In November, I got a LinkedIn message from a consultant who works for one of the major vape (aka e-cigarette) companies. The message was innocuous enough, and it certainly piqued my interest.
Many cold messages are generic marketing and don’t warrant a second look. But I did not get that sense from this one—so I replied. Why? Morbid curiosity, maybe. Or maybe something else entirely. I’m called Unbiased Science, after all, and I wanted to check my own biases.
As a reminder, or if you’re new here: I lost my dad to emphysema and bladder cancer. Dad smoked a minimum of two packs a day for decades. As young as six or seven, I became part of the process. The guys at the corner bodega knew me as little Jessy, Jeff’s daughter. Dad would wave from the driver’s seat, unable to find a parking spot because... South Brooklyn. When they saw me come in, they’d pull the Marlboro Golds off the wall without me even opening my mouth. Dad would give his signature wink and shout something like “thanks, my guy!” out the window while I hurried back with the goods. Before my door was even fully shut, he’d already lit up. Windows up for a surround-sound exposure.
My entire career in public health was built on the back of my obsession with tobacco policy (due to my front row seat to the damage that smoking does). Back when I was a doctoral student, probably around 2013, an announcement for a conference on e-cigarettes at Duke crossed my desk. I booked a flight to North Carolina thinking I’d be surrounded by fellow public health researchers and tobacco policy scientists in the heart of the research triangle.
Reader, it was not Duke University.
It was an industry event. I had wandered into enemy territory, a lost lamb who’d accidentally stumbled into the wolves’ den. I sat through a few talks, and it became abundantly clear that very little of the “science” being presented was untainted by Big Tobacco’s money. The whole thing left me feeling like I’d chain-smoked a pack of unfiltered Reds. Queasy doesn’t begin to cover it.
I don’t remember specific details from that conference, but I remember my spidey sense tingling the whole time. Unsupported claims. Weak study designs. The unmistakable feeling that the goal here wasn’t public health, it was selling products.
So when this consultant reached out last fall, I had every reason to ignore the message. Or to fire back something righteous and cutting.
Instead, I got on a call with him.
Tobacco companies control many of the top-selling vape brands in the U.S. market. The company he consults for, while independent, sells products regulated as tobacco products by the FDA. I told him it felt like sleeping with the enemy. He wasn’t defensive. He seemed to genuinely understand where I was coming from. He was kind. I have to admit, I was surprised.
His goal wasn’t to convert me into some kind of tobacco industry apologist. He sent me some research, and we agreed to keep talking. And some of what I read surprised me.
Let me be very clear about something before I go any further: vaping is not good for you. Ideally, no one would vape. No one would smoke. No one would use nicotine pouches like Zyn, another Big Tobacco darling that’s exploded in popularity. In a perfect world, we’d all have pristine lungs and no nicotine addictions to speak of.
E-cigarettes heat liquid nicotine into a mist that you inhale. Unlike cigarettes, there’s no combustion, or the burning of tobacco that creates smoke containing thousands of toxic compounds (like tar, carbon monoxide, and carcinogens). So compared to smoking, vaping generally reduces exposure to many of the toxins that make cigarettes uniquely deadly. But nicotine itself is highly addictive and not benign: it activates the sympathetic nervous system, which is the part of your nervous system that responds to stress and danger. This can increase heart rate and blood pressure and narrow blood vessels. Nicotine is particularly harmful for adolescents because nicotine exposure can disrupt brain development, affecting memory, learning, and even making adolescents more prone to psychiatric and substance use disorders later in life. Nicotine also affects immune signaling, which can slow wound healing and impair normal immune function—effects clearly seen with smoking and biologically plausible with other nicotine exposures.
Besides nicotine, e-cigarette aerosols can contain harmful substances like heavy metals, volatile organic compounds, and ultrafine particles that can reach deep into the lungs. We also don’t yet have decades-long data on the long-term health effects of chronic vaping, which is reason enough to be cautious, especially for young people and non-smokers.
And then there’s the youth marketing of it all. Joe Camel reincarnated as bubble-gum-flavored pods and sleek tech gadgets that look like USB drives. The industry has rolled out “smart” vapes with screens, games, and Bluetooth connectivity. They come in flavors like cotton candy, mango, and gummy bear. Nearly all young people who vape use flavored products. This isn’t an accident. This is a calculated strategy to hook a new generation on nicotine, and it’s working. E-cigarettes are now the most commonly used tobacco product by American kids.
