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How Big Tobacco in the United States Seized Control of E-cigarettes Designed to Prevent Teen Smoking

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More than 2 million teens in the US say they use e-cigarettes, with a quarter of them saying they vape daily, a new national survey finds.

Earlier this month, the US Food and Drug Administration (FDA) announced it has delayed its decision on whether to ban Juul, the biggest-selling vaping device on the US market, and whose arrival triggered the global popularity of pod-based vape devices.
Although it has vetoed 950,000 lesser-known e-cigarette products, Juul and other top brands remain on sale as the agency takes more time to review the evidence.

For Lauren Etter, this is one more chapter in a long and often disastrous history.

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Etter is an investigative reporter for Bloomberg News and the author of a new book, The Devil’s Playbook, which takes a deep dive into the story of Juul.

It is a tale of powerful personalities, staggering profits and losses, and it tells of how an agency charged with protecting public health was unable to intervene in time to prevent a new addiction crisis.

When Etter started reporting on Juul in 2019, the youth vaping epidemic was well under way. “I became very interested in Juul,” she says.

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“I thought it was fascinating; how had a Silicon Valley company become involved with nicotine?”

Very early on, she realised you can’t tell the story of Juul without also writing about the history of the tobacco industry.

Persuading people from both sides to talk was a challenge, as there has always been a closed culture among tobacco executives and, by then, Juul was under scrutiny and facing numerous lawsuits.

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“Ultimately, people who knew what was going on realised how interesting it was and wanted to share their story,” says Etter.

A big chunk of her book traces the history of Altria. Best known as the makers of Marlboro, this is the US company that split off from Philip Morris and went on to make a US$12.8 billion investment in Juul.

Etter exposes the tactics Big Tobacco has used to maintain its business while staying on the right side of regulators: quietly lobbying, noisily putting large sums into quit-smoking programmes and generously funding research.

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As the market for tobacco slowly shrank, Altria had been struggling to innovate, producing smokeless devices that failed to catch on. On to the scene burst James Monsees and Adam Bowen, two Stanford University product-design students with a passion for social change. And in their sights was the cigarette.

The good guys

Smoking tobacco is incontrovertibly harmful.

If you light a cigarette, it produces more than 7000 chemicals, at least 69 of which are known to cause cancer. As the smoke is inhaled, a sticky chemical-laced layer of tar builds up inside of the lungs, damaging the lining and eventually exposing the user to the risk of developing cancer and emphysema. Despite knowing all this, many people are too addicted to give up the habit.

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Monsees and Bowen asked themselves, what if there was a nicotine-delivery system that would give smokers the same experience and satisfaction without the same risk to health?

“There were one billion smokers in the world, yet the cigarette hadn’t been redesigned in more than a century,” says Etter.

As they set out to disrupt the market, like Big Tobacco before them, the two men were to discover that innovation in this space wasn’t easy.

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Starting their company, then called Ploom, they struggled to get investment. Etter describes Bowen mixing tobacco in a big metal kitchen bowl and soaking it in a rainbow of flavours – peach, coffee, mint – sourced from speciality flavour companies, then getting employees to test the different strengths and flavours.

In 2009, they rolled out the Ploom Model One, which used butane to heat up aluminium pods filled with tobacco. According to Etter, there was a sense of excitement at the company back then. People felt they were the good guys, united against a common enemy, Big Tobacco.

“I do believe Adam and James had a true interest in harm reduction,” she says.

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“They saw themselves as trying to put Big Tobacco out of business. They looked at this primitive product that had caused death and disease and wanted to create a technology that would reduce those harms.”

But at the same time, with a billion smokers in the world, there was a huge market of potential customers they could tap.”She reports that their first product wasn’t amazing. The nicotine hit was unsatisfactory and unpleasant, the device became too hot to hold and testers reported it was clunky to use. The second version swapped a lithium battery for butane, plus was sleeker and funkier, but still not a total winner.

By then, e-cigarettes from China were flooding on to the market. There was no legal age restriction on them, no clinical studies had been done to evaluate their safety and, unlike traditional smoked cigarettes, all kinds of flavours were allowed.

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From the beginning, the FDA was blindsided by this sudden flurry of new devices. The agency tried to exert some sort of control, seizing a shipment of NJOY e-cigarettes being imported from China, declaring them unapproved drug-device products.

