Although the survey approach described above would lead to "invalid" results, I would never argue that survey studies should be thrown out and that we should only be conducting RCTs. My point is that there are strengths and limitations of various study designs, and causal inference is enhanced by having research evidence from multiple study designs. On balance, the strengths and weaknesses balance each other out, leading to a much greater ability to draw valid conclusions.

(See: Schober W, et al. Use of electronic cigarettes [e-cigarettes] impairs indoor air quality and increase FeNO levels of e-cigarette consumers. International Journal of Hygiene and Environmental Health 2013; doie: 10.1016/j.ijheh.2013.11.003.)

Sadly, the FDA itself - in its proposed deeming regulations - that we do not yet know enough to determine whether vaping is any more dangerous than smoking. I find it horrific that the FDA - the agency which is going to supposedly be using science to make informed, evidence-based decisions regarding tobacco products - is not sure that cigarette smoking is any more hazardous than the use of fake cigarettes that contain no tobacco, involve no combustion, produce no secondhand smoke, have much lower levels of carcinogens, and have been found to acutely improve the health of smokers who switch to them.

"It'll seem to be cool," he said.

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