What is most disturbing to me about this story is that there is clearly no room for a difference in opinion in the tobacco control movement about certain dogmatic elements of the field. You can't express disagreement without facing personal attack, no matter how well you support your argument with scientific evidence. Like a religion, you can't challenge the gospel-like nature of movement's mantra without being viewed as a heretic.

What is so scary to these lung groups about the prospect of so many smokers quitting or cutting down substantially on their smoking? A cynic might say that it would cause these physicians to lose a huge number of patients. That these groups are trying to protect their own payment streams is as rational an explanation for their behavior than any science- or public health-based explanation I can ponder.

In other words, despite acknowledging that they cannot tell from their study whether e-cigarette use precedes smoking or whether smoking precedes e-cigarette use, they nonetheless draw the conclusion that e-cigarette use precedes smoking.

While the FDA sees the problem as being that the public believes electronic cigarettes are safer than smoking, I believe the problem is that the FDA fails to grasp the clear science and to appreciate that cigarette smoking is far more hazardous than vaping.

Fortunately, there is a simple way to evaluate this hypothesis, at least on a preliminary basis, prior to waiting for the results of longitudinal studies. Enough youth are experimenting with electronic cigarettes, and the increase in youth e-cigarette use has been dramatic and sustained enough, that if the gateway hypothesis were correct, we would be starting to see an increase in smoking prevalence among youth due to the many new smoking initiates that were converted from e-cigarette experimentation to smoking.

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