This cat’s nine lives 

 

When I turned 70 last month, several friends remarked over a drink that they felt it amazing we had all made it across these years in one piece. We swapped close-call stories. Here are mine. 

  1. Hepatitis A 

When I was 10 living in Bathurst, I became very ill. Our doctor came to the house and diagnosed hepatitis A. My urine was very dark, I vomited ferociously, felt more wretched  than I had ever experienced and was jaundiced. A boy at my primary school died from it. Our doctor told my distressed sister that I got it because I didn’t wash my hands after going to the toilet. He probably left out the part that the local town water supply was inadequately chlorinated. She developed compulsive handwashing for a few months. I found the taste of fat and cream repulsive for years afterwards and ever since have never enjoyed drinking too much alcohol. 

  1. Acute appendicitis 

When I was 13, my mother and sister went to England for three months on a ship. I stayed home with dad. One day he bought a huge bag of cherries home, a very rare treat. I ate lots, swallowing the pips so I didn’t need to interrupt the gorging. The next day I went to the school sick bay with bad pain in my guts. My appendix was removed the next day. I kept the morbid gray slug in a jar of formalin on my desk. It was filled with lumpy cherry seeds. Had it ruptured I may have got sepsis. But the good news is that I’m unlikely to ever get ulcerative colitis

  1. Fanging around Mount Panorama race track 

In late high school I had an older friend, Tony Mulvihill, who was three years my senior, an immense difference at that age which mesmerized me. He drove a grey Ford Anglia, a sedate vehicle mostly favoured as a second car by wives from the period to carry the shopping home. But Tony steadily souped it up. He had it lowered, fitted tramp rods, “fats” (wide wheels) with chrome go-domes, twin carbs and a sports muffler. Seat belts were not compulsory until 1971, and I don’t remember them in the Anglia. I’d often  join him for a thrash around the nearby Mount Panorama race track, something I didn’t tell my parents. One day he nearly lost control of it in the infamous “esses” at the top of the mountain. The car broadsided toward the crash barrier, but he gained control. While at school, I knew three kids who in died in road crashes. Tony went on to race Holden Commodores. I’ve never had so much as a rear-ender in 53 years of driving.

Ford Anglia
  1. Hitch-hiking 

When I came down to university in Sydney in late 1969, in the first year I several times caught the train to Penrith and then hitch-hiked to Bathurst to see mum and dad. I was picked up once by a Rolls Royce Silver Shadow. The lone driver had a thick eastern European accent. When he saw I was wearing a Vietnam war moratorium protest badge, he began haranguing me angrily about the evils of communism. He was shouting and menacing. With thoughts of him dispatching the long-haired commie scum beside him, I jumped out at a traffic light in one of the Blue Mountains towns. 

In 1973, I was hitching with my first wife Annie on a highway in Germany. We wanted to go to Koblenz to get a train to Cologne. Two Turks picked us up and we conversed in bad German about our destination. But they soon turned off the highway and drove us deep into the Black Forrest where eventually we came to a deserted brick factory. About 20 more Turkish men appeared in the upper floor windows. To read the full details of what then happened, go to page 29 (A bad end at Bad Ems) of this collection of short stories. 

  1. Motorbikes 

I owned three motorbikes in my early 20s, a Honda 90 step-through, a Honda Benley 125, and then, hey why not, a Triumph Thunderbird 650. I took a spill on the Thunderbird turning onto the Sydney Harbour Bridge off Falcon Street in the rain, the bike slid in the wet toward cars in the adjacent lane with me following behind donating skin to the road. Soon after I heard a road safety researcher on the radio say that the average motorbike commuter in Sydney could expect to be hospitalised  about once every 18 months. I decided that my motorcycling days were soon to end. One of the local motorcycle gangs kindly took my welfare into account and stole the bike from my Glebe backyard soon afterwards (full story from p12 in Undergraduate Housing

Triumph Thunderbird 1966

  1. England to Australia on the smell of an oily rag 

In 1973, I set off with my partner in penury to travel overland from England to Sydney. It was pre internet, pre credit card and pre mobile phones. We had our paltry cash in money belts around our waists. That would trick ‘em. We hitched to Brindisi in Italy, ferried across to Greece, then took local public transport to Calcutta where, riddled with diarrhoea, we took a junk charter flight to Perth and then tried to hitch across the Nullarbor to Sydney. From Turkey to India, and especially in Afghanistan, there was lawlessness everywhere. We saw fellow travelers raped by soldiers, junkies selling their blood and traveled in decrepit buses and cars that were death traps. But we made it. Full story at page 34, The life you (don’t) choose 

  1. Transporting bricks 

I needed to demolish a brick retaining wall in our garden. So I borrowed my brother-in-law’s box trailer and car with towbar. I stacked the bricks in the trailer, but then took a phone call where I needed to drive the car without the trailer to something that seemed more urgent. So the professor of public health set about unhitching the full trailer from the towbar. The huge weight of the bricks of course caused the back of the trailer to thunder to the road at the split second the towbar was uncoupled. This caused the triangular metal section that connects to the towbar to fly upward. It missed my jaw by millimeters and would have literally knocked my block off. 

Undeterred, and immediately wiser, I made a cup of tea and set about unloading the bricks from the trailer to enable me to re-couple it to the towbar. That accomplished, I refilled the trailer and set off on the 17km journey to a clean fill dump at Homebush Bay. Whistling dixie at my step-by-step progress through the day’s challenging tasks,  I was tootling along the M4 when the trailer full of god knows what massive weight of bricks began to fishtail the car. With an instant vision of the car flipping with the weight and the bricks’ momentum crashing them all on top of the car, I slowed the car like a conductor would direct a full symphony orchestra from the overture to the andante. The fishtailing stopped, the bricks were dropped off and I lived to tell the tale. 

