Vaping theology 18: Vaping is a fatally disruptive “Kodak moment” for smoking

30 Monday Oct 2023

Vaping advocates love to frame vaping as Big Tobacco having its very own, huge “Kodak moment” – a sweeping, game-changing point in an industry’s history when a revolutionary change saw an old way rapidly swept away by a technological breakthrough. Kodak made cameras and film, with hundreds of millions of snappers buying and fiddling with the film spools we needed to take photos. The arrival of digital cameras and then mobile phones with cameras relegated film cameras to niche enclaves of collectors and specialised photographers. Kodak infamously failed to appreciate the epoch-ending arrival and growth of digital photography and nose-dived into oblivion.

There are many, many other examples of such disruptive technology transforming industries: refrigeration replacing ice boxes and community cooling houses; vinyl records being replaced by cassette tapes which were then superseded by CDs which were then overtaken by MP3s and music streaming; the horse and buggy industry by the internal combustion engine, now being inexorably hammered by the rise of electric vehicles; telephone landlines by digital phones; fax machines by digital file transfers; and city street directories by GPS navigation. Cash and ATMs may soon be a thing of the past with tap card and phone payments.

So the Kodak moment/disruptive technology analogy pulls many powerful historic rhetorical levers. With each example that is likened to vaping, we reflect on the cumbersome and inefficient rituals that dragged on our time with the old ways. Who remembers using pencil to re-spool a favourite cassette tape that had become entangled in a Walkman? Or taking your film cannister to the local chemist and waiting days for your photos to come back. As an EV driver, it’s been two and a half years since I queued to fill a petrol tank.

We think of the obvious benefits of the new compared to the old. Why would anyone today bother with a home landline telephone unless they lived remotely and away from mobile reception? The multitude of advantages of cell phones are why their use is nearly universal today.

Those who cling to old technology are seen as quaint, doddery types needing to move with the times but who are rusted on to a decrepit past. They have no sense of history or perspective, unlike serial hyperbolist Prof David Nutt.

But the vaping replacing cigarettes “Kodak” progress analogy fails very badly when compared with the truly disrupting examples like those I mentioned above. In each of the examples above, the new technology rapidly caused redundancy and all but completely saw the old technology confined to collectors. The new technology was rapidly embraced because it was affordable and had clear benefits over the old.

But this is proving to be anything but the case with cigarettes. The two big pitches constantly made for vaping are that it is far less dangerous than smoking and far superior to any other way of quitting. But when you peer beneath these sales pitch slogans, it’s once again the story of empty vessels making the most sound.

Are vapes obviously less dangerous than cigarettes?

It’s clear that head-to-head, nicotine vaping products (NVPs) emit significantly less of most toxins than do cigarettes, the Mount Everests of risk. From this, many assume that it therefore follows that the reduced risks to health will simply be as proportionately less dangerous as the magnitude of the differences in toxin emissions. If there are twice as many of toxins X, Y and Z in cigarettes than in vapes, then hey, vapes are 100% less dangerous than cigarettes, right? Surely it’s then a no-brainer that vapes are all but “safe” compared to cigarettes?

The LD50s (median lethal dose of a toxin that will kill 50% of those exposed) for arsenic, cyanide, sarin and strychnine are all levels of magnitude different too. But no one proceeds from that to argue that any of them are relatively benign compared to the most lethal.

The argument assumes that any health impacts of vaping will be the same as those from smoking, but far less in magnitude. But vaping and cigarettes are very different products. This 2021 Johns Hopkins University study found fingerprints of nearly 2000 different chemicals in four popular vape brands by undertaking a full non-targeted analysis to determine the full range of chemicals in both vaping liquids and aerosols. Many of the chemicals were uncharacterised.

And daily vapers inhale much more than do daily smokers. In a recent (2023) study, observers found vapers took an average of 71.9 puffs across 90 minutes – 47.3 puffs an hour.

So across 24 hours, if we (conservatively?) assume 8 hours of sleep and four waking hours with no vaping, then a person vaping across the remaining 12 hours a day at this 47.3 puffs per hour rate, would pull 568 puffs deep into their lungs, 207,462 times in a year and 2.075 million times across 10 years.

By comparison, the average number of cigarettes smoked per day by Australian daily smokers today is 10.7. Unobtrusive observations of smokers smoking in outdoor leisure settings like beer gardens and parks show the average smoker inhales 8.7 times per cigarette. This suggests the average smoker inhales 93 times a day, about 34,000 times a year and 340,000 times across a decade.

Daily vapers thus inhale on average at just over 5 times the rate that daily smokers inhale. This is an almost frantic rate.

