China bans vape flavours, requires its exporters to “comply with the regulations of the destination country”

In 1992, I spoke at what was then the largest conference ever held in Africa on tobacco control. Delegates from 16 nations met in  Harare, Zimbabwe to discuss policies that could reduce tobacco use across the continent.

Zimbabwe’s health minister Dr Timothy Stamps’ talk was met with incredulity when he  commented that Zimbabwe’s huge export earnings from tobacco leaf was not inconsistent with the country’s own efforts to reduce smoking among its own people. Local lung cancer was bad, but OK elsewhere seemed to be the message.

I was reminded of this when reading official Chinese government communiques on its current internal efforts to reduce the appeal of vaping for Chinese citizens and its policies about controlling exports from Chinese vaping manufacturers to nations which have banned or strictly controlled vapes. Unlike Zimbabwe in the early ‘90s, China’s internal and export policies are consistent.

First, some context.

The major source of the tsunami of illegal nicotine vapes flooding Australia is China. The flood is dominated by cheap disposable vapes, hugely attractive to children. They are priced to make them highly accessible to anyone on a low income, including kids. With illegal importers able to buy single vapes providing up to 7000 puffs  in bulk amounts for as low as $1, and on-sell them for $15-30, massive profits can be made. They are mostly brought in by importers willing to buy in large volumes for wholesaling to retailers. But retailers, groups of vapers or individuals are also bringing them in.

Unless an order is placed with a doctor’s prescription, importation of nicotine vapes has been  illegal since October 1, 2021. Bulk imports, even if ordered with a prescription, are clearly illegal. Entering “importing vapes China” shows many ways of doing it.

Those openly importing and selling these illegal vapes reason that the probability of being caught whether via Border Security intercepts or when retailing them online or in any sort of retail outlet is vanishingly small. Many shops advertise on their front windows that they sell vapes and many openly display them on charts showing brands, flavours and puff volumes, with the actual vapes generally stored out of sight.

Data show that in the 11 quarters from Jan 1, 2020 to Sept 30, 2022 NSW Health seized 220,322 vapes after inspecting retail outlets and completed just 25 successful prosecutions. Fifty two percent of all illegal vapes seized were removed in the three quarters since Jan 1, 2022.

Health minister Mark Butler foreshadowed at a Parliament House press conference on Nov 30, 2022 that active consideration is being given to restoring and strengthening his predecessor Greg Hunt’s addition of vapes to the prohibited import list. States will need to lift fines for selling from the derisory maximum of $1600 (in NSW for example) to seriously deterrent amounts in the ballpark of those being handed out by the Therapeutic Goods Administration to those found advertising illegal vapes.

A letter signed by 28 LNP backbenchers opposing Hunt’s plan  scuppered it in the party room. The initiative was led by the coal lobby’s favourite senator Matt Canavan and signatories included luminaries like Hollie Hughes (“[British America Tobacco] They’re a cigarette company. They don’t define themselves as Big Tobacco. They’re a cigarette company and a tobacco company.”), Tim Wilson. Eric Abetz, George Christensen, Alex Antic, Andrew Laming, Bridget McKenzie, James Paterson, Gerrard Rennick, Amanda Stoker, Dave Sharma and Barnaby Joyce.

Many of the 28 are no longer in parliament. And those who are, are political eunuchs unable to block any bill or gut any policy that has support of the Labor government, the Greens and progressive independents, so hopes are high that Labor will continue its historic leadership in tobacco control.

Chinese government policy

In 2021 and 2022 the Chinese government began publishing  details about its emerging policies on vapes. From May 1 ,2022 China’s Tobacco Monopoly Administration prohibited the sale of “flavored e-cigarettes, other than tobacco flavors, and e-cigarettes to which users can add their own atomized substances.”

When it comes to exporting vapes from China, National Law Review summarises it this way:

“China’s Management  Rules for e-cigarettes require that e-cigarette solely for export must comply with the regulations of the destination country; when there is no relevant regulations and standards in the destination country, the product must comply with China’s regulations and standards”.

These local standards are set out here. Here is a site where you can see the names of all vape manufacturing companies operating in China with a government license and therefore subject to the regulations described. Warning 31 pages of them!

So how seriously will China actively police its rules?

I’ve been in China many times in the past 15 years working with colleagues in government and major universities like Fudan and Zhejiang. My scepticism that there might be gaps between what China says it’s doing evaporated fast when seeing how smoking bans on Chinese taxis, bused and trains were very strictly observed. I used the Beijing underground railway many times and saw teeming  millions pf people use it across weeks, but never once saw anyone smoking. This article describes China’s record in tobacco control.

Australian government officials in the health, trade and foreign affairs portfolios should clearly communicate the current illegal status of nicotine vapes in Australia to their Chinese counterparts, noting the positive developments in Chinese law. 

Lijiang, Yunnan province

14 unforgettable meals

At 71, I’ve rarely missed an evening meal. Until I was about 20, I had almost no experience with superb cooking, as did most who grew up in the 1950s-60s in Australia. Impoverished student days in the early 1970s were mostly spent eating pasta, stews, sausages and even lean meat offcuts our local butcher sold to greyhound owners (see sordid story at p12 here). But as I moved though the next decades, cooking and eating out became some of the greatest pleasures. Across over 18,000 evening meals and many thousands of lunches across 50 years, here, in no special order, are fourteen I will never forget.

With most, I’ve of course long forgotten exactly what I ate: it was much more about the total experience  — the food, the wine, the setting, the company, and  in the case of a night out in Istanbul (#14 below), what happened very unexpectedly.

Tetsuya’s Rozelle When I met my wife Trish in 1990, my heart melted. She was my 7 year old son Joe’s school teacher and parent-teacher interviews were a challenge for our concentration. I lived near Tetsuya’s first eponymous restaurant in Rozelle, Sydney and took her there not once but twice for their fabled degustation dinner. She’s small, beautiful inside and out and mesmerising. And so were each of the dishes we ate those nights, especially the confit of ocean trout, shown here. Tetsuya has now long been in Kent Street in the city. Here’s his history. It was very expensive then, and hideously so today. So we very rarely eat out at that level. But Tetsuya’s is unforgettable and compulsory in this selection.

M on the Bund ,Shanghai I was a staff-elected fellow of the governing Senate at the University of Sydney for two terms when Marie Bashir was Chancellor. I travelled to Shanghai with a party of senior academics for a graduation ceremony and meetings with Fudan University contacts. One night, a small party of us booked a balcony table with views across and down the Huangpu river. I sat next to Marie and well remember our conversation but little of what we ate other than it was utterly exquisite from start to finish. If you are ever in Shanghai, just go there.

Monoprix, Ledru Rollin, Paris We have a close friend who owns an apartment in Paris, near Bastille. We’ve stayed there twice when she’s back in Sydney. On our second trip, we arrived from the airport mid-morning. I went immediately to a huge Monoprix supermarket across the street and bought for lunch fresh peaches, baguette, porc rillette, an amazing saucisson with peppercorns, Lou Perac sheep’s cheese and a bottle of St Emilion grand cru. All for under 40 euro. You can eat like this all over France. Heaven.

