awful behavior, and what you can do to save a life.
This is long. Let’s begin.
Nicotine: The Good
Nicotine increases attention, working memory, fine motor skills, and episodic memory functions, which is particularly important when analyzing smoking rates in people who are cognitively deficient, such as schizophrenics, bipolar people, depressed people, and people suffering from ADHD. (Valentine and Sofuoglu, Current Neuropharmacology 2018) The ADHD link has been studied extensively. (van Amsterdam, Substance Use & Misuse 2017) (Bidwell, McClernon and Kollins, Pharmacology Biochemistry and Behavior 2011) Specific studies show nicotine reduces ADHD symptoms approximately 8% to 9% (Gehricke, Hong, Whalen, Steinhoff, and Wigal, Psychology of Addictive Behaviors 2009) with similar results shown in double blind, placebo-controlled, randomized trials. (Shytle, Silver, Wilkinson, and Sanberg, World Journal of Biological Psychiatry 2009) In fact most of the ADHD research is some version of the phrase “how can we get these people to quit this obviously beneficial drug?”
It also works on people with Alzheimer’s disease (Levin and Rezvani, Curr Drug Targets CNS Neurol Disord. 2002) and dementia. (Picciotto and Zoli, Journal of Neurobiology 2002) It looks promising in treating autism, although the study was very small and not necessarily trustworthy. (Lewis, van Schalkwyk, Lopez, Volkmar, Picciotto, Sukhodolsky, DG J Autism Dev Disord. 2018) It reduces pain from chemotherapy related neuropathies, including those from oxilaplatin, the regimen my wife was on before she passed away. I didn’t even know that at the time. (Mannelli, Zanardelli and Ghelardini, European Journal of Pharmacology 2013) It mostly works as a “MAO inhibitor,” which explains why it’s useful in counteracting depression. (Hogg, Nicotine and Tobacco Research 2016)
The attention enhancing effects not only work on people who are attention deficient, but on regular folks as well. (Levin, Silva, Hinton, Meck, March, and Rose, Psychopharmacology 1998) Nicotine increases your ability to differentiate intensity and frequency of sounds. (Sun, Kapolowicz, Richardson, Metherate, and Zeng, Open Access 2021) It increases exercise endurance. (Mundel and Jones, Experimental Physiology 2006) Nicotine is an appetite suppressant, increases your metabolism by 7% to 15%, and is often associated with five to ten pounds worth of weight loss. (Schwartz and Bellissimo, Appetite 2021)
There’s some study that nicotine may reduce cytokene storms during Covid-19 infection, but I’m less convinced than I used to be, as all the science around Covid-19 got completely politicized and ground through a culture war sieve in 2020. A lot of positive study has been done on nicotine’s effects on ulcerative colitis and Parkinson’s disease. There are studies on sleep apnea, epilepsy, and general inflammation that seem positive.
Nicotine, in short, has many benefits for certain folks with different medical diagnoses, and those results also extend to the general population, particularly with regard to cognitive function, memory, and attention. It may be the world’s most beneficial nootropic. Every link above is to a scientific study, and there are many more beyond that. If you claim that nicotine has no positive effects, your claim is not supported by the science.
Nicotine: The Bad
Nicotine does not give you cancer, but it does have some other bad effects.
Nicotine is a vascular constrictant, and at extremely high doses, a deadly paralytic. The estimated deadly dose of nicotine is somewhere between 250 and 500 cigarettes worth at the same time, but since the nicotine only constitutes 1% to 3% of the dry weight of tobacco leaves, someone would have to isolate it and use it as a poison. This very thing led to the invention of forensic pharmacology, because people in the 1800s were murdering each other with it.
The vaso-constrictive nature of nicotine can cause or exacerbate erectile dysfunction in men, since the penis is basically one big blood sack. Studies show the odds of having erectile dysfunction for vape users (for instance) is increased by a factor of about two and a half, after controlling for other multivariate effects such as cardiovascular disease. (Shahawy, Shah, Obisesan, Loney, Sherman, Mlaha, American Journal of Preventive Medicine 2021) Tobacco users experience similar effects.
