Who are the researchers in tobacco control with the 100 highest lifetime citation c-scores?

The scientific impact scholar maven John Ioannidis and his team from Stanford University have recently published an update (Ioannidis, John P.A. (2022), “September 2022 data-update for “Updated science-wide author databases of standardized citation indicators””, Mendeley Data, V5, doi: 10.17632/btchxktzyw.5)  of their 2019 massive ranking of the world’s most-cited authors across all scientific fields.

In their 2019 paper , the Ioannidis group used Scopus to analyse the output and citations of authors in 22 scientific fields and 176 subfields. They looked at citation data during the years Jan 1996-Dec 31 2017 for 6,880,389 authors, being the number who had published at least 5 papers. They presented rankings for the top 100,000 authors (in fact 105,026 were listed), some 1.45% of all who had published 5 or more papers across their career. For the 2019 paper, two searchable supplementary excel tables can be downloaded, one for all 22 years (“lifetime” citations) and the other for citations in the single year of 2017.

The 2022 update

The 2022 update includes the same tables updated with citation data contained from Scopus as at September 1, 2022 (and therefore cited in the 26 years 1998-Sept 2022) for 22 fields and 174 subfields. This time there are 194,983 authors listed in the top 2% of all who had published 5 or more papers across all these research fields. That number would therefore be some 9,749,150 authors (with 5 or more papers)

They ranked authors across all scientific fields “based on their ranking of a composite indicator that considers six citation metrics (total citations; Hirsch h-index; co-authorship adjusted Schreiberhm-index; number of citations to papers as single author; number of citations to papers as single or first author; and number of citations to papers as single, first, or last author). They refer to this as the composite or c-score which “focuses on impact (citations) rather than productivity (number of publications) and it also incorporates information on co-authorship and author positions (single, first, last author).”

As I did in this earlier blog published in Nov 2020, using the Ioannidis c-score I have constructed a provisional list of the top 100 ranked authors who have made substantial lifetime research contributions in the tobacco control field.

Most of these publish almost exclusively in the tobacco field, while others publish more widely, beyond their research in tobacco control. Those  who have published extensively on topics other than tobacco control are shown in italics in the table below. The number after each name shows their ranking based on their c-score. The bracketed figure shows show the percentage change in their c-score ranking between the 2019 and 2022 rankings

There is not a tobacco control research sub-field in the Ioannidis data. I therefore had to manually look up individuals’c-scores. I started by looking up all those who appeared in my 2020 list. I then used published lists of reviewers for Tobacco Control and other names in my contact lists to I look up the rankings of another 55 authors I thought might have scores high enough to get into the top 100. Many highly productive and influential authors I looked for were not shown in the 194,983 highest ranked authors. Many of these are younger people who are very likely to appear in the list as those with declining citations fall out of it.

If you believe there are authors who should be in this list but are not, please contact me (or better, look them up in the tables here and let me know their scores).

Several things stand out for me in the names that appear below:

  • the huge male dominance (21% are women)
  • an even greater dominance of anglophone authors 89% (USA 64,  UK 13,  Australia  7, New Zealand 3, Canada 2)
  • most of those on the list are older authors, reflecting their aggregated outputs across the 26 years of citation data
  • 32 authors increased their c-scores, with far more reducing theirs


  1. Neal Benowitz (USA) 344 (+3)
  2. Richard Peto (UK) 443 (-41)
  3. Carlo La Vecchia (Ita) 499 (-12)
  4. Michael Thun (USA) 673 (-69)
  5. Richard Doll* (UK) 929 (-4)
  6. Stephen Hecht (USA) 1044 (-27)
  7. Jon Samet (USA) 1320 (+17)
  8. Jim Prochaska (USA) 1735 (-40)
  9. Saul Shiffman (USA) 1767 (+0.4)
  10. Wayne Hall (Aus) 1885 (-5)
  11. John Hughes (USA) 1886 (+29)
  12. Robert West (UK) 2858 (+31)
  13. Susan Michie (UK) 3685 (+35)
  14. Wayne Velicer* (USA) 4617 (+22)
  15. Stan Glantz (USA) 6050 (-0.8)
  16. Ernst Wynder* (USA) 7140 (-24)
  17. James Pankow (USA) 7228 (-17)
  18. Ross Brownson (USA) 7378 (+10)
  19. John Pierce (USA) 8423 (-20)
  20. Michael Fiore (USA) 8691 (-32)
  21. Karl Fagerstrom (Sweden) 9234 (+71)
  22. Carlo DiClemente (USA) 9510 (-0.4)
  23. Judith Ockene (USA) 9700 (-45)
  24. Srinath Reddy (Ind) 9948 (+36)
  25. Meredith Minkler (USA) 10523 (+40)
  26. Lisa Bero (USA) 10971 (+4)
  27. Jean-Francois Etter (Swi) 12316 (+6)
  28. Nancy Rigotti (USA) 12397 (-8)
  29. Robert Beaglehole (NZ) 13484 (-22)
  30. Ray Niaura (USA) 15820 (-15)
  31. John Britton (UK) 16,181 (-23)
  32. Frank Chaloupka (USA) 16292 (+14)
  33. David Hammond (Can) 16365 (+41)
  34. Ruth Bonita (NZ) 16452 (-16)
  35. Ron Borland (Aus) 16754 (+5)
  36. Gil Botvin (USA) 16777 (-31)
  37. Simon Chapman (Aus) 16808 (-6)
  38. Steve Tiffany (USA) 16952 (-33)
  39. David Abrams (USA) 16953 (-13)
  40. Martin Jarvis (UK) 17828 (-19)
  41. Cheryl Perry (USA) 17657 (-18)
  42. Ken Warner (USA) 19439 (-10)
  43. Tony Biglan (USA) 19472 (-0.01)
  44. Judy Prochaska (USA) 20431 (+26)
  45. Mike Cummings (USA) 21501 (-2)
  46. Jennifer Unger (USA) 21881 (+16)
  47. Steve Sussman (USA) 22062 (+5)
  48. Rob Sanson-Fisher (Aus) 23960 (-7)
  49. Gary Giovino (USA) 23923 (-21)
  50. Sue Curry (USA) 24700 (+2)
  51. Emily Banks (Aus) 25853 (+54)
  52. Konrad Jamrozik* (Aus) 24748 (-19)
  53. Wasim Maziak (USA) 27248 (+18)
  54. Prahbat Jha (Can) 27508 (+22)
  55. Prakash Gupta (Ind) 28230 (-18)
  56. Lynn Kozlowski (USA) 28533 (-0.5)
  57. Riccardo Polosa (Ita) 29278 (+0.1)
  58. TH Lam (HK) 30263 (+0.01)
  59. Steve Schroeder (USA) 30931 (-32)
  60. Mark Nichter (USA) 31011 (+8)
  61. Tom Eissenberg (USA) 31707 (+11)
  62. Hein de Vries (Nld) 33466 (-5)
  63. Karen Emmons (USA) 33607 (-29)
  64. Dorothy Hatsukami (USA) 33809 (-11)
  65. Jack Henningfield (USA) 34723 (-147)
  66. Tracy Orleans (USA) 34790 (-54)
  67. James Sargent (USA) 36325 (+17)
  68. Paula Lantz (USA) 36387 (-10)
  69. Mohammad Siahpush (USA) 36523 (+0.5)
  70. Peter Hajek (UK) 37143 (+16)
  71. Joe DiFranza (USA) 37246 (-20)
  72. Michael Russell* (UK) 37437 (-38)
  73. Ellen Gritz (USA) 38835 (-25)
  74. Gary Swan (USA) 38847 (-61)
  75. Tim Baker (USA) 38741 (-0.8)
  76. Tim Lancaster (UK) 39068 (-2)
  77. Ann McNeill (UK) 39099 (+5)
  78. Robert Klesges (USA) 40562 (-44)
  79. Derek Yach (USA) 41874 (+20)
  80. Richard Hurt (USA) 43170 (-44)
  81. Michael Siegel (USA) 46259 (-6)
  82. Melanie Wakefield (Aus) 47231 (-11)
  83. Tony Blakely (Aus) 47753 (+14)
  84. Hu, Teh Wei* (USA) 47806 (-5)
  85. Robert Jackler (USA) 49015 (-23)
  86. Gerard Hastings (UK) 49682 (+16)
  87. David Levy (USA) 50203 (+10)
  88. Scott Tomar (USA) 52527 (-15)
  89. Paul Aveyard (UK) 55363 (+18)
  90. Ruth Malone (USA) 58425 (-2)
  91. Alastair Woodward (NZ) 60704 (+6)
  92. Lois Biener (USA) 62227 (-25)
  93. Lindsay Stead (UK) 62596 (-3)
  94. Doug Jorenby (USA) 65619 (-35)
  95. Esteve Fernandez (Spain) 67266 (#)
  96. Jonathan Foulds (USA) 68726 (-8)
  97. Ed Lichtenstein (USA) 68869 (-42)
  98. Jeff Niederdeppe (USA) 69855 (#)
  99. Mel Hovell (USA) 70152 (-10)
  100. Tim Coleman (UK) 72127 (-11)