My stewed rabbit in Chianti with porcini

When our three kids were in their early teens, we all flew to Rome, hired a car at the airport and drove for a month up to Paris. In Tuscany we rented a stone cottage from a Mr Botticelli about 10km outside of Poggibonsi. A Dutch couple had an adjacent cottage with the woman sunbathing topless for hours in full view of our captivated adolescent boys.

I drove to the nearest supermarket and found they had lots of skinned rabbit (coniglio). I bought two and using total guesswork without a cookbook or internet reception, seared them in butter, sage and onion, then stewed them in decent Chianti and fresh porcini mushrooms. The entire family, including me, was gobsmacked at the result. It’s been a signature dish in the years since. Three days later we ran into the Dutch couple in a street in Florence and had dinner with them in a restaurant right on the Arno. I ordered fegato (calf liver) with spinach. Unbelievably wonderful after a childhood of dry, overcooked liver.

Reykjavik, Iceland

I went to Iceland in 2003 to give some talks to local health workers. My host, Thor, was a prolific Icelandic author, a former member of the Icelandic football team, my counterpart in the Department of Health and an Icelandic god. He took me to a restaurant and I asked him to order for me. Here’s an excerpt from a travel short story I wrote (see p86).

“At lunch the next day, after I’d given a couple of talks to researchers and health department people, Thor asked me what I’d like to eat. “What you eat in Iceland” I told him. “Something local”, imagining herring pickled or cooked in an Icelandic way or smoked local meats preserved for the long winters. He took me to a small restaurant with a view over the sea and ordered several dishes while we talked about our lives and families. The first dish arrived. It was a small spread of thin strips of a dark meat, cooked in a light vinegary sauce, a little thicker than a carpaccio cut. It was as tender a flesh as I’d ever eaten. “So what is it?” he played with me. I guessed it might have been a prime cut of reindeer backstrap or fillet. No. Perhaps the dark meat of a local goose? No.

It was …. wait for this … puffin, those impossibly cute, small gull-like seabirds with their beautiful half-moon red and black striped beaks and wise little eyes. I’d assumed that they would be protected and that people would all recoil from killing and eating them because of their iconic beauty and cuteness. Well not at all, sunshines. It turned out they are commonly eaten in Iceland and on restaurant menus, listed as lundi, all over the country.

A few dishes later, a decent-sized steak arrived. It was as succulent as I’d ever tasted and assumed it must have been prime local beef. But no. It was whale. I thought Iceland might have been a signatory to some global treaty against whaling as I knew it had progressive social and environmental policies. Thor confirmed this, explaining that entrepreneurs anticipating the ban had stored tonnes of whale meat in refrigerated containers which were being very slowly consumed in the years since, as we had just done. If ever I’d experienced true, deep ambivalence, this was the moment.”

Hotel Windsor, Lake Toya, Hokkaido Japan

In September 2009, I went to Sapporo to give the opening address to the all-Japan conference on tobacco control. The entire meeting was in Japanese, with me being translated. I was keen to get back to Tokyo when my talk ended as I would understand little of what other speakers would be talking about. But the woman appointed by the conference to help me around, quietly advised that this would cause considerable offence and that the conference head, a leading surgeon, planned to show me the sights of Hokkaido. I decided I should stay.

And well I did. We travelled to the north west of the Island by train and were then driven from the station to the most luxurious hotel I could ever imagine, let alone stay in: The Windsor. It had hosted the 34th G8 meeting in 2008 and overlooked the volcanic Lake Toya through silent autumn mists. A Russian string quartet played discretely in the lobby throughout the day. On its top floor, there was a Michelin 3 star French restaurant to which the surgeon invited me and a Seventh Day Adventist from Tasmania who had also been at the conference, along with our interpreter.

The Adventist of course didn’t smoke. But neither did he drink alcohol, eat meat or drink tea or coffee, poor fellow. While we moved from a stunning Pouilly-Fuisse to a grand cru Haut Medoc, he sipped water. My wagyu steak was beyond words. The Adventist’s salad and mushrooms looked pretty good too.

Margot Jervies, next door

We’ve lived next to a couple for over 20 years, Margot Jervies and Wayne Wilkinson. The day they bought the house, I quietly asked the real estate agent who our new neighbours would be. “Oh a lovely couple! He’s an engineer and she works for British American Tobacco!” This will be interesting, I thought.

Things were polite and chatty for many years and then began to rapidly thaw after we both retired. You could not wish for better neighbours. Margot won an ABC radio cooking quiz about 10 years ago. We often could smell her dreamy cooking in our garden. When I later saw a whole room in their house with cookbooks from floor to ceiling on every wall, I knew that here was a very serious cook. And then the texts commenced “I’ve just made a big batch of passata [or duck confit, or rillette, or gravlax or baba ganoush &c], if you come to the back gate I’ve put some in a box for you”

There is nothing … nothing  Margot cannot cook that doesn’t leap into pole position for the “best I’ve ever had of that” prize.

When COVID first hit in 2020, the isolation was truly dispiriting. I hit on the idea that a few neighbours might meet in the back lane on late Sunday afternoon when we took out the bins. We would dress up fully for the nostalgia of fine dining, using our wheelie bins as tables to rest a few bottles of wine and bring a few horses’ doovers to share. All at strict distancing.

Wayne & Margot, sommelier & chef extraordinaire

Margot and Wayne took this to the next level when COVID restrictions changed to allow small numbers to come to houses. They put on  four hour plus le grand bouffe meals for a few of us. Margot’s food brough gasps from all around the table and Wayne, a very serious wine collector, always shares wonderful wines.

They’ve just been away for seven weeks. We’ve been counting the days.

Trish Kirby’s famous chicken and leek pie

Trish has always loved cooking and people who come here swoon at what she can do, especially with cakes. Our family often does a roundtable where we say “if you were going to have your last meal cooked by Trish, what would it be?” The unanimous verdict, across three generations, is always her chicken and leek pie.

A long-time close friend in Newtown had been nursing her aged mother at home for several weeks who was dying from breast cancer.  Trish baked a large pie and took it down for respite eating for our exhausted friend and her partner. 

The friend phoned the next day and said “you’ll never guess. Mum hadn’t eaten a thing in many days. But when she smelled your chicken and leek pie she asked for some and ate the lot!”

Her mother died the next day.

Kazkazuri, San Sebastian

In September 2016, I’d been running an advocacy course for four days at an old quarantine station on Menorca, in Spain’s Balearic Islands. When it was over we flew to Basque country to revisit San Sebastian where I’d last stayed in a decrepit dormitory hostel  in 1972. On a rainy Friday night we threw a dart at the list of the many restaurant recommendations friends and locals had given us. We chose the Kazkauri on the waterfront. It said 25 euro a head for three courses. Yeah, sure. Unlike the chaos of pintxos bars, this one had a sober, rather sterile interior, white napkins and obsequious waiters. And yes, the menu said 25 euro, including wine, water, bread, coffee.