But the US owners of the NJOY brand, lawyers Mark and Craig Weiss, took the FDA to court and won.

A judge ruled that e-cigarettes couldn’t be regulated as drug devices unless they were being marketed purely for therapeutic cessation purposes, which effectively left the FDA toothless.

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“E-cigarette companies were free to hawk their wares in any flavour they wanted and to whoever they liked,” says Etter.

Desperate to hang on to its market share, Altria began unveiling more smokeless products, such as the Marlboro sticks designed to swirl around the mouth. Other brands trialled tiny teabags filled with tobacco that could be held in the cheek. Nothing worked with consumers. They preferred cigarettes.

In the meantime, Monsees and Bowen recruited a brilliant young chemist called Chenyue Xing, who had a background in inhalation-drug development.

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Her job was to work on a nicotine formulation that had just the right kick in the throat without it being irritating and that delivered enough nicotine to create a buzz.

Xing spent a lot of time studying the chemical properties of tobacco, then began testing various formulations, first informally in the company’s San Francisco headquarters, and then in a lab.

That lab was in New Zealand. In early 2014, a team arrived at the world-class research facilities of the Christchurch Clinical Studies Trust. There, a group of male smokers tested e-cigarette nicotine blends and compared them with a traditional cigarette.

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Quickly, it became clear the nicotine-salt formulations, with the fastest rate of nicotine uptake in the blood, were the star performers. By the time the team left Christchurch, they were zeroing in on what Etter calls “the secret sauce”.

It was a formula that packed a big nicotine punch and delivered a smooth, enjoyable experience – basically, the e-cigarette version of Marlboro. Once it was packaged in a stylish device, Juul had arrived. While the FDA still remained tangled in red tape, it was launched on to the market.

In The Devil’s Playbook, Etter identifies the point when Bowen and Monsees’ baby turned into a monster.

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“It was the moment when the marketing came into play; sometimes I describe it as their original sin,” she says.

An initial plan for a quirky marketing strategy for Juul was rejected in favour of the “Vaporized” campaign, which was all glamour, good times and cool young models. There was a flashing billboard in New York’s Times Square, adverts in glossy magazines, lots of social media and, over the summer of 2015, parties where tens of thousands of free samples were handed out.

Had the company targeted existing smokers, most likely no one would have cared, aside from Big Tobacco. Juul’s mistake was appealing to a new market of young people who had never touched a cigarette before.

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“Juul didn’t have the institutional knowledge the tobacco industry had from having been in the fire for so many years,” says Etter.

The first Juuls weren’t perfect. The little pods that snapped into the device could leak, causing nicotine to seep into the mouth, and engineers had to scramble to fix the problem. But with a 5 per cent nicotine concentration, this was by far the strongest e-cigarette on the market. Just one pod delivered an amount of nicotine equivalent to an entire pack of cigarettes. And it looked really cool.

Juul heist

Sales to teenagers soared and, by spring 2016, the Centers for Disease Control and Prevention announced that three million school students reported having used e-cigarettes.

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Juul was having problems keeping up with demand. Yet no one knew how safe they were, what effect the vapour had on the lungs or what all those flavours contained. By the time the FDA managed to ban sales for people under 18, in August of that year, it was already too late. Kids were becoming nicotine addicts.

One of the pro-vape arguments is that, although people smoke for the nicotine, they die from the combustion and the tar. This is something Etter has wrestled with.”Nicotine can be a stimulant, it can make you brain more alert and it can be relaxing,” she says.

“There are studies that show it can exacerbate heart conditions and in pregnant women it can have adverse effects on the fetus, but overall it’s a fairly benign substance and people like to compare it with alcohol and caffeine.”

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But nicotine is different. No 1, it’s extremely addictive. And No 2, there’s nothing good that can come from a child using nicotine. In fact, there are studies that show it can affect the development of the adolescent brain.

“So, I feel as though you need to have two conversations. You have to talk about nicotine use among adults and nicotine use among adolescents. And you have to ask if there are potential long-term implications of a lifetime of e-cigarette use that we don’t know about today.”

A 2015 review published by government agency Public Health England concluded that vaping was 95 per cent less harmful than tobacco. This statistic has continued to be bandied around, although subsequent research has undermined it.