  1. Falling off a ladder 

When your gutters need cleaning, what do you do? You get stuck in and climb up a ladder and clean them out.   The sad details about older men falling off ladders in Australia are here. So I got up onto the flat skillion back roof of the house, cleaned them out and then began to climb down. The ladder lurched to the side and I crashed to the ground, wrenching a leg in the rungs as I fell. I landed on the ground between the back of the house and the raised edge of a deck. Had I landed on the edge of the deck, I may have broken my back. A torn meniscus and a few weeks hobbling while it healed. 

  1. Missed  by a bus 

When my granddaughter was about six, I was driving her from her parents’ place in Rozelle  to our place. We traveled across the bridge that crosses over the goods rail lines between Lilyfield Road to the Western Distributor approaching the ANZAC Bridge. There was a red light as we got to the Distributor, with our car being first at the lights waiting for them to change to green. When the light changed I put the gearstick into first and proceeded. I’d gone a few meters into the intersection when from right, a large empty bus flew through the red light on the left inside lane nearest to me with no effort to brake. When he saw me, he swerved and braked to the right. He must have been doing at least 60kph and missed us by less than a metre. Had I been slightly more forward, the full impact would have happened in my driver’s door, the car flipped and both of us would have been almost certainly killed. 

So at 70, my charmed scorecard reads like this. Never broken a bone. Never been in an ambulance. Never been in a car crash. Never been caught in a rip.  Never attacked by a dog, bitten by a snake or venomous spider. Never even been stung by a bluebottle. Never had an adverse reaction to a drug. Never had cancer, heart trouble. Nothing. Lived a blessed life. Here’s to the next couple of decades. 

 

Vaping advocates say the darndest things: 12: Nicotine is not very addictive

Search Twitter or Google for “vaping not addictive” and you’ll find many examples. Of all the mega-galactic nonsense promoted by vaping advocates that I’ve covered in this blog (see list at end of this piece), this one surely takes the biscuit.

You’ll look hard for anyone with three digits of IQ who will tell you that nicotine isn’t addictive. Here are how nicotine compares with four other addictive substances (caffeine, heroin, cocaine, alcohol and marijuana (cannabis) according to leading nicotine scientists, Neal Benowitz and Jack Henningfield. Both rated nicotine #1 for dependency in an article in the New York Times where they rated each of these six drugs on a scale of 1 (most serious) to 6 (least serious)  for five criteria.

HENNINGFIELD RATINGS

Substance   Withdrawal Reinforcement Tolerance Dependence Intoxication

Nicotine                  3                       4                          2                  1                      5

Heroin                     2                       2                          1                  2                      2

Cocaine                   4                       1                          4                  3                      3

Alcohol                    1                       3                          3                  4                      1

Caffeine                   5                       6                          5                  5                      6

Marijuana               6                       5                          6                  6                      4

BENOWITZ RATINGS

Substance   Withdrawal Reinforcement Tolerance Dependence Intoxication

Nicotine                   3*                     4                         4                   1                       6

Heroin                      2                       2                         2                   2                       2

Cocaine                    3*                     1                         1                   3                       3

Alcohol                     1                       3                         4                   4                       1

Caffeine                   4                       5                         3                   5                       5

Marijuana                5                       6                         5                    6                       4

*equal ratings

In 2019 I marched with tens of thousands in Sydney’s school climate strike.  After leaving Sydney’s Domain, I found myself in the sardine-can stream of people exiting the park area, walking right behind a woman who was vaping. She vaped the entire 30 minutes or so it took to shuffle to where the crowd began to disperse. Watching her vape was astonishing. I didn’t have a stop watch, but I’d estimate she pulled on her vape every 20-30 seconds. Not addicted, just enjoying it, right?

I’ve just finished writing a 120,000w book called Quit Smoking Weapons of Mass Distraction which will be published this year by Sydney University Press. There’s a large chapter in it on vaping where one of the issues I look at is what the research literature says about how frequently vapers like the woman in front of me fill their lungs with propylene glycol, nicotine, flavouring chemicals, and some 2,000 mostly unidentified chemicals all vaporised from the liquid that is heated by the metal coil heated by the e-cigarette battery.  Here are some excerpts.

A 2020 study monitoring vaping found those who were exclusive vapers pulled this cocktail deep into their lungs from point blank range on average 173 times a day — 63,188 times a year (173 x 365.25). Those who were dual users (i.e. who vaped but still smoked) basted their lungs 72 times a day with their e-cigarettes in addition to the smoke from their smoking. Another study found the average daily number of puffs taken was 200, with a range up to 611.   A third study, where researchers observed vapers using their normal vaping equipment ad libitum for 90 minutes, reported the median number of puffs taken over 90 mins was 71 (i.e. 0.78 puffs per minute or 47.3 per hour). (St Helen, Ross et al. 2016) If a person vaped for 12 hours a day at that rate, this would translate to 568 puffs across a 12 hour day or 207,462 times in a year.

We can contrast the counts above with the number of puffs today’s average 12 cigarettes-a- day smoker inhales. One study observing puff frequency in those smoking in social settings recorded an average of 8.7 puffs per cigarette with an average 38.6 second gap between puffs.  At 12 cigarettes a day, this would translate to 104 puffs per day or 38,106 per year.

So vapers’ puffing compared to smoking occurs at an almost frantic rate, making a mockery of the bizarre, die-in-a-ditch denialism often seen in vaping chat rooms insisting that vaped nicotine is not addictive.