We expected mediocre food and rubbish wine. Trish asked for the blanco, me the tinto, expecting a glass each. But two full bottles of very good white and  red arrived, crianza vintage. We then commenced a near-perfect three courses, both starting with stewed cod in rice. I moved to Iberian pork in a sherry sauce and señora chose roast duck. The dessert was an astonishing coconut pudding with chocolate, which was west of heaven.

Trish’s stewed cod in rice, Kazkazuri, San Sebastian, Spain

Pippi spaghetti

When our three kids were little, we’d go most years for a week or two down the south coast of NSW in months when you could swim in warm water. We loved the vast uncrowded beaches, dolphins and (once upon a time, long ago) cheap oysters. We went to Manyana, Culburra, Geroa and Bendalong, sometimes with other families.

Most afternoons, all of us would go down to the beach with a bucket looking for pippis, the common surf clam mainly used by fishers for bait. To find them, low tide is best particularly at tidal estuaries where the shellfish feed on micro organisms that wash down rivers and out to sea. Tell tale signs of  good spots include seeing them being rolled in the sand by the waves and quick strikes when you twist, Chubby Checker style, in the sand reaching down for them when you feel them underfoot.

Pippis are a wonderful but under-rated alterative for vongole, a seafood staple in Italian restaurants in pasta dishes. We’d try and get about half a bucket full to allow enough to feed our daily group of five. Once home, you put the live pippis in fresh water, which is supposed to cause them to spit out any sand.  This was never successful, so the served product was always a little gritty causing variable protests from the more Princess-and-the-pea members of the family.

You cook them up in white wine, with a base of garlic, lemon and olive oil, or a standard tomato base. A big bowl goes in the centre of the table for the spent shells.

This meal is imprinted in the childhood memories of all our kids, as well as two grandchildren. The photo shows Florence, aged about seven, jubilant at finding lots of shells after being knocked over fully clothed by a wave seconds after starting.

There’s something wonderful about collecting the food you want to eat and seeing everyone enjoy it so much.

Rhodes harbour café  In the 1980s one summer I stayed a few nights on a friend’s modest yacht in Rhodes harbour, once overlooked by the Colossos of Rhodes, the largest statue in the ancient world until it fell into the harbour in an earthquake in 226 BC. We talked and drank with other yachties till about 11pm and then decided it was time to eat. A small harbourside café produced bottles of the local white wine to go with plates of fried marida (whitebait) and the sweet barbouni (red mullet) with lemon. Still hungry, the only food left was BBQ’d quails, so a plate of them with ouzo was produced. We got back to the boat about 2am and slept till midday

Ristorante Vecchia Urbino, Marche, Italy

Kenneth Clarke’s Civilisation TV series has been etched into my memory for years, especially the episode on Raphael who painted at Urbino in Italy’s Marche region in the northeast. So on a trip to Italy, we looped from Umbria to Urbino, then on to Bologna, Parma and Milan. The one night we planned to stay in Urbino took us to a potluck choice of a restaurant a few streets off the main drag through the small town.

There was a central table covered in a huge selection of top drawer antipasto. Our waiter asked us for our wine selection. We’d had a superb glass of a local white, verdicchio, at lunch. Trish was very keen to have it again. I like both red and white, but prefer red. The waiter gave me an understanding look but brought the verdicchio.

When he bought our mains, mine was a glorious bistecca. He put it in front of me and returned with a steak knife and a huge glass of red. I said “oh, sorry I didn’t order that”. He replied “I know that you like red wine, so please have this one with our compliments.” He’d also brought us about five small bowls with different olive oil in them to soak with bread, all gratis.

And at the end of the meal, when we thought we’d need a forklift to get us out of our seats and declined dessert, he insisted and brought those as well, also gratis with several dessert wines.

The entire meal was perfect in every way and we drove the next today to Bologna feeling that we had been blessed to have lucked that choice and that we might not eat such a meal again for a very long time.

Ten minutes from the end of the 170km trip down the autostrada to Bologna, Trish asked me for my passport to get ready for the hotel registration. Ahh. I’d forgotten to collect it from reception at the Urbino hotel. Like groundhog day, we turned the car around, drove back to the hotel, booked in again and ate again that night at the perfect restaurant. Some shine was missing the second time, but still 9 out of 10.

Linda’s on King, Newtown

I’d walked past this small restaurant many times but never noticed it. It’s on lower King St – the St Peters end —  and right next to the European Grill, a Macedonian grill which is a carnivore’s eating orgy temple. Linda’s had been recommended by Newtown friends. I’d never even heard of it. But after our first meal there, I knew I would be a regular.

Linda cooks and her partner does all the front of house. The food is French. Well, modern French I guess. You can bring your own wine (although their list has some very good selections at reasonable markups). The last time I ate there I had a superb home made pork terrine of very generous proportions, followed by a perfectly cooked eye fillet steak with bearnaise sauce and perfect fritte, then a perfect vanilla pannacotta, mango sorbet, lychee granita and macadamia praline. Perfect, perfect. Sorry, but there was no other word for it all.  Here’s the current menu. Astonishing value.

Istanbul. The mesmerising item not on the menu

I leave the most unforgettable to last. It happened in Istanbul’s Taksim district one evening in 2014 when, as a wonderful Turkish meal got into full swing, something happened that took the attention of every diner in the restaurant. Full details here.

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

This meme has long been in the very top drawer of many vaping cultists. It proposes that any policy short of allowing nicotine vaping products to be openly sold and promoted without any regulatory encumbrance whatsoever will see untold thousands of vapers switch back permanently to smoking. Unlike vaping they say, this will kill many of them from smoking-caused diseases.

That last claim rests entirely on an assumption that the long term health consequences of  deeply inhaling 570 times a day (208,193 times a year) an unregulated cocktail of nicotine, propylene glycol and any number of thousands of unapproved for inhalation flavouring chemicals will be all but benign. Fifteen former presidents of the Society for Research on Nicotine and Tobacco stated in 2021 “High-quality clinical and epidemiological data on vaping’s health effects are relatively sparse. There are no data on long-term health effects, reflecting the relative novelty of vaping and the rapid evolution of vaping products. Determining even short-term health effects in adults is difficult because most adult vapers are former or current smokers.” [my emphases]

If the government and the Therapeutic Goods Administration proceed with their preferred options and make nicotine vapes a prohibited import (unless destined for the prescription-only pharmacy access route), vaping advocacy hysterics forecast a migration back to  smoking that would make the annual African wildebeest migration look like a geriatric dawdle.

Instead of  doing what Australians do 314 million times a year when they need a prescription-only drug, nearly all vapers will “go back to smoking”. “Bwahhhh! We want flavoured nicotine!” they’ll scream, all forgetting for the moment that the cigarettes they will allegedly stampede back to are also nearly all unflavoured too.