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One US study found that users of the common vape flavours menthol and mint are exposed to high levels of the carcinogen pulegone – synthetic pulegone is banned by the FDA as a food additive. And when cinnamon flavour is heated, it creates a unique aldehyde – cinnamaldehyde – that can damage the respiratory system. There are thousands of other flavours containing ingredients that are potentially toxic.

Plus, vapes contain humectants, such as propylene glycol and vegetable glycerine, which heat up to make the vapour. As they break down, these generate other more harmful components, including highly toxic formaldehyde, creating inflammation in the lungs.

Last year, a study from Stanford University showed that young people who vape are five to seven times more likely to be infected with Covid-19 than those who don’t. That study’s senior author, Bonnie Halpern-Felsher, is a developmental psychologist and the founder of the Tobacco Prevention Toolkit.

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Addiction danger

During her many years in tobacco research, Halpern-Felsher says she has never seen such a quick surge in uptake with any other product. Everything about Juul appealed to young people.

“Their flavours, colours, their marketing, the fact that they’re small and easy to hide, but also their salt-based nicotine – it’s smoother, it gets absorbed more easily and it tastes good,” she says.

The term e-cigarette isn’t one that young people even use; they call it vaping, or Juuling, or maybe puffing. And Halpern-Felsher’s research has shown that many of them aren’t aware of the potential harms.

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“I think teens are starting to get it now, but there are still some who say it’s harmless water vapour. And early on, when I published what were probably the first couple of papers out there on Juul, teens didn’t understand how much nicotine was in them, or know about the chemicals in the flavours, or appreciate how addictive they are.”

The lungs are an efficient route for a drug to reach the brain. Nicotine moves quickly from there to the bloodstream, then crosses the blood-brain barrier and binds to receptors in the brain that release neurotransmitters, including dopamine. We get a hit, then it wears off, so we crave another one.

Parental backlash

Young people are particularly vulnerable to nicotine addiction. Almost 90 per cent of daily smokers started smoking before the age of 18. But although cigarette use is more common among lower-income, lower-education groups, vaping has similar levels of popularity across all the demographics of wealth and gender.

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“It’s what I call an equal-opportunity bad thing,” says Halpern-Felsher.

When she gives talks about vaping to parents, many are still unaware of the levels of nicotine the pods can contain, and there is always someone who doesn’t know what a Juul looks like. In her book, Etter tells the anecdote of one Silicon Valley parent who noticed that when his kids had friends over, they had devices plugged into power outlets that he assumed were flash drives.

Eventually, the adults caught on and Etter describes how parent-power became a key part of the Juul backlash in the US. “Parents were so upset, because they’d had no idea this was a thing,” she says.

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“They had been concerned about cigarettes and drugs, and then this came out of nowhere. It hit the market and cascaded through middle schools and high schools.”

Groups such as Parents Against Vaping and the Campaign for Tobacco-Free Kids fought back against a style of marketing and a product that seemed directed at their teens.

In response to the increasing pressures, Juul did make some changes, with no more beautiful young models on social media and an increased focus on the stop-smoking angle of vaping. Plus, it removed some of the more appealing flavours from its bricks-and-mortar stores.

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Still, the company’s problems continued. The city of San Francisco – Juul’s hometown – banned the sale of e-cigarettes. Then, young people with damaged airways started showing up in hospital emergency departments.

The condition was dubbed “Evali” (e-cigarettes or vaping use-associated lung injury). Some of those patients died, and even though the problem was mostly linked to vaping THC-laced cannabis products, the pressure on e-cigarette companies intensified.

By now, alarm bells were ringing loudly at the FDA and Juul was being run by a former Altria executive, KC Crosthwaite, who knew about being in survival mode.

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He pulled all the fruit- and dessert-flavoured products from the US market, and when a study showed Juul mint pods were actually the most popular flavour with teens, they were removed, too, despite mint pods comprising 70 per cent of Juul’s business.

Last year, the FDA banned flavoured cartridges for products such as Juul. And thousands of lawsuits against the company started flying in, some filed on behalf of minors who had become addicted and others from adults claiming the product had contributed to lung injuries.

