Ron Phillips was health minister in the NSW Fahey Liberal government from June 1992- March 1995. One day I was invited to meet with him in his office. I wasn’t briefed about the purpose of the meeting but when I got there, I found myself with a handful of colleagues I knew well from tobacco control.

Phillips adopted a confidential tone and explained that a delegation from the International Olympic Committee would soon be in Sydney to meet with government, sporting and business officials at a critical phase in the selection process for which city would host the 2000 Olympics.

His message to us was that several key members of the IOC group were smokers known to be irritated by not being able to smoke wherever they wished. Australia was internationally in the forefront of tobacco control policies like banning advertising and increasing smoke-free spaces. There were concerns that while the IOC was in town that if we opportunistically turned up the heat on the government to ban smoking at all Olympic facilities and in restaurants, pubs and clubs throughout the state this might irritate some of the smoking members of the delegation and jeopardise their votes. Every possibility was being covered off.

Phillips asked if we would all please put any concerns we might have on ice until the delegation left town and voted. He was highly sensitive to how this request might go down, and subtly hinted that if we would cooperate, the government would be immensely grateful. He emphasised that there was lots of support within the government for finishing the job on smoke-free areas. Public transport, airports, cinemas and theatres had long been smoke-free. A large number of workplaces had banned smoking indoors and many restaurants voluntary offered non-smoking sections, with magic lines dividing smoking from non-smoking sections. However, somebody had forgotten to tell the smoke about how it was supposed to behave, so policy reform was well overdue.

The barely hidden subtext was that if we played ball and kept temporarily quiet, things could change after the Olympics announcement. We all instinctively and immediately agreed that this was a very sensible thing to do.  

Around coffee, I noted aloud that someone who was prominent in tobacco control advocacy in NSW was absent. Phillips said this person had not been invited because it was feared that they would rush straight from the meeting and megaphone what had been said to the media. For this person, there could be no compromise: if environmental tobacco smoke was harmful, it was harmful in every setting, not just those already lost by pro-smoking lobby groups.

We all of course agreed with this colleague’s aims. But where we differed was in the tactical process that would best achieve the reforms we wanted.

The announcement that Sydney had won the bid was made on September 24, 1993, seven years out from 2000. The Fahey government lost power to the Bob Carr Labor opposition in March 1995. No advances in smokefree policy were made in the 25 months between the Olympics host announcement and the defeat of the Liberal government but we had avoided the possibility of tobacco policy being blamed if Sydney had lost the Olympics. Then, with the new Labor government, we all rapidly cranked up smoke-free policy advocacy, and well before the 2000 Olympics, the government declared Olympic facilities would be smoke free. Restaurants banned smoking 10 days before the Olympics commenced. This was politically assured by personal leadership especially from premier Bob Carr and his health minister (1999-2003) Craig Knowles. Pubs and clubs followed in 2004, with Frank Sartor, NSW Minister Assisting the Minister for Health (Cancer), being politically resolute in the face of fierce lobbying from the pubs and clubs lobbies.

Long game perspectives

Phillip’s remark about the uninvited advocate burned into my understanding of the long game of how policy changes. I incorporated the episode into my public health advocacy teaching in the Master of Public Health  at the University of Sydney. It kindled a research interest into questions of the nature of public health influence and of how it is that politicians, their staff and senior bureaucrats decide to consult and work with particular experts, leaders and lobby groups and ignore others.

A 2008-10 NHMRC grant I led, What characterises influential public health policy research in Australia? produced seven papers. Four of the most important were:

• Chapman S, Haynes A, Derrick G, Sturk H, Hall WS, St.George A. Reaching “an audience that you would never dream of speaking to”: influential public health researchers’ views on the role of news media in influencing policy and public understanding. J Health Communication 2014;19(2):260–73
• Haynes AS, Derrick GE, Redman S, Hall WD, JA Gillespie, Chapman S, Sturk H. Identifying trustworthy experts: the ways that policymakers find and assess researchers for consultation and collaboration. PloS One 2012; 7(3): e32665.
• Haynes A, Derrick G, Chapman S, Gillespie J, Redman S, Hall W, Sturk H. Galvanisers, guides, champions and shields: the many ways that policymakers use public health researchers. Milbank Quarterly 2011;89:564–98
• Haynes AS, Derrick GE, Chapman S, Redman S, Hall WD, Gillespie J, Sturk H. From ‘our world’ to the ‘real world’: exploring the behavior of policy influential Australian public health researchers. Soc Sci Med 2011;72:1047–55

