Vaping theology 27: “Vapes are 100% more effective than nicotine replacement therapy”: where do such comparisons come from and how do they conceal far more than they reveal?

03 Friday Jul 2026

Tags

blindness-integity, cochrane-library, randomised-controlled-trials, real-world-quitting, smoking, unassisted-cessation, vaping

Vaping hyperbole maestro Prof David Nutt

The two giant pillars underpinning vaping advocacy are that (1) vapes are essentially all but as safe as breathing clean air and that (2) vaping is now finally cemented at the highest level of evidence as “the most effective way” we have of quitting smoking. I’ve previously looked at the first of these claims here. This time I’ll look at the effectiveness argument.

Randomised controlled trials: the “gold standard of evidence”

Many smoking cessation advocates megaphone evidence obtained from systematic reviews of randomised controlled trials (RCTs) to argue for the superiority of different drugs or nicotine replacements (especially vapes), over largely unassisted quitting. Quitting cold turkey is routinely cast into a purgatory dungeon as having the lowest level of effectiveness of all ways of quitting. This is despite 70 years of evidence showing that quitting without drugs, aids or professional assistance is and always has been by far the way that most ex-smokers stop on their final quit attempt (see later in this blog). Apparently and preposterously, such quitting is not “evidence based”.

The double-blinded RCT has been elevated to the hallowed zenith of evidence-based medicine. But there are many important ways in which RCTs seriously differ from how therapeutics are used in real world settings, away from the close involvement of RCT researchers. Nowhere is this clearer than with smoking cessation.

When a vaping advocate wants to broadcast the wonderful evidence on vaping, they rarely qualify their claims about RCTs by highlighting or even noting any of these differences. So what does the RCT evidence say and what are these critical differences?

Cochrane evidence on smoking cessation RCTs

The Cochrane library is a global project to pool RCTs on treatments and diagnostics for a wide range of health issues, winnowing those with high quality evidence from those with significant flaws. It has a dedicated sub-section focussed on drugs, nicotine replacement, behavioural and policy interventions to stop tobacco use.

The most recent (10 Nov 2025) Cochrane review of the effect of vaping on smoking cessation measured at (at least) 6 months after the trials concluded that across 104 studies involving 30,366 adults:

“for every 100 people using e-cigarettes to stop smoking 8 to 11 might successfully stop, compared with only 6 in 100 people using NRT, 6 in 100 using e-cigarettes without nicotine or 4 of 100 people having no support or behavioural support [typically advice, counselling etc] only.”

For simplicity here, let’s be generous and take 10 in 100 as the outcome for the e-cigarette group, instead of the stated range 8-11. The Cochrane sentence describes in plain English what is known as the absolute difference in efficacy between vapes, NRT and no support/behavioural support when it comes to quitting. But vaping advocates seldom lead with statements of absolute effect sizes, preferring to use relative effect sizes. Here’s a quick explanation of the important difference between relative and absolute differences, very basic but often misleadingly used concepts at the heart of questions about smoking cessation effectiveness (effectiveness means how something works in the real world; efficacy means how it works in the artificial world of trials).

Absolute vs relative impact

An absolute difference means the exact mathematical difference in event rates (here quit rates) between groups. So if 100 people were to use a smoking cessation medication and 10 quit, while 100 took a placebo and 5 quit, the difference between the two groups at follow-up would be a 5 percentage-point absolute difference. Five more in 100 who used the medication quit (10 altogether) compared with the 5 who used a placebo.

But the relative difference between the two groups is that those on the medication did 100% better than those on placebo (10% being twice as much as 5% — or 100% better). So, if a smoker heard that a particular quit smoking method worked twice as well (ie: 100% better) they would understandably think that here was a no brainer: a way of quitting which was very substantially better that a placebo (or a comparative drug).

So in other words with the latest Cochrane data described above, if you are in a RCT (notwithstanding all the serious caveats set out below) and you used a nicotine vape to try and quit, there would be an absolute positive difference of 4 percentage points higher than if you had used NRT or a nicotine free vape, and 6 percentage points higher than if you had no support to quit or (for example) called a quitline for some counselling.

Flipping this around, this would also mean that a smoker using a nicotine vape would be 90% likely to be still smoking after at least 6 months if they used a nicotine vape; 94% if they used NRT or a nicotine free vape and 96% if they tried to quit pretty much unaided.

So if you were to only express these percentages in relative improvement terms, things will sound so much more encouraging! Now, the improvements from nicotine vaping leap to 66% better than NRT or nicotine free vapes (10/100 v 6/100, the 4/100 difference being 4/6 or 66% better), and 150% better than quitting virtually unaided!

How much more impressive do relative improvements of 66% or 150% sound than the meagre absolute increases of 4 and 6 percentage points?

Veteran vape promoter Alex Wodak had no hesitation in using the heavy ordnance to talk vaping up here when celebrating the release of an earlier Cochrane report:

The Lancet’s policy is that when describing “risk changes or effect sizes … absolute values rather than relative changes” should be used in reports.

Ordinary people typically understand the concept of therapeutic effectiveness as being straightforward. They have many experiences of personally using drugs to alleviate or prevent fever, pain, itching, cramping, nausea, gut problems, contraception, hypertension and more in a very long list.

If they ask a doctor whether a drug being prescribed or recommended “works” they mean works very well: they have high expectations. Few would be keen to use a drug that had a 90% failure rate (as with vapes) when it came to any of these health problems. And they would see trying to quit unaided as well beyond hopeless.

But this is the very low, dismal bar of absolute “success” we find with quit smoking meds, NRT and vaping in RCTs that are widely promoted as the best evidence we can get.

Critical differences between RCTs and real world use

But when RCTs are compared with “real world” studies of how successful vapes are in smoking cessation, the bad news has barely got out of bed.

In RCTs, it is de rigueur to randomly allocate people to the experimental intervention or to a control group and not tell them which group they have been allocated. Those in the experimental intervention group are assigned to receive the active drug or procedure of interest while those in the control group(s) get an inert substance or placebo (a ‘sugar pill’ or saline solution are common). Sometimes there is an extra group being compared: a ‘usual care’ group who have the relevant condition (eg: insomnia, anxiety, migraine). This group are asked to simply continue using the drugs or strategies they normally use for the condition in focus.