*= deceased # percentage change not calculable as did not appear in top 2% in 2019 paper

Dutton’s doozie: “you can’t store renewable energy at the moment.”

Our hapless opposition leader Peter Dutton recently told the 2GB radio audience You can’t store renewable energy at the moment.

Really? I wonder if he might help me understand then, why our home battery has absolutely smashed our power and fuel bills?

In the 2020-21 financial year, our fuel and repair costs on our last fossil fuel powered car totalled $2333.89.  Electricity costs in our house were $1283.80: total $3617.69.

From mid 2018, we’d had a 15 panel 4.9kw solar array on our roof, significantly reducing our power bills.  From Aug 3, 2022 we added an Alpha ESS  battery capable of storing 10.3kw generated from the roof. We also added a further 6 panels (totalling) 2.22kw to our roof for a total of 7.12kw.  The fully installed cost of the  battery and the 6  additional solar panels was $11,232.

We took delivery of our Tesla 3 on Jul 26, 2021. After a $15,000 trade-in on our petrol car, the drive-away price was $52,346. In the 513 days since we’ve driven 13,783km at 26.9km/day. This has included a 10 day round trip from Sydney to the NSW north coast, a 4 day return trip to the central west of NSW and  two return trips from Sydney to Batemans Bay. Mostly, it’s urban trips in Sydney. We’ve had zero repairs and servicing costs on the car since we bought it.

The car included 1500kw of free Tesla supercharging, which we ran down by December 2021. In the 513 days we’ve had the Tesla we’ve spent all of $170.79 at Tesla superchargers. $133.62 of which was on the Sydney-Byron Bay trip plus local driving while up there. The return trip would normally cost us well over $200 in fuel.

For the rest of the time, we mostly charge the car in daylight hours in our garage on the many days when the sun is generating far more power than our house can use. We get a derisory feed-in tariff for excess electricity when we sell it to the grid, so topping up the car makes perfect sense. If it’s been raining or heavily overcast, we occasionally trickle charge the car overnight during the cheapest off-peak rated time.

So in effect, with the exception of buying power on occasional long road trips and lately having to pay power and grid connection charges during the shorter sunlight winter months, the car runs for free and our electricity bills are perhaps a tenth of what we might otherwise be paying.

Our power bills between the beginning of August 2021 when the battery was installed and today have totalled $384.35, all of which came in after the huge rises in June 2022. From August 2021 till June 2022, our bills were actually in credit.

With rising power costs, it’s hard to calculate exactly when our $11,232 battery investment will be paid for. But at savings of $3000 or so a year on household  power  and car running we are in clover.

The sun powers nearly all our car and household needs. The battery STORES the renewable energy, Mr Dutton. 33,000 Australian homes installed one like we did in 2021. How has this escaped you?  Perhaps you need to get out a bit more.

Walking in retirement around Sydney and its environs

For the past few years, my wife Trish and I have been a regular part of a Friday walking group. The group is led by retired journalism academic Chris Nash, who we all respectfully address as Dear Leader. It includes among others a retired judge, one of Australia’s leading children’s writers, a heritage architect, retired teachers, journalists, academics, a scientist, a political staffer, a children’s legal advocate and a criminal lawyer. All but three are women.

Above: your correspondent with Dear Leader

Nearly all of us are gold senior opal travel card holders, so our journeys to and home from our walks never cost us more than  $2.50 if we stay within the greater Sydney boundaries. These could take us as far south as Nowra, west to Mt Victoria,  north to the Hunter and south west to the southern highlands.

Our rules are few and include always using public transport to move to the start of a walk and again to come home on its completion. Where possible, we try to end walks somewhere where we can have a late lunch and replace some of the calories just burned. Last week that was in Cabramatta’s Vietnamese strip. We’ve ended at Harris Park to eat south Indian dosas, perfect fish and chips at La Perouse, and wolfed the best Lebanese pastries at Granville.

We start at 7am in spring and summer and 8am in autumn and winter and typically walk 10-15km, or in fitbit-ese, 16,000-24,000 steps. Good footwear and hats are critical, and good conversation pours out all day long. It’s a walkin’, talkin’ group.

In 2019, I gave a talk at an international conference in Copenhagen where the focus was on lobbying governments to introduce policies that can assist in delaying the onset  of dementia. Research here suggests that keeping cognitively, socially and physically active act synergistically to slow the slide that many will make into cognitive senescence.

With the exception of a few overseas stints, I’ve lived in Sydney since I was 18. For a time, I drove taxis as a uni student and thought I knew Sydney well. But driving through suburbs almost always takes you along very limited routes. I lived in Balmain for several years, but it wasn’t until we walked around its perimeter that I discovered so many wonderful parts I’d never seen.

Walking is like taking your time to eat a good meal or drinking good wine slowly: you experience and appreciate so many more dimensions. When you walk in a city, you see  houses, buildings, gardens, parks,  and interesting shops you’ve never noticed. And a profusion of wonderful bird life. Rookwood cemetery is worth a whole day, for the history, the different cultural aspects of burial and the many foxes you’ll see.


Highlights for me have included our longest walk that took us by train and bus to Kurnell and then walking across the spring wildflower thick escarpment where Sydney’s jets fly in, past the fishermen’s shacks at Boat Harbour and then the long  walk along the hard foreshore sands of Wanda and Cronulla Beach. Famed photographer Lorrie Graham joined us that day and recorded the walk in her blog here.

Circling Manly dam was special (I took my grandkids around it again soon after), as was walking through the bush from Lapstone to Emu Plains. We’ve done every section of the very long walk from Pyrmont to Parramatta via the many bays of the Parramatta River, as well as all beaches from Palm Beach to Manly, and Watsons’ Bay to La Perouse. These each take several Fridays to complete the whole distance.

One of our group has detailed historical knowledge of Kings Cross, Darlinghurst and Woolloomooloo and our heritage architect turns off her meter to talk us through different housing periods and the history of various stately homes.

Perhaps the most memorable was a route we took from Oxford St Woollahra across Centennial Park and onto Eastlakes golf course, all in the search for the holy grail delights of the Croquembouche Patisserie in Botany. After coffee at the clubhouse, we took the advice of a staff member that we should walk through the full length of the golf course, taking care to avoid flying balls, and then exit into the Botany suburb.

