The truth is that there are major advantages and disadvantages of both surveys and clinical trials to examine the potential benefits of electronic cigarettes. Both types of study designs have inherent biases which can produce results that are more "favorable" or "unfavorable." This is why the methodology of published research needs to be examined so carefully. It is not so simple as to dismiss RCT evidence and accept survey evidence. One needs to consider the strengths and limitations inherent in both approaches. And at the end of the day, the only defensible approach, I believe, is that both types of studies are necessary, and we must carefully interpret and synthesize the findings from studies of multiple designs, using the totality of the evidence to make final judgments about the benefits of electronic cigarettes.

The rest of the story is that this assertion by the FDA - that cigarette smoking may be no more hazardous than vaping - appears to be more politically-based than science-based. President Obama, in his inaugural address, called for a return of science to public policy. He asked that science be restored to its rightful place. However, the assertion that cigarette smoking is not known to be any more harmful than inhaling the aerosol produced by heating a solution of nicotine and propylene glycol is hardly something that can be viewed as science-based. Especially when e-cigarette vapor has been extensively characterized and shown to be far less toxic than cigarette smoke.

However, is the same thng true of a flavored e-cigarette?

1. Altria Client Services (on behalf of Nu Mark): "Nothing in the FSPTCA [Family Smoking Prevention and Tobacco Control Act] requires FDA to engage in all-or-nothing deeming for all purposes. Rather than deem an entire class of tobacco products categorically subject to the FSPTCA for all purposes, FDA has multiple options for proceeding in a reasoned, scientifically sound, and incremental manner. For example, FDA should exercise its statutory authority to deem e-vapor products commercially marketed before the Final Rule for certain purposes under the FSPTCA. Such products would be subject to age restrictions, warning labels, and disclosure requirements, without subjecting them to premarket authorization. Only those e-vapor products commercially marketed after issuance of the Final Rule would be subject to ... premarket authorization."

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.

It is perfectly reasonable for the government to intervene to prevent companies from making false or misleading claims to the public. Even severe infringement of free speech by corporations may be justified in the case of preventing the deception of consumers. However, there is little justification for prohibiting companies from telling consumers the truth, and there is no justification for suppressing the truth when those facts are the most pertinent information that the consumer needs to know in order to make an informed decision about using the product.

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