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[Starver]

It was after I first read this thread when news that vaping makes planes fall out of the sky first broke. Even if it's not actually a chemical side-effect, that vaping can lead to an auxiliary harm (like people who just had to tend to the chirruping Tamagotchi attached to their ignition-key key-ring whilst they were driving at speed, back in the day, and countless other potentially self-destructive abdications of common sense) should be considered.

For my part, I say that vaping is far less harmful than smoking (for health, if not for wealth, depending on the pricing involved), but not even vaping is far less harmful than that (once you're over your actual dependency) and is also free. Except for whatever displacement activity you might take up in its stead. Ultimately, if I were feeling preachy, I'd suggest use smoking substitutes (of whatever kind) as a way of weaning yourself off of the whole thing. But we all know that this isn't how it often goes, so take more notice of the medical professionals (without retainers by Big Tobacco or Big Vape concerns) than any moralising from me. But, if you really want an additional push, maybe this is just enough extra. Or maybe I just disgusted enough people to have them fall off the wagon again.

[Reelya]

they might hesitate before recommending someone with schizophrenia to stop smoking (depending on the circumstances), but they certainly did NOT recommend them to start smoking.

Sure, but nobody was actually saying that they should take up smoking. The links to symptom abatement and nicotine are just in the data, so they round out an understanding of why people smoke, rather than just saying "it's bad!!! stop it!!!" which is the general population attitude, and is what I was referring to originally. The point about "recommend them to start smoking" is kind of a red herring here.

I was checking the current recommendations in medscape (which is my general medicine go-to guide btw. Poor man's Up to Date insofar it's actually free, but not really any worse), and I found an interesting tidbit

Smoking tobacco products induces the liver enzyme CYP1A2 (though nicotine patches, nicotine inhalers, and chewing tobacco do not); this enzyme metabolizes a number of antipsychotic drugs, so that, for example, patients who stop smoking while being treated with clozapine or olanzapine often experience increased antipsychotic levels; a patient who has stopped smoking may have a variety of complaints, and checking drug levels can help determine their etiology

That's a strong confusing factor for smoking cessation and  schizophrenia (and mind you, I think withdrawal alone is likely a strong confusing factor by itself.



Also, more relevantly: I looked up the NICE guidelines for schizophrenia, and, sure enough, they DO NOT recommend to smoke, and they DO recommend smoking cessation.

But those recommendations might not take into account the research that's going on, much of which was only actually conducted in the last 3-4 years, while the correlational data goes back further than that. Remember it wasn't that long ago that the official medical advice was to prevent babies having peanuts as long as possible, to prevent allergies,  and now it's to give them peanuts as early as possible, to prevent allergies. This 180 degree change in peanut allergy advice for babies happened in the USA about 18 months ago.
https://edition.cnn.com/2017/01/05/health/peanuts-allergy-prevention-guidelines/index.html
However, if you kept up with the literature, it's was quite well established that there was a link some time around 15-20 years ago. The point here isn't that they should have changed the advice to say "eat more peanuts early" as soon as preliminary data showed a link, it's that the previous orthodox medical advice wasn't based on any actual data to start with. So, there was literally zero data supporting the medical establishment's orthodox treatment whatsoever, yet they've demanded that competing ideas fulfill a "burden of proof". That's just pure confirmation bias. The original advice didn't in fact have any data to support it, so the alternate idea should have been accepted on "preponderance of evidence" around 15 years ago, because the old advice should have been thrown out already, on the basis that it was pure guesswork/opinion and not based on any medical research.

How this relates to the current debate is that many people and organizations hold a "nicotine is always bad" attitude to a near-religious level of zeal, much more strongly than the "avoid peanuts for babies" thing: and we all saw how hard it was to change that wrong advice. So there's strong confirmation bias against any study showing any positive correlations for nicotine.

And of course, none of that is to condone "smoking" or "taking up smoking" it's just to point out the potential that people are self-medicating and the research showing that nicotine has valid therapeutic uses. Alternate delivery methods such as vaping might shift the balance between harm/good to the point that there is data showing that doctors should be recommending vaping to some people, especially if they're already smokers and they're schizophrenic. The only reason to stick against that no matter the evidence is an ingrained prejudice that "nicotine = bad/evil".

[PTTG??]

You know, one of the tactics of pro-smoking advocates and climate change deniers is to invent a spurious and impossible to live up to definition of "sound science."

Somehow, 99% of scientists get it wrong, and the one percent that manage to do science right work for enron or Philip Morris.

[ChairmanPoo]

Canadian guidelines are from last year and they recommend the same

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593250/?report=classic

Persons with schizophrenia have been reported to die up to 20 years earlier than persons without this diagnosis, with the majority of this accounted for by cardiovascular factors.33–35 While the focus in psychiatric practice often has been on mitigating the metabolic effects of antipsychotic medications, cigarette smoking remains the leading preventable cause of premature death and disease in Canada.36,37 Cigarette smoking likely is the primary modifiable cardiovascular risk factor in those who have schizophrenia, as they are more frequent cigarette smokers, smoke more cigarettes and are more often nicotine dependent.37–39

They include a link to a cochrane meta analysis  of smoking cessation trials, even. They reviewed data from 34 trials, which didnt report major adverse events. The ones that did specifically mention the participant's baseline before cessation state that there were no significant changes

Three studies also reported the effect of abstinence on the mental state of the participants, and found no effects of smoking abstinence on positive, negative or depressive symptoms (*Evins 2005; *Evins 2007; *George 2008).