But there’s another little problem with this forecast In Australia, in 2019, 53% of e-cigarette users were also smokers (“dual users”), 31% were past smokers and 16% had never smoked.

So most vapers also still smoke or never smoked. Do you see the wee problem here: how can someone who is still smoking be driven to smoke?

Among people aged 18-24 (where we see by far the highest vaping prevalence), half of all current e-cigarette users had never smoked. They are not vaping to quit cigarettes because they never smoked. Vaping theologists implacably repudiate the gateway hypothesis that vaping can lead to smoking, so presumably none of them are going to publicly argue that never-smokers who vape will start smoking.  

So combined, we have 69% of vapers who can’t migrate back to smoking because they are already smoking or never smoked.

More  recent national data available (2020-21) show the same picture. By far the largest group of people who have vaped in Australia are those who “formerly” tried vaping (1.428m) compared to those who currently vape  (442,800 – which includes a majority who also smoke). The overwhelming number of this 442,800 are not smokers who vaped then quit, but smokers who tried vaping but then quit vaping and continued smoking. And all this returning to smoking happened before the prescribed access policy was even introduced.

The main driver of the government’s proposed plan to restrict vaping access to those with a prescription is the out-of-control rise in teenage addiction to nicotine vapes, regularly belittled by vaping theologians as no big deal and mocked with “won’t somebody please think of the children” self-absorbed me-me-me values.

The UK, a nirvana for our local vape advocates, is now desperately struggling with an unprecedented spike in vaping by kids and has a bill in parliament like Australia to ban disposable, flavoured vapes.

Mark Butler and the TGA’s reforms could not come at a more critical time.

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

Finding gold in an op-shop: Caroline Chisholm’s Female Immigration (1842)

In the early 1970s, I lived for a year in Surry Hills. My then wife Annie and I were undergraduate students. I worked in the Wynyard Travelodge on weekends as a carpark attendant (see short story here at page 20) and Annie did secretarial work. We were so broke that we would go to Paddy’s market in the Haymarket just before closing time where you could buy the dregs of unsold fruit and vegetables for next to nothing.

Annie loved searching opportunity shops for cheap crockery and bric-à-brac. There was one in Albion Street near where we lived that she would frequent.

One day she arrived home with an ancient little book that someone many years ago had pasted over with now long-faded white paper. She’d bought it for 20 cents. To our amazement, it was an 1842 book by Caroline Chisholm, Australia’s first advocate for humanitarian rights for immigrants, especially young women, titled Female Immigration, Considered in a Brief Account of the Sydney Immigrants’ Home. 

A friend, the late Gary Simes, was an English scholar and bibliophile. He suggested we take the book to a man who was said to know more about rare books than anyone else in Sydney. I’m pretty sure he worked out of an office crowded with books in an old building in Foveaux St near central railway. I’d value his name from anyone who may recall him.

I took it down without an appointment and passed it to him across his large crowded desk. He immediately knew what it was I’d handed him and became quite excited. He looked it up in a giant catalogue of rare books and listed off libraries in Australian and overseas which had a copy. I think he said there were something like five known copies.

“What do you plan to do with this” he asked. “You know it would be worth a lot of money to a collector”. He mentioned several well-endowed US libraries that might pay something like $5000. In the early 1970s this was an unthinkably large amount of money.

He said repeatedly that he hoped we would do our best to keep it in Australia. I had no hesitation in agreeing.

After discussing it with Annie, we took it to the University of Sydney’s Fisher Library and asked what they might be able to pay us. They offered $300 which we accepted in a blink. I think we might have had a slap-up Greek dinner at the fabled Diethnes in Pitt Street that night with a bottle of white demestica, an under-rated retsina sadly no longer available.

A few years ago I was walking past the rare books section in the Fisher building and on a whim went to the desk and asked if I might see the book. It was brought out to a reading desk in full view of the staff. I had to put on thin white gloves to browse the book. I took a few photos, including those above and this one showing the price of a pound of tobacco in 1842: three times the cost of a pound of sugar!

You can read the digitised book here

Tobacco and vaping industry leaders’ deep concern about health risks

Over the years, I’ve collected some glorious examples of the tobacco industry’s efforts to promote health and hose down public concern about the risks of smoking. There was Philip Morris’s effort in Australia in the 1980s to sell a sunscreen to protect us all from skin cancer. They thought it was a great idea to give it the same brand name as another of their products, Peter Jackson cigarettes, which like all cigarettes kill two in three of their long term users. Lung cancer prevention = bad; melanoma prevention = good. All got that? It was quietly and swiftly withdrawn when this little problem given some sunlight.

Then there was the time in 1999 that Philip Morris  listed itself in a corporate promotional brochure as sponsoring the Red Nose Day Foundation, Australia’s largest research charity supporting research on sudden infant death syndrome (SIDS). Sleeping in the prone position and exposure to tobacco smoke are the two most important, known risk factors for SIDS. The glossy brochure, resplendent with photographs of the company’s products including cigarettes, identified the charity as among “recipients of support or sponsorship from Philip Morris and its operating companies in Australia”. Red Nose Day organisers had obtained, for fundraising purposes, two giant Toblerone chocolate bars from Philip Morris’s Kraft corporate arm, not realising the then connection with the tobacco parent company.

On learning that Philip Morris was using the Toblerone donation as part of its efforts to promote its corporate image, the executive director of the Foundation complained that its name and cause had been misused and announced that the money raised would be returned as unwanted to Philip Morris.

World wide Philip Morris had aggressively disputed evidence that environmental tobacco smoking is harmful. Anne Jones, director of Action on Smoking and Health (Australia) commented at the time that Philip Morris claiming to support SIDS research was “about as offensive as Slobodan Milosovic donating to Kosovar refugee relief”

Promoting “light” cigarettes

When Philip Morris owned Kraft (Kraft has had no affiliation with Philip Morris or its spinoff Altria since 2007) its tobacco division was globally busy inculcating the idea that some cigarettes were less deadly than others. “Lights” was one of the magic words they and other tobacco companies branded these cigarettes with, until regulators outlawed it as misleading and deceptive and heavily fined them for knowing this for many years. There was no evidence “lights” were less deadly than any other cancer stick.

Before the curtain fell heavily on this deceptive conduct, Philip Morris used Kraft to help its efforts. Here’s an ad showing how “light” was used to directly imply healthy. Just the trick to use to imply the same healthier claims for cigarettes.

Smoking? Well what about …?

Tobacco companies have a long history of trying to mine research and expressions of public alarm about various risks to health to foment public confusion that “everything gives you cancer these days”, so why worry about just one risk, smoking? Perhaps the most florid example of this was a 20 page A-Z dossier of health risks from 1984. This was designed to be used as a crib sheet for tobacco industry employees to spray examples around in media interviews when the troublesome issue of the dire risks of smoking arose. Here’s a sample. You can read the rest via the link.

