About That Mysterious Lung Illness Related To Vaping (Updated)

There have been recent reports of a mysterious lung illness, a pneumonia-like syndrome that appears to be linked to vaping.  Fingers are being pointed all over the place right now, since it is still not clear exactly what (let alone which products) are causing it and why, but several theories abound, and there are some very strong, if not probative, clues now.

Here's what we do know so far.  As of September 16, 2019, there have been over 450 possible cases (revised down to 380 confirmed cases) of severe lung illness and/or damage (and even six seven confirmed deaths) in the USA that may be linked to vaping, though the symptoms haven't always followed a consistent pattern.  Not all cases have had all variables teased out, and it all still needs to be fleshed out some more, but vaping of some sort is the only factor that we know is common to them all.  And it's not just young people either (though many of them are), as even people in their thirties, forties, fifties, and now sixties have also succumbed to this syndrome as well.

Many, but by no means all, of the cases involved vape products containing THC (i.e. the primary psychoactive component of cannabis), and virtually all of those had been purchased on the black market (mostly in non-legalization states) based on what we know so far.  And many of those have been found to contain questionable additives, such as Vitamin E oil, that are NOT friendly to the lungs.

Thus far, only one case has been linked to a THC vape product (of undisclosed brand) purchased from an undisclosed licensed dispensary in Oregon, which could be a fluke or perhaps confounded by other products, but it is still possible that even some legitimate products contain such harmful additives, as not all legalization states specifically ban all of such additives.  (Why authorities are being so hush-hush on the details of this case, we really don't know.)

As for the cases that reportedly only involved nicotine, keep in mind that there are also many counterfeit nicotine vape products going around too, so that could perhaps be another culprit in this epidemic.  (That, and perhaps underreporting of illicit THC vaping in non-legalization states.)  That said, as much as JUUL Labs wants to believe and assert it, this does NOT yet automatically exonerate legitimate brand nicotine-containing vape products such as theirs.  And no one should pretend that it does either.

(Separately, there are also three recent reports of seizures and even one report of a stroke thought to be linked to the JUUL brand specifically, presumably due to their very high nicotine content, so they really shouldn't be so smug.  Especially since JUUL is basically circling the drain right now.)

It is important not to create or fan the flames of a moral panic about vaping in general, as that is likely to be counterproductive.  Much more research is necessary until we know more.  So what advice should be given in the meantime?

• First and foremost, do NOT vape, juul, or dab anything that you get from the black market, whether it's THC or otherwise.  They are inherently unregulated by definition, with no quality control, and thus you really don't know what you are getting.
• Especially avoid the pseudo-legitimate sounding (but actually always black market) THC brands "Dank Vapes", "Chronic Carts", and "West Coast Carts".  Avoid them like the plague!  (Ditto for the apparently very bad actor, gray market CBD vape brands "Diamond CBD", "Green Machine", "Magic Puff", and "Yolo!" as well.)
• Do your research and due diligence before buying any vaping product on the legitimate market as well.  Google is your friend, but don't believe everything you hear or read.  This is true whether it is nicotine, THC, CBD, "just flavoring", or anything else for that matter.
• Avoid any oil-based vape products when possible, especially for unfamiliar brands.
• Do NOT modify vaping devices or use any homebrew products with vaping devices.
• And last but not least, if you are not currently addicted to nicotine, do NOT vape (or smoke) anything that contains nicotine.  Keep in mind that all JUUL brand products contain high levels of nicotine, as do many other brands as well.

That seems like sensible advice for now.  As for government officials, the best thing they can do right now is regulate the vaping industry better to quash bad actors and improve quality control, cap nicotine levels, and also legalize cannabis nationwide for everyone over 18 (while keeping the taxes low) in order to quash the black market as well.

And for those who are still concerned:

If you currently vape nicotine, DO NOT go back to combustible cigarettes or any other combustible tobacco products!  If you are concerned about vaping, you can always switch to snus, lozenges, or any of the available nicotine replacement therapy products currently on the market (patches, gums, lozenges, and inhalers).  At the very least, stick to the top-shelf stuff.

If you currently vape "just flavoring", be sure that it really IS "just flavoring" (spoiler alert:  it usually is NOT, and all JUUL brand products contain high levels of nicotine).  But really, what's the point of that?