The golf course is massive. We took the crow-flies direction from Dear Leader and after a good many kilometres struck an unscalable high wire fence which seemed to surround the entire course. Golfers we asked about exit points all gestured vaguely that we should keep walking and surely we’d find a way out. “We just drive around in our buggies” they told us helplessly. Trish copped a golf ball in the bum before we eventually found a section of the fence that had been vandalised, promising our escape rather than retracing ours steps all the way back.

Outside the fence we saw a single railway track with another unscalable high wire fence on the other side of it. As luck had it, a man in high viz gear sat alone next to the track in a folding chair. His car was nearby on a dirt track. His job seemed to be to wait for trains to pass. Nice work if you can get it.

“Hi mate, which way should we walk, left or right, to get out to the Botany streets?” I asked.

“Youse are not meant to be here. You’re trespassing. You need to get out of here straight away.” he  told us in monotone, in what we later decided must have been among the most exciting episodes of his employment.

“Yes, that’s exactly what we’re trying to do … so which way do we head, right or left””

“Youse are not allowed to be here”

“Right, we get that, so how do we leave. That’s what we’re trying to do.”

He refused to answer. Google maps suggested we head right. But after 300 metres the track stopped and we felt unsafe at the idea of walking down the railway track, so we headed back down to old mate in the high viz.

“I’ve phoned through to the rail crew down past me and told them about youse. I think you’ll find the police waiting for you to charge you with trespassing.”

Our retired judge became excited at the prospect of a magistrate listening to some drone solicitor for the railways trying to secure a conviction for us all. Half a kilometre later the rail crew were sitting about and waved at us. And no police, of course.

On another walk we noticed a former church incorporated into the community sections of a harborside high rise housing estate. It looked interesting so our terrorising group of 10 or so  60 and 70 year olds walked up the path to look over the old church. High up from a balcony a woman called out to us “This is private property! You have to leave!”  Understandably. When you’re a wealthy property owner, you don’t want a dishevelled bunch of people who might be from poorer suburbs lowering the tone and gawping at your estate!

I look forward all week to the walks.  Our Dear Leader has an insatiable appetite for new suggestions and has a particular liking for following urban creeks that flow into the Cooks or Georges Rivers. There’s talk of walks in Japan, Victoria and the NSW South Coast. We sometimes run into other small groups and exchange tips.

It’s been a sheer unexpected pleasure for us all in our zimmerframe-banishing retirements. Walking in streets is endlessly interesting. But walking in bushland with its sounds, smells and clean air is sheer intoxication, Highly recommended.

Two views near South Durras

The very worst example of Big Tobacco mendacity I recall

John Dollisson, CEO of Tobacco Institute of Australia 1983-87, then with Philip Morris International

I’ve often been asked by journalists, interviewers and friends what it was about tobacco control that kept me engaged and interested in it across the 45 years I’ve been active in research and advocacy for policies capable of driving down smoking and the diseases it causes. Some are probing to see if there was some road to Damascus epiphany I had early in life. The early death of a heavy smoking parent? No. Or perhaps some religious or neo-puritan calling to deny people the so-called pleasures of smoking? Hardly, I’m a very long term atheist, love wine and good whiskey, and like most people of my age, used cannabis for about half my 20s.

Some are keen to steer the conversation to what it is about working in tobacco control that “drives” me. I often wonder if people working in clinical medicine are ever asked the same question (“why have you kept working for so long as a kidney surgeon?”; “You’ve been a cardiologist for so many years, what is it that keeps you at it?”)

The answer to such questions from clinicians is self-evident. People with diseases and injuries that might be cured or alleviated are very keen to come into the orbit of specialists who can help them and are profoundly grateful when they succeed. Clinicians try to help people who want to be helped, so they are seldom asked to account for why they do what they do, unless they have somehow been exposed as behaving unethically or ineptly.

There is some common ground here with smoking. Some 90% of smokers regret ever starting; most smokers want and try to stop, sometimes often; and I’ve never met any parent who wanted their kids to smoke. “Prevention is better than cure” is regarded as a truism because prevention saves suffering from ever occurring. Everyone who has never been seriously injured in a car crash would rather this had never happened than endure surgery and rehabilitation after being injured.  Successful clinical interventions save lives one at a time while successful global public health policy can save millions of lives at a time.

Tobacco control is a multi-disciplinary pursuit. My colleagues over the years have been clinicians, epidemiologists, biostatisticians, social scientists like psychologists, economists and political scientists, pharmacologists, lawyers, mass communication specialists, agronomists, historians, investigative journalists and politicians. This has made it endlessly fine-grained and fascinating work.

But most working in it will readily agree about a factor that turns the temperature right up in motivating public health advocacy for the policies and mass reach campaigns that drive smoking down. The pinguid, dissembling types who do Big Tobacco and (today) Big Vape’s bidding. For over 70 years, the tobacco industry has been represented  by people whose goal has been to use every possible roadblock to tobacco control policies which seriously threatened tobacco sales.

Thankfully in Australia and many other countries, they have lost every single battle they ever fought.

Today, in déjà vu, we see vaping advocates currently in overdrive to cement the narrative that the health risks of ecigarettes are as benign as breathing steam in the shower and the dramatic rise of school vaping is simply a fad like hula hoops and yoyos that we should all relax about, as a leading vape promoter told the Daily Telegraph in 2021. With 13 year olds calling the Quitline for help with their vaping addiction, I may have missed it but I don’t recall yoyo or hula hoop helplines across the country.

Similarly and infamously, Big Tobacco publicly denied for decades that smoking was harmful, that nicotine was addictive and that children were in their marketing and promotional cross-hairs as essential to their present and future customer base.

In 2001, I was awarded a four year US National Cancer Institute grant and another from the National Health and Medical Research Council to sift through many millions of pages of internal tobacco industry documents made public through the 1998 Master Settlement Agreement between 46 US state governments and the tobacco industry. My research group published 38 papers from these grants, 16 here, 13 here and another 9 linked in my CV between 2001-2005 here.

The documents acted like violently emetic truth serum to the tobacco industry. Its galactic public lies across every conceivable tobacco policy area instantly stopped with the revelations about what they had long known to be the truth, now available for anyone to wave in their faces via their very own internal documents. The only one that persists today is their collective hand-on-heart denial that they slaver over the teen nicotine addiction  market, this being the sine qua non of both the smoking and vaping business models.

I’ve often been asked to nominate the very worst examples of this conduct. This recording of a debate I had with John Dollisson in 1984 on (now ABC chair) Ita Buttrose’s Sydney morning radio program on 2UE is very hard to beat. Dollisson was the Sydney-based head of and main spokesman for the fully tobacco industry funded Tobacco Institute of Australia (TIA) from 1983-87. This 2003 paper by one of my colleagues (now) Professor Stacy Carter, describes the history and activities of the TIA. Dollisson was heavily involved in trying to stop the advance of smokefree indoor areas and bans on tobacco advertising. But his bread and butter was attacking claims about smoking risks.

The full transcript of the 2UE conversation is below. The most disturbing part came when a smoker with lung cancer called in and said she believed her cancer was caused by “stress” as she was a highly nervous person, and that if she stopped smoking, she might die sooner. Dollisson told her it was “good to see you have taken an objective assessment” of her situation and that if other factors like genetics, stress, and indoor and outdoor pollution were taken into account, smoking’s role “was virtually removed”. Buttrose’s popular mid morning program would have been heard by tens of thousands of listeners.

Listen to their conversation here.

This figuratively and literally sickening excerpt from an ABC “Pressure Point” TV program also from 1984,  shows Dollisson and Philip Morris’ Bill Webb both faithful to the Big Tobacco script of the day. For those with the stomach, here’s the full 25 minute program.

