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  • Writer's pictureRyan Allen

Are all forms of smoking created equal?

We all know that smoking tobacco is pretty much the single most important behavior to eliminate for long-term health. At this point, it has been indisputably and causally linked to the development of various chronic diseases (most notably the two heavy hitters of cardiovascular disease and cancer). Thus, if longevity is your priority, this is the first thing to curb, especially if you’re working hard to get much more complicated things like your diet, exercise, sleep, or stress in order. Smoking is the lowest-hanging fruit, as we know unambiguously the significant degree of harm it poses.

That said, one of the questions I get asked more than any other from friends is that of how other “forms” of smoking (i.e. smoking marijuana, vaping, etc.) stack up to classically smoking cigarettes. When we say smoking is a major risk factor for all of these diseases, do we mean all smoking, or just cigarettes? The short answer is that we don’t really know, but the nuances of the long answer may be worth a listen when it comes to how you interpret this.

The major takeaway from this has two components. Firstly, yes, in general there is a lack of quality, long-term, established evidence on both marijuana and vaping (for different reasons that we’ll get into). Second, and we cannot emphasize this principle enough, the absence of evidence is not evidence of absence. If we don’t have sufficient data to really tell you if smoking marijuana causes lung cancer in the same way smoking cigarettes does, there is absolutely no logic to assuming smoking marijuana comes with no harm, or even less harm. If something has not been shown in the data like this, that means we effectively know little or nothing about it. In no way does it imply there is nothing important there, should it be studied.

Therefore, as we outlined in an Instagram Reel recently, the safest course of action would undoubtedly be to use the cautionary principle and avoid these other forms of smoking to the extent possible. This is because, even though smoking marijuana and vaping have not yet been shown to cause cancer or cardiovascular disease in the way tobacco does, they also have not been shown to be positive or neutral on those disease risks. It is also reasonable to assume that inhaling any form of combusted material in smoke at high temperatures could mechanistically act the same way as in tobacco smoke. As we discuss in the Reel, it is certainly possible that on a per-smoke basis, you’re still doing the same sort of chemical damage to the endothelium (walls) of your blood vessels, or the alveolar lining of your lungs.

In fact, if there is anything to the largely anecdotal and preliminary speculation that smoking marijuana appears less harmful for these diseases than smoking cigarettes, it would probably be for this reason. It’s not necessarily that the smoke is any less harmful; it’s just that people generally smoke less. Cigarette smokers notoriously smoke several cigarettes, or even multiple packs, a day. And well, some may disagree, but you really can only smoke so much marijuana. I can already hear those challenging this claim, but just please don’t try to test it yourself.

This concept, though, is one of a couple reasons why vaping actually concerns me slightly more than smoking marijuana. The first is as we’ve discussed: I’m sure that people who vape do so far more often than marijuana-users smoke. In this sense, the total hits one gets from a vape is far more comparable in frequency to cigarette usage. If we’re operating under the massive assumption that on a per-unit basis, this could be on a similar level of harm to smoking cigarettes, then that would of course be quite concerning.

The second reason vaping poses greater cause for concern? Its effects just have not been studied long-term at all. At least with marijuana, we have some subpar data or anecdotal, empirical evidence over years and years of its existence to suggest it might not be as bad as cigarette smoking (again, this has certainly not been sufficiently demonstrated to my knowledge, but at least we do have people who have used it over the course of a lifetime to individually look at). The only reason we don’t have better data on marijuana usage is, in my opinion, the absolute nonsense of its federal criminalization in the U.S. and subsequent lack of research funding despite the significant proportion of the country using it. But I digress. Vaping, on the other hand, simply has not existed long enough to study on a meaningful time horizon. It is virtually a black box at this point, where we don’t have the slightest insight into long-term consequences. So, if you choose to vape, it’s important to recognize we technically have no evidence that it is any “better” than smoking cigarettes. We suspect it would be (that’s supposedly why the technology was created), but we have no idea by how much, or if it even is at all.

I know this post might not have been the most insightful, in the sense that the only actual thing to say from a scientific perspective is “I don’t know.” But this is important to acknowledge sometimes, and if you take nothing else away from this post, please remember that opening message on what this really means. Proceed with great caution on things you know nothing about. As is so often the case in health and medicine, ignorance may be bliss in the short term, but it also has untold potential for harm in the long term.


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