With double blinding, the aim is to have neither the trial participants nor the trial research staff know which subjects are in either group. Here, independent third parties are charged with group random allocation and those running the trial are kept in the dark about who is in which group until after the trial has concluded and the data are being examined. Those in the ‘usual care’ group of course know that they are not in the experimental or control group because they are not getting anything.

Enhanced or amplified placebo effects

Allocation is blinded to avoid staff inadvertently letting the cat out of the bag and telling subjects that they are getting the active drug or procedure or the placebo.

This is of critical importance because this knowledge can powerfully influence the expectations of those in a trial. Knowing you are being asked to take a dummy pill (or ointment, patch, lozenge, spray etc) or an established treatment that has been around for decades is understandably likely to deflate expectations of experiencing a positive outcome. This may increase the likelihood of people dropping out of the study (“I know I’m not getting the real thing here, so why bother?”) or adopting other strategies to reduce the problem that inspired them to join the trial to fix the problem. Equally, knowing you really are on the active ingredient intervention may raise your expectations, mirroring those that occur in real world use of a drug.

The asymmetry between knowing you are getting the active drug and knowing you are not may well artificially widen the gap between the performance of the two groups, flattering the performance of the active intervention or drug. This is because of what is termed the enhanced or amplified placebo effect. Belief about whether you are taking an active drug or placebo has been shown to have a substantial impact on therapeutic outcome, with stronger positive expectations resulting in greater therapeutic improvement. This is especially the case when it comes to psychiatric outcomes.

Ideally, those allocated to both intervention and control (placebo) groups should have identical toss-of-a-coin probability of guessing to which group they have been allocated. But many RCTs don’t even test for this “blindness integrity” and when they do, those using the active drug guess correctly far more than by chance,

A 2004 study of 73 nicotine replacement therapy (NRT) trials found only 17 tested for blindness integrity and that in 12 of these 17 subjects (71%) accurately judged treatment assignment at a rate significantly above chance. In a varenicline RCT, those in the varenicline arm were >3 times as likely to believe they were taking varenicline, versus “not sure” and the belief that one had received varenicline was significantly associated with a 5x increase in cessation rate. There’s a similar story with bupropion: Compared to those who guessed “not sure” those guessing they were taking bupropion were more than twice as likely to have been randomized to bupropion.

With nicotine-delivery products (including NRT and nicotine vaping) those with nicotine dependence are thoroughly familiar with the physiological cues they get many times every day when their brain signals to them “feed me, feed me more nicotine please!” So if they have been allocated to placebo group and are still getting those strong sensations, it’s little wonder they often guess they are not getting active nicotine in the trial.

How did the latest Cochrane review handle the issue of blindness integrity?

The Cochrane authors judged all 9 studies in their e-cigarette vs NRT cessation comparison (Analysis 1.1) to be at low risk for “Blinding of participants and personnel (performance bias)”.

Here’s how they get there. The authors say that for randomised studies without blinding, they still rated this domain low risk “if the intervention was compared to an active control of similar intensity”, because they “judged performance bias to be unlikely in this circumstance.” No elaboration of their reasoning was given here.

The lack-of-blinding problem was basically waved through on the assumption that an active NRT comparator neutralises performance bias. But in a field where it is common for trial authors to have spent years publicly and forcefully barracking for e-cigarettes, trial staff enthusiasm and investigator attitudes can shape encouragement, troubleshooting, adherence support, follow-up energy, and participant expectations. So the low-risk performance bias rating for all 9 studies is surely highly questionable.

Combating trial drop out

When RCTs are being planned, calculations should always be made to ensure that sufficient numbers of eligible participants are enrolled to enable enough statistical power to be available to reliably point to any meaningful differences in quit rates. Those running trials must also plan for inevitable dropouts who start a trial but who do not complete it for whatever reasons.

Trial managers are acutely sensitive to the serious threats to scientific integrity, budget blowout and delayed trial completion posed by significant participant drop out. Accordingly both formal ‘tried and tested’ protocols and informal practices are involved in trying to minimise participant attrition. Trial managers use retention strategies which centre around building good relationships with participants to motivate them to remain in trials and maintain their data records. Staff qualities seen as influencing retention include “empathy, being approachable, having a good manner, making trial participants feel appreciated, as well as staff who chat, listen, and answer participant queries, and go ‘the extra mile” … “Having face-to-face contact, or regular follow-up calls with participants, is felt to facilitate building good rapport … Less participant contact possibly hinders retention, as participants do not have a relationship built with trial staff and consequently may not feel as obliged to complete follow-up”

The phenomenon of “research participation effects” (RPE) has largely replaced investigation of issues previously conceptualised as the Hawthorne effect. These constructs are acknowledged as introducing factors which can add important motivations for trial participants to want to please the researchers with whom they have formed positive relationships. Trials often include staff who are PhD candidates who are highly motivated to ensure good trial retention so that their PhD research papers cross that elementary standard of trial integrity and reduce the risk of rejection by journal editors.

Walsh’s 2008 review of 12 smoking cessation trials found subjects were contacted on average 7.1 times across these trials. This level of on-going contact with people who are reminding you and willing you on to keep using a drug for at least the minimum recommended time does not occur when a smoker buys a course of NRT from a supermarket or pharmacy, picks up a script for varenicline, bupropion or cytisine from a doctor or buys a vape.

And here’s the crunch. A review of 7,521 participants in 16 NRT cessation studies found 61% of those in RCTs adhered to their full course of NRT compared with only 26% doing so in population studies. Only 20% of participants in an Australian bupropion trial had completed their full course when followed up. These are radically different levels of adherence, demanding scepticism when RCT results are seamlessly extrapolated to real world relevance.

Smoking cessation treatments are free to trial participants

Again, unlike in real world use, trial participants are provided with free drugs, NRT or vapes. Neither do they pay doctors’ consultation fees where these are relevant. These savings may be particularly attractive to those on low incomes and may positively bias their volunteering in trials. With illegal vapes in Sydney today costing $70-90 for rechargeable products and $50-60 for non-rechargeables depending of the number of puffs obtainable, free vapes will motivate some smokers but represent an unrealistic factor.