Other blogs in this series 

Vaping advocates say the darndest things 1: The Cancer Council Australia takes huge donations from cigarette retailers. WordPress  30 Jul, 2020

Vaping advocates say the darndest things 2: Tobacco control advocates help Big Tobacco. WordPress 12 Aug, 2020

Vaping advocates say the darndest things 3: Australia’s prescribed vaping model “privileges” Big Tobacco Feb 15, 2020

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

Vaping advocates say the darndest things 5: I take money from China and Bloomberg to conduct bogus studies. WordPress 6 Mar, 2021

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

Vaping advocates say the darndest things 7: Vaping prohibitionists have been punished, hurt, suffered and damaged by Big Tobacco WordPress 2 Jun, 2021

Vaping advocates say the darndest things 8: I hide behind troll account. WordPress 29 Jun, 2021

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

Vaping advocates says the darndest things: 10: Almost all young people who vape regularly are already smokers before they tried vaping. WordPress 10 Sep, 2021

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

Should COVID vaccine refusniks now be restricted and fined?

With 90.42% of Australians aged 16 and over being double vaccinated as of today and the omicron variant surging, many of us are recalibrating how we should run our lives over the next months.  In my family’s case, a fully vaxed daughter-in-law is being torn in half about whether she should use the ticket she’s bought to fly home to see her 80 year old father after 5 years. What if she picks it up in transit and gives it to him? What if Australia closes our borders with the UK and she can’t return home for many months to her young family and job?

We’re triple vaxed, but across the next month have a theatre ticket, two indoor Sydney Festival concerts, three dinner invitations and a Christmas lunch where there will be nine booster-vaxed adults and two unvaccinated primary school kids.

We’ve all agreed to do rapid antigen tests on Christmas morning, but at $15 a pop, this is unlikely to be an option taken up many on low incomes. But what about the rest of our plans while it’s surging? I’m having lots of conversations with people who have decided to personally lock down, not going out to public venues to eat or drink. If this is a widespread sentiment, many businesses will again suffer further and some may close for good.

With NSW and Victoria now seeing record new daily diagnoses, even small fractions of these needing hospital and intensive care may see health care workers in ambulances and hospitals face potential bursting point admissions, at a time when there are staff shortages. This viral tweet from yesterday sums up the ethical pointy end of it:

There is no debating that those who are unvaccinated are at much higher risk of acquiring COVID-19 and therefore of passing it to others, both unvaccinated and vaccinated (because no vaccine confers 100% immunity to all and the dynamics of the omicron variant’s infectious footprint is still far from being understood). An unvaccinated person is around 20 times more likely to infect you than someone who is vaccinated, according to University of Melbourne modellers.

Every expert, and all but the most demented of our politicians, continually implore those who are not yet vaxed to get jabbed. So it’s here that we get to questions of what should be done about all those who continually refuse, sometimes very vocally, to do so. And some of these questions throw up some seriously naïve suggestions.

I’ve heard some commentators talk about how we need “to try to better understand where vaccine refusers are coming from”, presumably so that we can “reach out” to them. There are many stories about a confused uncle who went and got vaxed after a fundamental misconception was patiently explained to them, or reclusive neighbour who just needed a nurse to come to them.  Vaccine hesitancy may well erode with careful, respectful and sensitive communication often to people who are poorly informed about what vaccination is and how it works. But vaccine refusal is a different beast altogether.

Reaching out …

93.8% of Australians have had at least one jab. This means there are 1.274m Australians aged 16 and over who have still not had a single shot. Clearly there are large number of these who are determined people, proud of refusing to be vaxed, who do not believe they pose a danger to the community and will resist any attempt at being persuaded to do so.

Civil societies make many laws and regulations to protect people, businesses and corporations from conduct that poses serious risks to others. Road rules; food and pharmaceutical safety; and vehicle, occupational health, building, and consumer product safety standards are some of the areas where many rules govern individual and business behaviours. Here’s a list I complied in 2013 of 150 ways that health laws and regulations protect a population’s health.

Examples of zero tolerance for those who endanger lives

We have zero tolerance for those who say “I know I can drive perfectly well, when I’m over the blood alcohol limit” or “I know I pose no risk at all to anyone by having banned semi-automatic firearms in my house. I don’t believe in gun laws”, “I don’t believe in the nanny state, so I won’t comply with a fence around my swimming pool” or “Allowing the sewage from my caravan park or toxic waste from my factory to drain into a nearby river is fine … it’s a very big river”. We do not decide that we should all be comfortable with those who tell us they have studied the risks and are making informed decisions here. Instead, we see them as self-absorbed dangers to the community who fully deserve the harsh penalties they often get.

So by what bizarre public ethics reasoning do we even begin to argue that we should accommodate those who want to live and freely move around unvaccinated and unmasked in communities and have the gall to argue that we should all feel fine about them putting the rest of us at risk, ruining businesses etc? And let’s say it, being vectors for spreading a disease which has so far killed 5.34 million.

Reintroduction of threats of being refused entry to cinemas, restaurants, pubs and shopping malls today will not persuade any vaccine refuser. We have all by now experienced perfunctory or totally absent verification of vaccination status at many such venues. I have shown my vaccine certificate many times and not once did anyone ever read it carefully or ask me to show photo ID to confirm that the certificate I flashed was actually mine. And that’s before we even get to questions about how anyone with rudimentary computer skills could knock up a fake certificate, screen shot it, and show it whenever asked.

Here’s what other nations are doing. Germany is shaping to make it compulsory. Greece is fining those each month who refuse. The vaccination status and address of every Australian with a Medicare card is known. The government can therefore pinpoint with great accuracy all those who are unvaccinated. Persuasion under threat of significant fines can be precisely targeted. Those with verifiable health exemptions and who were only hesitant out of confusion and willing to get vaccinated, would be OK. But ideological refusers can wear their convictions with movement restrictions and fines, just like others who decide to endanger us all do.

Scott Morrison says that he wants COVID restrictions banished to “give us back our freedoms”. Zero tolerance for refusing vaccination would do just that.

