00:00:06 --> 00:01:13

Grzegorz Król: Hello everyone here in the room and those watching us online. Dr. Roberto Sussman is a full-time senior researcher and lecturer at the Institute for Nuclear Services of the National University of Mexico. He specializes in general relativity, cosmology and other areas of physics. He is the founder and director of ProVapeo Mexico and a member of INNCO. Roberto actively works towards promoting proper regulation of tobacco harm reduction products in Mexico. He advises consumers on countering misinformation and prejudice and directs efforts to share scientific information about nicotine and safer nicotine products, which happens to be the subject of his today's oration. Roberto, the floor is yours.

00:01:26 --> 00:51:48

Roberto Sussman: Thank you very much for your nice welcoming. I have to see, ah, yes, okay, that's the beginning. That's me over there, and where I work. And I'm very happy to, very honored to be addressing to you in this formation. And okay, let me, hopefully I don't have technological problems here. Ah, here it is, perfect. Okay, first, from galaxies to vapes. How I got here? Okay, sorry. Okay, yes, you know, short guy. Okay, how I got here? Right? Okay, a bit slow. Okay, I was a happy smoker, right? But I have to be honest, I always resented anti-smoking policies, and especially anti-smoking bans. But, and I had no intention to quit, I was quite happy. And health problems took a long time for having signals of this type. And I never thought about that. I just smoked. That's it. I agreed with the indoor bans and I complied with them because I understood that non-smokers had to be protected from my smoking. So I understood that. And it's reached an equilibrium. Sometimes I question the justification, like why not having a smoking section and non-smoking, but it was not so important in any case. However, I never thought that smoking was going to be banned outdoors. Like, for example, in Windy Beach, or in the whole campus, a huge campus was banned. And also in parks, in open parks. I never imagined that it happened. In fact, during the early 2010s, There was this bands were taken in many communities in the United States, expanded to Canada, to Australia, and that really took me off, no? And then, Celestial Music, our aim is to protect the health of the population, especially the children. And that immediately, triggered my bullshit detector. Yeah. Then I have a training as physicist. I know gases and aerosols because galaxies and aerosols, they're run by physics, you know? I knew there was no science behind that, but nevertheless, I wanted to see references. And I asked lots of people. And this is a type of reply I got, for example, from MDs that I asked them, say, you are an astrophysicist. You understand galaxies and black holes, but you don't have medical training. So you cannot understand the immense damage that even a small exposure to smoke can cause. And so, in other words, I was being told that there is some sort of special medical knowledge that is beyond my reach. And that it's also beyond the realms of the physics I know. I have heard these explanations when I talk to priests or rabbis. this type of explanation, oh, you cannot understand the creation, et cetera, Big Bang, I don't care, et cetera. Okay, well, but still, this was not an important issue for me. It was just in my background. And also, I was told once, and this was by an American MD, who was more or less connected with tobacco and with oncology and things like that, he told me, you are missing the big picture. Don't come with your physics arguments. We want to save lives. These bans are absolutely necessary. It's the only way we can break this damning addiction propelled by a predatory, powerful industry that is killing so much people. So, in other words, our task is too important. We don't need to explain to you. We're saving lives. Come on, we're saving lives. Yes, yes, yes, we hide some truths, which is a form of lying, but it is for your own good and for the common good. At least this was a very honest reply. Finally, I had a glimpse of the evidence, of the scientific evidence. It was the Helena Montana miracle. What was that, for those who don't know? It was an article by, you'll see who, you can see already who, claiming that Outdoor smoking bans produce a 60% reduction of admissions to have infections in a remote place called Helena, Montana. This piece, this article, was received with a lot of praise in New York Times, the BBC, The Lancet, sources that I trusted, and they were giving a lot of praise to this thing. I knew it was fraudulent. It was simply a random fluctuation chosen for convenience. Why it didn't happen in time? One million things that you can question of this thing. Now, this thing, this article has been cited 690 times. These are more sites than my best cited paper in 30 years of career. And it was debunked in 2016. And the author, Stanton Glantz, never acknowledged this fiasco. He never said, no, I made a mistake, sorry. No, no, he defended it. And then he was never reprimanded or nobody called attention to him. Nobody said anything in the medical community. And outside of the medical community, nobody was interested either. Now, this man has accumulated 27,000, more than 27,000 