If you currently vape cannabis derivatives (whether it's THC, CBD, or both), and you don't have access to legal and licensed dispensaries where you live and/or you still don't trust the stuff on the shelves there, but you still don’t want to combust (smoke) weed, there are always dry-herb vaporizers out there (remember those?), as well as edibles, capsules, oils, and tinctures for using cannabis products orally.  Or at least stick to the top-shelf stuff for now.  But DO NOT vape, juul, or dab anything from the black market, the street, pop-up shops, or any homemade concoctions.  EVER.

(For the record, at least in some states like Oregon, with as low as $5 per eighth and $40 per ounce in some places, plain old bud purchased from legal stores is now actually cheaper than vape cartridge concoctions after several years of legalization there.)

Let's be adult about this, shall we?

UPDATE:  As of September 20, 2019, the number of reported cases of what is now called Vaping Associated Pulmonary Injury (VAPI) has crossed the 500 mark, and the number of deaths has increased to eight.  All deaths, and all reported cases except one, have occurred in the USA (the remaining one reported case was in Canada), and no other countries.

As of September 26, 2019, the number of confirmed cases has now crossed the 800 mark, and the number of deaths has now reached 12.  Again, if you must vape, stay away from anything bought on the street or in pop-up shops, or anything otherwise suspicious or sketchy in any way.  Consider alternative methods of use as noted above.  And if you notice any of the telltale signs and symptoms of VAPI, get thee to a doctor, stat!  And be sure to be honest about your vaping with them, so you will be properly treated with corticosteroids rather than antibiotics.

As of October 10, 2019, there are additional theories as to the cause of the outbreak, most notably acute "toxic chemical injury" to the lungs.  More specifically, it seems that inhalation of cadmium fumes from the solder in cheaply made vape pens and cartridges may be causing a particularly severe form of "metal fume fever" known as cadmium pneumonitis, which presents rather differently from lipoid pneumonia.  Though the oil (such as Vitamin E Acetate) causing lipoid pneumonia theory has not been entirely disproven either, as some cases do seem consistent with lipoid pneumonia, and there could in fact be more than one cause as well.  Caveat emptor.

JUUL Is Circling The Drain

Looks like JUUL Labs just bit off far more than they could ever possibly chew, and they are now choking on it as we speak.  These quislings have asked for a ton of karma for years now, and now they seem to be getting it.  Their share price is in warp-speed decline right now.  As per the famously time-tested Seneca effect, their growth was relatively slow at first, but it looks like their ruin will be very, very rapid indeed.

First, they managed to get a new generation of young people hooked on nicotine with a sleek, deceptively seductive, fruity- and candy-flavored product (with excessively high nicotine levels, and more addictive than conventional cigarettes) and even more deceptive, Big Tobacco-style marketing, all while bragging about how supposedly "woke" they were.  Then they made a deal with the devil himself, Big Tobacco, when they literally SOLD OUT to them.  And then when these cowardly quislings were finally called out on their misdeeds, they threw 18-20 year olds under the bus by supporting the ageist abomination that is Tobacco 21 laws.  They even threw the rest of the vaping industry under the bus as well.  At the end of the day, they are really nobody's friends, never were, and never will be either.

And now with that mysterious vaping-related illness reaching epidemic proportions, albeit most likely driven by black-market products with questionable additives, as well as homebrew concoctions and modified devices (though JUUL still has yet to be exonerated), the moral panic around vaping that JUUL effectively helped to create has reached such a fever pitch that the Trump administration (and several states) are passing or at least considering flavor bans for vape products.  That will be the final kiss of death for JUUL, since most of these proposed bans will only allow tobacco-flavored products (yuck!) or unflavored products (meh), not even menthol or mint.  Even if the ban is later lifted, if (when) it passes they are basically dead and done by that point.

And if that itself doesn't ultimately bankrupt them, the mounting lawsuits against them sure will.

Now a corporate "person" without a country, what ever will they do?  (Plays the world's smallest violin)

Somebody call the coroner quick, JUUL is now circling the drain as we speak.  Let's hope they take their Big Tobacco parent company, Altria (aka Philip Morris) down with them as well.  And no, we will never, ever mourn their loss, not in a million years.