Cell phone tower electromagnetic radiation angst

Paul Adams (pictured above) was the chief executive of British American Tobacco’s head office in London for seven years until he retired in 2011. Adams presided over one of the world’s largest tobacco companies whose products today contribute to the global total tobacco death toll of 8 million smokers a year. We can safely assume he knew an awful lot about the health impact of his company’s business across his years at BAT. But in December 1993 he was very worried about another alleged health risk: electromagnetic radiation from a proposed transmission mast in his community and sent a personal protest letter to his local district health council.

Health risks from mobile phone towers or the phones themselves have never been demonstrated across the decades. It would be highly improbable that Adams did not use a mobile phone himself. Phones don’t work without transmission towers.

WiFi and Bluetooth

And in 2019, we come to Josh Fett, British American Tobacco’s Senior Regulatory Engagement and Campaigns Manager for Asia Pacific and Middle East. Fett tweeted two telcos “trying to figure out” if it was safe to use WiFi/Bluetooth around babies in the home.

Sarah White’s (then CEO of Quit Victoria) pertinent question below to Fett unfortunately went unanswered.

WiFi began being offered by communication providers from 2002 and by 2014 was being used in 25% of houses worldwide. Bluetooth began its rapid rise in popularity from 2004, going through seven different upgrades by 2016 as its provision and use became almost standard in lots of electrical equipment.

So across this time, hundreds of millions of neonates, infants, children and adults have received up to 17 years exposure by the time Fett asked his question.

Vertical integration of smoking and death

In 2019, Philip Morris International set up a life insurance company. As a next step in its business model, this was just masterly! Sell highly addictive, lethal tobacco products to your customers and at the same time, get them to also pay you a life insurance premium. I couldn’t resist adding a few more suggestions in the tweet below. So many ways for one of the world’s largest and longest purveyors of cigarettes to get a place at health industry tables and representative groups!

You’re in the health care industry!

But I save the best for last. Below we see the UK’s Vaping Industry Association (UKVIA) proudly megaphoning the message given to its 2022 conference by UK Conservative MP Adam Afriyie. Afriyie was a member of the All Party Parliamentary Group for Vaping which  both received funding from UKVIA and  from November 2016 until 2020, even had UKVIA operating  as the Secretariat for the APPG for vaping. Afriyie wanted vape manufacturers and retailers to get it into their heads that they were not in the tobacco industry, not in the nicotine addiction industry but, yes, in the healthcare industry.

That would be the vaping industry whose products are now sounding all the health alarms you see in reviews like those shown here.

George Orwell would be having a field day if he was alive today.

Vaping theology 13: “Kids who try vaping and then start smoking,would have started smoking regardless”

Like all cultists, those who live and breathe vaping by telling everyone at every opportunity that it has saved them, embrace a set of fervent beliefs. Vaping theology is a set of sacrosanct, inviolable beliefs that all adherents repeat regularly at risk being cast out of the vaping temple by other true believers.

At the end of this blog are another 12 of these creeds, with many more in preparation. This one looks at a belief that is never far from the lips of those who patrol policy debates on vaping where proposals or evidence threaten in any way to inhibit their mission.

Common liability theory

The garlic-encrusted crucifix hoisted high at the first syllable of any vampire-like suggestion that vaping might act as training wheels for children and teenagers to take up smoking is known as the “common liability hypothesis”.  The hypothesis first gained modest prominence in debates about the “gateway hypothesis” in drug uptake research where crude post hoc ergo propter hoc (after, therefore because of)  reasoning has often insisted that  (for example) that those who try cannabis and then later start using narcotics because they first smoked dope

We all appreciate that if one thing follows another it often does not mean the first thing caused the second. Breast milk is often followed by infant formula, water, then by fruit juice and clamour for carbonated drinks, then later by alcoholic drinks.  So can we say meaningfully that breast feeding causes Coke and alcohol consumption? Obviously not.

But there are plenty of examples of where one thing very much does greatly elevate the probability of another, satisfying several causal criteria. Prison incarceration is followed so frequently by reoffending on release that responsible legal sentencing practice tries to avoid imprisonment whenever reasonable to prevent crime. Intoxication and speeding so greatly increase the odds of motor vehicle crashes that deterrence and penalties are set high in most governments’ policies.

The current national concern about untrammeled betting advertising is seeing huge concern about the Pied Pipers of betting trying to lure starting punters into seemingly benign little flutters whiile turbo-charing promotions for multi betting. A classic example of gateway engineering.

Yes, there are always confounding factors that can be highlighted in such examples, but these seldom exonerate the critical role of an earlier variable (eg incarceration, drinking before driving).

When it comes to vaping and smoking, there are some entirely relevant observations. Both involve inhaling and exhaling nicotine through cylindrical delivery systems. Both involve the often rapid onset of signs of nicotine dependence in users. Both share a word (cigarette/e-cigarette) that seems to point to a similarity. Both involve repeated hand-to-mouth movements and a richly semiotic repertoire of holding and gesturing. Both see clouds of smoke or vapour billowing from their users, sometimes in clever displays. Both very frequently start in early teenage years. For some, both are important accoutrements of the passage from childhood to early adulthood, richly signifying and often peer group reputationally rewarding rebellion against parental controls and school rules.

With vaping and smoking, the common liability hypothesis posits that those children who vape and then subsequently start smoking would have mostly taken up smoking even if vaping had never been invented. It argues that kids who smoke in today’s smoking denormalised social environments have a propensity to be rebellious and so are also likely to take other risks: they vape, they smoke, try illicit drugs, have sex early, miss school, graffiti walls and so on. With the vaping “leading to” smoking debate, common liability adherents point to these propensities for kids who vape to be more likely to smoke simply because smoking is one of a constellation of adult-disapproved behaviours that bring peer status and petty prestigious notoriety to those seeking such distinction.

Nobel prize winning (2000) neuroscientist  Eric Kandell and his wife have described a molecular basis for nicotine being a gateway drug whereby nicotine in one form primes the brain to make it more susceptible to using other forms of nicotine. 

As a schoolboy, I smoked, got older kids to buy me alcohol, got suspended from school for buying beer on a school drama tour in year 11 and was the first in my year to have sex. I would have probably scored high on any scale of risk-taking a social psychologist might have pushed in front of me.

There have now been at least four systematic reviews/meta-analyses of the fast-emerging research literature on whether vaping increases the likelihood of taking up smoking.

Soneji et al (2017) JAMA Pediatrics: (9 studies) “The pooled probabilities of past 30-day cigarette smoking at follow-up were 21.5% for baseline past 30-day e-cigarette users and 4.6% for baseline non-past 30-day e-cigarette users.” (ie 4.7 times higher)

Baenziger et al (2021) BMJ Open (25 studies) “comparing e-cigarette users versus non-e-cigarette users, among never-smokers at baseline the OR for smoking initiation was 3.19 (95% CI 2.44 to 4.16, I2 85.7%) and among non-smokers at baseline the OR for current smoking was 3.14 (95% CI 1.93 to 5.11, I2 91.0%). Among former smokers, smoking relapse was higher in e-cigarette users versus non-users (OR=2.40, 95% CI 1.50 to 3.83, I2 12.3%).”