RCT subjects are often paid

And again, unlike real world purchasers of quit smoking products, subjects in RCTs are almost always compensated for any expenses incurred in their participation. These includetravel expenses, parking, meals during study visits, accommodation if required and compensation from time away from work. “General inconvenience” payments are also common. Research ethics committees generally will not approve payments that might inordinately influence trial participation “just for the money”. But again, those on low incomes may be attracted to trials and more motivated to see them through even where “general inconvenience” honoraria may be only a few hundred dollars.

Eligibility criteria Ideally, those enrolled in trials should mirror as closely as possible the characteristics of smokers in the population. Some of these are very well established with over-representation in smokers of social disadvantage (low income, education) and higher mental health problem rates than in the general community. This data linkage study of a sample of 1.5m Danish people (1995-2018) found 80% of the population had a history of treatment for a mental health disorder in a hospital setting, from general practitioners or private psychiatrists.

But those running trials prune out participants prior to trial commencement who can be expected to have unacceptable likelihoods of dropping out of the trial, fail to follow the expected procedures and contacts with the researchers or who live in situations where they are hard to contact.

In this review of exclusions from smoking cessation trials, 66% of those with nicotine dependence were excluded and 59% of those motivated to quit were rejected. In the table below the two largest criteria were smoking less than 10 cigarettes a day and insufficient motivation to quit. This is in spite of recommendations for light smokers to use medications and efforts to promote medication use in unmotivated smokers as part of pre-quittng or “preparation to quit” interventions, developments often promoted by pharmaceutical companies.

This US study found 36% of 1206 smokers screened for smoking cessation trial were deemed ineligible for reasons that included serious mental illness, alcohol and drug issues. While 24% of Caucasians were ineligible, 42% of African Americans were excluded.

A review of reviews on 279 RCTs of smoking cessation using pharmacotherapies found 18.3% explicitly excluded participants with any MHDs (mental health disorders), 54.5% conditionally excluded based on certain MHD criteria and 27.2% provided insufficient information to ascertain either inclusion or exclusion. The authors concluded that “smokers with MHDs are not sufficiently represented in RCTs examining the safety and effectiveness of smoking cessation medications.”

In summary, when we add the widespread culling of those less likely to fully participate throughout a smoking cessation trial to the known radically lower levels of treatment adherence as described above, we are looking at serious differences between those participating in trials and those independently using quit smoking aids in real world, totally unsupervised contexts.

Collectively, these differences are likely to significantly flatter the communicated success rates for vaping (and any quit smoking med) promoted from RCTs compared with real world outcomes.

Defenders of RCTs here counter that because trial outcomes are typically calculated using intention-to-treat (ITT) analysis, that RCT outcomes always take attrition into account. ITT analysis involves considering the outcomes of all participants “according to their original assigned treatment group, regardless of whether they actually received the treatment, or dropped out”.

But as discussed above, this does not consider the intense efforts undertaken in RCTs to retain trial participants and to initially screen them to preclude those with known propensity to drop out or with other factors known to be associated with poot outcomes. These collectively introduce important biases into RCTs that make those participating very different and have very different experiences to random cross-sections of smokers trying to quit in the real world.

Longitudinal cohort and population studies

My 2023 (open access) book Quit Smoking Weapons of Mass Distraction (see from pp 185-198) summarises longitudinal population cohort studies on the success of vaping in quitting. It looks also at the question of whether nations with widespread, open-slather vape access have lower smoking prevalence than those where vapes are more restricted or even banned.

Longitudinal cohorts show a similar desultory performance to RCTs, with by far the most common experience of vaping by smokers over several years of follow-up being continuing smoking and vaping (dual use) and abandonment of vaping while smoking continues (see the above pages my book for details).

And when it comes to asking whether nations with now over a decade of widespread liberal access to vapes have plummeting smoking prevalence compared with those with stricter controls, the answer is similarly mostly negative. On this, our recent piece in Addiction shows that with the exception of New Zealand, there is very little difference in smoking prevalence between the five nations shown below nor any obvious relationship between the prevalence of vaping and that of smoking.

Moreover, globally, there are 45 nations which have smoking prevalence under 10%, with most of these nations having negligible vaping.

“A few quit smoking on their own. Good. But most don’t”

Earlier, I noted the denigration of unassisted quitting as the low water mark of useful ways of quitting. The Australian Department of Health notes that “While quitting cold turkey may not work for everybody, many smokers quit smoking this way.” This is quite an understatement (see here). Wodak’s statement is flagrantly, stonkingly incorrect and suggests he has little understanding of population-wide smoking cessation.

The reputation of unassisted quitting (cold turkey) for having a poor success rate derives from a research obsession with evaluating the outcome of individual quit attempts, rather than taking a population perspective on how large numbers of former smokers stopped smoking on their final, successful attempt.

If we ask “which method of quitting has the best success rate per quitting attempt?” common assisted quitting methods perform better than unassisted attempts. But if we instead ask, “For every 1000 former smokers, what method of quitting has produced the most quitting numbers?” unassisted cessation always wins the prize. What this obsession with success rates rather than with success numbers camouflages is that population attributable quit volumes are a product of success rates multiplied by the number of smokers using various methods. And here, there is daylight between smoking trying to quit without assistance and any (and sometimes all combined) other quit strategy.

Other blogs in this series:

Vaping theology: 1 The Cancer Council Australia takes huge donations from
cigarette retailers. WordPress 30 Jul, 2020

Vaping theology: 2 Tobacco control advocates help Big Tobacco. WordPress 12 Aug, 2020

Vaping theology: 3 Australia’s prescribed vaping model “privileges” Big Tobacco WordPress Feb 15, 2020

Vaping theology: 4 Many in tobacco control do not support open access to vapes because they are just protecting their jobs. WordPress 27 Feb 2021

Vaping theology: 5 I take money from China and Bloomberg to conduct bogus studies. WordPress 6 Mar, 2021

Vaping theology: 6 There’s nicotine in potatoes and tomatoes so should we restrict or ban them too? WordPress 9 Mar, 2021

Vaping theology: 7 Vaping prohibitionists have been punished, hurt, suffered and damaged by Big Tobacco WordPress 2 Jun, 2021