The characteristics that most would expect that politicians would seek in the experts they chose to consult were invariably mentioned by the senior informants we interviewed. These included research seniority and reputation, prestige of their institution, prominence, ability to communicate scientific complexity to non-experts, and responsiveness to urgent requests for guidance. But we were also struck by how often informants mentioned qualities that were decidedly personal.

Personal attributes important

Outstanding among these were comments about experts’ sophistication in understanding the complexity and contested nature of the policy process, the frequent need to play the longer, incremental game rather than always expect iconoclastic, rapid change and critically, what we might bluntly call the “no dickheads” rule.

Professional attributes such as deep knowledge, a helicopter view of evidence, determination, passion, persistence and effective communication skills were highlighted by those we interviewed. But interpersonal factors such as likability, friendliness, generosity and having a sense of humour were given equal emphasis by many interviewees.  Those who were seen as prickly, dogmatic or selfish were viewed as seldom influential by both other researchers and policy makers.

These personal attributes are not the sort of qualities that are typically taught or coached in postgraduate public health degrees alongside epidemiology, biostatistics, health promotion, health economics and the myriad disease or injury specific specialisations that students elect to study.

Instead they are lessons that many of us learn very early in life in our upbringing and from reflections about the type of people we respect, like and want to keep company with, and the obverse, those whom we deliberately ignore and avoid.

We can all immediately think of some we know whom we don’t respect, are obnoxious in some way and who consequently we actively avoid. We see them coming toward us at a social gathering and say to those around us “quick, let’s move away. Dickhead X is on his way over”. We don’t return their calls and emails, ignore, mute or block their tweets and often share our assessment of them with others who typically instantly reciprocate with their own florid experiences.

A lightning-fast route into this purdah is the truly bizarre belief that the best way to have a politician, health agency or expert group want to rush you into their inner circle of confidence and trust, is to rain down florid abuse and criticism on them from the outset.

Imagine you were a health minister who hears a critic tearing into her day-after-day in the media. Strange as it may seem, most people actively avoid those who regularly berate them. Politicians are no different.

Vaping advocates’ self-exile outside the policy tent

In recent years, policy development on vaping has seen a tiny group of “let it rip” medical advocates in policy lock-step with extreme-right politicians, all Big Tobacco companies and the cash-hungry convenience store lobby, with its Big Tobacco connections.    During the Turnbull and Morrison years, they might have expected much common ground with a conservative government, except that they came up against Health Minister Greg Hunt who was implacably committed to strong regulation of vapes, a baton seamlessly accepted by Labor via an equally committed Mark Butler.

These advocates’ unerring response to this has been to turn up the pillory volume to 11,  and play endless pantomime-standard roles as heroic Galilean truth-tellers who are locked out of the political tent but  will one day be vindicated as their truths are validated.

They seem blind to the reality that they are reaping the legacy of their fervid embrace of their right-wing political bedfellows who are marks of Cain on all those known to have fawned over them.  

In concluding, I  emphasise that all this does not mean that effective advocates need to be slavering sycophants to politicians, agreeing with their every pronouncement if they want to secure influence. Most experienced politicians immensely value independence and integrity in their advisors and understand that there will always be areas of disagreement.   

In periods when various factors conspire to make it unlikely that a policy you are advocating will be quickly adopted, the long game need not be barren. While dickhead public health advocates blaze away at their political enemies, guaranteeing an enduring lack of influence that can last years or even decades, there are long game objectives about building enduring respect.

During the Howard years, I was rarely consulted or invited onto committees because I had spent 20 years as a strong advocate for regulations that gave many conservative governments dyspepsia.   Labor governments have generally been more willing to embrace public health reforms.  Instead, in those lean years I put effort into assisting colleagues who were inside the tent in bureaucracy or on committees who often reached out for advice, as well as continuing to publicise my research to the media.