O’Brien et al (2021) BMC Public Health (14 studies) “our meta-analysis calculated a 4.06 (95% confidence interval (CI): 3.00-5.48, I2 68%, 9 primary studies) times higher odds of commencing tobacco cigarette smoking for teenagers who had ever used e-cigarettes at baseline, though the odds ratio were marginally lower (to 3.71 times odds, 95%CI: 2.83-4. 86, I2 35%, 4 primary studies) when only the four high-quality studies were analysed.”

Chan et al (2021) Addiction (11 studies) “a significant longitudinal association between vaping and smoking [adjusted odds ratio (aOR) = 2.93, 95% confidence interval (CI) = 2.22, 3.87]. Studies with sample sizes < 1000 had a significantly higher odds ratio (OR = 6.68, 95% CI = 3.63, 12.31) than studies with sample sizes > 1000 (OR = 2.49, 95% CI = 1.97, 3.15).”

All of the above reviews found that non-smoking children who had vaped at baseline had significantly increased odds of smoking cigarettes at follow-up, compared with those who had not vaped.

Yet in a recent editorial in Addiction, Pesko et al say that the public and health-care professionals pointing to the evidence in these reviews must be “confused”, writing:

“significant evidence now exists that this association between vaping and smoking is not causal, which is a source of confusion for the lay public and health-care professionals. Survey data show youth cigarette use declining steadily despite vaping increasing. When past-30-day youth e-cigarette use rates were as high as 32.9% in 2019, youth smoking rates should have been rising if the SG’s statement that ‘e-cigarette use is associated with the use of other tobacco products’ represents a causal relationship. Instead, by 2021 the youth cigarette use rate fell to a record low 1.9%.”

So why not settle the question with a randomised controlled trial?

All the studies reviewed in the four reviews above were observational longitudinal studies. In the first week of epidemiology training, every student is required to write out 1000 times at pain of death that “association does not equal causality” and play the sport of finding unwarranted causal inferences in observational study reports like those reviewed above.  It’s only in randomised controlled trials that authors are  given a gold pass to start suggesting causality.

Randomised controlled trials (RCTs) are venerated in medical and behavioural science because an important goal of randomisation is to disperse biases randomly across trial participants. Randomisation  theoretically eliminates confounding factors that may play dominant roles in determining outcomes, even ahead of the influence of the key intervention variables of interest (eg vaping vs NRT or unassisted cessation in evaluating the effectiveness of ways of quitting).

Because variables like age, sex, education, smoking in one’s family and peers, or personality traits like determination, self-efficacy or parenting styles are seen as likely to be important in how a person traverses decisions to smoke, drink or take drugs, randomisation — particularly in large trials — is designed to randomly spread the allocation of such variables across different arms of a trial (ie those receiving  an active drug – here, nicotine vapes – and those not vaping), in theory thus eliminating their influence.

But of course there will never be a randomised trial of vaping in children. No research ethics committee is ever likely to consent to such a trial because it would mean that researchers would be requiring randomised trial volunteer minors to start using highly addictive nicotine vapes. With smoking rates in early teens fast approaching zero in some nations like the USA, Canada, Australia, the UK and New Zealand,  imagine the outcry if a research group wanted to risk addicting nicotine naïve children to nicotine.

Imagine further, the unlikely event that a study group was able to recruit a large number of parents who would give their full consent to their children being given vapes like this. Not even in the most totalitarian of political regimes would we find such behaviour condoned.

Knowing this, those who stridently insist that the available data on transitions to smoking in young vapers is associative but not causal, know that they will always be able to use this policy fire extinguisher and train their “association” hoses on the worrying fires of gateway claims. This is a devious game intended to perpetually dismiss concern about collateral damage to kids arising from policies that allow them very easy access to vapes.

Controlling for “propensity to smoke”

With RCTs out of the question (just as they are for example, with randomising drivers to get intoxicated to see if they really do have more crashes in real world conditions than those who’ve not consumed alcohol), the next best evidence available is when researchers control their analyses for the very ‘propensity to smoke’ factors gateway critics say are the real determinants of smoking uptake.

Here we have several studies which have set out to do just that. Let’s take two recent examples.

Using US PATH study data, Osibogon et al (2020) looked at 2 years follow-up of 12-17 year old non-smokers who were vaping and those who were neither vaping nor smoking.

They found that current e-cigarette users (cigarette non-current users) at baseline were 5 times more likely to become regular cigarette smokers at 1-year follow-up than non-vapers. However, this association was not significant at the second year of follow-up. In reaching this conclusion, the authors controlled  for variables known to be associated with progression to smoking in youth.

A second example is  a 2021 paper on the UK’s  huge Millennium Cohort. It found:  

“Among youth who had not smoked tobacco by age 14 (n = 9,046), logistic regressions estimated that teenagers who used e-cigarettes by age 14 compared with non-e-cigarette users, had more than five times higher odds of initiating tobacco smoking by age 17 and nearly triple the odds of being a frequent tobacco smoker at age 17, net of risk factors and demographics.” [my emphasis]

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

In a huge blow to common liability adherents the authors concluded:

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

Pesko et al didn’t reference these inconvenient papers either.

Pesko et al’s paper was an editorial, not a systematic review, It cited none of the above reviews nor indeed any of the papers in those reviews, instead basing its glib dismissal of that evidence as “based on statistical association rather than clear evidence of causality”.

Instead it enlisted another old chestnut: that the gateway hypothesis conclusions are simply incompatible with the fall in smoking prevalence in youth when their vaping is rising. (“youth smoking rates should have been rising if the Surgeon General’s statement that ‘e-cigarette use is associated with the use of other tobacco products’ represents a causal relationship. Instead, by 2021 the youth cigarette use rate fell to a record low 1.9%”

This argument is frankly very feeble. I dealt with it in a 2018 paper with two colleagues in Nicotine & Tobacco Research. It relies on an assumption that the net population impact of any putative gateway effect of e-cigarette use would be larger than the combined net impact of all other policies, programs and factors which are responsible for reducing adolescent smoking prevalence (e.g. tobacco tax and retail price, measures of the denormalisation of smoking, exposure of children to adult-targeted quit campaigns, retail display bans, health warnings and plain packaging) and the important synergies between all of these.

Many nations have seen pleasing and continuing falls in adolescent smoking commence well before the advent of widespread vaping. Vaping is thus far from being the only factor responsible for declining smoking.

But this is the ridiculously  high bar that gateway critics demand that anyone suggesting gateway effects needs to jump over. If smoking is falling, the suggestion is that the uptake of vaping is causative. Note here too the ease with causal attribution from ecological data is invoked when it suits one’s purpose.