[funkydwarf]

edit - im just a funky dwarf and a jerk sometimes

[Reelya]

even with cotton wick its under 10 "carcinogens" vs over 200 in a traditional cigarette. Of course some chemicals are probably worse than others(h2o and o2 are chemicals after all), so even just one of the wrong carcinogen for your genetic phenotype may mean trouble....but it clearly reduces the chances

"200 chemicals" vs "10 chemicals" also misses the point a little. That's just pointing out the variety of dangerous chemicals, not the total amount. Point being, the reduction in total volume of harmful chemicals is in fact the big health benefit compared to cigarettes.

And of course, going back to the schizophrenia thing, none of the evidence supports smoking so bringing up smoking deaths related to schizophrenic's excess use of cigarettes is a tangential argument. It's only a really valid point if there are no other means of administering nicotine as a pharmaceutical. Plenty of useful substances are mixed in with bad stuff and need to be isolated before their benefits outweigh the risks. The chemical needs to be isolated and further tested. However, in the mean time, 80% of schizophrenics in the USA smoke compared to 20% of the general public, so suggesting that they consider vaping as an alternative is the most realistic harm-minimization option.

BTW, it's not really the cigarette companies behind the schizophrenia research. Cigarette companies are in the business of selling "relaxation" so having their products strongly linked to mental illness isn't really good PR. "Most people who take our product have a diagnosable mental illness" isn't the message they intend to send. Schizophrenia researchers really only noticed how many schizophrenics smoke after the general population level of smoking declined heavily, but did not decline among schizophrenics. Sure, you can say the research about that is bogus all you want, but it's clearly a real and robust phenomenom, hence why further research is being conducted about it. Sure, maybe it doesn't "fit the theories" but it's observable, so it deserves research effort.

Somehow, 99% of scientists get it wrong,

False equivalency. 99% of scientists say smoking is really bad. 99% of scientists don't unequivocally say that nicotine, by itself is automatically bad and has no medical uses. Also, as we learned from the climate debate it doesn't matter what percentage of scientists as a whole believe something, unless it's actually in their field of expertise. If your friend the zoologist holds that climate change is man-made you discount his opinion as not being relevant because he's not a climate scientist. Similarly, if people researching pharmaceuticals say there are uses for the substance nicotine, but 99% of scientists who aren't in that field disagree, then the 99% of scientists from irrelevant fields are just wrong, or at least, their opinion on the matter is worthless.

[Rolan7]

martinuzz has the best take going. Abort if you already *choose* to have a fun new toy, a baby, but want to taint its development for personal unrelated pleasure. Too many people make everything about parenthood all about themselves like its a new fun hobby.  If you think not smoking for 9 months is too hard, just wait till that dude/duder pops out, things get way harder.

Stop nicotine(for nine months) or dont *choose* to have a child.  The choice to have a kid is obviously to fill selfish needs and has nothing to do with the childs needs.

I'm just going to point out that the OP only posted once in this thread, asking for advice and expressing worry.  You're arguing against some hypothetical monster who treats children as toys...  Which is fine, but I want to point out that that's not the OP.

[Reelya]

I'll just drop this here as relevant, quoting the relevant stuff with parkinson's disease and nicotine.

http://discovermagazine.com/2014/march/13-nicotine-fix

“I understand that smoking is bad,” says neuroscientist Maryka Quik, program director of the Neurodegenerative Diseases Program at SRI International, a nonprofit research institute based in California’s Silicon Valley. “My father died of lung cancer. I totally get it.”

Yet over the years, she has published dozens of studies revealing the beneficial actions of nicotine within the mammalian brain. “The whole problem with nicotine is that it happens to be found in cigarettes,” she says. “People can’t disassociate the two in their minds.”
...
The first hint of nicotine’s curious benefits came from a study published in 1966 by Harold Kahn, an epidemiologist at the National Institutes of Health. Using health insurance data on 293,658 veterans who had served in the U.S. military between 1917 and 1940,.. At any given age, cigarette smokers were 11 times as likely to have died of lung cancer as nonsmokers, and 12 times as likely to have died of emphysema. Cancers of the mouth, pharynx, esophagus, larynx — on and on. But ... one oddball jumped out: Death due to Parkinson’s disease occurred at least three times as often in nonsmokers as in smokers.

Following up, researchers expected the finding to be just a statistical aberration in Kahn’s data, but instead quickly confirmed it. ... in 1971, epidemiologists Irving Kessler and Earl Diamond of Johns Hopkins University published a study comparing the smoking history of living Baltimore residents recently diagnosed with Parkinson’s with age-matched controls. Sure enough, they found that the Parkinson’s patients were much less likely than other residents to have ever smoked.
...
 Since the 1960s, the gold-standard treatment for the disease has been the drug levodopa, also known as L-dopa, a dopamine precursor that can cross the blood-brain barrier. But the drug is not perfect: L-dopa treatment eventually induces dyskinesia - quick, involuntary movements of the hands, and sometimes of the head and trunk ... Putting together the emerging lines of evidence, Quik decided to treat Parkinson’s disease in squirrel monkeys by administering nicotine. In a landmark 2007 paper, she reported that the monkeys had 50 percent fewer tremors and tics, and that nicotine had reduced dyskinesia 35 percent in those already receiving L-dopa. Studies by Quik and others involving rats, mice and nonhuman primates have since found similar effects. In short, by driving dopamine, nicotine appeared to ease the tremors and tics caused by Parkinson’s, and even the movement disorder induced by the major Parkinson’s drug.

They go on to talk about then-current clinical trials of nicotine patches to help with Parkinson's disease. One such trial was sponsored by the Michael J Fox Foundation for Parkinson's Research, which I don't believe is a paid arm of the tobacco lobby.

https://www.michaeljfox.org/foundation/news-detail.php?nicotine-patches-to-stop-parkinson-disease

[PTTG??]