Good riddance! May your name and memory be forever blotted out, JUUL.

UPDATE:  As of September 25, 2019, their CEO, Kevin Burns, was essentially forced to resign, replaced with a Big Tobacco executive from Altria, and they pulled all advertising from the USA.  And the company agreed to accept the flavor ban as well.  And now they are embroiled in a criminal investigation as well.

Don't Fear The Reefer: Why Fearmongering Backfires

The US Surgeon General recently issued a chilling warning about cannabis, particularly in reference to young people and pregnant women.  While this announcement does contain some kernels of truth, it was overall quite exaggerated and melodramatic fear-mongering, with a touch of Reefer Madness thrown in for good measure.  The National Organization for the Reform of Marijuana Laws (NORML) did a reasonably good job of setting the record straight, of course, but Twenty-One Debunked would like to add to that.

While NORML is indeed correct that legalization and regulation are far more effective at protecting vulnerable populations from any real risks of cannabis, and include age restrictions in the list, they unfortunately punt on exactly what sort of age restrictions they would support.  In an effort to remain neutral as far as the age question goes, and to not be accused of condoning teen cannabis use, they simply leave it unanswered.  And that is a shame, because setting the age limit too high only guarantees that the black market with its products of unknown safety and quality will prevail (and does not check IDs either), and also throws young adults under the bus in the process as well.  As we have noted repeatedly before, there is really no hard scientific evidence supporting an age limit any higher than 18 for cannabis.  Yes, you read that right.

The Surgeon General disingenuously conflates 18-24 year old young adults with people under 18, all the way down to 12 year olds, in fact.  That is a serious category error at best, if not full-blown ageism.  While there is evidence that using cannabis before age 18 (especially before 15, and/or heavily and frequently) is riskier than using it after 18, and that excessive use can be harmful at any age, there is really no hard scientific evidence that using it at 18 is any more harmful than using it at 21, 25, or even 30 for that matter.  And the "no safe level of exposure" claim is also unscientific and highly misleading as well.

It is a proven fact that the human brain continues to develop well into the 30s and 40s, and perhaps even beyond that, but somehow the Surgeon General leaves that inconvenient truth out of his warning about "marijuana and the developing brain".  And while the brain is thus still developing well beyond 18, the key difference is that it is no longer developing at a fundamental level anymore much beyond roughly mid-adolescence.  Thus any brain development that occurs from 18-25 is essentially on the same spectrum as any development that occurs after 25, making 21 or 25 completely arbitrary age cutoffs.

Exaggerating the actual and (mostly) theoretical dangers of cannabis use has the unfortunate side effect of losing credibility among young people, who then are less likely to believe anything about the very real risks of not only cannabis, but alcohol and various other (and far worse) substances as well.  Thus, such a boneheaded strategy is thus doomed to backfire, especially among the age group being targeted the most by such messages.

Twenty-One Debunked does not encourage anyone of any age to use cannabis, alcohol, tobacco, or any other substances.  But if you do, it is important to be an informed consumer and do your research rather than blindly believe everything you hear or read.

About That Mysterious Lung Illness Related To Vaping

There have been recent reports of a mysterious lung illness that appears to be linked to vaping.  Fingers are being pointed all over the place right now, since it is still not clear exactly what (let alone which products) are causing it and why.

Here's what we do know so far.  As of the end of August 2019, there have been over 200 possible cases of severe lung illness and/or damage (and even one reported death) in the USA that may be linked to vaping, though the symptoms haven't always followed a consistent pattern.  Not all cases have been confirmed, and it all still needs to be fleshed out and other variables accounted for, but vaping of some sort is the only factor that we know is common to them all.  And it's not just young people either (though many of them are), as even people in their thirties have reportedly also succumbed to it as well.

Many, but by no means all, of the cases involved vape products containing THC (i.e. the primary psychoactive component of cannabis), and virtually all of those had been purchased on the black market (mostly in non-legalization states) based on what we know so far.  And as much as JUUL Labs wants to believe and assert it, this does NOT yet automatically exonerate nicotine-containing vape products such as theirs.  And no one should pretend that it does.