Vaping theology: 8 I hide behind troll account. WordPress 29 Jun, 2021

Vaping theology: 9 “Won’t somebody please think of the children”. WordPress 6 Sep, 2021

Vaping theology: 10: Almost all young people who vape regularly are already smokers before they tried vaping. WordPress 10 Sep, 2021

Vaping theology: 11 The sky is about to fall in as nicotine vaping starts to require a prescription in Australia. WordPress 28 Sep, 2021

Vaping theology: 12 Nicotine is not very addictive WordPress 3 Jan 2022

Vaping theology 13: Kids who try vaping and then start smoking,would have started smoking regardless. WordPress 20 Jan, 2023

Vaping theology 14: Policies that strictly regulate vaping will drive huge
numbers of vapers back to smoking, causing many deaths. WordPress 13 Feb, 2023

Vaping theology 15: The government’s prescription vape access scheme has failed, so let’s regulate and reward illegal sellers for what they’ve been doing. WordPress 27 Mar 2023

Vaping theology 16: “Humans are not rats, so everybody calm down about nicotine being harmful to teenage brains”. WordPress 13 Jul, 2023

Vaping theology 17: “Vaping advocates need to be civil, polite and respectful” … oh wait. WordPress 3 Oct, 2023

Vaping theology 18: Vaping is a fatally disruptive “Kodak moment” for smoking. WordPress Oct 30, 2023

Vaping theology 19: Vaping explosions are rare and those who mention them are hypocrites. WordPress 17 Nov, 2023

Vaping theology 20 : Today’s smokers are hard core nicotine dependent who’ve tried everything and failed – so they need vapes. WordPress 14 Dec, 2023

Vaping theology 21: Australia’s prescription vapes policy failed and saw rises in underage vaping and smoking. WordPress 10 Jan, 2024

Vaping theology 22: “Prohibition has never worked at any point for any other illicit substance”. WordPress 17 Mar 2024

Vaping theology 23: “84% of the Australian public are opposed to the way the government will regulate vapes” WordPress 2 Apr, 2024

Vaping Theology 24: “Tobacco control advocates are responsible for vape retail store fire bombings and murders. WordPress 27 May, 2024

Vaping theology 25: Vaping is as harmless as breathing in stream. So everyone relax. 10 tenets of vaping harm denial.WordPress 10 Mar, 2026

Vaping theology 26: “If Australia allowed vapes to be sold openly, this would lower smoking prevalence and kill illegal tobacco stone dead” WordPress 5 Jun,2026

“Prohibition never works”. Oh really? 150 examples where it does

28 Sunday Jun 2026

Posted by Simon Chapman AO in Blog

≈ Leave a comment

Tags

health, legisaltion, libertarianiosm, nanny-state, regulation

Of all the arguments flung at public health over the 50 years I’ve worked in it, the claim that “everyone knows prohibition doesn’t work” has few rivals on the podium of insults. It’s fraternal twin barb, the odious, interfering “nanny state” epithet, often walks hand-in-glove with the enemies of prohibition.

I got a confused post recently telling me that the illegal tobacco problem in Australia was caused by prohibition which “never works”. Last time I looked, legal tobacco was on sale in every supermarket (except Aldi), corner store, service station, newsagent, tobacconist and many more. So prohibition clearly was not to blame, but anyway … just put it out there anyway!

“Works?”

Those beloved of this meme rarely explain what they mean by “hasn’t worked”. Do they mean that any ban which is ever ignored by even a tiny minority has therefore failed? Or is the only acceptable bar here, one of a ban eradicating eternally every last instance of a problem?

Slavery began to be outlawed in the nineteenth century. It remains legal in Afghanistan under the Taliban with the International Labor Organisation estimating that 50 million live in illegal slavery today around the world. So put your hand up if this mean that the prohibition on slavery has failed and so should now be abandoned.

“Everyone knows” US alcohol prohibition failed

Most claiming that prohibition doesn’t work point to the example of alcohol prohibition in the USA. Alcohol and drugs expert Professor Wayne Hall from the University of Queensland commenced his 2010 (pay-walled) review in Addiction of the lessons to be learned from alcohol prohibition in the USA with “ ‘Everyone knows’ that national alcohol prohibition in the United States between 1920 and 1933 was a quixotic and failed social experiment”.

In his erudite myth-busting review, Hall examined this factoid (unreliable information that is reported and repeated so often that it becomes accepted as fact) and its implications for policy debates about “bans” on alcohol. He concluded “It is incorrect to claim that the US experience of National Prohibition indicates that prohibition as a means of regulating alcohol is always doomed to failure. Subsequent experience shows that partial prohibitions can produce substantial public health benefits at an acceptable social cost, in the absence of substantial enforcement.”

His review and this piece suggest that prohibition was associated with a number of positive social and economic changes while it lasted, and that the almost universally accepted “fact” that it caused widespread growth in the black market for alcohol and in associated crime and corruption may in fact have been phenomena only documented for a small number of US cities. But most people just know it was an unmitigated failure cross the USA.

Outrage about prohibitions and the nanny state has a long history

Attacks rained down on Edwin Chadwick, the architect of the first Public Health Act in England in 1848. He proposed the first regulatory measures to control overcrowding, drinking water quality, sewage disposal and building standards. After he was sacked for his trouble an editorial in The Times gloated: ‘We prefer to take our chance with cholera and the rest than be bullied into health. There is nothing a man hates so much as being cleansed against his will, or having his floors swept, his walls whitewashed, his pet dung heaps cleared away’. And yet on the 150th anniversary of the Public Health Act a British Medical Journal poll saw his invention of civic hygiene, and all of its regulations, voted as the most significant advance in public health of all time.

In February 1985, The Age reported that at least three Australian children had been disemboweled in the past two years after sitting on swimming pool skimmer box covers shaped like children’s seats. Before the advent of mandatory shatterproof safety glass for showers, over the years many suffered major lacerations and occasionally died after bathroom accidents. Before 2008, it was legal for fast buck retailers to sell children’s nightwear that could easily catch fire: many children were hideously burnt and scarred for life. Random breath testing was first introduced in 1976, to the chagrin of the Australian Hotels Association. In NSW it was followed by “an immediate 90% decline in road deaths, which soon stabilized at a rate approximately 22% lower than the average for the previous six years”.