I saw this as a long game which would eventually mature with changes in government.  The first time I met Nicola Roxon was in her final months of being in political opposition. I mentioned that I didn’t believe we had ever met. She instantly replied that she felt like she’d known me all her adult life, presumably because of my many years of policy advocacy. After she became Health Minister, I was delighted to be one of those whose advice she followed in introducing plain packaging and other strong tobacco control measures. It was similar with Mark Butler, whom I’d also never met or written to. Within weeks of the new government coming to power he organised a meeting where I gave an overview of where tobacco control might head.

Australia’s vaping advocates, like the tobacco industry before them, are totally marginalised in political circles with any power. Their public voices are confined to a diminishing number of news outlets, to social media echo chambers,  blogs and personal  videos with mostly desultory viewing numbers. Without exception, Big Tobacco has lost every policy battle it fought. Vaping promoters are on the same trajectory. Their regular splenetic ranting at anyone not sharing their vaping theology precepts is seeing their credibility evaporate.  Keep it up, guys.

I’ve written about the most memorable meals I’ve ever had the pleasure to eat.  So now it’s time for the very worst. Here are five traumatic experiences.

Photo by Towfiqu barbhuiya on Unsplash

Andouillette

I ordered this once in 2006 at a renowned restaurant, Les Adrets on Rue de Boeuf in Lyon’s old town. We lived in that wonderful city for 7 months. The menu described a classic French sausage, served on a bed of mustard sauce. I’d eaten and loved many market-bought French saucisson, so what could go wrong?

Dear readers, a whole lot. The large near semi-circular andouillete arrived. I could smell it coming from across the room. As I later learned, someone had described it “something that looked, smelled and tasted like it belonged in a toilet.” It smelled for everything like the smell of the first concentrated warm piss that greets you on a cold winter’s morning.

Oh well, in for a penny, in for a pound I thought and sliced off the first of what I could see would need to be many discs of the rotund beast on my plate. Now, I confess here that I have never tasted warm urine (I am unpersuaded by arguments for its virtues). But this was the overwhelming sense of what I was eating. The texture was also confronting. On inspection, the creature was made from tightly wound intestine, which I later learned to be pig. What to do in such a refined setting? The napkins were linen and so unsuitable for a mouthful of barely chewed pig-inards. So I borrowed a tissue from Trish, surreptitiously spat into it and put the mess in my pocket for later.

I sat there glum while the other three at our table enjoyed their wonderful choices. The waitress passed and noticed my disconsolate demeanour. “Oh, you do not like  l’andouillete?” she said to the Australian culinary philistine. No, I simpered in sheepish apology. She whisked it off the table and moments later returned with the tourist meal stand-by, coquille St Jacques. It was delicious.

Here’s Stanley Tucci absolutely nailing the attractions of anandouilette.

Papuan mumu cooked pig flaps

In 1983, I was working in Papua New Guinea for WHO. A guy I was staying with in Port Moresby ran an adventure travel business. He asked if I might be interested in spending the weekend rafting with him and about a dozen paying customers down the Angabanga river, which sounded like something straight out of a Phantom comic. There was a space in one of the rubber boats they used. It was on the house, he said. We’d be leaving the next morning and back in Moresby late Sunday night. Is the Pope a catholic, I asked.

On the second day around 11am we pulled into a small village where a family had an arrangement to cook up pig meat in a ground oven (mumu in tok pisin). In a shallow earth pit, a fire had been heating up rocks before our arrival. Banana leaves were then placed on top of the rocks, and large flaps of raw pig and yams positioned on top of this. More banana leaves were then added, then soil and more fire started above the soil, if I remember it well enough.

We all then sat in a raised, wall-less hut and tried chewing betel nut while dranking warm South Pacific lager from cans with a few of the men from the household.

About four hours after arriving, and with us all nearly dropping with hunger and the forgettable effort to politely drink lousy warm, flat beer in the heat, steps were taken to check whether the meat was showing signs of being ready. The soil and top layer of banana leaves were removed and after some discussion about whether it needed to stay in for another hour, the vote was to give it a try.