Once the fastest-growing start-up in Silicon Valley, Juul found things weren’t looking so rosy any more. Altria, which had paid US$12.8b in 2018 for a slice of the action, creating so-called “Juulianaires” in the process, saw the value of its investment dwindle, and in October last year, it announced its stake was worth just US$1.6b.

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“It’s a fascinating arc of history connecting these two companies and I’m curious to see how it all plays out,” says Etter.

“I think Altria is going to be fine. Certainly, the investment in Juul was a total disaster. But it is able to continue to raise the price of its cigarettes to offset the decline in usage. There are still 38 million smokers in the US, so they still have a stable business model.”

But for Juul and other popular vape brands, everything continues to hang in the balance.

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“Juul’s fate is really in the hands of the FDA right now, which is not a great position for a company to be in,” says Etter.

“But the FDA is in a difficult position, too. No matter what decision it reaches, there is going to be a lot of anger. And I have a hard time imagining the FDA putting an American company out of business.”

You were reading: How Big Tobacco in the United States Seized Control of E-cigarettes Designed to Prevent Teen Smoking

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«Se pone mejor»: 34 mentiras que las personas de este grupo en línea se convencieron de creer en ellas para sentirse mejor acerca de la vida

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«Se pone mejor»: 34 mentiras que las personas de este grupo en línea se convencieron de creer en ellas para sentirse mejor acerca de la vida

Desafortunadamente (o no), la vida no siempre es arcoíris y mariposas. Estar vivo significa inevitablemente acostumbrarse a que las cosas no salgan de la manera que planeamos, que la desgracia suceda sin ninguna razón en particular, perder a seres queridos, perderse y muchas otras cosas por las que la mayoría de nosotros no estamos tan emocionados. Sin embargo, ese «acostumbrarse» y aceptar la realidad por lo que es tiene sus desafíos.

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Recientemente, el usuario de Reddit mynameisnotbecky1 preguntó a otros miembros de la comunidad: «¿Qué es una mentira que la gente se dice a sí misma para sentirse mejor sobre la vida o el mundo en el que vive?» La publicación recibió bastante atención y, a partir de ahora, tiene más de 13 mil respuestas y casi 30 mil votos a favor. Con eso dicho, Panda aburrido te invita a revisar algunos de los mejores comentarios que logramos encontrar.

Más info: Reddit

# 1

Hay algunos, pero el principal me digo a mí mismo si las personas que me lastimaron también están sufriendo. Cuando era niño, pensaba que la gente se intimidaba porque sus vidas apestaban, y luego me di cuenta de que mi vida también apestaba y no trataba a otras personas así, ¿cuál era su excusa?

Créditos de la imagen: dumpsterfire1998

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# 2

«las miradas no importan»

Me he dado cuenta de que, por lo general, lo dicen personas atractivas y personas que nunca han tenido problemas para salir con alguien.

Créditos de imagen: RadiantHC

# 3

La gente siempre recibe lo que le espera.

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La realidad es que a veces las personas que te atormentaron hace tantos años probablemente estén viviendo muy buenas vidas.

Créditos de la imagen: yeetgodmcnechass

# 4

El dinero no puede comprar la felicidad.

¿No tienes casa, trabajo y te mueres de hambre? ¡No se preocupe, solo porque sea pobre, no significa que tener una mansión, comidas de 5 platos o un salario de seis dígitos lo hará más feliz!

Créditos de la imagen: Dark_Wolf04

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# 5

Una actitud positiva te hará mejor físicamente. Como chica con cáncer, recibo mucho el consejo de «solo tener la actitud positiva» … lo que siempre me molestó. Nadie que se sienta como una mierda quiere fingir una mentalidad positiva para hacer que los demás se sientan mejor. Mi respuesta favorita cuando alguien me dijo eso (nuevamente) fue en realidad de una enfermera en la habitación que dijo: “¡Por ​​favor! He visto a muchas perras verdaderas sobrevivir al cáncer «. Esa enfermera es para siempre mi héroe.

Créditos de imagen: KATinWOLF

# 6

«¡Si solo termino con esto, todo será fácil!»

La vida nunca se queda sin olas para sacudirte. Pero aunque no es fácil, aprendes a surfear mejor.

