E-cigarettes burst onto the scene nearly 20 years, disrupting the cigarette industry and leaving anti-smoking advocates uncertain about how to respond. The devices, now more commonly called “vapes,” looked and functioned like cigarettes, yet they contained no tobacco—supplying users with a low-risk source of vaporized nicotine. A growing body of research has since shown that vaping is significantly less harmful than smoking and can help adult smokers quit their deadly habit. But this conclusion wasn’t obvious at the time.
On the latest episode of the Facts and Fallacies podcast, Cam English and Dr. Liza Lockwood welcome veteran tobacco control advocate Cliff Douglas for a thoughtful discussion on nicotine, vaping and the future of tobacco harm reduction.
With nearly four decades in the field — from helping ban smoking on airplanes to advising the U.S. Surgeon General — Douglas brings a unique perspective. Once deeply embedded in traditional tobacco control, he now champions a science-based, pragmatic approach that recognizes the vast continuum of risk between combustible cigarettes and newer nicotine products.
Douglas highlights dramatic progress: high school smoking rates have plummeted from 36% in the late 1990s to about 1.5% today. Yet he argues that knee-jerk hostility toward vaping and nicotine pouches stems from fear, historical distrust of the tobacco industry and outdated views conflating nicotine with the deadly chemicals in cigarette smoke. He stresses that separating nicotine from combustion creates far safer options.
A powerful theme emerges from a careful survey of the science: harm reduction is both a public health imperative and a social justice issue. Douglas urges meeting smokers where they are, noting that traditional cessation methods fail most people (quit rates hover around 6%). He encourages older smokers especially — whose rates have stagnated — that it’s never too late to switch and improve quality of life.
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Cliff Douglas is a public health expert and legal scholar dedicated to reducing death and disease from combustible tobacco use. He was president and CEO of Global Action to End Smoking and director of the Tobacco Research Network at the University of Michigan School of Public Health. He held senior roles at the American Cancer Society and the U.S. Surgeon General’s office. Follow him on X @cdoug
Dr. Liza Lockwood is a medical toxicologist and the medical affairs lead at Bayer Crop Science. Follow her on X @DrLizaMD
Cameron J. English is the executive vice president at the American Council on Science and Health. Follow him on X @camjenglish