But you don’t just inhale nicotine when you vape. Vapers learn to titrate their puffing to obtain the desired level of blood nicotine. Importantly, the nicotine is mixed with an excipient – a substance that serves as the vehicle or medium for a drug to be consumed. Propylene glycol (PG) is the most common excipient used in vapes. Dow Chemical is a leading manufacturer of PG. Here’s what it has to say about breathing it in.

“Therefore breathing spray mists of these materials should be avoided … Dow does not support or recommend glycols in applications where breathing … is likely”

So with ~568 puffs a day by daily vapers, that’s 568 point blank deep lungfuls of vapourised PG – not just nicotine – that that vapers are getting.

Put simply, there has never been any precedent for the mass exposure of hundreds of millions of people – dominated by 15-30 year olds – to the humungous frequency of point-blank lung bastings of the chemical cocktail that includes vapourised nicotine, thousands of unregulated flavouring chemicals (none approved as “generally regarded as safe (GRAS) for inhalation), propylene glycol and metal particles sloughed from heated metal coils in vapes.

Thank goodness there is no shortage of vaping advocates around –often industry supported — to assure us that there is really just nothing at all to worry about here.

Long disease latency periods

Chronic diseases caused by smoking like cancer, respiratory and cardiovascular disease take decades to manifest clinically, and widespread vaping has only been around for 10-15 years in nations where it is now widespread. The famous 1994 graph (see below) known by every public health student on the lag time between smoking uptake and its death rates, showed that several decades pass between the uptake of smoking and deaths from the diseases it causes.

Another example of such a lagged effect is the always-fatal asbestos caused respiratory cancer mesothelioma which has a median age of diagnosis of 75, when many workers have been first exposed to it from their late teens onward.

No one but the epidemiologically ignorant or wilfully deceptive could seriously claim that the evidence jury was now in on how risky vaping will prove to be across the decades to come. John Britton, a senior British physician who has been a supporter of vaping nonetheless said in 2017 “Inhaling vapour many times a day for decades is unlikely to come without some sort of adverse effect. And time will tell what that will be.”

And, as 15 former presidents of the Society for Research in Nicotine and Tobacco emphasised in 2021 “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 is difficult because most adult vapers are former or current smokers”

So just how exceptional are vapes in helping smokers quit?

The other big claim for NVPs being the Kodak moment for cigarettes is the idea that they are driving unprecedented numbers of smokers to quit, far more than any previous way of stopping smoking.

Australian vaping advocates repeatedly argue out of one side of their mouth that Australia’s comparatively restrictive vaping policies are preventing teeming thousands of smokers from quitting and that Australia’s recent record of driving smoking down is an embarrassing failure. But out of the other side, they claim that there some 600,000 Australians who vape.

So how compatible are both statements if vaping is such a fast lane into quitting smoking? If so many are vaping and vaping is so good at driving down smoking, why then is smoking in the population not falling dramatically as these statements would imply? Surely we would be seeing turbo-charged smoking cessation?

The obvious answers here are (1) that many who are vaping are not vaping to quit – this includes those who have never smoked but now vape, and dual users (vaping and smoking) who we know have comparable quit rates to smokers who don’t vape and (2) that in the real world, vaping is not very good at helping smokers quit. Here are 16 reviews published since 2017 summarising this evidence.

In chapter 6 of my 2022 book Quit Smoking Weapons of Mass Distraction, I looked at length at the evidence from England that vaping was driving down smoking across that population. The evidence is desultory rather than strong on vaping having being a decisively Kodak moment force.

The Cochrane Collaboration’s systematic reviews show vaping performs marginally better than nicotine replacement therapy (NRT) under the entirely artificial conditions of randomised trials. But RCTs differ radically from real world conditions of use. Chapter 2 of my book summarises the main reasons for this. For example:

Some 70% of smokers are illegible for RCT enrolment because factors like of mental health history, health problems or pregnancy
There are many “cohort retention” strategies routinely used in RCTs which greatly enhance adherence to recommended dose and duration of use compared with unsupervised real world use where drop out rates are often large.
RCT participants get free drugs and are sometimes paid, both factors that never happen with real world use.
Many smokers allocated to the placebo (no nicotine) arm of a smoking cessation trial will guess very quickly that they are not getting nicotine because for years they have had strong bio-feedback from their brains that they need re-dosing with nicotine. They will then have little confidence that what they are using will be effective

The upshot of all this is that RCTs of quit smoking products greatly flatter real world results. But even RCTs show that about 90% of vapers are still smoking after at least 6 months. Is there any other drug where a 90% failure rate is ever called an effective drug?

Vaping has been dismal, not disruptive, in the project of helping large numbers of people quit.