The combined impact of the abovementioned factors in preventing smoking uptake could easily mask considerable smoking uptake that might not have occurred in the absence of e-cigarettes. That uptake may not be big enough to reverse net falls in smoking prevalence which has seen hundreds of thousands of children and adolescents not take up smoking in nations where it has happened.

But the undeniable consistency in observational cohort studies, almost without exception, shows that if you don’t smoke and do vape, you are far more likely to smoke later, even when “propensity to smoke” factors are adjusted in studies which have done this.

To keep repeating these discredited slogans (“kids who try stuff, will try stuff”, “kids who are going to smoke, will smoke”) dignified by high-falutin’ hypotheses  like “common liability” that don’t survive first pass adjustment for their assumptions, discredits those who continue this narrative.

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

New Zealand’s gloves-off smoking policies should see smoking fall dramatically

On December 13, 2022 the Aotearoa (New Zealand) parliament passed amendments to  the Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Bill,  making three major changes:

  • reducing the amount of nicotine that is allowed in smoked tobacco products
  • decreasing the numbers of retailers that sell tobacco
  • making sure tobacco is not sold at all to anyone born on or after 1 January 2009.

In doing so, Aotearoa -New Zealand vaulted itself into clear international policy leadership in tobacco control policies likely to drive tobacco smoking to near extinction over the next 20-30 years as fewer smokers start, more quit and inevitably, higher smoking caused death rates continue in the fewer remaining smokers.

However, some important questions of implemention remain when the new legislative rubber meets the road of real life.

Reduced retail outlets

The law will see a maximum 600 licensed tobacco retailers by the end of 2023, down from the present 6000.  The thinking here is that many small retailers such as “dairies” (small mixed businesses which often sell tobacco) will stop selling tobacco, reducing access and “spontaneous” purchases. Smokers will need to plan their purchases to align with visits to the fewer outlets which will be selling tobacco.

New Zealand has no floor price on retail tobacco, so price discounting competition still occurs (eg: The tobacco industry has long fought tax increases, knowing what higher prices do to sales. In 2011 a CEO of British American Tobacco told an Australian Senate hearing under oath “What I do believe is that . . . if the objective is to reduce consumption then you would move towards areas which have been evidence based not only in this country but in others around the world –…We understand that the price going up when the excise goes up reduces consumption. We saw that last year very effectively with the increase in excise. There was a 25 per cent increase in the excise and we saw the volumes go down by about 10.2 per cent; there was about a 10.2 per cent reduction in the industry last year in Australia. “

In Australia liquor discount chains like Dan Murphy’s  (owned by the Endeavour Group) and First Choice (owned by the Coles Group) have radically changed the face of liquor retailing via both offering massive product range and significant price discounting. My local Dan Murphy’s this morning advertised 24 330ml Peroni beers for $51.99 while one of the few remaining independent liquor outlets in the same suburb had them at $58.99, 13.7% more.

The sheer buying power of major players in effective retail duopolies drives customers away from small retailers who can’t compete. I’ve yet to read a persuasive argument why the same thing won’t happen by concentrating tobacco retailing when not done within the constraints of parallel floor pricing policy.  Someone retuning to Australia today after being away 15-20 years would find it startling how fewer liquor outlets there are in suburbs and towns. But they would not notice any obvious decrease in drinking. Will the same happen with tobacco retailing?

 No sales to anyone born after Jan 1, 2009

This change in the law will mean that with each year that passes, the minimum age at which it will be legal to purchase tobacco products will rise by a year. For example, by January 1, 2040, you will be need to be over 31 to buy cigarettes legally. Penalties will apply to those who sell, not those who buy.

Minimum age for tobacco purchasing of course  has applied in many nations, often for a long time. In Australia it has been illegal to sell tobacco to minors in NSW (1903), South Australia (1904), Queensland (1905), Victoria (1906) and Western Australia (1917).  But these laws have rarely seen retailers who sell to minors prosecuted or prevented from again selling tobacco. In tobacco control circles, to call for the “strict enforcement” of bans on selling tobacco or vapes to minors is to label yourself a very naïve new kid on the block (or a cynical mouthpiece for the vaping and tobacco industries which also routinely call for such enforcement, hand-on-heart).

It is illegal now to sell cigarettes and vapes to those aged under 18, yet smoking remains widespread as the graph below from ASH New Zealand shows. In 2008, one third of New Zealand kids who smoked purchased their cigarettes, with no change in this pattern since 2000.

So why will New Zealand’s 600 tobacco retailers at the end of 2023 behave any differently than the 6000 do today, with illegal sales to kids being common?

However there is a way that tobacco sales could always be conditional on being linked to an official proof-of-age card. The way prescribed drugs are dispensed shows how this could easily happen. No pharmacist would ever think of selling a prescribed drug to a person without a prescription. To do so would see the wrath of both the pharmacy industry and the government end such a pharmacist’s license to practice.

Every antibiotic, every oral contraceptive, every blood pressure medication, every prescribed drug ever sold is always linkable to a prescription with a named individual with a Medicare record including date of birth. This is used by governments to oversee prescribing patterns including doctor shopping by those trying to stockpile drugs for personal or on-selling purposes,

In this 2012 PLoS Med paper and this 18 minute video, I set out in detail how selling tobacco could be very easily be managed through the introduction of simple swipe card (or these days through a phone app) that linked to an official date-of-birth record. We would not simply leave it to an honour system like those utter joke “are you over 18?” self-declaring barriers to entering on-line tobacco and vape shops.

Trace levels of nicotine

In my view, the absolute towering elephant in the room is the effective de-nicotinisation of cigarettes. With reducing nicotine levels to trace (non-addictive) levels, implementation will be easiest. Since 2020, all manufactured loose tobacco and cigarettes have been  imported into New Zealand, with all importers long having been required to provide  government with full details of the nicotine yields (plus all other additives) of each brand being imported and retailed. It is unimaginable that one of the Big Tobacco importing companies would try to falsify this information or import products which did not match the yield data they had provided the government. This would risk their importer rights and be further catastrophic for their already bottom-of-the-barrel business ethics status.

But critically here, cigarettes with insignificant nicotine to satisfy cravings are likely to be experienced as pointless by most smokers and quickly fade from commerce. So this policy has immense potential to see smokers abandon smoking in large numbers, making the above considerations of price discounting and verifying legal age of purchase all “after the event” of smokers turning right off the only cigarettes which will be legally available. If they won’t want to buy nicotine-tepid cigarettes, few will be bothered looking for price-discounted brands. You can’t put lipstick on a pig.

New Zealand will then need to face the challenges of vast numbers of kids who would have never used nicotine in any form were it not for vaping being addicted to nicotine vapes. Those who have trivialised the health risks and sloughed off people puffing on vapourised nicotine, unregulated flavouring chemicals and glycol 500 times a day may have a lot to answer for as the evidence of health risks mounts.