(Separately, there are also three recent reports of seizures thought to be linked to the JUUL brand specifically, presumably due to their very high nicotine content, so they really shouldn't be so smug.)

It is important not to create or fan the flames of a moral panic about vaping in general, as that is likely to be counterproductive.  Much more research is necessary until we know more.  So what advice should be given in the meantime?

• First and foremost, do NOT vape anything that you get from the black market, whether it's THC or otherwise.  They are inherently unregulated by definition, with no quality control, and thus you really don't know what you are getting.
• Especially avoid the pseudo-legitimate sounding (but actually always black market) THC brands "Dank Vapes", "Chronic Carts", and "West Coast Carts".  Avoid them like the plague!  (Ditto for the apparently very bad actor, gray market CBD brand "Diamond CBD" as well.)
• Do your research and due diligence before buying any vaping product on the legitimate market as well.  Google is your friend, but don't believe everything you hear or read.  This is true whether it is nicotine, THC, CBD, "just flavoring", or anything else for that matter.
• Avoid any oil-based vape products when possible, especially for unfamiliar brands.
• Do NOT modify vaping devices or use any homebrew products with vaping devices.
• And last but not least, if you are not currently addicted to nicotine, do NOT vape (or smoke) anything that contains nicotine.  Keep in mind that all JUUL brand products contain high levels of nicotine, as do many other brands as well.

That seems like sensible advice for now.  As for government officials, the best thing they can do right now is regulate the vaping industry better to quash bad actors and improve quality control, cap nicotine levels, and also legalize cannabis nationwide for everyone over 18 (while keeping the taxes low) in order to quash the black market as well.

Let's be adult about this, shall we?

UPDATE:  As of September 5, 2019, researchers seem to be zeroing in on the most likely cause: specific additives found in primarily black market THC vaping oils and cartridges.  Thus far, only one case has been possibly linked to a THC vape product (of undisclosed brand) purchased from a licensed dispensary (in Oregon), which could be a fluke or confounded by other products, but it is possible that even some legitimate products contain such harmful additives.  And while nothing has been ruled out as yet, the aforementioned advice still remains sound:  avoid all black market vape products, don't vape nicotine if you aren't already addicted, and do your research.

As of September 6, the number of possible (not all of which confirmed) cases of the mystery vaping illness has now reached at least 450, including four confirmed deaths and possibly a fifth one as well.  At this rate, we would hate to see what the casualty toll will ultimately climb to by Friday the 13th (next week).  Regulators really need to root out the questionable additives and bad actors, yesterday.

As of September 9, several theories abound as to what exactly is causing this now-epidemic mysterious illness, from questionable additives (such as Vitamin E oil) to black market products to home-made concoctions influenced by YouTube videos to even Chinese tariffs steering vapers towards cheaper and janky products (and this means nicotine too).  Again, it is still under investigation, but the above advice nonetheless remains sound for the time being. 

And for those who are still concerned:

If you currently vape nicotine, DO NOT go back to combustible cigarettes or any other combustible tobacco products!  If you are concerned about vaping, you can always switch to snus, lozenges, or any of the available nicotine replacement therapy products currently on the market (patches, gums, lozenges, and inhalers).  At the very least, stick to the top-shelf stuff.

If you currently vape "just flavoring", be sure that it really IS "just flavoring" (spoiler alert:  it usually is NOT, and all JUUL brand products contain high levels of nicotine).  But really, what's the point of that?

If you currently vape cannabis derivatives (whether it's THC, CBD, or both), and you don't have access to legal and licensed dispensaries where you live and/or you still don't trust the stuff on the shelves there, but you still don’t want to combust (smoke) weed, there are always dry-herb vaporizers out there (remember those?), as well as edibles, capsules, oils, and tinctures for using cannabis products orally.  Or at least stick to the top-shelf stuff for now.  But DO NOT vape, juul, or dab anything from the black market, the street, pop-up shops, or any homemade concoctions.  EVER.