Dollisson seems to have long moved on from tobacco. Here is his Linked In page which includes his post TIA 4 year stint with Philip Morris and their “Vice President, Corporate Affairs, World Wide”.

To my knowledge, Dollisson has never made any public statement showing any regret about his tobacco industry years. Industry employees often sign non-disclosure agreements. If he’s reading this, I’d be happy to give him space to do so.

How inexperienced are you? a game that might tell you

About 35 years ago during the Irish ‘troubles’ I flew from London to Belfast and with 40 or so others, took a chartered bus down the east coast  to a convention centre overlooking the Irish Sea. On the return journey a couple of days later, our bus was stopped by the police. There was some sort of security operation going on. It was dark and the bus stayed on the side of the road for several hours with other vehicles till we were given the OK to proceed.

Needing something to help us pass what could have been  a long time in a bus with no lights allowed on, various people told travel tales, tall stories and charades. I  proposed a game that went on for at least an hour to gales of laughter.

Here are the rules. Everyone in the group has to try and think of something they have never done, which they guess that everyone else in the room has done. Absolutely anything qualifies, with the exception of naming places, countries, cities etc where you have never been. For each nomination you make that no one else in the room has ever experienced, you get a point, with the winner the person who has the most points.

The skill is thinking about experiences that you calculate to be widely experienced that makes it likely that your innocence is unique. Not having skydived is unlikely to win you a point, but never having played scrabble may well do so. Common foods and drinks are fertile grounds, as are common sports for the non-sporting, not having read popular books, authors, or seen popular movies or TV series. 

The game can be risky because some will nominate edgy, illegal or reprehensible activities which they guess most will not own up to. The Irish bus was full of public health researchers. Oxford University’s Sir Richard Doll was on the bus with his secretary. She got a highly acclaimed point right out of the blocks by saying she was confident she was the only person on the bus who’d never been to university. I knew that this also applied to at least one other person in the group who chose to keep silent. 

Admitting you’ve never had group sex, smoked dope or gone back to a supermarket and paid for an item that was missed by the check-out staff are all probably likely to produce highly unreliable results, depending on who’s playing the game.

Here are some points I usually score on when I play the game.

Snow skiing. Never been in an ambulance or broken a bone. Never stung by a bluebottle. Not read any science fiction book. Never worn sandals as an adult. Never voted conservative. Never ordered or accepted a glass of Baileys, Chartreuse, Tia Maria or Benedictine (after having had a previous sip). Never swam in the sea in mid-winter. Never read anything by Tolkein or JK Rowling. Never seen a single episode of Friends, Dallas, Dynasty, Sex in the City, South Park, the Simpsons and a bewilderlingy long list of other US produced TV fare since the 1970s.

Sydney University awards Nick Greiner, former tobacco company chair, an honorary doctorate

Nick Greiner on smoking and his tobacco job

My University has awarded former NSW premier Nick Greiner an honorary Doctor of Business (honoris causa) during a ceremony held in New York on  8 October, presided over by the University’s Vice-Chancellor and university President, Professor Mark Scott AO. 

“Across business and politics, Nick’s achievements are remarkable,” said Professor Scott. “Throughout his illustrious career, he has served the nation and helped the community through his work in policy and his environmental efforts. He continues to influence the next generation of leaders, the future of business and the important relationship between Australia and the United States.”

The University of Sydney’s website noted that “Mr Greiner’s achievements in business over the last 30 years have been significant. He has served as Chair or Deputy Chair of organisations including Harper & Row (Australasia), Bradken, Citigroup (Australia), Coles Myer Ltd, Rothschild (Australia), Stockland Trust, QBE Insurance and Castle Harlan Australian Mezzanine. In addition, he was Chairman of Infrastructure NSW and the European Australian Business Council.”

Significant in its absence here is that Greiner was also a board member and chair of the tobacco company WD & HO Wills (later amalgamated with Rothmans to become British American Tobacco Australia – BATA).

Greiner’s own website includes his BATA role, so it seems inconceivable that the University was unaware of this and has deliberately air-brushed Greiner’s tobacco history from its decision and communications.

In 2003, I led a group of academics and health and medical students in protesting the Greiner appointment, then chairman of BATA, to chair Sydney University’s graduate school of government. One senior paediatrician was so incensed he threatened to resign if the appointment went ahead.  I persuaded the University Senate to overturn the appointment. They agreed with me and Greiner resigned from the role. I wrote a detailed account of how this occurred as a case study in public health advocacy at the end of this paper in the BMJ’s Journal of Epidemiology and Community Health.

At the time, the then University Chancellor Kim Santow AO wrote to me that Griener’s appointment had nothing to do with his tobacco industry role but was all about his distinguished career in politics and public administration. This was a version of the Jeckyll and Hyde defense: the upstanding citizen by day, who strenuously denies his evening persona has any relevance to his overall reputation.

In 1982, Sydney University was the world’s first University to formally adopt a policy whereby neither the university, nor any staff member or student could accept any form of support, grant or scholarship from a tobacco company. This was subsequently strengthened in amendments. Careers fairs at the University have long excluded tobacco companies from pitching employment to students. Universities around the world have followed suit, including Harvard and the London School of Economics.

When Nicola Roxon, the former Australian Health Minister and Attorney General was awarded an honorary doctorate of laws in 2019, the then Vice Chancellor Michael Spence AC noted that:

“the honour was also a fitting continuation of the University’s role in tobacco control. The University of Sydney has a long history of engagement in tobacco control and was the world’s first university to implement a policy preventing staff and students from accepting grants from tobacco companies. This has been emulated by nearly all Australian universities and many others around the world.

At the University of Sydney, we share Ms Roxon’s genuine desire to build a better, healthier future for the world and we are so proud when our world-class research is used by policymakers to bring about real change”

Greiner’s parting shot at the University in 2003 was to say that “his departure points to broader problems in the university, including mismanagement.”

“It’s the ultimate sort of inmates-in-charge-of-the-asylum situation and I just didn’t think it was worth the hassle” he said.

To my knowledge, Greiner has never expressed a syllable of regret about his role with BATA. This is important. History records many prominent people who have gone out of their way to express remorse and regret about dark periods or events in their past. Civil society has codified five steps for contrition that we expect people to exhibit before society turns the page:

Greiner openly admits he worked at the very peak of a tobacco company, with his eyes wide open. But he has never taken the next four steps. Draw your own conclusions.

It has been decades since any tobacco executive has been awarded a civic honour like an Order of Australia or knighthood. For such a thing to happen today would be like a rabid dog winning London Crufts dog show. The World Health Organisation’s historic Framework Convention on Tobacco Control has been ratified by 181 nations. Its Article 5.3 precludes governments from any engagement with the industry. Two in three of the tobacco industry’s most addicted, “loyal” smokers die from tobacco caused disease. There are light years between that toll and that attributed to any other industry.

Sydney University’s gesture to Greiner might simply be a case of failed corporate memory in a new administration. Perhaps there is no one on the present Senate which would have signed off on the award who is aware of the history. Or perhaps there is and they didn’t care.

But the omission of his tobacco links from the university statement suggests this was done in full awareness. This is very regrettable.

Vaping sophistry redux: a response to Colin Mendelsohn

Following the publication of my new open access book Quit Smoking Weapons of Mass Distraction (Sydney University Press) I’ve been speaking to thousands of Australian GPs at conferences around Australia about vaping. The book includes a 16,000 word chapter looking at hype about vaping. My talk to the GPs focuses on 10 cornerstones of what I call “vaping theology”  – beliefs that all vaping true believers hold to be inviolable. The Medical Republic published a lengthy piece summarising my Sydney talk.