Some of the vaso-constrictive effects of nicotine may contribute to cardiovascular disease, as discussed below in “Vaping: The Bad.” Skip ahead if you like, but the punch line is that a large number of the affects on your cardiovascular system from smoking are from the smoke, but a small number are indeed from the nicotine itself. These don’t show up at all in tests of some nicotine delivery mechanisms, and they show up in small but measurable amounts for vaping.
Nicotine is addictive because part of its mode of action releases dopamine in the same way that alcohol, gambling, or getting hits on social media does. Nutt et all (Health Policy 2007) characterized it as a 2.21 on a scale of 0 to 3, where heroin was 3.0, cocaine was a 2.39, amphetamine was a 1.67, and alcohol was a 1.93. We might say nicotine is “not quite as difficult to kick as a coke habit.” Addictions are bad, and physical withdrawal from nicotine after quitting “cold turkey” can last three days, whereas psychological addiction can last weeks or more. It’s not easy to quit.
Tobacco: The Good
Some people like how it smells. It’s used worldwide and you can use cigarette packs as barter in third world countries. If you learn to do tricks with your Zippo then women might think you’re sexy, depending on how old they are. You can get it at every gas station and every grocery store in the country. These are basically the only good things about tobacco.
Tobacco: The Bad
Tobacco smoke contains over 69 known carcinogens, most of which are a product of combustion. (Surgeon General / CDC, 2010) Tobacco related cancers kill about a third of a million people per year in the USA, and a third of all cancer deaths are caused by cigarette smoking alone. The risk of lung cancer goes up by a factor of between 20 and 25 if you’re a cigarette smoker. This is all true stuff and basically everyone knows it.
Tobacco smoking is also a risk factor for many different aspects of cardiovascular disease.
In total, the various bad effects of tobacco use knock about ten years off of your life on average. (Jha P, Ramasundarahettige et al, New England Journal of Medicine, 2013)
It’s tremendously expensive. The average cost of a pack of cigarettes in the United States is $8 a pack, which is almost entirely sin taxes the government charges to try and dissuade smoking. New York taxes raise the average price to $12, which creates a black market for selling “loosies” on the street corners, fought by cigarette tax enforcement goon squads such as the one (comprised of both black and white cops) that choked Eric Garner to death for selling loosies and birthed “Black Lives Matter.” Garner wasn’t killed for being black, he was killed for cigarette tax evasion.
As smokers typically smoke one to two packs a day, this habit costs between $3000 and $6000 per year, which would be 10% to 20% of the entire yearly earnings of a median income earner in the United States. It’s not much for a rich person, but for a poor person it’s the difference between making rent and not making rent. There are lots of highly convoluted ways the policy making class explains away how incredibly regressive cigarette taxes are, and their impact on the poor, which is a topic many other publications have hit on. If there’s a such thing as “moral taxation,” cigarette taxes are the least moral taxes in the USA today. All that aside, the current cost of tobacco is a huge drawback to smoking.
Vaping: The Good
“Electronic cigarettes,” or “vapes,” work by dissolving nicotine into vegetable glycerin or propylene glycol and aerosolizing it with a heating element, into a ‘vapor,’ and then inhaling the nicotine. Just like there’s no cancer in nicotine, there’s no evidence of cancer in vapes. See below for references. All of the “Good” stuff of nicotine can be acquired through vaping, as well as all the ‘bad’ stuff such as addiction. Most of the research to date has been about these fluid based systems instead of “nicotine salt” based systems like the Juul, so I will narrow my focus of this article on these systems. Quite honestly I don’t know enough about the Juul style salt systems to have an opinion one way or another.
In addition to granting the “good stuff” from nicotine, vaping is incredibly cheap, especially if you do it yourself. You can buy a gallon jug of 100mg/ml nicotine dissolved in vegetable glycerin for $165, which is enough to support a “pack a day” nicotine habit for 26 years. You need to dilute it yourself in pure vegetable glycerin down to at least one fifth that concentration, however, because 100mg/ml concentration is dangerous. If you’re ok mixing your own stuff, nicotine is effectively free in vape form.
Vaping: The Bad (?)