You May Not Like It, But Here's the Answer to (At Least Greatly Reducing) College Rape and Sexual Assault

(NOTE:  This is an updated version of a post from 2018)

As we had noted in a previous post five years ago, rape and sexual assault is a persistent epidemic in the USA, including (but not limited to) college campuses nationwide.  Lately, the chattering classes have been endlessly wringing their hands about it for years, but little real progress has been made in recent years, and since the Trump administration began we seem to have even regressed a bit in that regard, the #MeToo movement notwithstanding.

Most rapes and sexual assaults, especially those involving college students on or near campus, are committed by people known to the victim, and many if not most of those involve alcohol to one degree or another, whether by the perpetrator, the victim, or both.  We should first and foremost note that the only thing that actually causes rape is the rapists themselves, period.   While alcohol (among other substances) can indeed fuel it and is often used as a weapon to incapacitate victims, rape would simply not happen without rapists, period.  And the onus should always fall on men not to rape in the first place, instead of falling on women not to "get themselves raped".  The fact that so many people still deny such an obvious truth in 2018 shows just how far we have yet to go towards eliminating or even reducing this epidemic, and those who blame or otherwise put the onus on potential or actual victims are in fact part of the problem.

We seriously need to drain the proverbial swamp of rape culture, yesterday, and thus revoke the rapists' social license to operate.  Culturally, we need to tackle the root causes of sexual violence by rejecting the highly toxic "commodity model" of sexuality and replacing it with the "performance model" (while also avoiding the negative connotations and pitfalls of the word "performance"), and more generally rejecting the "dominator model" of society and replacing it with the "partnership model".  And for alcohol, we need to recognize that while adopting a "Prohibition-Lite" approach of any sort is most likely to backfire and would throw the proverbial baby out with the bathwater, its link with sexual violence still needs to be dealt with in the meantime as cultural changes can take much time to occur.

So what measures can be taken in the very near term to quickly reduce or at least take the dangerous edge off of this seemingly intractable epidemic?  The reader may or may not like the answer, but here goes:

1. Lower the legal drinking age to 18, yesterday, full stop.  The 21 drinking age makes drinking that much more dangerous than it has to be by forcing it underground, which can put young drinkers in more dangerous situations that increase the risk of sexual assault, and the law itself can be used as a cudgel to silence victims.
2. Raise the tax on alcoholic beverages, both federally as well as at the state and local level (especially in college towns), with extra levies on bulk alcohol such as kegs, cases, and handles. Studies have shown a significant inverse correlation between alcohol prices and rape in general.
3. Legalize cannabis for everyone 18 and older, yesterday.  Cannabis is clearly the safer choice in that regard, as it is highly unlikely to fuel violence or be used as a date-rape drug the way that alcohol all too often is.
4. Pass "Yes Means Yes" laws (aka affirmative consent laws) similar to California's.  If properly written, these laws will essentially eliminate the concept of so-called "gray area rape" by putting the onus on the initiator of sexual activity to be sure that they actually have consent before proceeding further.
5. Last but not least, hold the perpetrators accountable for a change, no matter how powerful or privileged they happen to be.  That includes enforcing both criminal laws as well as campus conduct policies to the fullest extent of the law.  No more Brock Turners.

As for the idea of colleges trying to influence upward the prices of cheap alcohol at parties (particularly Greek parties) that are typically $5 or so at the door for all-you-can-drink, that would be rather difficult to enforce in practice.  But if the drinking age was lowered to 18, most frats would likely end up having a "going out of business party" since their modern-day speakeasy services would no longer be necessary.  And those that remain would, in practice, throw less frequent parties and/or  ones with less beer (or liquor) to go around if the tax on such beverages is also hiked as well.

As for "Yes Means Yes" laws, there has been quite a bit of confusion, contention, and obfuscation among the chattering classes as to what such laws really are.  To reiterate the difference between different types of rape laws, the following is a good summary:

Force standard (archaic): No Means Yes
Consent standard (current): No Means No
Affirmative consent standard: Yes Means Yes
MacDworkinist standard: Yes Means No

The third item on the list, the affirmative consent standard, is the one that we support. The archaic force standard is problematic for obvious reasons, while "No Means No" is necessary and important but NOT sufficient.   The essential difference between the "No Means No" and "Yes Means Yes" is that in the former, the default answer is "yes", and in the latter, the default answer is "no".  That's it. And the MacDworkinist standard is, to put it mildly, a logistical nightmare at best and a dystopian kettle of fish at worst, not to mention infantilizing and agency-denying to women.  We would never support that.