Former NSW Premier and Labor Foreign Minister Bob Carr has urged the government to follow Singapore’s lead by charging unvaccinated people for any COVID19 related health care. Scott Morrison, in words that would be cheered at any QAnon anti-vax rally, commented that anti-vaxers should not be demonised for making “their own choices”.

The next time a drunk driver slams into pedestrians, let’s see how that defence goes down in court.

A Sydney Film Festival MUST SEE: The Rumba Kings

Directed by Alan Brain (2021) 94m

Screening at The Sydney Film Festival and on demand. Dates here

Trailer

Facebook and website

Interview with director by Banning Eyer

Anyone with even a passing familiarity with world music knows about the unstoppable global impact of American blues, Jamaican reggae, and Cuban rumba, son and danzon.  Muddy Waters and other Chicago blues legends, Bob Marley and the multiple tentacles that spread from the 1996 Buena Vista Social Club documentary and albums all have found their way into millions of homes.

But far fewer are familiar with African music beyond Paul Simon’s huge global leg-up to South African township jive with the 1986 Graceland album, Senegal’s Youssou Ndour’s world hit 7 Seconds Away with Nenah Cherry (1994) and perhaps Guinea’s Mory Kante 1986 monster dancefloor hit Yé ké yé ké.

Most people I know, including those with  eclectic musical tastes, could not name a single musician or band from the Congo. But across much of African, Congolese rumba and its faster variant soukous are peerless as a kind of pan-African musica franca. No form of African music other than Congolese rumba has permeated the night clubs and bars of francophone west Africa and beyond. I’ve seen Congolese bands in Harare, Kampala and Nairobi. But in the west it remains marginalised in world music festivals and rarely if ever played on mainstream radio.

I’ve been obsessed with west African jazz since seeing Sam Mangwana and the African Allstars in London in 1984. It was simply a life changing experience that over the next four decades saw me seek out and buy many 100s of albums and spend hours in the African quarters of every city I visited in Europe and north America searching for hard to find albums.

Alan Brain’s documentary is a glorious experience, a testimony to his vast access to extraordinary archival photography and footage of Congolese musicians from a four year period living in the Congo. Much of it is told directly by surviving and recently deceased musicians from the golden era of rumba (1950s-1980s) around which the film is concentrated.

Belgium’s King Leopold II achieved recognition for the Congo Free State in 1885, turning it into the Belgian Congo in 1908. Congolese were treated like slaves by the colonialists and the film has wrenching material showing this oppression. Music emerged as a salve for many Congolese. The Belgians broadcast news through loudspeakers in the streets, but also played music. This drew crowds and foreign music infected an appetite for the new sounds in many Congolese. Cuban rumba records were first brought to the country by merchant sailors from the 1930sand became very popular in Kinshasa. Greek and Jewish entrepreneurs tapped the vast interest in the music and film shows several examples of Congolese singers and musicians from the 1940s who developed followings.

Three pioneering giants, singer and bandleader of African Jazz Joseph Kabasele (le Grand Kallé), the guitarists “Dr Nico” Kasanda and the incomparable Franco Makiadi Luambo are profiled, with superb guided explanations of their innovations. Franco led TPOK Jazz from 1956 to his death in 1989 and released 84 original albums and many more compilations, with one estimate being that across his 40 year career he averaged  releasing “two songs a week … which ultimately comprised a catalogue of some 1000 songs”

Western guitar-based music centres around two guitars, lead and rhythm. There’s a spell-blinding scene where three guitarists demonstrate the unique third or mi-solo guitar role in Congolese rumba. There are also several street performances from veteran musicians including a sublime song filmed on a river boat.

Over and again, those interviewed explain the way in which the Congolese infatuation with music lifted spirits and national pride particularly after independence in 1960. My first taste of  Congolese music has never left me. This potent film seems likely to drive a lot of interest in this often mesmerising music.

Recommended reading & my Spotify Best African playlist (573 tracks)

Graeme Ewens. Luambo Franco and 30 years of OK Jazz 1956-1986. A history and discography. (1986) Off the Record Press: London 64pp

Ronnie Graham. Stern’s guide to contemporary African music. (1988) Zwan: London. 315pp

Ronnie Graham. The world of African music. Vol 2 (1992) Pluto Press: London 235pp

Graeme Ewens. Congo colossus. The life and legacy of Franco & OK Jazz. (1994) Buku Press: North Walsham 320pp

Gary Stewart. Rumba on the river. A history of the popular music of the two Congos.(2000) Verso: London 435pp

Vaping advocates say the darndest things 11: the sky is about to fall in as nicotine vaping starts to require a prescription in Australia

Irrepressible vaping advocates Colin Mendelsohn and Alex Wodak were at it again in the Sydney Morning Herald yesterday with their usual litany of gloom about the apocalypse that starts from Oct 1 when anyone wanting to legally vape nicotine will need to have a prescription authorising purchase or imports.

Vaping advocates have had 15 months to spruik their message about the scheme to Australia’s 23,000 practising GPs, but have often lamented that only a handful have been willing to issue prescriptions, an option that has been allowed for several years already.

So how has it happened that nearly 100% of Australian GPs have apparently decided that prescribing vaping was not such a good idea? What do they know that our good doctors don’t? Perhaps they’ve read some of the 16 reviews and major cohort studies published since 2017 that say the evidence for vaping being good for quitting smoking is poor? Or one of the many reviews of cardio-respiratory disease markers that point to very worrying developments? (eg here, here, here)

Political support for vaping has always been dominated in Australia by the extreme right of politics. The 28 MPs who signed the Matt Canavan initiated letter included a who’s who of deep political conservatism, climate science denialism, sports rort facilitation and ex-Institute of  Public Affairs staffers.  Here’s the letter the 28 sent to Greg Hunt.