The figure above is from a very well done scientific study by Benowitz and Burbank in 2016 for Trends in Cardiovascular Medicine, which is worth examining in detail by following the link. They dug out all of the cardiovascular problems with tobacco, identified all the different mechanisms by which cigarettes cause cardiovascular problems, and isolated the causes of each to differentiate between tobacco smoking and vaping.
Some of the paths of cardiovascular disorders identified in smoking are tied directly to nicotine. It increases heart rate and constricts blood flow, which temporarily increases blood pressure. Animal studies show nicotine alone (without smoke) contributes to irregular heartbeat. The majority of smokeless tobacco studies, however, do not support an increase in hypertension due to nicotine from this route, so it appears that the impacts on blood pressure from vaping are transient.
Nicotine’s relation to inflammation is curious and confusing. Tobacco smoke is unilaterally understood to increase inflammation, but nicotine appears to decrease it, so the net effect of a cigarette with nicotine may in fact be less than a hypothetical cigarette without it. This makes studying the effects of vaping on endothelial dysfunction, which is the constriction of vessels around the heart, difficult to say. The net effects of vaping on endothelial dysfunction might cancel (vaso-constriction but with less inflammation) or they might not. The Benowitz and Burbank study states that on balance nicotine isn’t a major contributor one way or another to the inflammation caused by smoking.
Cigarette smoking lowers HDL (the good) cholesterol and increases LDL (the bad) cholesterol, and the studies on nicotine gum, patches, and vaping are a mixed bag on where this comes from. Chalk that up in the ‘bad’ column. Cigarette smoking increases the incidence of Type-2 Diabetes, and studies on nic gum seem to conclude that this is because of the nicotine releasing insulin-antagonistic hormones. Another one in the ‘bad’ column.
I’m going to quote the three most important sections of this study directly.
Nicotine Medications and Cardiovascular Disease
Randomized clinical trials (RCT's) testing nicotine medication in cessation trials for CVD patients, case control studies, long term longitudinal studies, and meta-analysis have found no increased risk of serious CV events in patients given nicotine medication, even in the context of acute and chronic CVD. (2, 18, 23, 24) A RCT in 1996 randomized 584 smokers with high-risk pre-existing CVD to transdermal nicotine vs placebo and found no significant increase in CV events. (24) Another study treated 36 smokers awaiting elective coronary bypass surgery with nicotine patches (initially 14 then 21mg) and urged them to stop smoking (25). Participants underwent exercise nuclear perfusion studies and measurement of exhaled carbon monoxide, and plasma nicotine and cotinine levels at baseline and after patch use. By self-report most continued to smoke, but did reduce tobacco consumption while on the patch, which was confirmed by lowered carbon monoxide levels but higher serum nicotine and cotinine levels. Despite higher nicotine levels, tobacco reduction markedly improved myocardial perfusion, suggesting that combustion products rather than nicotine were the primary contributors to smoking-induced cardiac ischemia. A five year longitudinal study of 3,094 COPD users of nicotine gum in 1996 showed no association between rates of hospitalization for CVD conditions or deaths from CVD with use of nicotine gum, dosage of nicotine in gum, or dual use of nicotine with cigarettes (18). A network meta-analysis performed in 2013 analyzed 63 RCT of nicotine medications including 21 NRT studies, 28 bupropion studies and 18 varenicline studies and found no significant increase in major adverse CV events (death, myocardial infarction, or stroke) with any of the three therapies, but a slight increase in less serious CV events (e.g. tachycardia and arrhythmia) with NRT (23)
Summary: nicotine medications such as gum and patches do not appear to have any impact on cardiovascular disease in randomized clinical trials.