Doing these things will go a long way towards reducing the rape and sexual assault epidemic in the near term.  Anything less would be uncivilized. So what are we waiting for?

Even The New York Post Supports Lowering The Drinking Age to 18

Apparently, even the conservative New York Post--or at least Scott Johnston, the author of a recent article--supports lowering the drinking age to 18.  And yet, very few progressives and Democrats will openly come out in favor of doing such. In fact, many support Tobacco 21 laws these days (along with some Republicans too).  So what gives?

In the USA, it seems that even many self-proclaimed progressives are not as progressive as they claim to be, and we already know that most Democrats are now neoliberal corporate shills at best.  And of course, we know there are plenty of "third way" New Democrats that are closet (or not so closet) authoritarians in many ways.

It would be truly Kafkaesque if one day Republicans become seen as the party of youth rights, something they are not exactly know for, and the Democrats seen as the (selectively) puritanical prude lobby.  So the Dems need to do a serious gut check if they want to win elections in the future.

Twenty-One Debunked Opposes Most Drug Testing

In light of recent reports of student drug testing now including nicotine in some schools due to the moral panic over vaping, Twenty-One Debunked needs to reiterate our general opposition to such testing:

• We oppose any drug testing that is not strictly to determine current impairment or "fitness for duty" in cases of driving, operating machinery, or working at safety-sensitive jobs.
• We oppose any drug testing that privileges or excludes some people over others, whether by age, socioeconomic status, race, or any other suspect or quasi-suspect classification.
• We oppose schools and employers having any jurisdiction whatsoever over what students and employees do to their own bodies off the clock and off the premises, as long as it does not unduly adversely affect their job or school performance and behavior.
• Even if the above criteria are satisfied, we still oppose any drug testing method that has detection times longer than a day or two at the cutoff used, and/or uses inactive metabolites as a proxy for the main substances being tested.  That excludes essentially everything except blood and saliva tests for most substances.  (Note that SCRAM bracelets and sweat testing for offenders in the 24/7 Program are an exception to this rule.)

Twenty-One Debunked, therefore, opposes the vast majority of drug testing done in this country.  We are the supposed land of the free, it's time to start acting like it!

We Still Excommunicate JUUL Labs (Updated)

(Editor's Note:  Twenty-One Debunked has never been affiliated in any way, shape or form with JUUL Labs or any other vaping, tobacco, alcohol, or cannabis company.  And we never will be, either.)

Dear JUUL Labs,

Since you were founded in 2015 as a spinoff from Pax Labs, you have always presented yourselves, at least publicly, as the underdog saving the world in the fight against the evil Big Tobacco.  Little did America know that you were about to pull the wool over everyone's eyes and make fools, and then cynics, of us all.

Why do we hate thee, JUUL?  Let us count the ways:

• You loudly proclaimed yourselves as the sworn enemy of Big Tobacco, but you began to copy their playbook awfully quickly in terms of advertising to young people and cynically implemented your own "anti-vaping", "anti-tobacco", and "holistic health education" progams in schools and youth camps. (You claimed that was just an oversight.  Riiiiiiight.)
• Your sham "educational" programs even told teens that your products were "totally safe" yet for "adults only" (wink wink).  And some of your summer camp programs apparently targeted children as young as eight years old.
• You recruited social media influencers with slick advertising campaigns that at least gave the appearance of deliberately targeting young people in marketing your products.  You also went out of your way to target Native Americans with your addictive poison-peddling as well.
• You chose a much higher nicotine level for your products than other vape brands, by far.  And your patented nicotine salt formulation clearly gives a much bigger "kick" of nicotine as well.  That was most likely to try to edge out the competition, and it worked--at the expense of a new generation of nicotine addicts, that is.
• You lowered your nicotine content when selling JUUL in the European Union and Israel (who by law set the maximum allowable nicotine content of vape products much lower than the American version of your products), but curiously still do not offer such reduced-nicotine products in the USA, or any nicotine-free products.
• You gave your products various kid-friendly fruity, candy, and dessert flavors, because reasons.  Or something.  I mean, we all know that adults need their nicotine vapes to taste like candy in order to help them quit smoking, right?
• Until very recently, you failed to adequately warn users that your products contain nicotine and are highly addictive.  Many young people did not even know that all JUULs contain nicotine, let alone such a high level of it.  And some still may not know yet.
• In fact, if anyone were to deliberately design the most effective and efficient way to surreptitiously get young people hooked on nicotine in the 21st century, it would really look an awful lot like JUUL.
• When the FDA finally blew the whistle on you in late 2018, you responded in the most cowardly way possible.  You decided to throw young adults under the bus by calling for the age limit for vaping products to be raised from 18 to 21, and you banned 18-20 year olds from your website.  And you still made no significant changes to your highly-addictive products, save for the removal of a few flavors in stores.
• And worst of all, you literally SOLD OUT to Altria Group (aka Philip Morris), whose name is literally synonymous with Big Tobacco.  You know, the evil industry you once claimed to be fighting against?  Your deal with the devil may have made you richer and bought you some temporary protection, but everything comes with a price, and your day will come very soon.
• Finally, thanks primarily to you, young people are losing even more rights now.