With a few exceptions, the slabs of meat were barely warm. A few from down near the hot rocks were almost there and these were sliced up and given to us with a chunk of barely cooked yam and another can of warm beer. The skin still had bristles all over it, now covered with half congealed, oozing fat making it all the more appetising. Forget crackling. Forget the idea of any meat you wouldn’t have thrown straight in the bin anywhere else. I tried to extract what might have been a sliver of lean meat from its thick fat surrounds. The little I got was barely past raw, and whatever hunger I had rapidly abated at thoughts of all the stomach problems I could imagine erupting a few hours later.

It was clear the others held this gustatory feast in the same esteem as I did. So we took a few tentative bites out of the bland, under-cooked yams and indicated to our crew leader that we thought we’d best continue our journey. Never again.

Chiko rolls

The legendary Chiko roll was an early pioneer in Australian take-away food. I my hometown of Bathurst in the 1950s and 60s it graced the bain maries of every cafe and fish and chip shop in the town, along with gelatinous dim sims, potato scallops, and hamburgers-with-the-lot.

I cannot do more justice to this excrescence than to cite Sydney gastronome David Dale from his Facebook seriesEverything Ever Invented, illuminated by cartoonist Matthew Martin.

“In my high school playground, The Big Question, after “Who’s better, the Beatles or the Stones?” was this: “What is actually IN the deep-fried Chiko rolls we buy at the fish and chip shop on the way home from school (alternating with potato scallops)?” When you bit the blackened end off, you could see bits of cabbage and carrot in the filling, held together by a translucent mucus. But were those greyish-brown bits supposed to be meat, and if so, from what animal? And if animal, from what parts of the animal?

We did not know at the time that the Chiko roll had been “invented” in 1950 by Frank McEnroe, a former boilermaker who used to drive around country shows in outback Victoria and southern NSW selling pies and pastries from a caravan. His aim was to build a sturdier and more portable version of the spring rolls he’d eaten in the Chinese cafes that abounded in Australian small towns (often beside the Greek milk bar). The first place McEnroe sold the prototype was Wagga Wagga, which now proudly proclaims itself the birthplace of the Chiko.

Having constructed the roll, McEnroe went into partnership with a freezing works, which enabled him to send the cylinders around the nation to any food outlet that possessed a deep fryer, along with special bags into which they would squirt tomato sauce before sliding in an orange cylinder freshly tonged from the boiling fat.

Now it can be told: The lumps inside were mutton and, in more recent times, beef. Plus, in the version now made by Simplot, Flavour Enhancer 635.”

Chartreuse liqueur

There’s not much I don’t like drinking, although the attractions of Campari, Greek retsina and Laphroaig single malt are completely lost on me. But I once bought a bottle of Chartreuse, in a period where I was intrigued by French art house film, impenetrable existential philosophy and Bridget Bardot. Made since 1737 by  Carthusian monks north of Grenoble, it blends distilled alcohol with 160 herbs and flowers. I cannot put it any plainer than this. It is absolutely vile, tasting as I imagine castor oil must taste. Never, ever make the mistake of buying it.

Maotai liqueur

Maotai is a Chinese liqueur. It is the toasting drink of choice at many Chinese dinners. I’ve visited China about six times for research collaboration with Fudan University scholars in Shanghai and to teach for a week in Shandong province, near Korea. At the dinner at end of that week, the leader of the Chinese group stood to thank me for my efforts. He filled my glass with a liquid I couldn’t guess at. At different times in his speech he’d toast various senior people in the group, and me for a variety of reasons.

After the first toast, I knew I was in big trouble. The drink I later learned was maotai was quite disgusting. I swallowed the first toast in a gulp and knew I couldn’t do it again. So I politely tilted the glass each time and kissed the surface of the vile stuff.

I knew from toasting rounds in previous visits that this would go on for some time, as new speakers rose to go through the ritual. Finally, it would be my turn, all translated by an interpreter. So I left the room on a toilet pretext, went up to my room and brought down my unopened duty free litre of Glenmorangie. I could do my toasts with this in a kind of muddled thinking gesture of respect.