Smokeless Tobacco and Cardiovascular Disease
Smokeless tobacco (ST) delivers as much nicotine to the systemic circulation as does cigarette smoking, albeit with slower absorption (21). Worldwide, ST exists in many forms, but the best epidemiologic studies of smokeless tobacco and CV health have been conducted in Sweden, where 25% of men use a form of ST called snus. Non-invasive studies of the extent of atherosclerosis, using carotid intimal wall thickness, found the expected increase among smokers, but no difference between snus users and non-smokers. Case control studies in Sweden have shown no increased risk of myocardial infarction or stroke, but a small and statistically significant increased case fatality rate for both among snus users compared to non-tobacco using controls. In contrast the a large cohort study in the United States and the InterHeart study of smokeless tobacco users in many countries around the world did find an association between ST and myocardial infarction (26, 27). The explanation for discrepant findings may be differences in ST products or other CV risk factors in various regions of the world. A recent Swedish study raises concern about nicotine safety in people with CVD. Among survivors of acute myocardial infarction who were snus users at the time of the event, those who continued to use snus after the event had a significantly higher mortality compared to those who quit.(28) This study suggests that nicotine may be hazardous in patient with CAD. Smokeless tobacco has also been reported to increase in the risk of heart failure, but unlike cigarette smoking does not increase the risk of atrial fibrillation. (29, 30) The American Heart Association reviewed the cardiovascular risk of ST and concluded that while ST most likely conveys less cardiovascular risk than smoking, it still poses some CV risk and recommended against it use in patients with cardiovascular disease. (21)
Summary: smokeless tobacco has less impact on cardiovascular health than cigarettes, but the impact is measurable and statistically significant.
Cardiovascular concerns from e-cigarette aerosol constituents other than nicotine
Low levels of PAHs, volatile organic compounds, phenolic compounds, acrolein, acetaldehyde, and formaldehyde have been found in some aerosols (36, 37). While levels are generally much lower than those generated by cigarettes, at high battery voltage and power, aldehyde generation can be as high as that from cigarettes. Particulates are generated by e-cigarettes and are present in concentration similar to those of conventional cigarettes. However, the particulates are primarily liquid, dissipate quickly, and are of uncertain relevance with respect to human disease. This is in contrast to particles from combustion that contain solid matter and are persistent in the environment. Heavy metals (cadmium, lead, nickel, silver) and silicates may be present in trace amounts due to device heating element rather than liquid. Novel compounds in e-cigarette vapor with unknown cardiovascular effects, include a wide variety of flavorings and fragrances (largely untested in inhaled products). Propylene glycol can be a pulmonary irritant, although chronic exposure studies in rodents report few significant pulmonary effects. If e-cigarettes do produce pulmonary injury and chronic inflammation, this could increase cardiovascular risk.
This passage of the report is bullshit. Footnote 37 above is to Tayyarah and Long from Regulatory Toxicology and Pharmacology in 2014, who found (follow the link) that the total amount of potentially harmful constituents in cigarette smoke was 1,500 times greater that what they found in vapes. And the CDC founds most of their anti-vape propaganda on the bullshit within this passage and similar passages.
The anti-vaping literature talks a lot about exposure to heavy metals, but the science on this is rife with activism and bad methodology. Soulet and Sussman in Toxics (2022) performed a comprehensive review of prior studies on the subject, and found the entire field was full of cheaters and bad science:
All experiments reporting levels above toxicological markers for some metals (e.g., nickel, lead, copper, manganese) exhibited the following experimental flaws:
(i) high powered sub-ohm tank devices tested by means of puffing protocols whose airflows and puff volumes are conceived and appropriate for low powered devices; this testing necessarily involves overheating conditions that favor the production of toxicants and generate aerosols that are likely repellent to human users;
(ii) miscalculation of exposure levels from experimental outcomes;
(iii) pods and tank devices acquired months and years before the experiments, so that corrosion effects cannot be ruled out;
(iv) failure to disclose important information on the characteristics of pods and tank devices, on the experimental methodology and on the resulting outcomes, thus hindering the interpretation of results and the possibility of replication.
In general, low powered devices tested without these shortcomings produced metal exposure levels well below strict reference toxicological markers.
Put simply, the researchers juiced the vape voltage and burn time to burn out the coils and then celebrated that they found metals in the vapor because it met their prior biases. And then that research finds its way onto the CDC website, because the CDC cares less about public health than it does about public control.
In summary, vaping has all of the benefits of nicotine, which are measurable, noticeable, and positive in both people with mental conditions and people without. Vaping catches all of the drawbacks of nicotine as well, which include an increased rate of erectile dysfunction and a possible increase in cardiovascular disease, albeit significantly smaller than cigarettes. Improper handling of concentrated vape fluid could be poisonous. Vaping is also a significant addiction, and addictions aren’t good. But the relative health difference between vaping and smoking is stark.