Créditos de la imagen: charlie_wonka

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# 7

No soy alcohólico, no es una adicción que pueda detener cuando quiera … ¡es solo fiesta, cumpleaños, miércoles o lo que sea que me haya ganado este y el próximo!

siendo así durante 22 años, viniendo de un hogar muy alcohólico, me puse sobrio hace unos años y fue, con mucho, la mejor decisión de mi vida.

Créditos de imagen: thekrecik

# 8

Hay alguien para todos. No todo el mundo encuentra a su pareja, no hay ninguna regla que deba seguir el amor.

Créditos de imagen: Barbicore

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# 9

«Voy a contar / vivir MI verdad». Tu verdad es solo una excusa para tus acciones, simplemente o no. No es la verdad objetiva.

Créditos de la imagen: madevilfish

# 10

«Si me duermo ahora mismo, dormiré X horas».

Vas a estar despierto un rato, cariño.

Créditos de imagen: PM_ME_UR_LAST_DREAM

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# 11

La religión hace más bien que mal

Créditos de la imagen: PositivityCentral

# 12

Creo que todas las personas (yo incluido) piensan que son un poco más inteligentes de lo que realmente son.

Créditos de imagen: CartWader

# 13

El gobierno nunca mentiría sobre ______.

Créditos de imagen: HealthyMmm

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# 14

Todo sucede por una razón

Créditos de la imagen: Glittering-Ship1910

#15

Que solía haber «Los buenos viejos tiempos» cuando en realidad nunca los hubo.

Créditos de la imagen: warlordwinters

#dieciséis

El crimen no paga. Conozco a alguien que malversó más de $ 1 millón y obtuvo libertad condicional y tiene que devolver menos del 10% de restitución

Créditos de imagen: ATXdadof4

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# 17

Que la mayoría de la gente tenga buen alma y buen corazón.

Me digo esto todo el tiempo. Constantemente se demuestra que estoy equivocado. En realidad, la mayoría de la gente es egoísta y cruel, especialmente cuando se trata de otras personas.

Créditos de imagen: Retrosonic82

# 18

La sabiduría llega con la edad.

Créditos de la imagen: Scallywagstv2

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# 19

Se pone mejor.

10 años después y todavía te lo dices a ti mismo.

Créditos de imagen: ShawnWilson000

# 20

Para adultos específicamente: hacer lo mejor que puedas = éxito. No me malinterpretes, hacer tu mejor esfuerzo es algo de lo que estar orgulloso, pero hacer tu mejor esfuerzo sin preparación / dedicación / práctica no lleva a ninguna parte.

Créditos de la imagen: bowlingforbats

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# 21

Acabo de ver al querido Evan Hansen. Está fuera de lugar cuando se trata de enfermedades mentales y trastornos de la personalidad, pero no sorprende que haya tenido tanto éxito en Broadway. Se apoya en gran medida en todos los mitos que la gente quiere creer. La verdad es que acercarse a su familia o amigos a menudo no ayuda porque no tienen idea de cómo ayudarlo o incluso podrían ser parcialmente responsables de su trauma. Para algunas personas, la depresión y la ansiedad son intratables incluso con el mejor tratamiento posible. Algunas personas son constitucionalmente incapaces de sentir empatía y siempre dañarán a quienes las rodean.

Créditos de imagen: j0m1n1n

# 22

Que los buenos momentos que tenemos ahora – gasolina barata y disponible, comida en abundancia, incluso un clima agradable – pueden continuar indefinidamente. Nos quedaremos sin nitrógeno para el crecimiento de los cultivos, agotaremos el crudo disponible, el cambio climático nos alcanzará. Nuestros nietos no tendrán los abundantes recursos que hemos disfrutado durante décadas, punto.

Créditos de la imagen: milescowperthwaite

# 23

Si trabajas duro, todo saldrá bien al final

Créditos de imagen: SlimWorthy

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# 24

La policía puede protegerme.

Créditos de la imagen: DayVCrockett

# 25

Para los niños, los buenos héroes siempre ganan. Cuando creces, es solo una fantasía.

Créditos de imagen: DarkVoid_666

# 26

Personas que idealizan estar ocupadas en el trabajo.

Créditos de la imagen: justheretoscroll_

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# 27

Que el mundo es justo. El karma es una perra. Lo que les espera. Etc.