The Nationals received $55,000 from Philip Morris as “gold” level support in 2019-20. Money well spent!

Mendelsohn and Wodak suggest Australian politicians should be quaking about the uprising of angry vapers coming down the tracks, 3500 in every seat, who may tip out sitting members at the next election. That threat has worked so well in the past when at various elections the now fully politically plucked Liberal Democrats told vaping voters they would fix things for them. So who will these angry voters turn to? Not the LNP, who have given them the loathsome prescription scheme. Not Labor or the Greens who support it. Maybe One Nation? That seems like a plan.

British American Tobacco Australia’s lobbyist Michael Kauter (second from left) with Pauline Hanson

Australia might have 600,000 vapers now, they say. Of course no source is given for that nice fat number. It’s 80,000 above the 2019 National Drug Strategy Household Survey figure for the number of Australians who were “currently” vaping then. That “current” number included those who vaped less than monthly, so was about as meaningful as saying that we should count “current” French champagne drinkers as everyone who has as much as one glass in the last year.

There are 2.9 million Australians who smoke at all, with 2.3 million smoking daily. If, switching to vaping is the factor driving down smoking rates faster in the US and UK than in Australia, and our two numbers men say we might have 600,000 who vape today, then that’s a 21% fall in smoking prevalence they might predict when the next national survey is due next year. Nothing remotely like that has ever been recorded.

Of course this utterly fanciful stuff isn’t going to happen and it’s not happening in the UK or the USA where the evidence is that most vapers keep smoking and have higher rates of relapse back to smoking than quitters who don’t vape.

A 2019 US PATH longitudinal paper reported that former smokers who had quit a long time ago but who vaped were far more likely than those who had never vaped to relapse back to smoking and that vapers were far more likely than those who had never vaped to have transitioned from being never smokers to smokers:

“Distant former combustible cigarette smokers who reported e-cigarette past 30-day use (9.3%) and ever use (6.7%) were significantly more likely than those who had never used e-cigarettes (1.3%) to have relapsed to current combustible cigarette smoking at follow-up (P < .001). Never smokers who reported e-cigarette past 30-day use (25.6%) and ever use (13.9%) were significantly more likely than those who had never used e-cigarettes (2.1%) to have initiated combustible cigarette smoking (P < .001). Adults who reported past 30-day e-cigarette use (7.0%) and ever e-cigarette use (1.7%) were more likely than those who had never used e-cigarettes (0.3%) to have transitioned from never smokers to current combustible cigarette smokers (P < .001). E-cigarette use predicted combustible cigarette smoking in multivariable analyses controlling for covariates.

A 2020 paper from the ITC four country (Australia, USA, UK, Canada) survey found that after 18 months:

“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, and perhaps current vaping tools at best bring the likelihood of quitting up to comparable levels of less dependent smokers. The findings of our international study are consistent with the findings of the US PATH transition studies, and other observational studies, in that most smokers remain in a persistent state of cigarette use across time, particularly the daily smokers.

But cigarettes don’t need a prescription!

Mendelsohn and Wodak reel off the argument that cigarettes are sold freely from 20,000 retail outlets while nicotine vapes require a prescription. How wrong is this, they ask. As I argued here, every conceivable error was made in allowing tobacco products to be sold freely from the nineteenth century onward. We’ve been pulling political teeth since the 1970s to win the suite of policy and legislation that today sees tobacco highly taxed, plain packaging, a total advertising and sponsorship ban, graphic health warnings, personal import bans, a duty free limit of one pack, universal smokefree legislation and the lowest adult and youth smoking rates ever recorded.

I do not recall either of them playing any role in the struggles for that. And I must have missed them editorialising for a ban on the sale of cigarettes.

The prescription model will allow adults who want to vape nicotine to do so, but will make it so much harder for kids to buy these products from vape shops and convenience stores where selling will attract huge fines.

The $220,000 fines for possession or importing without a prescription will of course never be applied to an individual vaper but are set as a maximum for industrial level importing and illegal sales, just as they would be for criminals importing commercial quantities of tax- evading tobacco or prescribable opiates. Without such serious deterrents, many would take their chances with getting a wrist-slap level fine.

The Herald’s sub-editor who captioned the photograph below accompanying their article got it very right, writing “Vaping can help accelerate smoking levels”. Every tobacco company in Australia is strongly opposed to the TGA’s prescription approach. That ought to tell us all we need to know.

Vaping advocates say the darndest things 10: “almost all young people who vape regularly are already smokers before they tried vaping”

On September 3, 2021 the very busy vaping advocate Dr Colin Mendelsohn published a blog on his website where he critiqued a large report in the Sydney Morning Herald on the inundation of disposable flavoured nicotine vaping products into Australia.  Early in his blog, Mendelsohn made three statements about the prevalence of vaping in underage, young people.

1.“Official government figures show that underage vaping is rare in Australia, and frequent vaping is very rare. Less than two per cent of Australian teenagers vaped in 2019 and more than 90% had never tried vaping. News reports suggest vaping has increased since then but we have no data to confirm that, just ‘anecdotal’ reports.”

2. “What the article didn’t say is that almost all young people who vape regularly are already smokers before they tried vaping.”

3. “They also forgot to mention that most vaping is infrequent and short-term and one in three young vapers do it only once or twice.”

In his blog, Mendelsohn switches between two data sources, the National Drug Strategy Household Survey (NDSHS), conducted in 2019 and published in July 2020, and the Australian Secondary Students’ Alcohol and Drug (ASSAD) survey, conducted two years earlier in 2017.

Let’s look closely at how his statements align with what the two reports actually say.

Statement 1: Less than 2% of Australian teenagers vaped in 2019

Here, he links to the 2019 NDSHS as his source. There are 17 data tables on vaping in Australia at the NDSHS link. Table 2.19 shows any lifetime vaping (ie even experimental puffs) for 14-17 years olds at 9.6% and Table 2.24 that current use is 1.8%, a doubling since 2016.