When it came to my turn to toast I poured about half a glass, mentally calculating the number of people I would need to thank. This worked well. But when I’d finished, mandatory government party official who’d hovered in the classroom throughout the week, picked up the Glenmorangie bottle, filled his glass to near the top, then filled mine. He made a short speech then sculled the lot in several huge gulps. He then signalled that I should do the same. It was drink-the-foreigner- under-the-table time. I chickened out to gales of laughter.

Updated 8 Aug 2023 (see end of blog)

Image by Brian Neises from Pixabay

The Australian government announced in May that it is now illegal to import or retail nicotine vaping products into Australia unless these products are destined for sale in pharmacies to those with a doctor’s prescription for a nicotine vaping product.

These products will be sealed “pod” systems where the liquid containing nicotine and flavouring chemicals and the battery that heats and vapourises the liquid will be sealed, with attempts to open it destroying the integrity of the product.

Many older vapers use vaping systems which allow the user to remove the tank containing the liquid and refill it with new liquid once the tank has emptied. Users have been able to openly buy liquid flavours and nicotine either pre-mixed or that they mix up themselves. The charge from the battery that heats up the metal coil that vapourises the liquid can also be adjusted.

If these liquids had nicotine in them, they have always been illegal in Australia. But the wholesale diversion of many health department staff to COVID duties across three years has seen only a few prosecutions occur, with thousands of retailers openly breaking the law knowing they had a homeopathic probability of being prosecuted.

The Labor government, in collaboration with six Labor-led states and Tasmania will see a dramatic change in this. We are seeing momentum in significant seizures and fines. In May a Queensland retailer had 45,000 vapes seized and was fined $88,000 including court costs. The Therapeutic Goods Administration has recently issued infringement notices of $105,600 (July 2023), $558,840 in June, $16,000 in May, and $66.600 in April.

The word on the street is that in the hiatus period before widespread raids on retailers commence, vape sales are booming with customers being told “you’d better stock up now because all this is going to end pretty soon”.

When this happens and personal supplies are exhausted, there will be thousands of mod/tank systems lying unused in drawers around the country with other redundant technologies like VHS tapes, film cameras, Walkmans, cassette tapes and passé gaming units.

The Therapeutic Goods Administration was able to make regulations on nicotine because nicotine when sold outside of cigarettes is classified in Australia as either a poison or a therapeutic substance. So it has no remit to make recommendations about mods/tanks themselves other than in relation to approved NVPs that would be approved for sale as prescription items.

This raises the serious question about whether the government ought to consider adding mods/tanks systems to the prohibited imports list. This can be done simply by the stroke of a pen under customs regulations. Few Australians would realise for example, that  cat and dog fur products, dog collar protrusions, electronic insect swatters, kava and ice pipes are among all 71 prohibited import items that were included without extended parliamentary or community debate.

Use of mod/tank systems by children in Australia is rare, with disposable sickly sweet flavoured vapes overwhelmingly dominating. But adult use is far more common.

What’s the problem with mods/tanks?

The primary issue has always been the devices themselves. Users are able to control the power settings. More power means that more ‘juice’ is being consumed, i.e., increasing exposure to the nasties. In less complicated devices, more power also translates to higher temperatures which creates even higher levels of by-products of thermal degradation (e.g., acetaldehyde, acrolein, formaldehyde and others).

But if there is no legal access to liquid nicotine, then why should anyone worry? Why would anyone bother buying one of these devices from now on? It’s common to see bongs, pipes and other dope-smoking paraphernalia on open display in shop windows. So why not also allow mods/tanks to be imported and displayed in shop windows? 

The outstanding concern here is that mod/tank vaping apparatus can be used to vapourise other drugs which according to this San Diego drug treatment centre can include cannabis. LSD, GHB (gamma hydroxybutyrate) and ketamine.  This is far from rare. A 2022 Kings College London survey found that 14.7% of people aged 18+ in the UK had ever vaped a non-nicotine drug, with nearly 1 in 56 (1.8%) currently doing it. In 2019, 3.9% of 19-24 Americans ( 1 in 26) had vaped cannabis in the last 30 days. I’ve found no data on other drug vaping by under 18s, which of course does not mean it is not happening.