CDC Messaging: All Bad
After decades of denial, deflection, and anti-vape propaganda, the FDA finally said the quiet part out loud in September of 2022. Here are some excerpts of an interview with Brian King, the director of the center for tobacco products at the FDA, about e-cigarettes:
Q: Surveys have shown that many adults think e-cigarettes are as dangerous as traditional cigarettes. Is that a problem?
A: I’m fully aware of the misperceptions that are out there and aren’t consistent with the known science. We do know that e-cigarettes — as a general class — have markedly less risk than a combustible cigarette product. That said, I think it’s very critical that we inform any communication campaigns using science and evidence. It has to be very carefully thought out to ensure that we’re maximizing impact and avoiding unintended consequences.
Q: What’s your view on the potential for vaping to help reduce adult smoking?
A: I think there’s a lot of really important science and innovations that have occurred in the industry in recent years. The most notable I think is nicotine salts (in e-cigarettes).
We know that when you smoke a tobacco product, it’s a very efficient way to deliver nicotine across the blood-brain barrier. So it’s been very difficult to rival that efficiency in another product. But in the case of nicotine salts you have the potential to more efficiently deliver nicotine which could hold some public health promise in terms of giving smokers enough nicotine that they would transition completely. But you also have to consider the opposite side of the coin, which is the inherent risks of initiation among youth. So I do worry about that.
So there’s a lot happening and I think that it could be promise or peril. But I think it’s important that the science drives that.
This was the very first time in two decades that the United States government has admitted that vapes aren’t near as harmful as cigarettes. He states that the government has an obligation to inform its communications campaigns with science, but the CDC is explicitly not doing that, as we’ll see below.
Let’s contrast that with statements from other global health agencies. The Royal Society for Public Health in the UK says this about nicotine alternatives:
Nicotine is harmful in cigarettes largely because it is combined with other damaging chemicals such as tar and arsenic, and as a highly addictive substance getting hooked on nicotine is one of the prime reasons why people become dependent on cigarettes. Electronic cigarettes and Nicotine Replacement Therapy (gum, lozenges, and patches) contain nicotine but don’t contain the harmful substances found in cigarettes.
Alarmingly RSPH research reveals that 90% of the public still regard nicotine itself as harmful and the organization is now calling for measures to promote safer forms of nicotine products to smokers and make it harder to use tobacco. Among the measures which are being called for in its report: Stopping smoking by using other sources of nicotine…
The World Health Organization’s European cancer branch has this to say:
Does nicotine cause cancer?
No. Nicotine is a common chemical compound found in tobacco plants, and its effect is to make tobacco addictive rather than to cause cancer directly. People who are addicted are more likely to continue to expose themselves to the carcinogens in smoked or smokeless tobacco.
Foreign health agencies state explicitly that nicotine does not cause cancer, that vapes are a largely safe alternative to cigarettes, and are alarmed that the public doesn’t know this. The phrase “nicotine doesn’t cause cancer” cannot be found on the CDC website, and the CDC intentionally obfuscates the science with their messaging:
What is in e-cigarette aerosol?
The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances, including:
Ultrafine particles that can be inhaled deep into the lungs
Flavoring such as diacetyl, a chemical linked to a serious lung disease
Volatile organic compounds
Heavy metals such as nickel, tin, and lead1
The CDC doesn’t state that nicotine doesn’t cause cancer, nor that the ultrafine particles are entirely or almost entirely vegetable glycerin, nor that no instances of lung disease from vaping have been identified, nor that the ratio of total “volatile organic compounds, cancer-causing chemicals, and heavy metals” in e-cig vapor are 1/1500th as much as that from a cigarette, nor that the only way they were able to find heavy metals in vape was by intentionally burning out the heating element. Later:
Besides nicotine, e-cigarette aerosol can contain substances that harm the body.1
This includes cancer-causing chemicals and tiny particles that reach deep into lungs. However, e-cigarette aerosol generally contains fewer harmful chemicals than smoke from burned tobacco products.
They keep saying this over and over:
Are e-cigarettes less harmful than regular cigarettes?
Yes—but that doesn’t mean e-cigarettes are safe. E-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes. However, e-cigarette aerosol is not harmless. It can contain harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents.