Dr Colin Mendelsohn, or the folksy “Dr Col” as he likes to call himself these days, is Australia’s  Energizer Bunny of vaping promotion. He didn’t like what he read and took to his blog to provide us with a “detailed …more scientific analysis”, giving himself a giant tick.

Let me take apart his sophistry one claim at a time. A warning, this won’t be pretty.

Response: I’m very sorry Dr Col, but it is true. The 2014 paper reported on a consensus of 12 people convened by the hyperbolic Prof David Nutt in 2013. They rated 12 nicotine containing products for harm and judged vaping as having 5% the harm of cigarettes, after acknowledging “A limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria”. Just read that again. Caveats don’t come more sweeping than that. So this was a estimate not worth a cracker.

David Nutt on vaping 2013-2022

But I am wrong about the provenance of the figure says Dr Col: he says the 95% figure came from the 2016 report of the Royal College of Physicians (RCP) and the now defunded Public Health England’s (PHE) 2014 report and 2015 update, both written after the Nutt paper.

In this 2019 blog, I forensically searched the RCP and PHE reports for the evidence informing the 95% figure. Nowhere in either report is there any worked calculation of the 95% factoid, which with others I shredded in the American Journal of Public Health in 2020. But in both reports, all referencing roads lead back to the Nutt report. 

Dr Col’s blithe “not the point” dismissal of the lack of precision about the relative toxicity of vaping and smoking would amuse any toxicologist.  Strychnine is less dangerous  than cyanide.  Proximity to sharks less dangerous than sharing a room with someone with Ebola. The point though, is that all deserve the utmost caution, not that we frame the choice as one or the other. How about quitting smoking and vaping?

Response: Dr Col always calls for vapes to be openly sold as “consumer products”, just like ordinary grocery items including cigarettes. With the support of nearly every health authority and NGO in the country, the Australian government has instead commendably restricted legal access to nicotine vapes to those with prescribed authority to access them through a pharmacy.

All new pharmaceutical products are scheduled by the TGA to enable tracking of prescribed use and reporting of adverse events. These reports over the years see drugs rescheduled up or down (sometimes including bans) in response to data on any problems found with short or long term use. Many vaping advocates argue strenuously against vapes being prescribed, invoking the urgent duty to save millions of lives. But advocates for life-saving drugs for cancer, HIV-AIDS and heart disease don’t think their drugs should be available over the counter in corner shops. Vaping advocates seem to think their issue is far more important than any other therapeutic good.

Response: There is in fact a large research literature about the roles of nicotine in a wide range of disease processes.  I captured some important examples of this here, including disturbing emerging evidence on nicotine as a possible cause of schizophrenia and as a promoter for several cancers.

The role of the vasoconstrictor nicotine in cardiovascular disease has long been known, and with unregulated flavoured disposable vapes flooding many world markets and providing as much nicotine in some vapes as in 9 packets of cigarettes, nicotine is by no means some benign vitamin-like substance that vaping theology insists.

Neal Benowitz, arguably the world’s foremost nicotine pharmacologist, summarised current awareness of nicotine safety risks in a presentation to the annual nicotine/vaping  conference  in Warsaw in 2019 (see his slide below). In only one area (COPD) was there any assessment matching Dr Col’s assertions.

Dr Col has previously pilloried evidence about vaping toxicity from animal studies. But as a prescriber he’d be well aware that the standard LD50 metric (Lethal Dose required to kill 50% of exposed laboratory animals) is used globally to rate the toxicity of chemicals. He’d also be aware of the vast record of animal studies being used in the development of safety and efficacy of many life saving drugs.

Yet when it comes to inconvenient information about possible negative effects on adolescent brain development, vaping theologians instinctively wave the dismissive “pure speculation” flag.

This recent longitudinal study of very young children who used any form of nicotine found, using neuroimaging outcomes, “a significant association was found of early-age initiation of tobacco use with lower crystalized cognition composite score and impaired brain development in total cortical area and volume. Region of interest analysis also revealed smaller cortical area and volume across frontal, parietal, and temporal lobes.” 

Nothing to see there, Dr Col?

Response: Dr Col writes that flavours encourage uptake of vaping “by current smokers” in the same way that they do with NRT gum and lozenges. Errmm … there are two rather large issues carefully omitted here. Vaping involves inhaling vapourised chemical flavours, while NRT flavours via gum and lozenge are ingested. In this blog and my book, I set out in detail why it is that no inhaled pharmaceuticals are flavoured (such as asthma puffers) and why the US flavour and extracts manufacturing industry (which stands to make billions if governments gave the green light to flavours in vapes) has spoken strongly against flavours in vapes.

And then there’s the teensy little issue of the huge attraction of flavours to nicotine naïve children who are flocking to vaping all over the world, and the importance of flavours in predicting on-going vaping. Why did you omit this, Col?

Response: Sadly, Dr Col apparently did not attend my talk, so has completely misunderstood what I actually spoke about here. I showed data from the UK government’s annual Opinions and Lifestyle Survey showing that the average number of cigarettes smoked daily by smokers who vape (8 a day) is almost identical to that by smokers who have never vaped (8.1 a day).

But in any case, his selective summary of dual use is a cherry-picked special.  Dual users are also exposed to more toxins than cigarette smokers and dual use does not predict smoking cessation, as shown in this 4 nation study where “smokers with established concurrent use [smoking and vaping] were not more likely to discontinue smoking compared to those not vaping … it is clear that the rates of transitioning away from smoking remain unacceptably low.”

Response: Again, Dr Col responds to something he’s guessing I was talking about here. What I actually spoke about was the bankruptcy of the so-called hardening hypothesis. Dr Col’s response indicates he’s fully signed-on to the idea that today’s smokers are predominantly those who “can’t” quit. The US smoking cessation maven John Hughes reviewed 26 studies which examined the hardening hypothesis to see if this was true. Hs conclusion? “Some have argued that a greater emphasis on harm reduction and more intensive or dependence-based treatments are needed because remaining smokers are those who are less likely to stop with current methods. This review finds no or little evidence for this assumption.”

Response:  My book has a section of a whole, large  chapter (#2)  explaining why participants in smoking cessation RCTs bear scant resemblance to those from real world longitudinal use. Just to take one example, two thirds of smokers would not be deemed eligible to enrol in an RCT. Reasons here include mental illness, which is much higher in smokers. Such ineligibility will mean that RCTs are likely to be strongly biased to not include many deeply nicotine dependent smokers. My chapter also explores many other issues that differentiate the attention paid to RCT participants by researchers compared with how cessation products are used in the real world.

And yes, meta-analyses of RCTs like Cochrane do find that vaping is more successful than NRT. But the “success” here is utterly, stonkingly dismal. Ninety out of 100 smokers assigned to vaping in RCTs continue to smoke, compared with 94% using NRT. Is there any other drug in the whole of medicine that would attract the epithet “successful” with a failure rate of 90%?

Longitudinal cohort studies of smokers who vape also reach conclusions that vaping is far more dismal than disruptive, with plausible concerns that it may hold more in smoking than it tips out of it. Again, my book discusses this at length.

Response: Oh dear, Dr Col is at it again. He’s using data in August 2022 that is way out of date. In this blog I wrote in April 2022, I explained how the dotted line you see in Col’s graph above for Australia is now down to 11.8% (if we take all smoking …even very irregular smoking … into account) and down to 10.7% for daily smokers. That’s because we have 2021 Australian data, which unfortunately don’t fit Col’s narrative so he leaves it out.  Australia is just behind New Zealand (on just one year’s data), but ahead of the UK and USA.

Response: Debate about whether vaping leads (ie increases the likelihood) to smoking or whether it’s simply a matter of “kids who try stuff, will always try stuff” (dignified as “common liability theory”) will always be on-going because it will of course never happen that children will be randomised to vape or not vape and then followed up for several years. The best we can do is to look at large cross-sectional cohorts and control in analyses for the very factors that common liability theorists say confound claims that vaping leads to smoking.