citations from 18,000 documents. So, For me, this is a short circuit in tobacco control science. In physics, this would not happen. Somebody who makes this fiasco will not get so many citations and will be marginalized. There is no science behind this, so what are the justifications? And it's worth reading them. For example, this article in the New England Journal of Medicine. It is about a discussion in which a commissioner is explaining council members the goodness of the bans that then-Major Bloomberg had been imposing in New York. And he wasn't very convincing until he had to emphasize, and I read, I quote, he had to emphasize the importance of protecting children from exposure to adult smokers who would serve as negative role models. Families, he said, should be able to bring their children to parks and beaches knowing that they won't see others smoking. This is the argument that a homophobe would say about homosexuals, right? We have to be frank in this. Okay. Okay, it's the normalization, stupid. I got it. What is the normalization in terms of outdoor smoking bans? Notice I'm not talking about research on smoking, on inhaled smoking, on indoor bans in smoking. Those I accepted. I agree there was substance, but we're talking about outdoor bans. And it's an institutional effort disguised as science whose goal is not protection of public health or understanding. It is the eradication of a conduct, even in conditions where this conduct is not causing any harm. All this is in the past. Fifteen years have passed, and at that time I recognized that smoking was the issue. Okay? So in 2016, I became a vaper, like millions of other people who use harm reduction products as a substitute of smoking. So we can say that maybe with smoking, there was a utilitarian justification for the normalization, right? We can say smoking is so harmful that the end justify the means. I do not agree, but I understand this reason. Now, the question, can this be justified for vaping? This is the question, okay? And there are ominous signs that an ongoing institutional effort is ongoing. to denormalize vaping as it was done on smoking. There are signs of that, right? Now, are we going to allow this? And my answer is absolutely not. No, as I learned. And this is what has brought me here. This has thus combined my passion as an activist, as an advocate, and as a scientist, right? And so this says, why am I here? How come galaxies to vapes? Tobacco nicotine science. Let's have a look at it. The tobacco control community is freed as a reaction to the disruption of vaping. We have the American-centric model in which THR is associated with a regression. They see it as a regression over the original goals against smoking. have updated their goals, their original goals, now is anti-nicotine. And also, a very interesting thing is that the fulfilment of a regulatory policy determines the science. And as opposed to this conception, we have a British-centred dissenting minority. And this dissenting minority is saying that no, it's the opposite. These products are helping to the original goal of eliminating smoking. And they also oppose this idea to be anti-nicotine. And also they say no, policy must be subjected to science, not science subjected to policy. And of course, It's a big conflict, okay, but it is not a symmetric conflict. is very asymmetric, because on the side of the majority, you have a lot of resources, the FDA, CDC, the organ associations, the medical establishment, the Bloomberg complex, the WHO, et cetera, et cetera. And who's on the other side? Well, essentially, health institutions in the United Kingdom and New Zealand, and individual scientists and consumers. So it's a very uneven, It's a very uneven conflict. And of course, the tobacco industry is completely outside of the picture, et cetera. So I would like to dwell a little bit on the similarities and differences between what I call common science practice and the science practice by the majority orthodox tobacco control. I think that the dissenting minority is following more common science practice and there are external similarities that make it hard to appreciate the profound differences internally. All of them are in the same type of institutions, right? All of them have similar type of staff, professors, students, false dogs, et cetera, right? And they engage in similar activities, publishing in peer-reviewed journals. But there are significant differences. Orthodox tobacco control science does not resemble other types of science, other scientific communities. For example, Orthodox tobacco science, say, Science is settled. We hear that. We heard that from the US surgeon, Carmona, said science is settled, therefore there is no need for more fundamental research. The main core issues are fully known. There is no need to go on further. And disruption and dissent are unacceptable because they are challenging solid science or promoting the interests of the industry. On the other hand, in common scientific practice, we never say the science is settled. Science is temporarily settled, and it is subjected by a majority-peer consensus that is always unstable. Replication and criticism and dissent are essential. Disruption and dissent are unavoidable and are accepted and we're encouraged to do