Créditos de imagen: VividTangerine

# 28

Vivo para mis seres queridos. Perdí a mi esposa durante el parto y 4 meses después mi hija falleció de una afección cardíaca inoperable.

Créditos de imagen: ThatOneWildWolf

# 29

«Hay luz al final del túnel». La vida es el viaje dentro de ese túnel. A veces ese viaje se vuelve difícil, otras veces se vuelve más fácil, pero nunca llegaremos a esa luz. La idea de un lugar perfecto no existe, porque la vida en sí no es perfecta ya que siempre tenemos algo de qué quejarnos.

Créditos de imagen: qwerkykev

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# 30

Que son más únicos que similares a todos los demás.

No. No. No. Eres un ser humano típico. Buen intento Karen.

Créditos de imagen: LowerCanary

# 31

Dios tiene un plan

Créditos de la imagen: D00fenshmirtzEvilInc

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# 32

Que podrían haber sido un campeón mundial en un deporte si no hubieran encontrado alcohol / drogas / búsqueda, etc. La disciplina es lo que nos separa a la mayoría de nosotros, a menos que tengas una gran red de apoyo para mantenerte encaminado, es autodisciplina y ambición que impulsa a las personas a ser de clase mundial. Pero es más fácil culpar a otras cosas que a ti mismo

Créditos de la imagen: Jimi1454

# 33

Se dicen a sí mismos:

«No importa lo que los demás piensen de ti. Sé tú mismo, lleva tu vida de la manera que desees, las cosas tienen una forma de funcionar».

Créditos de imagen: Back2Bach

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# 34

«El tiempo que disfruté perder no fue tiempo perdido».

Créditos de la imagen: Aureliusmind

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El ex presidente Bill Clinton dado de alta del hospital

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El ex presidente Bill Clinton, de pie con su esposa, Hillary, y los médicos, fue dado de alta del Centro Médico UC Irvine el domingo por la mañana.

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Allen J. Schaben / Los Angeles Times a través de Getty Images


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Allen J. Schaben / Los Angeles Times a través de Getty Images

El ex presidente Bill Clinton, de pie con su esposa, Hillary, y los médicos, fue dado de alta del Centro Médico UC Irvine el domingo por la mañana.

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Allen J. Schaben / Los Angeles Times a través de Getty Images

El ex presidente Bill Clinton fue dado de alta de un hospital de California donde estaba recibiendo tratamiento para una «infección no relacionada con COVID». Clinton, de 75 años, había estado en el hospital desde el martes.

Un portavoz de Clinton, Angel Urena, tuiteó una declaración del Dr. Alpesh N. Amin, quien había estado supervisando al equipo de médicos que trataba al ex presidente en el Centro Médico de la Universidad de California en Irvine.

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«El presidente Clinton fue dado de alta hoy del Centro Médico UC Irvine. Su fiebre y recuento de glóbulos blancos se normalizaron y regresará a su casa en Nueva York para terminar su tratamiento con antibióticos», dijo el comunicado.

Amin dijo que los médicos continuarán monitoreando el progreso de Clinton.

El viernes, el presidente Biden dijo a los periodistas que había hablado con Clinton sobre su salud por teléfono.

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«Quería ver cómo le estaba yendo. Lo está haciendo bien. Realmente lo está», dijo Biden. «No está en una condición grave».

El presidente agregó que esperaba almorzar con Clinton pronto.

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Adele, ‘Easy On Me’

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Para su primera canción nueva en seis años, Adele se desvía del esperado sencillo principal espectacular: adiós, «Hello». En cambio, el «Easy On Me», decididamente sencillo y dolorosamente honesto, es lento. Producido por el colaborador frecuente Greg Kurstin, el sencillo de regreso de Adele encuentra al cantautor británico reconociendo los demonios internos y el daño que han infligido. No es un himno de angustia tanto como una balada tentativamente esperanzadora de una mujer que emerge de un período emocionalmente abandonado. Áspero con el sentimiento, el vibrato flexible de Adele se estira antes de saltar sobre una intensa progresión de piano. «Easy On Me» es una súplica: un recordatorio para uno mismo y un ser querido de que darse por vencido no es necesariamente un fracaso y que incluso en nuestros errores, somos dignos de tierna paciencia. 30, El cuarto álbum de estudio de Adele, se lanzará el 19 de noviembre.

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