Thus, in light of the above grievances, we hereby excommunicate you, forever.  Here is your bell, book, and candle, you cowardly quislings.  Now go take your crack nicotine and shove it!

We at Twenty-One Debunked urge everyone to #BoycottJUUL yesterday.  If you don't currently smoke, vape, or otherwise use nicotine, don't start!  You are far better off without this highly addictive poison in any form, period, even if vaping does reduce most of its other toxic chemical satellites and byproducts compared with smoking.  But if you currently do, make it any brand but JUUL, and give 'em a swift kick in the margins!  And best of all, JUULers who switch to other vape brands may find it easier to phase out and finally quit all forms of nicotine for good.

New Tobacco 21 Study Leaves Us With More Questions Than Answers

A new and very preliminary study of recently-passed Tobacco 21 laws appears to find that such laws significantly reduce tobacco smoking (both recent smoking and current and established smoking) by as much as 39% among 18-20 year olds.  The study looked at survey results of 1869 18-22 year old young adults in 2016-2017 in 48 states and DC (excluding New York and Massachusetts), and compared those in states and localities that raised the tobacco age to 21 versus those that did not, and further compared 18-20 year olds versus 21-22 year olds, after adjusting for potential confounders such as cigarette taxes as well as demographics and parental and peer smoking.

However, there are still reasons to be skeptical of these findings:

• Correlation is not causation, and there may still be selection bias, reporting bias, and residual or unmeasured confounding.
• Only a few states and localities had an age limit of 21 for tobacco in 2016-2017, especially when New York and Massachusetts are excluded.
• In some of these few Tobacco 21 states/localities, the number of individuals surveyed was in the single digits.
• Even if these results are 100% due to the hike of the age limit to 21, the study may only be measuring short-term effects since the laws are so recent and only data from 2016-2017 were used.  More longitudinal data are needed.
• Such "early-adopter" effects may not be generalizable or durable, as we saw with the 21 drinking age according to Miron and Tetelbaum (2009).
• Data were collected from November 2016 through May 2017, and yet New Jersey was listed a Tobacco 21 state even though their law didn't go into effect until six months later in November 2017.  Thus, we noticed at least one potential coding error.
• California raised the cigarette tax significantly as of April 1, 2017, within the period of the study.  And Illinois and Chicago have raised their cigarette taxes several times in the years before and after Chicago's Tobacco 21 law that was implemented in 2016.
• Smoking was already on the decline nationwide long before any Tobacco 21 laws were passed, and the data are not adjusted for pre-existing trends.
• Vaping was not examined in this study, and in any case all of the data was from before the JUUL craze came on the scene.
• And most importantly, the study did NOT look at people under 18 at all.

Thus, these results are preliminary at best and need to be taken with at least a grain of salt, if not a whole pound.  Especially since, as we previously reported, according to the YRBSS data there is really no robust correlation between high school smoking or vaping rates and whether the smoking/vaping age is 18, 19, or 21.  And even in this new study of 18-22 year olds, the effects were limited to only those who had already tried cigarettes before, and that typically occurs well before 18.  But wait, isn't the strongest pro-21 argument that Tobacco 21 laws would reduce smoking (and vaping) among people under 18?