it. We're not blocked to do that. Now, a single conflict of interest with the tobacco industry is absolutely determinant It's regardless of the technical merit. That is a totem, absolute totem, right? And people live terrified that you are going to be pointed out as having a conflict with an interest conflict, and the interest conflict is never well defined. It's always advancing to microscopic micromanagement, right? Okay, there is no equivalent of this attitude in any other science that I know. Even climate change, they invite car companies. I've never seen something like this. And even orthodox tobacco control science doesn't do that with other industries. So there is also a narrative, the narrative of the Trojan horse, in which all THR, It's a marketing strategy to bring new addicts. This narrative is prevalent. And the totemic animosity against the industry, perhaps it was justified in 1990, right? But today, this narrative allows, in many cases, I'm not going to say every case, but in many cases, tobacco control researchers, the orthodox ones, they deflect criticism by pro-THR research alluding real or imaginary conflicts of interest with the industry. It can be the tobacco or the vaping industry. And this has created a toxic academic environment, right? The fact that policy determines science allows many sloppy papers to be published as long as they support the policy. This is the main criterion, then lots of technically sloppy papers move. And this, yeah, I've just said that, right? There is a large volume of literature, of papers that agree with this policy but are technically sloppy. This is completely self-sufficient. Authors can cite this literature, ignoring authors that do not follow this policy or this type of literature. And I think the fact that there is no exchange of ideas, it is a toxic academic environment. Let's make a quick tour around the science today. First, I have this interpretation of what are the motivations of the orthodox tobacco controllers. I repeat that people in tobacco control who are part of the THR minority are not acting like this. So we have this diagram. Those who are ignorant on THR and knowledgeable. The idealistics and the cynics. And there are transition zones. So here is the majority of junior researchers. They are idealist, but they are very ignorant on THR, partly because they are recent. Now, some of them might cross the transition line, remain ignorant, but become scenic. I'm not saying, this is a tendency. I'm not saying everybody follows it. And most professional, THR community remain idealist, but have become knowledgeable. Why idealist? Because if you are opposing, it's an unequal conflict, academic conflict. You have to have some idealism to do that. That's why I assume they are idealist. And then you do have people who are knowledgeable, but nevertheless are cynic. I personally know people like this. I have talked to them, right? So, this sort of explains more or less, I hope I did not offend anybody. Now, what is the science? First, we have inhaled and exhaled emissions. This is taken care of. It is multidisciplinary by analytic chemistry and aerosol physics. There is also pharmacology of nicotine. Nicotine is also inhaled. And we want to know the biological effects once this material enters our body. So we have for clinical, cytotoxic and animal models. And we still don't know how much this translates to humans, but we can speculate. And then we have laboratory studies, which can be biomarkers, can be in the lung, respiratory or cardiovascular. And then we also have the smoking cessation issue, which is dealt either by clinical studies, observational cohorts, or by randomized control trials. And this is the domain of the medicine. And of course, we also have subpopulations, teen raping, and this is handled by population studies and statistical methods. Okay, so I'm going to start reviewing rapidly these different areas. The most frequent methodological error that people do that are looking tin-laping, there are several. For example, the usage of the past 30-day measurement disregarding the frequency or not playing down the frequency. This is a major flaw. The fact that they don't, a lot of commentators, they say there is a teen vaping epidemic or whatever, but they do not go to the numbers. Another flaw, is they're ignoring that most of the usage is exploratory. The few that are frequent vapors are the ones that are, this is the liability hypothesis. Also, gateway has to be gateway in and gateway out. You have to look at both cases. Some studies exclude the smokers so they don't know how many smokers go into vaping. And they also assume that automatically that flavors are the attractor when there are other factors as well. And finally, it's very important, they ignore the vape substance. And a lot of teenagers that are vaping cannabis are using tobacco products. So these are flaws. Now, considering these flaws, in my opinion, and I know many people agree, The vaping youth academic is a political construct. It has no scientific substance. Of course, youth vaping is a concern, but it's not the major crisis or problem. It is used politically. Nicotine, what's the problem in the case of nicotine? For example, the effect, the deleterious effect in the development of adolescence. This