We are all hoping that New Zealand will boot smoking right out of the park, just as we are excited about Australian Health Minister Mark Butler’s Nov 30 announcement of radical reforms to tobacco and vaping policy in Australia (see his speech here -sorry about the amateur camerawork!)

Very happy to publish and information or civil responses relevant to the concerns above.

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

[Updated 28 Dec, 2022]

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

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

The 2022 update

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

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

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

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

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

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

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

  • the huge male dominance (23% are women)
  • an even greater dominance of anglophone authors 90% (USA 65,  UK 13,  Australia  7, New Zealand 3, Canada 2)
  • most of those on the list are older authors, reflecting their aggregated outputs across the 26 years of citation data
  • 37 authors increased their c-scores, with far more reducing theirs


  1. Neal Benowitz (USA) 344 (+3)
  2. Richard Peto (UK) 443 (-41)
  3. Carlo La Vecchia (Ita) 499 (-12)
  4. Michael Thun (USA) 673 (-69)
  5. Richard Doll* (UK) 929 (-4)
  6. Stephen Hecht (USA) 1044 (-27)
  7. Jon Samet (USA) 1320 (+17)
  8. Jim Prochaska (USA) 1735 (-40)
  9. Saul Shiffman (USA) 1767 (+0.4)
  10. Wayne Hall (Aus) 1885 (-5)
  11. John Hughes (USA) 1886 (+29)
  12. Robert West (UK) 2858 (+31)
  13. Susan Michie (UK) 3685 (+35)
  14. Wayne Velicer* (USA) 4617 (+22)
  15. Stan Glantz (USA) 6050 (-0.8)
  16. Ernst Wynder* (USA) 7140 (-24)
  17. James Pankow (USA) 7228 (-17)
  18. Ross Brownson (USA) 7378 (+10)
  19. John Pierce (USA) 8423 (-20)
  20. Michael Fiore (USA) 8691 (-32)
  21. Karl Fagerstrom (Sweden) 9234 (+71)
  22. Carlo DiClemente (USA) 9510 (-0.4)
  23. Judith Ockene (USA) 9700 (-45)
  24. Srinath Reddy (Ind) 9948 (+36)
  25. Meredith Minkler (USA) 10523 (+40)
  26. Lisa Bero (USA) 10971 (+4)
  27. Jean-Francois Etter (Swi) 12316 (+6)
  28. Nancy Rigotti (USA) 12397 (-8)
  29. Marina Picciotto (USA) 12414 (-17)
  30. Robert Beaglehole (NZ) 13484 (-22)
  31. Ray Niaura (USA) 15820 (-15)
  32. John Britton (UK) 16,181 (-23)
  33. Frank Chaloupka (USA) 16292 (+14)
  34. David Hammond (Can) 16365 (+41)
  35. Ruth Bonita (NZ) 16452 (-16)
  36. Ron Borland (Aus) 16754 (+5)
  37. Gil Botvin (USA) 16777 (-31)
  38. Simon Chapman (Aus) 16808 (-6)
  39. Steve Tiffany (USA) 16952 (-33)
  40. David Abrams (USA) 16953 (-13)
  41. Caryn Lerman (USA) 17411 (-89)
  42. Jodi Prochaska (USA) 17587 (+13)
  43. Martin Jarvis (UK) 17828 (-19)
  44. Cheryl Perry (USA) 17657 (-18)
  45. Ken Warner (USA) 19439 (-10)
  46. Tony Biglan (USA) 19472 (-0.01)
  47. Judy Prochaska (USA) 20431 (+26)
  48. Mike Cummings (USA) 21501 (-2)
  49. Jennifer Unger (USA) 21881 (+16)
  50. Steve Sussman (USA) 22062 (+5)
  51. Rob Sanson-Fisher (Aus) 23960 (-7)
  52. Gary Giovino (USA) 23923 (-21)
  53. Sue Curry (USA) 24700 (+2)
  54. Emily Banks (Aus) 25853 (+54)
  55. Konrad Jamrozik* (Aus) 24748 (-19)
  56. Wasim Maziak (USA) 27248 (+18)
  57. Robin Mermelstein (USA) 27503 (+1)
  58. Prahbat Jha (Can) 27508 (+22)
  59. Prakash Gupta (Ind) 28230 (-18)
  60. Lynn Kozlowski (USA) 28533 (-0.5)
  61. Riccardo Polosa (Ita) 29278 (+0.1)
  62. TH Lam (HK) 30263 (+0.01)
  63. Steve Schroeder (USA) 30931 (-32)
  64. Mark Nichter (USA) 31011 (+8)
  65. Tom Eissenberg (USA) 31707 (+11)
  66. Hein de Vries (Nld) 33466 (-5)
  67. Karen Emmons (USA) 33607 (-29)
  68. Dorothy Hatsukami (USA) 33809 (-11)
  69. Jack Henningfield (USA) 34723 (-147)
  70. Tracy Orleans (USA) 34790 (-54)
  71. Ovide Pomerleau (USA) 35955 (-48)
  72. James Sargent (USA) 36325 (+17)
  73. Paula Lantz (USA) 36387 (-10)
  74. Mohammad Siahpush (USA) 36523 (+0.5)
  75. Peter Hajek (UK) 37143 (+16)
  76. Joe DiFranza (USA) 37246 (-20)
  77. Michael Russell* (UK) 37437 (-38)
  78. Ellen Gritz (USA) 38835 (-25)
  79. Gary Swan (USA) 38847 (-61)
  80. Tim Baker (USA) 38741 (-0.8)
  81. Tim Lancaster (UK) 39068 (-2)
  82. Ann McNeill (UK) 39099 (+5)
  83. Robert Klesges (USA) 40562 (-44)
  84. Derek Yach (USA) 41874 (+20)
  85. Richard Hurt (USA) 43170 (-44)
  86. David Balfour (UK) 44092 (-19)
  87. Maxine Stitzer (USA) 44627 (-28)
  88. Michael Siegel (USA) 46259 (-6)
  89. Melanie Wakefield (Aus) 47231 (-11)
  90. Tony Blakely (Aus) 47753 (+14)
  91. Hu, Teh Wei* (USA) 47806 (-5)
  92. Robert Jackler (USA) 49015 (-23)
  93. Gerard Hastings (UK) 49682 (+16)
  94. David Levy (USA) 50203 (+10)
  95. Scott Tomar (USA) 52527 (-15)
  96. William Carrigall (USA) 54676 (-48)
  97. Paul Aveyard (UK) 55363 (+18)
  98. Ruth Malone (USA) 58425 (-2)
  99. Alastair Woodward (NZ) 60704 (+6)
  100. Lois Biener (USA) 62227 (-25)

*= deceased

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

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

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

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

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

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

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

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

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

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

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

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

Walking in retirement around Sydney and its environs

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

Above: your correspondent with Dear Leader

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

“Youse are not allowed to be here”

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

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

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

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

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

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

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

Two views near South Durras