These are just four of many examples of changes to laws, regulations, mandatory product standards and public awareness campaigns that were introduced following lobbying from health advocates. With these, as with nearly every campaign to clip the wings of those with the primitive ethics of a cash register, there was protracted resistance. I was a board member of Choice magazine for 20 years, and lost count of the number of times manufacturers staunchly resisted voluntarily making changes to their dangerous, ineffective or substandard products.

Tim Wilson MP

These bans and brakes on personal and commercial freedoms are routinely ridiculed as the interventionist screechings from that reviled harridan, the Nanny State. And the cathedral of the anti-nanny state in Australia has long been the Institute of Public Affairs (IPA). One of its early high priests in Australia was Tim Wilson, now Liberal Member for Goldstein, who pumped out an incontinent flow of the doctrine regularly in opinion pages and interviews.

In May 2013, Wilson, Australia’s champion of contemporary pet dung heap rights, railed that “Nanny state critics understand that incremental attacks on our freedom to choose are single steps down a longer road to remove individual choice and responsibility.” He wrote of the “rising groundswell of Australians who are sick of increasing local, state and federal government regulations of their choices”; denied that people like him want to “selfishly put their wants above the safety and happiness of others”; that we should all “learn to manage risk through our choices” and that it is not “the job of government to coddle us from the world’s evils, avoid risk and use taxes, laws and regulations to either steer or direct our behaviour.”

Those like Wilson opposed to state intervention in markets subscribe to often unarticulated social Darwinist values that imply that those with the misfortune to be killed, injured or made chronically ill by their participation in untrammeled marketplaces had it coming to them. The unregulated marketplace and community is a kind of noble jungle where the fittest survive thanks to their better education and judgment in their consumer choices, their better ability to pay for superior, less dodgy products and to keep up repairs on their cars and homes, and to get employment in work that is not dangerous or toxic. Children living in poorer housing near busy roads in the leaded petrol era, had only their parents to blame for their lead-lowered IQs: they didn’t have to live there! When a toddler drowned in a backyard pool before mandatory pool fencing laws, it was the fault of the feckless parents for not being more vigilant, and nothing to with failure of government to mandate the cost of a fence as part of the cost of a pool. When kids ingested lead or other heavy metals from dodgy toys when these were legal, their parents should have just done their homework and not bought them.

Those who can’t keep up find their way into national health statistics where across almost every area of public health, the poor and less educated have higher rates of disease, injury, major disease risk factors and death.

Below is a big list of nanny state coddlings and protections that a then profoundly ignorant Wilson would have said are “rarely supported by credible research”. I stopped at 150 and could have doubled, tripled or even quadrupled the list. We don’t hear much from the IPA and its ilk on any of these because they are all immensely popular, taken-for granted safeguards on our health, safety and quality of life. Other countries are climbing over themselves to emulate many of these as best practice. Australia is one of the healthiest nations on earth. The precious freedoms that they “erode” are almost always trivial and the industries that were regulated (with some exceptions like asbestos) reluctantly rolled over and still make money from safer products and procedures. No one cares less that their “choice” to buy leaded petrol has been removed. Only the most rapacious libertarians swoon at the unregulated, let-it-rip free market that would wind back the clock of civil society many decades if unleashed by their ideology.

So a public invitation to the IPA, Pauline Hanson and her ilk: which of these 150 heinous intrusions on people’s freedoms and the right to unbridled commerce have not “worked” and which does it wish to see abolished?

The regulations and laws below sometimes are explicit about prohibitions. But all set out what must happen for the standard to be operational. In doing so, each law, standard and regulation this sets up a prohibition on what would not be met if the standard was breached. So for example, compulsory third party motor vehicle injury insurance prohibits not having this insurance if you are a licensed driver.

150 ways …

Access to pharmaceuticals: Drug regulation and scheduling
Access to health care: Compulsory third party motor vehicle injury insurance
Alcohol control: Minimum legal drinking age law
Alcohol control: Responsible serving of alcohol law
Building standards: Balustrade and railing height regulations
Building standards: Builders’ licensing requirements
Building standards: Electrician licensing requirements
Building standards: Elevator standards and inspections
Building standards: Building fire safety standards
Building standards: Building for space standards (preventing over-crowding)
Building standards: Mandatory smoke alarms
Building standards: Mandatory swimming pool fences
Building standards: Maximum water temperature regulation
Building standards: Safety glass standards
Building standards: Swimming pool skimmer box standards
Building standards: Mandatory residual current devices (electricity)
Building standards: Plumber licensing requirements
Cancer control: Ban on commercial sunbeds
Cancer control: Sunsmart regulations for schools and day care (no hat, no play, shade provision)
Child protection: Background checks for staff working with children
Child protection: Child pornography laws
Child protection: Mandatory reporting of child protection incidents
Congenital malformation prevention: Folate fortification
Dental health: Fluoridation of water
Disability: Disability parking permits and penalties
Drug control: Pseudoephidruine pharmacy controls