comes from a few rodent studies, but nevertheless is voiced as a fact. And also, claiming that it promotes tumours when this evidence comes from Roland studies and this ignores the massive epidemiological evidence from snus usage in Sweden. Cohort studies on CVD and respiratory effects, there's a failure to account for former history of smoking. in many of the vapors. And also, there is a failure to account for the chronological order of the events, like the famous paper that was retracted from Glantz. And smoking cessation, there are also issues. Ignoring the demographic data from the UK, Sweden, and okay, here I'm going to go a little bit faster. Here I'm going to dissect a study on pulmonary physiological damage. The study is there. It was financed by the NHI. And you can see here, if you see at the red square, it says, we show that chronic e-cigarette use generates 200 proteins in airway epithelia. Further confirmation that this, that possible harm in chronic vapors. And of course, if you look at this, it looks impressive. Devastating harms from vaping. However, there's always a however. It has a lot of problems. What problem? First, the samples are very small. It's 18 smokers, 13, 18 non-smokers. The data is there, you can read it. And it is cross-sectional. It's difficult to make inference on causality if it's cross-sectional. And also, the authors claim that the biological effects are chronical, but actually their argument that it's chronical is because they look at in vitro and in vivo studies. They cannot prove that this is a chronical effect. But worse, they claim that fast smoking story of the vapors, all vapors are ex-smokers. in this study had no effect on their results. And they cite a reference, Zhang et al., that allegedly demonstrates that many genes return to baseline after smoking cessation. But I looked at this reference, and this reference doesn't say anything of this type. It deals with a completely different issue. And also, the statistics is quite muddled, and it's not conclusive. This article is really bad, really sloppy. This is what I mean. These are sloppy papers. And there are dozens of studies and reviews of studies of this type, and they are all cross-sectional. They observe effects that who knows if they are chronical. I don't know. And many of these, they do not compare with smoking or with air pollution or other stimulants. And they are unable to disentangle the biological effects from former smoking. They claim they do. But once you look carefully, it is doubtful that they do that, like in the article that I dissected. These are the studies that I cited, especially by pulmonologists and pneumologists in respiratory societies, to claim that vaping harms the lungs. At best, they could claim they are signals that vaping might harm might produce harms, but that's not the way it is presented. It's presented as a fact. According to the Spanish Respiratory Society, our lungs were designed to breathe pure and fresh air. That's nonsense, really, because if that was true, smokers will die in two years. If only fresh air, if that's the way... No, this is ignoring the defences of the lungs, which are very resilient. It takes 30 years for people to get sick from smoking, and smoking is massively toxic. You don't have to have a PhD to understand this. Emissions, this is my own research. Emission studies are very important because they are the ground level of the pyramid. This is the pyramid of tobacco harm reduction science, right? First, we prove the emissions in a machine, then we see it in vitro, in model, and then we go to the human body. But the ground level is very important because imagine if the aerosol was toxic, the rest of the pyramid would fall down or would not even emerge. So these are very important studies. Now, if it is true that the aerosol is toxic, it has metals, aldehydes, free radicals, the proof of this must be in studies that have analysed these emissions, right? OK. Lights went off. To evaluate this, my colleagues Sebastian and Juliette and I published in 2022 extensive reviews and we revised 48 studies of emissions, 12 on metals and 36 on organic byproducts. And these are the papers. And of course here you cannot put a detector in the mouth, so this has to be done in laboratory, the machines that simulate the inhalation. To evaluate consistency, we demanded several tests. For example, articles have to be, the laboratory studies have to be replicable. They have to provide all the information. An experiment that is not replicable is not worth anything. The devices cannot be obsolete and they have to be in good conditions. And also, the vaping machines must reproduce as best as possible the coughing habits of humans, because we want to know what are the effects on humans. And especially, in particular, high power devices have to be given a high airflow. This is very important. I'm going to go a bit fast here. Now, the basic physics of aerosol, I simplify this a lot. What we have is an equilibrium between heat flux and force convection. There is one energy enters to the vapour and when the user inhales, it keeps a balance of this energy. It's essentially the balance of the energy supplied and the evacuation of the aerosol. There are more details, but I'm not going to stop on this. So