As of February 18, 2020 a total of 2,807  people had been hospitalised in the USA for vaping product use-associated lung injury (EVALI). 68 people died. Of these:

• 82% reported using THC-containing products; 33% reported exclusive use of THC-containing products.
• 57% reported using nicotine-containing products; 14% reported exclusive use of nicotine-containing products.

Here’s a sad example of a young woman “cannamom” who never “leaves the house without carrying one of my looper vapes” to smoke weed.

No data appear to be available on the incidence of health incidents following vaping other drugs, but  the World Drug Survey included questions on it in a recent survey.

Australia’s vaping advocates have repeatedly emphasised their unswerving, inviolable conviction that vaping nicotine is all but benign. They have also warned vapers never to vape other substances. In doing this they have wedged themselves on this issue. They regularly retort that no one has ever died from vaping nicotine. With smoking-caused chronic diseases like respiratory, cardiovascular and cancers taking decades to manifest after smoking uptake, that would be entirely expected. The median age at which asbestos-caused, invariably fatal mesothelioma is diagnosed in Australia is 77, with first exposure typically 40-60 years earlier. Vaping has been widespread for less than a decade in Australia.

Mod/tank systems were invented and marketed to facilitate nicotine vaping. But like a Trojan horse, they have also enabled widespread vaping of non-nicotine drugs which have killed and seriously harmed thousands in the US alone. Vaping advocates just shrug at this and argue that this legacy is all irrelevant to nicotine vaping. But it’s not.

Collateral damage (what economists call negative externalities) from intended use is routinely considered in all formal risk assessments in health and community safety.  For example, gun control policy considers gun misuse, not just approved uses in hunting and target shooting; DDT was widely used in Australia in agriculture and termite control where it was extremely effective, but banned in 1987 because of its collateral residual health risks to humans.  Vaping advocates sneer at efforts to reduce kids’ access to vapes, sarcastically bleating “won’t someone please think of the children” memes, as they do all they can to wreck policies designed to do just that.

So here again, don’t hold your breath waiting for any calls for open vape systems to be banned from import or sale. Vaping leaders will unashamedly walk on both sides of the street, warning about the risks of vaping other drugs while demanding that the open systems  being used should be openly available to make some nicotine vapers happy.

Update 8 Aug

It seems my blog passed the proverbial scream test with flying colours. “Dr Col” Mendelsohn the vaping promoter was quick out of the blocks in apoplexy tweeting that it was “highly misleading” for me to cite this UK study showing that 1 in 56 UK adults had vaped drugs other than nicotine in the past 30 days. He implied that vaping cannabis in “a dry herb vaporiser”, and vaping caffeine or alcohol were not of “potential concern”, words he agreed applied to vaping opioids and benzodiazapines.

So what is the evidence that vaping caffeine and alcohol are of no concern?  This site outlines the risks of vaping alcohol. And what about caffeine? In December 2019,  the Australian government approved the banning of the sale of pure caffeine and foods and beverages containing high concentrations of caffeine. This followed the death from caffeine toxicity of a 21 year old Blackheath man, Lachlan Foote, after drinking a protein drink with added caffeine powder on New Year’s eve. A single teaspoon of caffeine can be fatal, containing the equivalent of between 25 to 50 cups of  coffee.  But hey, nothing to worry about in sticking caffeine in your vape tank and pulling anyone’s guess of whatever amount of vapourised caffeine deep into your lungs, according to our expert, Dr Col.

Dry herb vaporisers are already on sale in Australia (see this example). A search on PubMed for “dry herb vaporiser” (or “dry herb vaping”) shows that no studies appear to have been published in indexed journals on the toxicology of emissions from dry herb vaporisers. So how do these differ from nicotine vaporisers?

A Hong Kong supplier is helpful here:

“A popular misconception is that dry herb vaporizers are the same as e-cig type of vapes. Dry herb vaporizers are not the same as e-cigs. Unlike e-cigs, dry herb vaporizers are not intended to deliver nicotine or other substances found in tobacco-containing cigarettes. Instead, they are used to inhale various substances that are found in a plant called cannabis, which is better known as marijuana.”

So have we all got that? The only difference appears to be that one is used for vaping nicotine and the other for vaping cannabis.

So just who is being misleading here?