Drug regulation: Illicit drug laws
Environmental health: Backyard burning controls
Environmental health: Burial standards
Environmental health: Air quality standards for industrial emissions
Environmental health: Controls on industrial discharges into waterways
Environmental health: Vehicle emission control standards
Environmental health: Lead in paint banned
Environmental health: Lead in petrol banned
Environmental health: Legionella controls for cooling towers
Environmental health: Petrol and diesel fuel standards (for emission controls)
Environmental health: Planning regulations on open space
Environmental health: Recycled water standards for reuse
Environmental health: Septic tank standards
Environmental health: Sewage discharge standards
Environmental health: Stormwater discharge
Farm safety: Tractor rollover harm reduction
Fireworks: ban on private use
Food safety: Abattoir standards
Food safety: Food additive labelling
Food safety: Food allergy labelling
Food safety: Food handling standards
Food safety: Food standards (many)
Food safety: Genetically modified organisms regulation
Food safety: Pasteurisation of milk
Food safety: Café and restaurant food safety and hygiene standards
Food safety: Regulation of food storage temperatures
Health promotion: Mandatory physical education on schools
Health promotion: Rights to breastfeed in public places
Infection control: “blood rule”: in sport
Infection control: Autoclaving of dental equipment
Infection control: Bans on public spitting, urination , defecation
Infection control: Chlorination of water supply
Infection control: Dog faeces disposal
Infection control: Drinking water quality standards
Infection control: Immunisation standards
Infection control: Infection control standards and protocols in health care
Infection control: Regulation of sex on premises businesses
Infection control: Mandatory immunization for healthcare workers
Infection control: Mandatory sewerage and sanitation in urban areas
Infection control: Notifiable disease laws
Infection control: Sharps disposal and blood borne virus controls
Infection control: Skin penetration legislation re hairdressers, dentists, tattooists, body piercing
Infection control: Veterinary and animal husbandry standards
Infection control: Water standards in swimming pools
Information control: Advertising standards
Mental health: Mental health scheduling
Occupational safety: Workers’ compensation
Occupational health: Asbestos building ban
Occupational health: Dust standards
Occupational health: Hard hats
Occupational health: Harness standards
Occupational health: Noise standards
Occupational health: Personal protective equipment regulations
Occupational health: Scaffolding standards
Occupational health: Smoke free workplaces
Occuptational health: Asbestos removal standards
Product safety: Condom standards
Product safety: Controls, bans on lead (other heavy metals) used in toys
Product safety: Myriad of standards, bans, recalls etc.
Professional standards: Childcare facilities
Professional standards: Mandatory continuing medical education
Professional standards: Licensing of healthcare facilities
Professional standards: Medical, dental and allied health worker registration
Professional standards: Nursing home regulation
Public amenity: Outdoor noise regulations
Public safety: Agricultural and Industrial chemicals regulation
Public safety: Child resistant cigarette lighters
Public safety: Child resistant medical packaging
Public safety: Design rules for babies’ cots to reduce the risk of asphyxiation
Public safety: Dog and cat licensing
Public safety: Engineering standards for roads, bridges
Public safety: Extraordinary powers under the Public Health Act to deal with emergencies
Public safety: Gun laws
Public safety: Hair dryer standards to prevention bath electrocution
Public safety: Hazard reduction in playgrounds
Public safety: Nightwear for children mandatory standards
Public safety: Pesticides registration and control of use
Public safety: Poisons act
Public safety: Poisons labelling
Public safety: Quarantine Act
Public safety: Reduced ignition propensity cigarettes
Public safety: Regulations around provision of footpaths
Public safety: Safety standards fir fitness and leisure equipment
Public safety: Sunglass standards
Public safety: Total fire bans
Public safety: Access to dynamite
Public safety: Toy standards
Radiation control: Carriage and transport of radiated material
Radiation control: Dental x-ray equipment standards
Radiation control: Commercial sun bed bans
Radiation control: Uniformity in the control of radiation use
Road safety: Air bags in cars
Road safety: Bicycle helmet laws
Road safety: Breath alcohol ignition interlock devices for repeat drink drive offenders
Road safety: Double demerit points (driving)
Road safety: Drink and drug driving laws
Road safety: E-bike standards
Road safety: Energy absorbing steering columns
Road safety: Infant vehicle seat restraint laws
Road safety: Mandatory motorcycle helmets
Road safety: Motor cycle helmet standards
Road safety: Motor vehicle design standards
Road safety: Pedestrian crossings
Road safety: Provisional and learner licensing
Road safety: Random breath testing
Road safety: Random drug testing
Road safety: Seat belts in cars, school buses
Road safety: Speed limits
Road safety: Speed limits near schools
Road safety: Fitness to drive medical assessments
Road safety: Brake light standards on cars
Road safety: Traffic regulation in general
Road safety: Vehicle roadworthy inspections
Road safety: Dedicated bicycle lanes
Tobacco control: Health warnings on tobacco products
Tobacco control: Outlawing “light and mild” descriptors on tobacco
Tobacco control: Plain packaging of tobacco
Tobacco control: Smokefree public transport
Tobacco control: Sales to minors regulations
Tobacco control: Tobacco tax
Tobacco control: Retail display bans
Tobacco control: Strict duty free limits
Violence control: Criminalising domestic violence and coercive control
Violence control: Pepper spray ban everywhere but West Australia

Finally here is a list of 74 specific and categories of goods which are prohibited from import into Australia. It includes laser pointers, flick knives, body armour, chemical weapons, dangerous breeds of dogs, radioactive substances and mace. There are doubtless advocates for free access to all of these.

# This blog is an edited and updated version of my 2013 piece for The Conversation 150 ways in which the nanny state is good for us (read 43,000 times)

“An abominable moral calculation”: how Australia punishes poor smokers and the tragically misunderstood tobacco industry

11 Thursday Jun 2026

Posted by Simon Chapman AO in Blog

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Tags

smoking, sweden, tobacco-tax, vaping

James Martin is a Deakin University criminologist with a modest research track record in the tobacco control field. Of his 44 publications listed in Google Scholar, just five concern tobacco or vaping, with only two of these being published in peer reviewed journals. These five have received all of nine citations, with two being self-cites.

This background is relevant to his recent piece in Michael West Media, where he knits a loose thread between the current criminal tsunami of illegal tobacco and vape sales in Australia, Sweden’s falling smoking rates, Australia’s “punishment” of the tobacco industry, our alleged failure to reduce tobacco use, the failure of law enforcement to stem illicit sales and the heinous cruelty to the disadvantaged he says high tobacco prices cause.

His piece there provides just one reference to support his assertions. So let’s walk through how these stand up.

Tobacco control “harms poor smokers”

Martin argues that the Australian government has “abandon[ed] nicotine consumers, disproportionately some of our most vulnerable citizens, to early disease and death – an abominable moral calculation” because of instead of allowing vapes to be sold almost anywhere, it has confined legalised access to vaping through pharmacies to control the open supply of vapes to kids by self-described law-abiding convenience stores, tobacconists and vape shops.

While 2,358 pharmacies have dispensed over-the-counter vapes, and the government fully subsidises prescribed smoking cessation meds to low income health card holders, the unabated supply of cheap illegal, flavoured vapes by criminals continues to undermine the same potential of pharmacy access that we see year in and out when nearly all of us participate in the 440m annual visits to pharmacies to pick up 331m annual prescribed medicines.