But we don’t live in that perfect world where no one uses nicotine. We live in a world where nearly half a million Americans die from smoking every year. Where my dad spent his final years tethered to an oxygen tank. Where nicotine already has its hooks in millions of people who desperately want to quit but can’t.
So the question isn’t “is vaping good?” The answer to that is clearly no. The question is: for people who already smoke cigarettes and can’t or won’t quit, is vaping a less harmful alternative? And could it actually be more effective than FDA-approved cessation medications at helping people quit for good?
If you’ve been reading my stuff for a while, you know I’m a pragmatist. Cold turkey doesn’t work for most people—whether we’re talking about alcohol, diet, or any other behavior change. Harm reduction is my framework. Meet people where they are, reduce risk where you can.
So why should nicotine be any different?
The answer, for me, has always come back to one thing: harm reduction makes sense when you’re trying to reduce harm from an existing behavior or addiction. It doesn’t make sense as a justification for creating new addictions. And the massive marketing push from vape companies isn’t targeted at existing smokers who need help quitting. It focuses on youth. It’s about getting a new generation of nonsmokers hooked on nicotine they don’t need.
That reality pushed me into the “vaping = bad” camp, even though that’s not usually how I think.
Over the holidays, my beautiful niece, home from college, mentioned that vaping has become uncool among her peers. But cigarettes? Cigarettes are making a comeback. I nearly choked on my eggnog. Talk about a trend that should NOT return in 2026. I’m fine with high-rise jeans coming back, but cigarettes? Please, no.
And yet…
The Cochrane Collaboration, a leading producer of systematic reviews, has now examined dozens of studies on e-cigarettes for smoking cessation. Their finding: high-certainty evidence that nicotine e-cigarettes help people quit smoking more effectively than traditional nicotine replacement therapy (NRT) like patches or gums. Prescription medications like varenicline (Chantix) appear similarly effective to e-cigarettes, though fewer studies have directly compared them. Part of this may be behavioral—vaping mimics the hand-to-mouth ritual, the inhale and exhale, the sensory experience of smoking in ways that a nicotine patch, gum, or lozenge simply can’t.
In 2021, fifteen former presidents of the Society for Research on Nicotine and Tobacco—the world’s leading professional organization on the subject—published a commentary in the American Journal of Public Health. These aren’t industry shills. More than two-thirds of all living past society presidents signed on. Their argument: the American focus on youth vaping, while understandable, has created an environment where most smokers now believe vaping is just as dangerous as smoking. That belief is factually wrong. And it may be costing lives.
The National Academies of Sciences, Engineering, and Medicine concluded that e-cigarette use is likely far less hazardous than smoking. The Royal College of Physicians in the UK has said the same. Public health messaging has been so effective at scaring people about vaping that it may have overcorrected into something that looks a lot like misinformation.
The US and UK have taken remarkably different approaches to vaping products.
In England, e-cigarettes are officially endorsed as a smoking cessation tool. The NHS recommends them. Public Health England found vaping to be roughly 95% less harmful than smoking and estimated it was helping 20,000 people quit per year. Their concern was that too many smokers falsely believed vaping was just as harmful.
In America, the dominant frame has centered on protecting kids from nicotine addiction. This isn’t unreasonable—youth vaping rates spiked dramatically here in ways they didn’t in the UK. At the 2019 peak, more than a quarter of American high schoolers were vaping. In the UK, only about 4% of 11-17 year olds were current vapers that same year—and regular vaping among never-smokers remained rare.
Why the difference? Stricter UK advertising regulations, for one. EU rules also cap nicotine at 20mg/ml, while the US imposes no federal limit—American products like Juul reached 59mg/ml, nearly three times the European maximum. (And just last week, the Trump Administration shelved a rule that would have capped nicotine in combustibles.) As one Stanford researcher observed, the UK treats vaping as a replacement product for cigarettes, not an initiation product. But it’s not like we can copy and paste that culture. We have different regulatory histories, different institutions—and a tobacco industry that spent decades perfecting the art of marketing addiction to American kids.
A 2024 study in JAMA Health Forum examined what happened when states restricted flavored e-cigarettes. The restrictions did reduce vaping among young adults, but daily cigarette smoking increased. The study couldn’t tell us whether these were former smokers returning to cigarettes or vapers picking up combustibles for the first time—but either way, the trend is concerning.
Other research suggests that young adults who vape are at significantly higher risk of initiating cigarette smoking than peers who never used any nicotine products. Vaping may be training a generation to inhale nicotine, and when restrictions or cultural shifts make vaping less appealing, some reach for cigarettes instead.