The best example of this is a paper on the UK’s  huge Millennium Cohort. It found  “Among youth who had not smoked tobacco by age 14 (n = 9,046), logistic regressions estimated that teenagers who used e-cigarettes by age 14 compared with non-e-cigarette users, had more than five times higher odds of initiating tobacco smoking by age 17 and nearly triple the odds of being a frequent tobacco smoker at age 17, net of risk factors and demographics.”

Very importantly, the paper also knocked the stuffing out of the glib ‘kids who try stuff, will try stuff’ common liability dismissal of the concern that vaping acts as training wheels for later smoking uptake. In their analysis the authors controlled for a rich constellation of ‘propensity’ factors that have been suggested to predict smoking uptake in youth. These included parental educational attainment and employment status; parental reports of each child’s behaviour during the prior 6 months using the Strengths and Difficulties Questionnaire, with indicators of externalizing behaviours (i.e. conduct problems, hyperactivity, inattention; and internalizing behaviours (i.e. emotional symptoms, peer problems) parental smoking; whether a child spent time ‘most days’ after school and at weekends hanging out with friends without adults or older children present. Children, via confidential self-reports, indicated whether they had ever drunk alcohol (more than a few sips), ever engaged in delinquency (e.g. theft, vandalism) and whether their friends smoked cigarettes.

The authors concluded:

“we found little support that measured confounders drove the relationships between e-cigarettes and tobacco use, as the age 14 e-cigarette and tobacco cigarette estimates barely changed with the inclusion of confounders or in matched samples. Furthermore, early e-cigarette users did not share the same risk factors as early tobacco smokers, as only half the risk factors distinguished e-cigarettes users from non-users, whereas age 14 tobacco smokers were overrepresented on almost all the antecedent risk factors. If there was a common liability, we would expect similar over-representation for users of both forms of nicotine.”

And as for Col’s statement “Most young people who vape have first smoked cigarettes”, I’ll just leave you with this. In the 2019 New Zealand Youth Survey, “More than 80% of ever-vapers (N=2732) reported they were non-smokers when they first vaped, and 49% of regular vapers (N=718) had never smoked.”

Response: Do you all see what Dr Col has done here? He’s highlighted data in Philip Morris International’s second quarterly report for 2022 about the growth in revenue it’s getting from its putative reduced risk products. Premium products have long been far more profitable per unit for tobacco companies than budget products like much cheaper cigarettes. But in public health, we are more interested in how much of which products the tobacco industry is selling, not how much money they might make from each. Col might have missed this graph in the same report.

And from earlier in the year

With this brilliant observation

So, PMI’s much trumpeted drive to reduce consumption of its ultra-deadly cigarettes is, in their word, “recovering”. In Philp Morris-speak, the decline in cigarette use is now reversing at the same time as its pricey heat sticks are increasing. So much then for unsmoking the world, particularly in Poland, Turkey and Indonesia where cigarette shipments are increasing.

Four steps Australia’s health ministers must take tomorrow on teenage vaping

Tomorrow, Australia’s state and federal health ministers will meet for the first time since the May election routed the Morrison government. The national explosion in teenage vaping, driven by access to cheap, highly addictive, sickly-sweet, disposable vapes is on their agenda.

As we saw on Four Corners this week, there can be very few schools across Australia not struggling with the growing epidemic of vaping. Australia hasn’t surveyed teenage vaping in schools since 2017 (a new survey is in the field right now), but in New Zealand the government is now desperately trying to put the teenage vaping genie back in the bottle.

Between 2012 and 2015, prior to the widespread availability of vaping in New Zealand, overall smoking fell by 21% from 6.8% to 5.5% and by 37% from 17.7% to 11.2% in Māori teenagers. But after the advent of vaping, the decline in smoking changed to a growth of 9% between 2015 and 2019, with Māori smoking rising 21%. While this was happening, regular vaping was rising dramatically: between 2015 and 2019, the prevalence of regular vaping rose 173% (5.4% to 12%) and by a roaring 261% in Māori teens (5.4% to 19.5%).

In the USA in 2021, 11.4% of high school students vaped in the last month.

I recently asked my 12-year-old granddaughter what she thought attracted some of her Year 6 classmates to vaping. Instantly she replied “You can get lemonade flavour!”  There are more than 15,000 vaping flavours advertised on the web, many of which would not be out of place at a 5 year old’s birthday party.

Australia has 2.7 million people living with asthma. Not one of them uses a flavoured puffer to mask the unpleasant medicinal taste of the salbutamol they typically inhale a few times a day. Why? Because no pharmaceutical regulatory body anywhere in the world allows inhalable flavouring chemicals, with the US Flavouring and Extracts Manufacturing Association warning last year  “E-cigarette manufacturers should not represent or suggest that the flavour ingredients used in their products are safe because they are used in food because such statements are false and misleading.”

Daily smokers pull smoke deep into their lungs an average of about 100 times a day. But daily vapers average 500-600, making a mockery of the bizarre denialism spread by some vaping advocates that vaped nicotine is not addictive. As England’s Professor John Britton has said “Inhaling vapour many times a day for decades is unlikely to come without some sort of adverse effect. And time will tell what that will be”

As Four Corners explored on Monday, today’s flood of cheap, disposable vapes can be traced to former health minister Greg Hunt being rolled by a 28-strong backbench revolt led by Queensland National Senator Matt Canavan. Hunt had announced in June 2020 that any adult wanting to vape would need to get a prescription to do so. He also announced it would be illegal (as it has been since July  2019 with cigarettes) to import nicotine-containing vape products. Canavan’s signatories spooked the government and Hunt withdrew the personal import ban.

But the Canavan pro-vaping cabal has been shredded with the departure of Abetz, Falinski, Laming, Wilson and Zimmerman. Its residuals like Hollie Hughes, Canavan and Barnaby Joyce have been rendered political eunuchs by the May election. Hollie Hughes’ performance on Four Corners is causing weapons-grade levels of amusement on Twitter.

Vaping advocates are fond of arguing that because nicotine is freely available in tobacco products, it follows that nicotine for vaping should enjoy at least the same, if not greater accessibility and be freely sold anywhere as a “consumer good” like milk and groceries. This argument has all the integrity of a chocolate teapot. We made every conceivable mistake by failing to regulate tobacco because governments early last century had no idea of today’s 8 million global annual death smoking health toll that took 30-40 years to emerge. Widespread vaping had only been around about 10 years.

Very few kids import their vapes. Why would they bother when they can just walk into the many shops openly selling them, or buy from entrepreneurial kids who buy them in bulk off sites openly advertising them like Facebook Marketplace (search for “fruit” or “vapes”).  The vaping chain’s weakest links are retailers and on-line wholesalers. Hitting these is essential to seriously curtailing the tsunami of vapes getting kids. All state governments should introduce seriously deterrent fines for importing and any form of retailing.  If corner shops and convenience stores were selling codeine, requiring a prescription, they would be shut down.

Tomorrow, the health ministers should:

  1. Immediately add disposable vapes to the Prohibited Import Scheme (PIS). This is significantly more urgent from a public health perspective than attempting to close down the Personal  Import Scheme for Nicotine Vaping Products (NVPs). This could be achieved very quickly with the stroke of a pen and will cause zero political ructions.
  2. Harmonise large, significant national increases in fines for commercial quantity importing, wholesaling and retailing of NVPs across all states and territories. These fines and confiscations should be big enough to give serious pause to anyone assuming that their illegal trade can go on, with rare busts costing a fraction of the the profits being earned.
  3. Cooling agents should be also be immediately added to the exclusion list in the Therapeutic Goods Administration’s TGO 110 (also achievable with a stroke of a pen). These are being used to facilitate vapers inhaling large, highly  nicotine doses
  4. Closing the Personal Import Scheme (PIS) will be a longer game and careful thought should be given to how encouraging the TGA/APHRA/HCCC to focus on telehealth prescription “factories” which are churning out prescriptions often without any acceptable doctor-patient interaction. This could significantly curtail abuse of the PIS by non-legitimate users.