Statement 2: That “almost all young people who vape regularly are already smokers before they tried vaping”

Here Mendelsohn linked the 2017 ASSAD schools survey to support his statement. But the ASSAD report states “Of the students who had ever used an e-cigarette (n = 2,403), 48% reported that they had never smoked a tobacco cigarette before their first vape”.

We can also look at the NDSHS data on this issue. Table 2.27 shows that 64.5% of 14-17 year olds who had vaped were never smokers when they initiated use of e-cigarettes.

So Mendelsohn is very wrong here regardless of which data set he might have chosen to support his assertion.

Statement 3: “most vaping is infrequent and short-term and one in three young vapers do it only once or twice.”

Mendelsohn again links to the NDSHS data to support this statement. Here it seems likely that he used Table 2.28 for support here because the “big” numbers in the table for  “I only tried them once or twice” appear consistent with his claims. However it should be noted that Table 2.28 has no data specific to  teenagers; it relates to all users aged “14 and over”. The definition of ‘current smoker’ used in this table includes ‘social smoker’ and ‘occasional smoker’ as well as ‘regular smoker’. This is important because some of the people included in that column may be young people who had only experimented with smoking in a very limited way. Relevant here, the ASSAD report found that “Of the students who had smoked before they tried e-cigarettes, 20% had only smoked a few puffs of a cigarette, 11% had smoked fewer than 10 cigarettes”.

The ASSAD report found:

  • that for all 12 to 17 year old students overall in 2017, around 14%  indicated they had ever used an e-cigarette at least once, and 32% of these students had used one in the past month (Tables 3.11 and  3.12)

  • Of those who had tried e-cigarettes, younger students were more likely to have used them recently. Around 37% of 12 to 15 year old users and 27% of 16 and 17 year old users reported vaping at least once during the past month. Younger vapers were also more likely to have used e-cigarettes at least three times in the past month (12-15: 16%; 16-17: 10%).”
  • “Around 12% of students reported buying an e-cigarette themselves.”

The huge inundation of disposable flavoured vapes into Australia rapidly accelerated from mid-2020 and therefore are not reflected in the 2019 NDSHS data let alone the 2017 ASSAD data. If you Google “vaping in schools”, there are many reports of what Mendelsohn dismisses as anecdotes from school principals, teachers and parent, nearly all expressing alarm at the obvious surge in teenage vaping.

More blogs in this series:

Vaping advocates say the darndest things 1: The Cancer Council Australia takes huge donations from cigarette retailers. WordPress  30 Jul, 2020

Vaping advocates say the darndest things 2: Tobacco control advocates help Big Tobacco. WordPress 12 Aug, 2020

Vaping advocates say the darndest things 3: Australia’s prescribed vaping model “privileges” Big Tobacco Feb 15, 2020

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

Vaping advocates say the darndest things 5: I take money from China and Bloomberg to conduct bogus studies. WordPress 6 Mar, 2021

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

Vaping advocates say the darndest things 7: Vaping prohibitionists have been punished, hurt, suffered and damaged by Big Tobacco WordPress 2 Jun, 2021

Vaping advocates say the darndest things 8: I hide behind troll account. WordPress 29 Jun, 2021

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

Vaping advocates say the darndest things 9: “Won’t someone please think of the children!”

Last Friday I went to my local supermarket. Behind the checkout and below the closed cabinet where tobacco products have been legislated to be kept out of sight in NSW since 2008 was a clearly visible large stack of disposable flavoured vapes on sale. The sale of vaping products containing nicotine is illegal in NSW. I reported what I had seen to NSW Health’s on-line reporting page and posted on my local Facebook community page about it, providing the link for others.

The next  morning I read two posts saying that the vapes on sale were nicotine free. I then posted a link to this Australian study which showed that 60% of vape products sold as not containing nicotine in fact did contain it. Vaping products on sale in Australia are not subject to any regulatory oversight and could contain any substance or chemical compound other than proscribed illicit substances. Ingredient labelling is scant to non-existent and not legislated.

A self-described “fiercely passionate advocate for vaping” then chimed in, telling me without explaining why in even a single word that I was “wrong”, that I “don’t understand what [I’m] talking about”. He also wrote this: “They sell cigarettes in the shops too!!!!!!!!! Won’t someone please think of the children”. His Facebook photo showed him with three children.

Probably filched from Lovejoy’s Law after Helen Lovejoy in the Simpsons “Won’t someone please think of the children” has long been a meme beloved by vaping advocates. Redolent of  the curmudgeonly misanthrope W.C. Fields who made a virtue out of loathing children (“Children should neither be seen or heard from – ever again”) vapers who think they are on a persuasive winner here seem to be beyond clueless about how hugely self-absorbed this makes them sound.

What we all are supposed to understand by “Won’t someone please think of the children” is of course that no-one should ever think of the children. Moreover, there should be a plague put on the houses of anyone who dares to propose any policy, law or regulation which ever in the slightest way puts the interests of children in the path of adult vapers’ interests.

When it’s pointed out that the sickly sweet flavours that are popular with kids are also popular with some adults, we see a parade of special pleading from kidults explaining that they routinely buy sickly sweet alcopops too, furtively sneak bags of sweeties at 5 year olds birthday parties, and have no objection to cuddly animated cartoon characters promoting vapes because, hey, they think they are cute too.  There’s actually no pitch or appeal that could ever be said to be directed at children, because if even one adult vaper puts their hand up as being excited about (for example) the Tuck Shop range of flavours, that’s all that should matter.