The word “cancer” appears six times on the CDC e-cig web page, and every single time it’s in the phrase “cancer-causing chemicals” inferring that vapes cause cancer. And the FDA tobacco czar wonders why people are misled about vaping.
How misled are they?
The US Cancer Institute HINTS survey indicates that only 2.6% of the United States population correctly understands that vapes are much less harmful than cigarettes, and further that the American public is becoming less informed about this fact over time:
According to recent polling almost 80% of doctors worldwide mistakenly believe that nicotine causes lung cancer:
Twenty years worth of intentional, willful misinformation has created a plague of fake science and bad facts that has misinformed both doctors and the public, and that plague of willful misinformation has literally killed people.
How many people did it kill?
Counting Dead People
According to the CDC fact sheet, almost half a million people die from cigarette related illness per year in the United States. That’s about half the yearly Covid-19 death count at the pandemic’s peak, every year. According to the SAMHSA NSDUH Annual National Report, around 22% of the US population smoked or vaped in 2021, with 15.6% smoking and 4.7% vaping.
There are 127,000 deaths per year from lung cancer, 90% of which are due to smoking. There are 695,000 deaths per year from cardiovascular disease, 25% of which are claimed to be due to smoking. I’m not sure I totally buy that ratio, given how the CDC is goosing their other numbers in their messaging above, but let’s run with it for now. That totals 114,300 lung cancer deaths from smoking and 173,750 heart attack deaths from smoking, for a grand total of 288,050 total deaths from those two causes.
We know that the cardiovascular effects of vapes are noticeable, but less than cigarettes. No researcher is willing to throw a number at that. If we pretend for a moment that vapes are 100% safer for lung disease, which seems true based on the science, and 50% safer for cardiovascular disease, which is a total guess, then converting the US smoking population to vaping would save 201,175 lives per year. Or, put another way, the CDC’s vicious misinformation campaign is killing two hundred thousand people per year. Presuming a 100% cigarette to vape conversion, every five years worth of CDC vaping misinformation kills as many people as Covid-19 did during the pandemic.
There are 10,899 employees at the CDC. For every employee at the CDC, 18 people die per year from CDC vape misinformation.
As a moral, ethical human being, I would like to save lives. I normally get about 3,000 to 5,000 hits on these articles, which would mean about 624 cigarette smokers read them on average. If you’re a cigarette smoker, this section is for you. If you’re not a cigarette smoker, share the article with as many people as possible to increase the number of lives saved.
I know smokers who tried vaping and quit because it “didn’t hit right.” This is largely because over the counter vape solutions weren’t strong enough to simulate a cigarette, so they went back to cigarettes. If you want to transition to safer nicotine consumption, either on your way to quitting or simply to pursue a healthier (if not completely healthy) way to get your fix, I recommend starting by mixing your own unflavored vape juice from unflavored vegetable glycerin, and do it in concentrations that mirror a cigarette. The Surgeon General unwittingly provided a map for how to do this, in a document that was supposed to scare people away from vaping. Let’s look at his graphs.
The punchline is that 12mg/ml of nicotine in solution hits about like a cigarette. The footnotes include propylene glycol as a solvent but you shouldn’t use that because it’s may be linked to “popcorn lung.” While the popcorn lung thing isn’t proven, there’s no reason to risk it in my opinion. Use straight vegetable glycerin, because that’s a natural solvent that is literally in every plant on the planet.
Go to a vape shop and buy something that looks like this:
Go to a nicotine wholesaler and buy this:
Keep that nicotine jug well away from children or idiots because it’s dangerous stuff in that high a concentration, ideally in your freezer to keep the nicotine from degrading over time. Mix the two things in about a 5:1 ratio in another container. Stick it in the vape tank. Try that. It should hit about like a cigarette does. Do it for a week and your lungs will feel better than they have since you started smoking.
Then if you want to quit, mix the next batch of vape juice in a lower ratio and ween yourself off. Or don’t. Save $6,000 per year and spend it on guns or movies or political donations to change the people in charge at the CDC.
And if this saves your life, you can subscribe to this newsletter for the cost of a pack of cigarettes.