And for what it's worth, there is no evidence that Tobacco 21 laws (all of which now apply equally to vape products, by the way) have done anything to reduce the JUUL craze that began in very late 2017 and apparently continues unabated to this day in all states and localities regardless of the age limit.

Also, it just so happens that yet another recent and preliminary study was done, this time longitudinally using BRFSS data of 18-20 year olds from 2011-2016 compared to 23-25 year olds, and comparing the local tobacco age limits by metropolitan/micropolitan statistical area (MMSA).  This study, which was driven by even earlier adopters (mainly city and county-level Tobacco 21 ordinances), did find statistically significant reductions in current established smoking by 18-20 year olds that were not found for 23-25 year olds.  But the devil is really in the details, since the effect size was rather small (1.2 percentage points, and at most 3.1 percentage points in some models) for practical purposes, and may still have been driven by reporting bias, selection bias, and/or differential sensitivity by age to tobacco tax hikes at the same time.  And given how effect sizes for later adopters of any given policies tend to shrink over time compared to earlier adopters, these results do not look particularly encouraging.  Especially since a cursory look at the trendlines in the study finds that the slight divergence in smoking rates that emerges in 2014-2015 re-converges and essentially disappears by 2016, suggesting that the findings are likely driven by short-term effects rather than longer-term effects.

Bottom line:  it looks like the supposed benefits of raising the smoking/vaping age to 21 were, shall we say, all smoke and mirrors, at least for people under 18.  The supposed success of Needham, MA, for example, was likely a statistical fluke and/or a result of endogeneity, much like the "early adopter" effects of the first few states to raise the drinking age to 21 creating that particular mirage in the 1980s.  Or perhaps increased enforcement in general relative to neighboring towns did the trick regardless of the age limit, like it did in Woodridge, IL and several other communities the 1990s with an age limit of 18.  Studies show that whenever vendor compliance exceeds 90-95%, there is indeed a dramatic drop in teen smoking regardless, by as much as 50% compared with previously weak enforcement and low compliance rates, especially for the youngest teens.  More recent research bears this out as well, for teen smoking as well as vaping.   And keep in mind that those who make it to 18 without smoking are far less likely to take up this deadly habit later on.

This all should be food for thought for policymakers debating not just the age limit for tobacco, but also for alcohol, cannabis, or anything else for that matter.  And even if such benefits of the 21 age limit were real, we at Twenty-One Debunked would still not support an age limit any higher than 18, on principle alone.  Old enough to fight and vote = old enough to drink and smoke.  'Nuff said.

New York Raises Smoking Age To 21

Governor Andrew Cuomo of New York had to be a big shot, apparently.  Today on July 16, he finally signed the bill that raises the age limit for tobacco and vaping products to 21, effective 120 days from today.

When the lights went out on Broadway last Saturday, that was certainly an ominous sign.  And lest anyone think there is a consolation prize, Cuomo failed to even get weed legalized last month since he apparently couldn't even muster up the votes in the legislature to pass it.

Many counties and cities in the state, including NYC and now all of its "backyard", already set the tobacco/vape age limit at 21.  That of course includes my home county of Westchester, which raised it from 18 to 21 last year, and even Putnam County too.

The only silver lining is that the new age limit of 21, like the old age limit of 18, will only apply to vendors, as it will still not be illegal for "underage" people to possess or consume tobacco or vaping products.   But that still does NOT mean we should support it one bit!

With the "bookend" states of California and New York now down, plus several other populous and not-so-populous states, not to mention hundreds of localities across the country, and even our nation's capital, is our movement lost for good?  We sure hope not.  It looked like the Tobacco 21 movement had stagnated last year, but now with New York, Utah, Virginia, Washington State, Illinois, and Texas next to jump on the bandwagon, and soon the federal government as well, we clearly got way too complacent last year.  It certainly does NOT bode well for any near-future attempt to lower the drinking and toking ages to 18!

Hindsight is 2020, both the year and the vision.  There is still a slim chance that the America we know and love is not completely lost yet.  But that window is closing very, very fast.