Way back in 1980, Rothmans argued that Paul Hogan who fronted Winfield advertising could not be said to be in breach of the then self-regulatory code of tobacco advertising which did not allow anyone to advertise tobacco who had “major appeal to children”. Hogan appealed to adults too, they argued, so let us keep using him alone. That argument went down like a lead balloon with Sir Richard Kirby, who ruled that Hogan could no longer be used.

Vaping advocates, just like tobacco companies have done for 40 years, have perfected a public discourse routine that runs like this:

  1. Vaping is all but totally harmless and fantastically effective at helping smokers quit

Comment: Actually, every review that has ever looked at the evidence about possible harms from vaping  has concluded that we have no evidence about the long term health effects of vaping, just as we had no evidence for the massive harms caused by smoking for several decades after cigarette smoking became hugely widespread. And plenty of evidence on harm is already rolling in (see examples here). There have also been 14 reviews of the evidence for the effectiveness of vaping in smoking cessation published since 2017 which have rated  the evidence as low or poor.

2. The full range of flavours should be available to any vaper as these will help keep people vaping, which is a good thing.

Comment: The US Food and Drug Administration in late August 2021 took a decidedly different view of the risk-benefit balance when it came to flavoured vapes. Announcing that it had issued marketing denial orders over 55,000 flavoured vaping products submitted by three manufacturers it said the applications “lacked sufficient evidence that they have a benefit to adult smokers sufficient to overcome the public health threat posed by the well-documented, alarming levels of youth use of such products.”

3. As highly responsible people and companies, we certainly do not want to see children take up vaping

Comment: Again, this has been a mantra drilled into every tobacco industry employee for 40-50 years, but one that of course is beyond laughable when considered against the weight of a huge number of internal industry documents showing an acute, furiously salivating interest in as many children smoking as possible to replace quitting and dead smokers

4. For those who worry about kids vaping, we can recommend a range of measures that promise to be highly effective in stopping kids from vaping while not in any way inhibiting adults from accessing vapes.

Comment: This is where it all gets very funny, with chirpy, vague and profoundly naïve or disingenuous allusions to advertising that can be somehow only be seen by adults but not children; “crackdowns” on shops which sell to kids which will be as effective as all those crackdowns which stopped cigarettes being sold to kids … oh wait; and placement of those astonishingly effective signs in shops which say that vaping products will only be sold to adults. Such a pity that many shopkeepers cannot read the same signs in their own shops

5. But if some kids very unfortunately do vape, then this is far preferable to them taking up smoking, and seeing that we have already argued that vaping is almost entirely harmless anyway, there’s no big deal if kids do vape.

In the last months the Australian news media has been dominated with massive concern about the vulnerability of COVID-19 unvaccinated children. Predators on children are reviled and parents who neglect or harm  their children can have them removed by the state. Against that background, some in the vaping fraternity think sneering sarcasm about concern for children’s health will win them respect. Google “vaping” + “Won’t someone please think of the children” and be deluged with how widespread this  all-about-me meme has become.

In 45 years in tobacco control I don’t ever recall even the most frothing pro-smoker ever saying that they hoped their children would take up smoking. Ninety percent of smokers regret ever starting and the average smoker at 40 will have made about 40 attempts to quit smoking. 

A very recent paper in Addiction looked at adolescent electronic cigarette use and tobacco smoking in the UK’s huge Millennium Cohort Study. It concluded “Among youth who had not smoked tobacco by age 14 (n = 9046), 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.“ 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 trainer wheels for smoking take-up in later years in kids.

Vaping advocates  believe they are on a mission from God to save lives. This allows then to argue that, unlike all pharmaceuticals, foods, beverages, and cosmetics which are subject to standards and regulations, vapes are above regulation.  While quacks claiming that some magic potion can prevent cancer, asthma, COVID-19 or AIDS would be quickly prosecuted for making such claims, vaping manufacturers and advocates endlessly make therapeutic claims for the effectiveness and safety of vaping. The prevalent  smarmy indifference to vaping by kids needs to be called out whenever it occurs.

Other blogs in this series:

Vaping advocates say the darndest things 1: The Cancer Council Australia takes huge donations from cigarette retailers. WordPress  30 Jul, 2020

Vaping advocates say the darndest things 2: Tobacco control advocates help Big Tobacco. WordPress 12 Aug, 2020

Vaping advocates say the darndest things 3: Australia’s prescribed vaping model “privileges” Big Tobacco Feb 15, 2020

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

Vaping advocates say the darndest things 5: I take money from China and Bloomberg to conduct bogus studies. WordPress 6 Mar, 2021

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

Vaping advocates say the darndest things 7: Vaping prohibitionists have been punished, hurt, suffered and damaged by Big Tobacco WordPress 2 Jun, 2021

Vaping advocates say the darndest things 8: I hide behind troll account. WordPress 29 Jun, 2021

Vaping advocates say the darndest things 10: “Almost all young people who vape regularly are already smokers before they tried vaping” WordPress 10 Sept, 2021

1 in 7 Australians still plan not to vaccinate: time to erode this with tough campaigning

This week’s Guardian Essential Poll had some very disturbing news for all of us hoping that Australia will pull itself out of the basement of nations with high COVID-19 full vaccination levels. Just under half of respondents to the poll  (47%) said they would be willing to get the Pfizer jab but not AstraZeneca. Another while 24% are willing to get either, and only 3% are willing to get the AstraZeneca vaccine but not Pfizer. But here’s the clanger: 14% — 1 in 7 of us — remain resolved that they won’t be getting either.

With paediatric vaccinations, today we have national complete immunisation rates at 92.% for 2 year olds and 95.2% for 5 year olds. These are the rates that should be also possible for COVID-19.