Prescription access via pharmacies selling pharmaceutical grade products can supply adult smokers wanting to switch. Advocates of continuing the open slather access that is now occurring claim Hunt’s prescription access is “prohibition”. By that very silly argument antibiotics, the pill and every other prescribed drug are prohibited too.

Health Minister Mark Butler should seize his first Nicola Roxon moment, and reintroduce the personal import ban. Roxon was lauded internationally for plain packs and Butler can lead the world with workable prescription access not gutted by leaving the front door open to rampant illegal nicotine vape retailing that is addicting a new generation of kids to nicotine who had never smoked.

Selected quotes from  Quit Smoking Weapons of Mass Distraction

My new book  Quit Smoking Weapons of Mass Distraction (Sydney University Press 2022 359pp ISBN 9781743328538) was published as an e-book on June 26 and as a paperback on July 1, 2020

You can download a full pdf of the book FREE here OPEN ACCESS e-book or order the book at Amazon here ($AUD40.00 paperback)

Below are quotes from the book that I hope will stimulate your interest.

The core message of the book

“The core message throughout this book has been that the overwhelming dominance of assisted cessation in the way that quitting has been framed over the past three decades has done a huge disservice to public understanding of how most smokers quit. Around the world, many hundreds of millions of smokers have stopped without professional or pharmacological help.”

On the dominance of unassisted cessation in how most ex-smokers quit

“If we were able to estimate the total number of people who have ever smoked and the total number who later stopped smoking completely, the proportion who were assisted in quitting by the actions of any kind of therapist or interventionist, or by consuming a potion, a pill or nicotine replacement (pharmaceutical, or most recently, from e-cigarettes) would be a small minority.”

“the overwhelming majority of research on smoking cessation has always focused on the “tail” of assisted cessation, not on the “dog” of unassisted quitting.”

“The inverse impact law of smoking cessation states that the volume of research and effort devoted to professionally and pharmacologically mediated cessation is in inverse proportion to that examining how ex-smokers actually quit. Research on cessation is dominated by ever-finely tuned accounts of how smokers can be encouraged to do anything but go it alone when trying to quit – exactly opposite of how a very large majority of ex-smokers succeeded.”

On the medicalisation of quitting:

“Many concerns previously perceived as normal human differences or problems have now been defined as tractable illnesses that can benefit from diagnosis and often lifetime drug taking.”

“It appears that there is no smoker, regardless of how much or little they smoke, and regardless of whether they are not at the point of trying to quit, actively trying to do so or have long stopped smoking, for whom medication and especially NRT is not recommended. It is in the interests of that industry to persuade as many smokers as possible to use pharmaceutical aids for as long as possible.”

On the effectiveness of nicotine replacement therapy

“the best complexion we can put on the question of how good NRT is in keeping smokers abstinent into the longer term (here two years), is to say that NRT fares better than unassisted quitting while it is being used, but that both strongly fade as the months and years go by, to the point that there is no difference at two years. Smokers’ curiosity about whether they will fare better in the long-term with a course of NRT than with unassisted cessation therefore looks like a ‘no’.”

On why results from randomised controlled trials of quitting medications poorly reflect real world use results

 [one review] “found two-thirds of participants with nicotine dependence would have been excluded from clinical trials by at least one criterion … Those in such trials are thus very unrepresentative of all smokers wanting to quit.”

“frequent contact with research staff who are doing their best to ensure low rates of trial dropout, can combine to create an influential backdrop to using a quit-smoking medication or approach which is very different to the way people will use the same drugs or approach in “real-world” conditions outside a trial.”

“Undoubtedly, much smoker resistance to using cessation medication is due to many smokers learning from other smokers that real-world experience of using these drugs does not produce outcomes that remotely compare with benchmarks for other drugs they use for other purposes. Few if any other drugs for any purpose with such abject track records would ever be prescribed.”

“after over four decades of the pharmaceutical industry’s turbo-charged, no-expense-spared efforts to increase physician engagement and erode population resistance to pharmaceutical-based cessation, how many more years can the narrative of getting even more smokers to medicate retain any realistic credibility?”

On the pleasure of smoking

“The argument that smoking and inhaling nicotine is “pleasurable” is a bit like saying that being beaten up several times every day when you haven’t been able to smoke is something you want to continue with, because it feels so good when the beating stops for a while.”

On remaining smokers being “unable” to quit without help

“Those arguing that today’s smokers are increasingly heavily addicted and unable to stop, and therefore need assistance to do so, have very poor evidence supporting their case. Globally, vast numbers of smokers continue to stop or reduce their smoking every year. These include very heavy smokers and … many who quite suddenly stop smoking without making much if any preparation to do so.”

On quitline impacts

 “an estimated 0.87% of all US smokers [ever call a quitline], with the target being 6% or more. In not one year between 2009 and 2017 did the reach exceed 1.19% of smokers, falling some 500% below the minimum target reach set by the quitline consortium management.”

On the unpublicised news that many ex-smokers found quitting easier than expected

“in these striking data about many ex-smokers finding the quitting experience less traumatic than expected, we rarely (if ever) hear comments or see campaigns from those in tobacco control discussing or highlighting this. We very seldom hear any efforts to de-bunk or leaven the “it’s very, very hard to quit smoking” meme by pointing out that many ex-smokers were pleasantly surprised that quitting was not as tortuous as they expected.”

On vaping

“today the dominant narrative about smoking is being undermined by a shift from one about quitting smoking to one about switching to vaping, to the great delight of those in the industries whose very existence rests on the widespread continuation of nicotine dependency.”

“Vaping advocates are fond of arguing that because nicotine is freely available in tobacco products, it follows that nicotine for vaping should enjoy at least the same, if not more accessibility and be freely sold almost anywhere. This argument has all the integrity of a chocolate teapot.”

On vaping safety

“If any scientist had declared in 1920 that cigarette smoking was all but harmless, as vaping advocates insist today about e-cigarettes, history would have judged their call as heroically and dangerously incorrect. But this is the cavalier call that many vaping advocates routinely make, after just 10 years or so of widespread use in some nations.”

“High-quality clinical and epidemiological data on vaping’s health effects are relatively sparse. There are no data on long-term health effects, reflecting the relative novelty of vaping and the rapid evolution of vaping products. Determining even short-term health effects in adults is difficult because most adult vapers are former or current smokers”

“Inhaling vapour many times a day for decades is unlikely to come without some sort of adverse effect. And time will tell what that will be”

“if you both smoke and vape (dual use), you’ll have higher levels than those who only smoke. So if dual use is the Mount Everest of toxicant exposure, then smoking is the K2 exposure, vaping is the Matterhorn and never smoking or vaping is the toxicant exposure at sea level.”

“All tobacco companies now marketing e-cigarettes are delighted to [promote vaping as all but benign], while just down the corridor in their tobacco divisions they continue trying to maximise demand for the cigarettes that will cause the same billion deaths [this century] they claim vaping could prevent.”

“all vaping evangelists believe that no impediment should be placed in the way of their lifesaving work. But medicine of course has a very long history of claims being made by purveyors of a multitude of miracle cures who also believe their crusades are far too important to be regulated.”