If crime syndicates were also brazenly selling these medicines in every suburb to walk-ins without prescriptions, saving low income customers lots of money, should we applaud their public spirited service to the poor and let them get on with it? Or would we instead applaud swift and serious government effort to close this down and uphold the rule of law? I know what I would do.

And Big Tobacco — apparently the new white knights of health promotion – according to Martin now “grasps that its future, at least in the West, lies in selling nicotine without the smoke.” This is the same Big Tobacco which a decade on from entering the vaping and smokeless markets, still derives over 80% of its income from cigarettes with not one company setting a date to get out of tobacco.

Global Tobacco Industry Revenue Breakdown

Cigarettes: 83% to 88% of global sales
Smokeless tobacco: ~11%
Cigars: ~2%
Other products (e.g., vapes, pouches): ~3%

Company-Specific Financials

British American Tobacco (BAT): Reported that combustible products (primarily cigarettes) generated 80% of total global revenue.
New Category Products: “Next-generation” items make up 13.3% of BAT’s revenue.
Traditional Oral & Other: These account for the remaining 6.7%.

Philip Morris International: 58% of its revenue is still from tobacco

Source: https://www.tobaccoinaustralia.org.au/chapter-10-tobacco-industry/10-2-the-global-tobacco-manufacturing-industry

Martin’s claims about tobacco control harming low-income groups are also wildly uninformed. This link could have taken him to oceans of Australian data and graphs showing that, regardless of what definition of disadvantage is used (composite indexes, income, education) disadvantaged Australians have been smoking less in parallel with smoking declines in their more advantaged counterparts, continuously since at least 2001. This is the case for both declining prevalence and reduced cigarettes per day. Here’s just one graph of many that are inconvenient to his argument.

Yes, the lowest levels of disadvantage do have higher smoking rates than those in the highest, but as a criminologist Martin may be ignorant that this observation holds for almost every disease, cause of injury, vital statistic or health related behaviour (diet, obesity, alcohol etc), not just smoking. Poorer health travels with disadvantage.

And more news for him. It is not just tobacco prices which impact those on low incomes more than their more advantaged counterparts. This happens with every good and service they purchase, a truism in every country in the world where there is not perfect income equality for all people. In other words, everywhere.

In Australia today, there are only two groups where a majority of people smoke: those with psychosis and those in prison. In every other group, early school leavers, the unemployed, single parents and First Nations people there are more ex-smokers than smokers. Talk of people who, as Martin insists “can’t or won’t stop” smoking, will always struggle to explain why so many millions of these disadvantaged smokers over the years have managed to quit despite their disadvantage.

They regret having started to smoke, have agency to quit (mostly unaided), and are doing so more and more. Their higher smoking rates are explained far more by decades of higher smoking uptake than by lower quitting rates.

Few laws ever eliminate the problems they were intended to reduce. But we don’t see Martin’s equivalents in road safety calling for reduced penalties for drink driving because they badly sting those on low incomes, or ditching these laws because many continue to be detected over the limit.

We balance the harms to offenders with the declines in road deaths and injuries.

Can there be anything more perverse in public health than believing the poor would benefit by access to cheap cigarettes which will kill two in three long term users?

Cherry picking in Sweden

Sweden has a low smoking rate (4.8%) and according to Martin, this is all down to the enlightened widespread use of non-combustible nicotine, especially snus. Ergo, Australia need only look to Sweden for the answer, right? Here, Martin is a champion cherry picker when it comes to advancing his argument. Smokeless tobacco has been freely available in Canada and the US for decades and in both countries, it has low usage despite this open availability. In the USA, 2.6% of adults currently use smokeless tobacco and in Canada, only 0.6% regularly use it.

So do the US and Canada wipe the floor with Australia in reducing smoking given that they both allow open access to smokeless? Ermmm no. In the US, recent use of any combustible tobacco is 12.6% of adults in 2023-24. And Canada? In 2022 it’s 12.9% for any use in the last 30 days. This compares to 11.1% in Australia in 2022-23. So where’s the dramatic impact in the US and Canada of open access to smokeless tobacco on smoking rates? Why only highlight Sweden?

Sweden was one of the first nations to implement population-wide tobacco control polices like advertising bans, anti-smoking campaigns and health warnings. But clearly there are also cultural reasons why Swedes use smokeless, much in the same way they are unique in taking to surströmming, a famous Swedish fermented herring delicacy. It’s considered one of the world’s most foul-smelling foods, with an overpowering aroma often compared to rotten eggs, sewage and rancid butter. Or like Australians’ passion for vegemite, almost unique in the world.

“Punishing” the tobacco industry

Martin implies that “punishing” the tobacco industry with policies like taxation, plain packaging, and smoking restrictions is somehow a uniquely Australian thing. Is he seriously unaware that the global Framework Convention on Tobacco Control signed by 183 nations, has an entire section (“Article”) devoted to ways of controlling the tobacco industry’s efforts to wreck effective tobacco control? Here’s a report I co-authored for the WHO in 2008, which catalogues the many ways the tobacco industry has sought to defeat, delay, disrupt and dilute effective tobacco control policies. But for Martin, they are apparently now the good guys.

The industry screams loudest about policies that threaten its sales, and the very loudest screams have always been about high tobacco tax. Most people understand what this means, but Martin thinks it’s somehow unseemly and the nice people in Big Tobacco are misunderstood social welfarists leading people away from early deaths.

Here are a few historic examples of the industry screaming about tobacco tax. The tobacco company Philip Morris (Australia) in 1983 said:

… The most certain way to reduce consumption is through price.

Then again in 1985:

… Of all the concerns, there is one – taxation – which alarms us the most. While marketing restrictions and public and passive smoking do depress volume, in our experience taxation depresses it much more severely. Our concern for taxation is, therefore, central to our thinking about smoking and health. It has historically been the area to which we have devoted most resources and for the foreseeable future, I think things will stay that way almost everywhere.

And 1993:

… A high cigarette price, more than any other cigarette attribute, has the most dramatic impact on the share of the quitting population.

In 2011, British American Tobacco’s boss in Australia, David Crow, publicly acknowledged the impact of tobacco tax, telling a Senate committee:

We saw that last year very effectively with the increase in excise. There was a 25% increase in the excise and we saw the volumes go down by about 10.2%; there was about a 10.2% reduction in the industry last year in Australia. (see here at p xviii)

So if these (and many more like them) do not indicate virulent industry concern about tobacco tax, why has it carried on screaming about tax in the same way for at least 43 years?