These spectacularly good rates rates are a function of blanket vaccine availability and decades of targeted efforts to reduce a multitude of cultural, geographic and educational barriers. But they also reflect decades of efforts by many of the infectious disease epidemiologists, psychologists and educators who have become household names through their daily TV and radio presence since the pandemic broke in March 2020. Many of these people have spent years raising public awareness of the benefits of vaccination, putting the very small risks that exist into perspective and discrediting misinformation spread by dedicated anti-vaccination fruitcakes.

What sort of messaging cuts through most?

Australia has long been a world leader in public awareness campaigning across a wide range of health issues. I worked on Australia’s first major mass reach, well-funded health warning campaign, Quit. For Life (1980-82).  We ran ads like these, the most famous being the Sponge ad made by Sydney advertising director John Bevins, where a hand wrung out a sponge oozing with black tar into a beaker with the explanation that this was this was the amount of tar that the average smoker pulled through the filter into their lungs in a year. The quitline rang off the hook.

These ads worked wonders. In Sydney where the ads were run, 23% of a cohort who were followed up 12 months later had quit compared with just 9% in Melbourne where the campaign was not being run.

The Every Cigarette is Doing You Damage campaign (started in 1997) with its unforgettable ad showing white, gelatinous atheroma (plaque) being squeezed from an aorta turbo-charged the downward fall in smoking.  Research trialing various candidates for graphic health warnings on packs rapidly discovered that cheery positive messages about not smoking being wonderful, sporty and healthy rarely cut it while tough, unforgettable realism did. And remember actor Yul Brynner spoke from his grave after dying from smoking caused lung cancer saying “now that I’m gone, I tell you don’t smoke”?

Professor Melanie Wakefield’s group from the Cancer Council Victoria is a global leader in health campaign evaluation and strategic research for campaign development in health. An evaluation of the impact of different styles of Australian quit smoking advertisements looked at the differential impact of ads predominantly evoking fear, sadness, hope, or evoking multiple negative emotions (i.e., fear, guilt, and/or sadness).

Their 2018 paper concluded “Greater exposure to hope-evoking advertisements enhanced effects of fear-evoking advertisements among those in higher SES, but not lower SES areas. Findings suggest to be maximally effective across the whole population avoid messages evoking sadness and use messages eliciting fear. If the aim is to specifically motivate those living in lower SES areas where smoking rates are higher, multiple negative emotion messages, but not hope-evoking messages, may also be effective.”

The pioneering anti-smoking ads were the vanguard for several decades of gloves-off, see-once-and-never-forget campaigns in Australia. Millions of saw and have never forgotten the HIV/AIDS Grim Reaper ad (1987), hot-wiring demand for condom use in causal encounters ever since.  Road safety campaigns in several states showed the carnage of  drink driver and speed. Examples were vignettes of grieving drivers after realising they’d killed someone and exploding dropped watermelons simulating massive head injury from a head going through a windscreen. Annual NSW road fatalities per 100,000 population fell from 28.9 in 1970 to 4.4 in 2019. Each new policy introduced was accompanied by often hard-hitting warning campaigns.

There have been highly memorable campaigns about melanoma and sun tanning, preventing scalding in kids from boiling pots on stoves, wearing bicycle helmets and fire prevention, to name a few.

Old school experimental psychologists have tut-tutted for years about all of this, clutching onto a faded dogma dating from studies of dental education from the 1950s where showing pictures of decayed teeth to students made no difference to their brushing behaviour. But meanwhile,  ask any ex-smoker why they stopped and there is daylight between their number one reason (worry about health consequences) and whatever else is in second place.

A 2016 meta-analysis of  research on the use of fear and scare concluded “Overall, we conclude that (a) fear appeals are effective at positively influencing attitude, intentions, and behaviors, (b) there are very few circumstances under which they are not effective, and (c) there are no identified circumstances under which they backfire and lead to undesirable outcomes.”

So what have governments learned from all this in Australia with COVID-19 in 2021? Instead of massive national campaigning, we’ve seen dreary memos-to-the-public style ads advising that COVID is highly infectious and deadly, and that vaccination is very important. These are in scintillating writing, with all the magnetism of wallpaper and bring messages that you would needed to have been asleep in a cave on Mars for 18 months to have never heard.

We also had an actress rigged up on a ventilator gasping for breath in a bed. This drew instant criticism from critical care clinicians who were angry at the implication that patients in hospitals would be lying in terror without being intubated and sedated. The ad seems to have quickly disappeared, thankfully. This was an object lesson in how not to use scare in persuasion.

The recent momentum toward COVID-19 vaccination passports is very welcome. While there are many who never plan to travel overseas and rarely go to the cinema or restaurants, if app-based passports are required to get into shops, bars, football games, the TAB and the rest this will doubtless drag many vaccine refusniks to get jabbed.

Please, let’s get serious and see some significant government investment in developing messaging that will erode vaccination apathy and hestitancy, and bolster public momentum toward zero tolerance for those too self-absorbed to play their part in ending lockdown and reducing death and serious illness from this pandemic   We did it for drink driving. We did it for indoor smoking. We can do it for COVID-19.

See also:

Is it unethical to use fear in public health campaigns? WordPress 11 Aug 2018

Should those avoiding AstraZeneca vaccination because of the clotting risk also avoid having an anaesthetic? WordPress Jun, 2021

Eight common excuses for not being COVID-19 vaccinated and what you can say that might help. WordPress 27 May, 2021

With the risks of AstraZeneca blood clots being tiny, what explains COVID19 vaccine hesitancy? WordPress 23 May, 2021

A reverse white feather? Let all who are COVID19 vaccinated wear a badge proclaiming and normalising it. WordPress 21 May, 2021

The ethics of shaming prominent COVID-19 mask opponents. WordPress 26 Jul 2020.

How can we erode self-exempting beliefs about COVID-19 contagion and isolation that might subvert flattening the curve. WordPress Apr 19, 2020.