the equilibrium state, what we have is that this can be verified in the laboratory by a linear relation between the evaporated liquid mass and supplied power. And it defines the powers where the devices work. And above these powers there is overheating, below there is underheating. Okay. Now, our results, we put our results in a traffic light system, and the results are as follows summarized. About one-third of the studies failed the quality tests. Therefore, the results are not reliable. Eighteen studies were in the middle. They failed two of the tests, so the results are in doubt. They are questionable. They may be okay. They are doubtful. And 14 results satisfied the test. Therefore, the results are reliable. And what a coincidence that all the studies that detected high toxic content are the studies that do not pass the consistency tests. And all the studies that detected low toxicity, and here low or high depends on comparing with toxicological standards, they were the ones that were well done. In fact, you can say that all studies detecting excessive toxicity were unreliable. And this, for us, answers this issue of the toxicity of the aerosol, right? Now, the most common error is spotting a huge, powerful device with very low airflow. What happens in this case is that the range of power where the devices operate becomes very narrow. And this can be a problem. Hey, lights went off. Okay, see, and also what happens that if you are just outside the optimal regime in the power range, this triggers the exponential production of carbonates, of toxins. So this is why, and the user knows it, because if the user is vaping at too high powers, the aerosol will taste like shit. But in the laboratory we can identify that, right? OK, now it is many, many, many, many, many studies, and I'm talking about hundreds of studies, do this error. What they do here, they test the green square is the power range where the devices operate without overheating. And look, they test them in extremely high powers. And of course, with a lot of carbon, if you test a device at this power, you are going to get a horrible aerosol, hot, full of toxins. And this is what they report. It's amazing. That's very bad. And there are many studies that do that. Now, just bear in mind the last slide. You have cytotoxicity and animal models. What are these? You are exposing cell lines and rodents to an aerosol. And how is this aerosol generated? Well, this aerosol, there are hundreds of studies that have generated the aerosol the way I described in the previous set. We're talking about hundreds of studies. We're already beginning to review them and it will be a scandal because there are hundreds of studies on cells and mice that are literally poisoning the cells and mice with poisonous aerosol. because of the generation of aerosol. Now, these studies, they say, well, we just use the standard, but the standard is appropriate for cigarettes that the tobacco industry makes, e-cigarettes, which are low-powered. The standards do not work for high-powered devices, but we have told them, but there is no, you know, When policy determines the science, criticism is irrelevant. That's politics, I don't want to talk about that. But then, this is a problem. This is a problem. Now, let me go very fast through environmental emissions. There are about 100 studies of secondhand vapor. They generate emissions using vapors because it's environmental. You can use volunteers. You need to use volunteers. Most of the studies, they have methodological problems. For example, the authors talk about the dangers of particles without understanding the chemical composition of the particles. The vaping volunteers sometimes are naive vapors and so the exposure is not realistic or they are forced to vape, like in one study, 80 times in a minute inside of a car. Of course, that's terrible. Also, most studies do not subtract the environment before vaping, so we don't know to what degree what they measure is contamination that existed before. environmental, let's compare with tobacco smoke. See, in tobacco smoke, environmental, you have two emissions, the mainstream coming out of the mouth of the smoker, and the side stream, that it comes from the cigarette tip, right? In vaping, you only have the mainstream. But there is more, like 80% of what is released is from the side stream, because the side stream is a continuous emission. On the other hand, mainstream is intermittent. Over 1,500 toxic compounds in significant quantities. And we all know that smoke, environmental tobacco, stays for a long time. Now what happens here with environmental vapor? First the vapor absorbs and retains 90% of what inhales. 