On vaping flavours

“I recently asked my 11-year-old granddaughter about what she thought attracted some of her Year 6 classmates to vaping. Instantly she replied, “You can get lemonade flavour!”

“Why aren’t any asthma puffer drugs flavoured? Because the pharmaceutical industry knows it would struggle to demonstrate that inhaling flavours is acceptably safe”

“By 2016–17 [available e-cigarette flavours] had more than doubled to 15,586”

“E-cigarette manufacturers should not represent or suggest that the flavour ingredients used in their products are safe because they have FEMA GRAS status for use in food because such statements are false and misleading (Flavor and Extracts Manufacturing Association (FEMA) 2021).”

“Compare daily inhalation numbers: asthma puffers:4-6; daily smokers:104; daily vapers 500-600 … making a mockery of the bizarre denialism that vaped nicotine is not addictive.”

How good are vapes for quitting smoking?

“17 reviews of the evidence and position statements by professional health associations published since 2017 have concluded that the evidence for e-cigarettes being effective for smoking cessation is inconclusive, insufficient, weak or inadequate”

“But there can be few if any other drugs, used for any purpose, which have even come close to the dismal success rate of e-cigarettes or NRT in achieving their main outcome. If we went along to a doctor for a health problem and were told, “Here, take this. It has a 90% failure rate. But let’s both agree to call this successful,” we would understandably take the view that “success” when used in this context was not the way that it is used in any other treatment context”

On whether vaping reduces amount smoked per day

“Data from 2019 from the UK government’s annual Opinions and Lifestyle Survey also show that the average number of cigarettes smoked daily by smokers who vape (8 a day) is almost identical to that by smokers who have never vaped (8.1 a day)”

Read reviewers’ comments here

Australian vaping advocates hit political rock bottom but keep digging

On the evening of 10 June, shortly after ABC-TV screened the first edition of its news backgrounding program The Context looking at the evolution of tobacco control, inveterate vaping proselytiser Alex Wodak, cleared his Twitter throat. In prose redolent of Churchill, he advised the world:

Prohibitionism? The overwhelming position of the Australian public health and medical community has been to strongly support the policy introduced by former health minister Greg Hunt who approved the supply of nicotine vaping products (NVPs) to anyone with a doctor’s prescription from October 2021.

Describing this as “prohibition” is like arguing that prescribed antibiotics, oral contraceptives or cholesterol control drugs are also prohibited.

Last year, 27 LNP government backbenchers plus legendary deputy prime minister Barnaby Joyce internally rolled health minister Greg Hunt’s accompanying policy of banning personal importation of NVPs. They wanted these highly addictive, unregulated products to be made available for sale anywhere that cigarettes can be sold. And that’s anywhere that includes the many places that are supplying kids across Australia with flavoured, disposable vapes.

When the extent of the carnage caused by smoking was first consolidated in the early 1960s, factory made tobacco products had already been sold openly as ordinary items of commerce for 60 years. Across the next 60 years we saw the glacial introduction of policies that began slowly reeling in that disastrous unregulated free-for-all. Every step was fought hard (and all lost) by Big Tobacco, a fight which it continues unabated today. It’s often been said that if cigarettes had been invented in 1960, with their unparalleled risk profile known in advance, they would have never been let onto the market.

Because of this, governments around the world made every possible ignorant mistake possible in failing to regulate cigarettes, but that’s what let-it-rip vaping advocates want to risk again. By contrast, controlled access via prescription builds a platform that can be liberalised or tightened in light of emerging understanding of the risks and benefits of NVPs.

Vaping advocates  in Australia have always nailed themselves to support from deeply conservative and reactionary political figures.  But since the cataclysm of the May 21 election, they have found themselves in the political wilderness where they are likely to remai for years. Today, their former go-to political besties couldn’t make an impression in a soft cushion. Federally, the Liberal Democrats have long been toast, Fiona Patten’s Reason party got homeopathic level votes in May and Pauline Hanson and her little buddy Malcolm Roberts are impotent in the new Senate. The heroic “I vape and I vote” bumper stickers  generated not  a political bang, but a whimper.

During the last year of the Morrison government, open slather vaping advocates were supported by the 28 LNP backbenchers. With the LNP now political eunuchs and prominent LNP vaping spear-carriers Wilson, Abetz, Laming, Zimmerman and Sharma gone from parliament, vaping advocates have no political friends with any policy influence. Hollie Hughes, Matt Canavan, the lugubrious Senator James Patterson and Barnaby Joyce are the best they have. Just think about that.

Vaping’s go-to A-team from 2022

On Jun 12, 2020 this rock bottom epiphany saw a lot of people clearly playing with Wodak’s head. In a tweet he pointed at Labor, the LNP and five of Australia’s biggest health and medical NGOs who were “condemning” vaping. In fact, there are a lot more than five (see table above).

Later that day he also tweeted a graph (below) purportedly demonstrating how Australia seems to have choked badly  in reducing smoking compared with three other nations, all with  more liberal vaping regulations than us. Wow, look at how badly Australia was doing!

But there was a teensy-weensy problem here: the Australian data was for 2019 with a number then projected for 2021, while the other nations showed smoking prevalence for 2020 and 2021. Wodak should have known that the Australian Bureau of Statistics published smoking prevalence data for 2020-21  from its National Health Survey  showing that 10.7% smoked daily with 11.8% smoking daily or less than daily. So why didn’t he cite that inconvenient data? I think we can guess.

And there’s another important problem too. As I pointed out in an earlier blog looking at how Wodak’s advocacy mate Colin Mendelson engages in the same exercise, there are important differences in the way that different countries count “smoking”. Australian and US data on “current smoking” include all combustible tobacco (cigarettes, cigars, pipes, shisha) while England and New Zealand count only cigarettes and roll-your own as “smoking”.

  • Australia ages 18+) (includes cigarette and roll-your-own smokers plus all exclusive users of other combustible tobacco products like pipes, cigars, hookah and shisha)
  • USA: (ages 18+) (like Australia, includes all combustible tobacco product users)
  • New Zealand (ages 15+) (includes cigarettes & RYO only)
  • UK (ages 18+):(includes cigarettes and RYO only)

A 2017 editorial in Addiction made this same point, when looking at the most recent available data at that time:

it is likely that overall combustible tobacco use prevalence for adults18+ in the United States is higher than 15.1% [in 2015], and somewhere in line or just below the 2013–14 National Adult Tobacco Survey (NATS) estimate that 18.4% of US adults aged 18+ were current users of any combustible tobacco product

The COVID 2020-21 lockdowns saw a lot of smokers exposed to repeated advice to quit smoking. With lungs particularly susceptible to COVID, many smokers heard that message many times. In the first 5 months of 2020, downloads of the government’s Quit Buddy app increased 310%. There are good reasons to expect that the projected downward slope in Wodak’s tweeted graph would have been steeper.

So of the four nations shown  in Wodak’s graph updated for the latest national government data, Australia sits at second on 11.8% smoking at any level, behind New Zealand with 10.9% and ahead of England on 12.1% and the USA on 12.4%.

The disastrous abandonment of Hunt’s planned ban on personal importation of NVPs should be revisited. With massive quantities of totally unregulated, illegal disposable NVPs flooding Australia and driving the teenage vaping surge, the universal support of state and federal health departments to shut this down will offer Mark Butler his first Nicola Roxon moment in prevention.

Roxon’s bold introduction of plain packs, now dominoing around the world, was lauded by the health and medical community. Twenty one nations have now finalised plain packaging legislation. Restoring the ban on personal importation of NVPs and introducing and enforcing seriously deterrent fines for their commercial importers and retailers looks like a very smart move.

High Level Meeting of the General Assembly on the prevention and control of non communicable diseases speaking: Nicola Roxon, Minister for Health and Aging, Australia