This brings me back to my niece, and to something I keep turning over in my mind… the generational dimension of all this.
Smoking has become increasingly concentrated among older adults. Current smoking rates among young people are at historic lows—under 2% of high schoolers smoke cigarettes regularly now. The people most likely to benefit from vaping as a harm reduction tool are existing adult smokers, many of whom are middle-aged or older, lower-income, and disproportionately struggling with mental health conditions or other addictions.
In some ways, this makes the harm reduction argument time-limited. As this generation of smokers ages, the urgency of finding less harmful alternatives may diminish. But that assumes we don’t create a new generation of nicotine addicts through vaping and products like Zyn… or worse, that we don’t watch cigarettes make a cultural comeback.
And that’s exactly what my niece was describing. Zendaya lights up in Euphoria. Timothée Chalamet and Dua Lipa get photographed puffing away. To Gen Z, cigarettes aren’t the thing that killed grandpa—they’re retro, like Polaroids and vinyl records. They didn’t grow up with the visceral anti-smoking campaigns that Millennials did. The shock factor has worn off. The cultural memory is fading.
If vaping trained a generation to inhale nicotine, and now cigarettes are becoming cool again while vaping becomes uncool, we may have successfully scared young people off the less harmful product, only to watch them pick up the more deadly one. That would be a public health disaster of our own making.
Meanwhile, the nicotine landscape continues to evolve. Zyn and other oral nicotine pouches have exploded onto the scene, with sales nearly tripling between 2023 and 2024. Nearly all of these products are flavored. They’re marketed as discreet, smoke-free, spit-free. And yes, they’re owned by the same tobacco companies that spent decades lying about the dangers of cigarettes.
The pattern is familiar: a new nicotine delivery system emerges, young people adopt it, public health scrambles to respond, industry rakes in profits. It’s exhausting to watch.
The Truth Initiative, the same organization running anti-vaping campaigns, now operates free text-based quit programs for people trying to stop vaping. Their “This Is Quitting” program has enrolled over 400,000 young people, and clinical trials show it increases quit rates by nearly 40%. They’ve even expanded to help people quit nicotine pouches. It’s good that these resources exist. It’s also a little heartbreaking that we need them—that we’re building infrastructure to help kids quit products that never should have been marketed to them in the first place.
I don’t know how to reconcile all of this cleanly. I’m honestly not sure it can be reconciled cleanly.
Nuance is hard. Reflexive positions are easy. Public health has a long, fraught history with Big Tobacco, and that history makes it difficult to look at anything the industry touches without suspicion. I get it. I feel it.
But I don’t want my own biases to become a blindspot. I don’t want my personal grief—and it is raw, blinding grief, still, after all these years—to prevent me from seeing what the evidence actually says.
Maybe there is a place for e-cigarettes in harm reduction. I don’t think we’ve struck the right balance yet. And I’m not naive about the industry. Even if there are individuals at these companies who genuinely want their products to help people quit smoking—and maybe they can, and maybe they do—the Big Tobacco machine is still optimized for profit margins, not public health. That tension isn’t going away.
My dad is gone. Cigarettes took him. The industry that sold him those cigarettes knew exactly what they were doing, and they did it anyway. I carry that with me into every conversation about tobacco and nicotine, including this one.
I took that call because I wanted to check my biases. Because if I’m going to call myself Unbiased Science, I have to be willing to sit with information that makes me uncomfortable. I have to be willing to update my priors when the evidence points somewhere I didn’t expect.
Even when it feels like sleeping with the enemy.
Stay Curious,
Unbiased Science
There is an upstanding professional on Linkedin who's wanted to chat with me for years. Your substack is exactly what I imagine, so I keep researching myself and I've gotten to a similar place.
A modest proposal: Live and let live EXCEPT legislate: no advertising (like the UK) AND reduce nicotine caps on e-nicotine devices and maybe cigarettes too!!
I smoked for 13 years since I was a teenager, vaping helped me quit cigarettes. Then I got addicted to vaping, but I’m grateful for vaping bc I wouldn’t have ever been able to quit. I eventually quit vaping too for 4 years, then started vaping again. Addiction is a chronic condition that requires constant work and monitoring. I’m clear that nicotine is harmful but at the same time , I feel better when I have it. Maybe all my years of smoking at a young age some way rewired my brain to feel better when nicotine is in my system. No Perfect solution here, just reducing harms as realistic goals, even if it’s not ultimate ideal.