99.9% of the full aerosol particles and gas is the solvents and water, right? And it evaporates in less than 20 seconds. So yes, both are aerosols, but they are radically distinct aerosols. And warning, warning, warning. Everybody be careful. Secondhand vapor contains ultrafine particles that get into the lungs of bystanders. You've been warned. Now, I would like you to meet the dreadful killer particle. This is the killing particle. It's a killer. So, we have a nice lady doing her vaping, and then, bang! The particle And the particle, oh, hey, what happened here? You missed my joke. The particle will go into the lungs, into the lungs of the children. Terrible, no? Terrible. But sadly, well, sadly for whom? Reality is less dramatic. The particles are not harmful. They are liquid droplets made with the solvents propylene glycol, glycerol, nicotine and water. That's it. These are not terrible particles. They are not killer particles, like for example PM2.5 of air pollution or the particles of tobacco smoke. This is the story of a particle. It evaporates very fast. In five seconds, they lose 50% of the mass. And of course, nicotine and VG and PG evaporate at different rates, but they all evaporate, yeah? So imagine you're exposed to a killer, but the killer is evaporating. Right? So, no, but you know, all this stuff is an environmental vapor. They warn you, the particles, the particles, but that's nonsense. Nothing to do with the particles of evolution. Now, what happens here? It is not obeying A, the person who is managing this. Hey, somebody is, what's wrong here? They almost lose, ah, here, okay. What, okay, okay. Now, it's very important to appreciate the environmental impact of vaping to emphasize that first, it is diluted. Second, it is visible. Third, it is intermittent and fourth, it is directional. This is very, very important. Here, direct aerosol exposure happens only in the jet direction. Here we have a vapour and there are circles 1.5 to 2.5 metres. What happens during the puffing? See, it is a jet, and it's directional. Here I'm assuming no ventilation, but no ventilation is the most dangerous, the most harmful, right? Now, 50% of the droplets will evaporate at 1.5 meters, and only 5% of the droplets will be at 2.5 meters. But then what happens at that distance, oh, what's the matter with this? Hey, somebody's controlling this. Yeah, do it for me. Yeah, because I think there's some magic thing over there. OK. So, no. OK, no. You were right here, right? So the blue thing, can you pass it? Yeah, okay. The blue thing is the turbulent area, because the jet becomes mixed with air and the velocities become the same as the environmental velocities. Circular motions make it turbulent, right? But the important point that you should see is that outside of the direction of the jet, there is zero exposure. However, the studies of environmental vapour they do what I call shooting, fusilamiento. That is, here is a vapor, the volunteer vapor, and he's going to vape, or she's going to vape, and the sensor is here. Have you ever seen somebody that is vaping in a restaurant and throwing the vapor to the face of somebody? No. So these polys are really exaggerating because they are measuring only in the area of exposure. But all other directions, there is zero exposure. This is just to give you an idea of the environmental impact. Let's move to the... This was during puffing, a few seconds. Now, after puffing, boom, okay. After puffing, next. Next, the jet has dispersed and there is only turbulence around the dispersion of the fourth. and there is exposure only to a dilute gas because all the particles have evaporated into a gas and this gas is extremely diluted and is made of light particles with high kinetic energy. So basically there is nothing. This is why we can wait and nobody will notice because of the physical properties of the aerosol. I'm next? Okay. Although none of the studies, the industry studies are different, I must say. But none of the studies, they find anything. None of them find anything, yeah. But nevertheless, they claim that is toxic and the particles, the killing particles, et cetera, and it is also bad for vulnerable people, has to be prohibited in all spaces. So we are seeing something familiar. Next, please. There is no justification for this extreme precautionism. It's just the normalization. It's the normalization. It's the same process, right? Okay. Next. Okay, comparing with cigarette, tobacco, cigarette is overkill. In reality, vaping aerosol is less toxic than many household aerosols, cooking, vacuum cleaning, candles, odorizers, but this is for another talk. I have also evidence and now, this is, I'm finishing now. Being overwhelmed by huge, brutal forces in October 1936 in Salamanca, Spain, the philosopher Miguel de Unamuno, not armed, without resources, no funding from Bloomberg, nothing, right? Just a humble professor of philosophy, told the Franquistas, Franquistas have all the army, He told them, next, Vencereis mas no convencereis. This means you might win, but will not prevail. Next, please. This is my final message. No pasaran. And we have to be very firm on this. We have to really defend, and when we argue with the other side, we have to argue with conviction. Example, oh, raping academic, the youth, et cetera. No, sir, there is no raping academic. Ah, how can you say that? There is no raping academic. You want to talk about raping academic, we talk about politics, but there is no science in that. We have to say that, because if you say, oh, yes, true, it's a raping academic, but fortunately, it's decreasing, and yeah, we will, no. because you are playing into their narratives. Don't say that. Just say there is no raping epidemic among youth. It's a problem. It's an issue that has to be dealt, but it is not the problem that people make. Say it. No pasaran. This is my final message. Thank you.