Reducing tobacco tax?

Martin has been prominent arguing for the “obvious” necessity of reverting tobacco excise tax to the halcyon days before illegal tobacco erupted in Australia. In this he and a handful of others are in lockstep with the entire tobacco industry who have chorused that Australia should revert to 2020 tax levels. The table below shows what this would likely do to recommended retail prices for a current budget brand, JPS.

JPS Classic (20s)	May-20	May-26	Difference
Excise per stick (1)	$0.94964	$1.52829	$0.57865
Excise per pack	$18.99	$30.57	$11.57
Manufacturers cost (2)	$6.65	$8.33	$1.69
Wholesale price per pack of 20 (3)	$25.64	$38.90	$13.26
Retailer margin (4)	$3.72	$4.28	$0.56
GST 1/11th of final price (5)	$2.94	$4.32	$1.38
Final price per pack of 20
Recommended price (listed in wholesale price lists) (3)	$32.30	$47.50	$15.20
(1) ATO tax rates (2) Manufacturer cost derived by deducting excise from wholesale cost (3) Wholesale & Recommended price lists 2020 and 2026 (4) Retailer margin is at industry discretion (5) Calculated by dividing the final price by 11

So today, when a pack of illegal cigarettes can be bought for $7 if you buy a carton, in what universe would price sensitive smokers look at a tax-reduced pack of JPS from Woolies for $32.00 and not continue to immediately walk across the street to buy a pack for $7 in an illegal shop –at less than four times the price?

And that $7 price could even go lower. Cambodia is a high corruption index nation (ranking 158/180 worst in the world). It is also a major transit hub for smuggled tobacco to other destinations. There, a pack of locally taxed cigarettes can be bought for as little as 34c. There is clearly wide scope for the price of illegal cigarettes to go much further south if ever required by ever lower tax drops.

And then there’s the inconvenient problem of Martin’s silence on how it happens that there is also massive illicit tobacco trade in many nations with tobacco tax much lower than Australia’s.

Vaping theology 26: “If Australia allowed vapes to be sold openly, this would lower smoking prevalence and kill illegal tobacco stone dead”

05 Friday Jun 2026

Posted by Simon Chapman AO in Blog

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Tags

australia, new-zealand, smoking, vaping

Photo credit: Lindsay Fox

Vaping advocates eat, live, breathe and rejoice in their nicotine addiction. But in 2024, they lost the political debate on vaping policy when the Australian Senate voted to make vapes only legally accessible through pharmacies.

You could hear their wailing deep into the night. This heinous decision would make accessing vapes hugely difficult, they swore. It was gently pointed out that Australians make 440m annual visits to some 5000 pharmacies, an average of 18 times per year, walking out with 331m subsidised prescriptions. So onerous that vapers should have to go to such lengths.

They then retorted that the tiny range of allowed flavours were massively unappealing. They’d lost the parliamentary vote, but will never stop insisting that, unlike every inhalable drug in the global pharmacopeia where flavours have never been allowed for safety reasons, it’s just fine with vapes. It’s not OK to inhale flavouring chemicals in lifesaving therapeutics, but it’s quite OK to do that hundreds of times a day when you vape. Makes perfect sense eh?

The two main vaping advocacy groups, the Australian Tobacco Harm Reduction Association (ATHRA) and Legalise Vaping Australia both put up their white flags quietly and shut down. Those remaining are tiny inconsequential echo chambers.

But the recent focus on Australia’s massive illegal tobacco and vape trade has acted like smelling salts to a few punch drunk vaping advocates who were down on the canvas. They are now disporting themselves in new white hero hats holding aloft their messianic vision that the time is now right for the government to repeal its galactic folly on pharmacy-only vape access.

If vapes could be re-liberated from pharmacies and made available through all those highly responsible tobacconists, vape shops and convenience stores (who have never been known to break the law by selling illicit tobacco or selling to kids), many smokers who for the last 12 years have apparently never heard of vapes let alone tried them, would have the tape peeled from their eyes. En masse, they would discard their cheap cigarettes and storm into vape stockists. Smoking prevalence would drop like a stone.

There are a couple of teensy-weensy problems with these wide-eyed fantasies.

First, almost every illegal tobacco shop across the country – and there are thousands — is also stocking illegal vapes and have been doing so for at least four years. The vaping advocates’ dream is already a reality with a huge number of stockists and the cornucopia of flavours they lie awake dreaming of. This being the case, why then haven’t we already seen an avalanche of smokers switching to vapes? Shouldn’t we be seeing vaping going through the roof already?

Not quite.

Second, there are many countries where the very policies that these fantasists dream of are a reality, for many years. Vapes are freely available in much of Europe, across the USA, in Canada, the UK and New Zealand. And sorry to mention this, illegal tobacco also proliferates.

This being the case, it should be obvious that smoking prevalence in such nations should be embarrassing the socks off Australia, right?

Let’s then take a look at data in a range of countries around the time that Australia’s most recent national data on smoking and vaping was published (the next data will be ready by the end of 2026)

Source

It’s clear that New Zealand is an outlier here: the other comparator regions have similar smoking prevalence, with the Smoking Toolkit Study estimate for England being higher and that for Europe much higher. Similarly striking is Hong Kong: despite banning the sale and public personal possession of vapes, it has just reported a 2025 smoking prevalence of 8.5%, down from 9.1% in 2023.

With highly liberal vape retail access across the past decade occurring as much, if not more, in England, USA and Canada as in New Zealand, and smoking prevalence in all these nations declining, any putative causal generalisation about the downward effect on smoking of liberal versus restricted vape access as in Australia becomes immediately contentious. If liberal access to vaping sees smoking fall across populations, why are not all liberal access nations’ smoking rates much lower than Australia’s after at least a decade of widespread use and liberal access?

And then there’s this bell ringer. In nations where data are available, there are 45 nations which have smoking prevalence under 10%. Just one of these nations (New Zealand) has liberal vape access policy. The rest don’t. So much for the vaping theology that vaping is somehow necessary to reducing smoking to rock bottom.

Other blogs in this series