In 2009, a combined 112 million Americans used either tobacco or marijuana. In 2020, the last year for which the Substance Abuse and Mental Health Services Administration posted data, 120 million used either.

As a public health matter, that’s bad news. According to a new Canadian study published in the journal Radiology, the health effects on the lungs of smoking marijuana may be as bad as — or worse than — using tobacco.

The Radiology study found:

• Emphysema, a chronic lung disease that causes shortness of breath, in 75 percent of marijuana smokers vs. 67 percent of tobacco-only smokers 
• Bronchiectasis, a chronic lung condition that widens and damages the airways, in 64 percent of marijuana smokers vs. 42 percent of tobacco-only smokers
• Mucoid impaction, an overproduction of mucus in the airways, in 23 percent of marijuana smokers vs. 6 percent of tobacco-only smokers

The findings come as the number of Americans using tobacco fell by more than 12 million, according to the National Survey on Drug Use and Health, likely a result of federal, state and local governments aggressively publicizing tobacco's dangers, imposing new taxes and restricting where people can smoke cigarettes.

But since Colorado and Washington state legalized recreational marijuana in 2012, 19 more states have legalized recreational use. And the number of people who say they’ve used pot in the prior year has grown by 37 percent, the survey has found.

Caveats: The study, while peer-reviewed, only looked at 56 marijuana users and most of them also smoked tobacco. The study didn’t examine how they consumed the products, how often, or how much. Also, the research was done at a single hospital network, so outcomes may differ in another setting.

“We don’t know if these effects are from marijuana alone or from the combination with tobacco,” said researcher Giselle Revah.

In an editorial that accompanied the Radiology study, Jeffrey Galvin, a radiologist at the University of Maryland School of Medicine, and Teri Franks, senior pulmonary and mediastinal pathologist at the Department of Defense Joint Pathology Center, warned that it took decades to identify the harms of tobacco and said they feared the same could prove true of marijuana.

They also said they’d seen worrisome increases in pneumothorax, or a collapsed lung, in marijuana smokers, as well as “bong lung,” or tar build-up on the lungs.

Galvin and Franks acknowledged that researchers have struggled to clearly define marijuana’s effect on the respiratory system, given the myriad ways people use the drug.

But they argued that it’s imperative that researchers continue to study it.

This is where we explore the ideas and innovators shaping health care. 

Twitter is no longer enforcing the coronavirus misinformation policy it put in place in 2020, in which it added warning labels to tweets that went "directly against guidance on COVID-19 from authoritative sources of global and local public health information." Is this a loss for public health? Tell us what you think.

Today on our Pulse Check podcast, POLITICO's Emily Schultheis talks with Ruth about the doctors, researchers and women’s activists who convened in Riga, Latvia, to explore ways to use pills to circumvent anti-abortion laws.

Congress wants HHS to make medical records more portable so patients can more easily switch doctors and doctors can better care for patients.

This fall, HHS has moved on two key reforms:

1. Yesterday, the department issued a notice of proposed rulemaking aimed at making it easier for providers to share patients’ substance use disorder treatment records. 
2. In October, HHS ordered that providers, tech developers and health information exchanges must share electronic health information. 

The new rulemaking would implement a provision in the 2020 CARES Act. The October rule implemented a congressional directive in the 21st Century Cures Act of 2016.

Stricter regime: Currently, privacy regulation for substance use disorder treatment records is stricter than for medical records governed by the health privacy law, HIPAA.

Patients usually have to consent each time substance use records are shared. Providers say that sometimes means they don’t have access to all the information they need to treat patients and the rules pose a compliance burden.

Under the proposal, providers would need to get a patient’s consent only one time to share substance use records.

No hoarding, but: The rules HHS implemented in October contain some broad exceptions to allow providers to refuse record-sharing if they think doing so is infeasible, will cause harm or violate privacy. The regulation also lets providers charge for copies of records and make a reasonable profit in doing so.

The last lobbying firm working for Guarding Against Pandemics — an advocacy organization funded by embattled cryptocurrency mogul Sam Bankman-Fried — is no longer on its payroll.

Bankman-Fried, whose cryptocurrency exchange, FTX, went bankrupt earlier this month after investors asked for their money back, was a believer in effective altruism. That’s a philanthropic movement that aims to bring business principles to charitable giving.

He hired his brother Gabriel to run Guarding Against Pandemics and tasked the group with seeking new Covid-19 relief funding from Congress.

Lobbyists benefited: Guarding Against Pandemics spent about $750,000 on lobbying since last year with the goal of bolstering Covid-19 funding and pandemic preparedness.

Monument Advocacy — which had begun working with Guarding Against Pandemics on Oct. 1 — filed a termination report with the House and Senate indicating its work ended on Nov. 14.

The firm’s team included Kate Mills, a former aide to Rep. Zoe Lofgren (D-Calif.), and Andy Lock, who used to work for Sen. Roy Blunt (R-Mo.).

Monument Advocacy was the last of the group’s outside firms amid a lobbying exodus since Bankman-Fried’s and FTX’s fall. Capitol Counsel, Ogilvy Government Relations, Ridge Policy Group and Van Scoyoc Associates had also lobbied for the group since it was founded last year, but they aren’t anymore.

Lawyers up: FTX and Bankman-Fried, who had also bankrolled Democratic causes, are under investigation by the Justice Department and Securities and Exchange Commission.