Others in this series

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Vaping theology 17: “Vaping advocates need to be civil, polite and respectful” … oh wait

03 Tuesday Oct 2023

Posted by Simon Chapman AO in Blog

≈ Leave a comment

Updated 31 Jan 2024

As happens with all new and emerging science, things are moving fast in the research evidence base that informs vaping policy. When there are huge vested interests (commercial, personal/doctrinal) involved in generating, interpreting and critically appraising research evidence, things can get heated. Here, vaping research and advocacy has fast moved to the very front of the grid when it comes to relentless nastiness.

Across my 45 year career in public health, I’ve come under sustained attacks from the gun lobby, mandatory backyard swimming pool fence and bicycle helmet opponents; anti windfarm, mobile phone and WiFi radiation phobic fruitcakes; climate change deniers; far right and extreme libertarian opponents of state regulation and the dreaded nanny state; and of course the tobacco industry. One of my favourites was an anti-vax queen bee from the Blue Mountains who once challenged me to bare my backside on national television to be jabbed with multiple vaccines. As it turned out, I’d then recently been vaccinated for typhoid, cholera, hepatitis A, tetanus and even plague because of planned travel to central Africa, Pakistan and India.

In public health advocacy, you need to grow rhino hide. But vaping fanatics are the next level. Here’s a selected list of some of the worst examples targeted at me that I put aside some 5 years ago. I’ve long blocked activist vaping trolls after relentless, insistent streams. I explain why here.

Dr Alex Wodak, who has an entry in that list, is a veteran advocate for harm reduction in the drug field. In recent years, he’s become a prominent advocate for vaping.

He’s also a prodigious, almost incontinent user of Twitter.

If you go to Wodak’s twitter feed and search for “polite”, “civil” or “respectful” you will find many tweets like those below. He unctuously bangs on about this with great regularity.

But like many vaping theologians, Wodak has a deep penchant for rushing into abuse and sheer nastiness. Here are a few examples.

He has repeatedly and falsely accused the Cancer Council of taking money from Australia’s biggest tobacco retailers (supermarkets) and never apologised. (the truth is that supermarkets pass to the Cancer Council money collected in their stores from customers and staff making donations and buying Daffodil Day pins).

He’s played the Nazi card, implying those supporting the serious regulation of vapes are group-speak Nazis, like those in the photo he selected below. Another strike for Godwin’s Law which states “As an online discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches one”. Wodak should read the brilliant essay by Stanford University’s historian Robert Proctor on Playing the Nazi card in tobacco control which I published in 2008 when editing Tobacco Control. Proctor is the author of the seminal The Nazi War on Cancer.

Note above the gratuitous slur that anyone not in complete agreement with his take on vaping is “a Big Tobacco Little Helper.” I’ve explored this galactic nonsense here.

He’s accused the Australian Council on Smoking and Health in Perth (formerly directed by Maurice Swanson) of being quietly funded via Michael Bloomberg money apparently routed through “a few [of course nameless] organisations”. Very odd indeed, that neither Swanson, ACOSH nor Bloomberg know anything about this. It must be like one of those effusive letters we sometimes get from Nigerian correspondents saying that untold, unexpected riches are waiting unclaimed to be delivered to us.

He retweeted a tweet claiming my university (and therefore me presumably) also took money from Bloomberg and a Chinese Research Centre to critique vaping, when neither was in any way true.

He tweeted in agreement with someone who said I hid behind a fake Twitter account. I have never done this. He offered no evidence and never apologised.

He retweeted some miscreant’s twitter push poll inviting people to vote that tobacco control researchers’ highest priority was to “murder smokers & vapers” (below).

He asserted that the reason there was such animosity to Big Tobacco in public health was that many of us had been punished, hurt, suffered and damaged by Big Tobacco. There were more laughs in this claim than at a week long comedy festival.

Wodak is not averse to arrogant Jurassic “Dr knows best” rhetoric either.

Does he imagine that Quitlines across the country which talk with many 1000s of smokers a year are staffed by clinicians?

His co-director Joe Kosterich at ATHRA, the vaping lobbying group that today has three directors and no members and which hasn’t put out a press release on its website for 42 months, went one better with this little cracker below, when interacting with a post from England’s Prof Robert West who (whoops!) has no medical qualifications.

This one is pants-wettingly funny because a large number of the pro-vaping leadership are not medical clinicians either. What must have Scott Balin, Clive Bates, Linda Bauld, Ron Borland, Jamie Brown, Paddy Costal, Cliff Douglas, J-F Etter, Wayne Hall, Peter Hajek, Martin Jarvis, Lyn Kozlowski, Ann McNeill, Ethan Nadelman, Ray Niaura, Lion Shahab, Gerry Stimson, David Sweanor, Ken Warner and Robert West –all “clowns” with no medical degree and no “real world experience” all made of their fellow vaping enthusiast’s excoriating criticism?

Wodak goes full offensive

On 29 January 2023, thirsty for polite, respectful debate, Wodak published the tweet below, responding to a tweet posted by the Northern Territory Seniors for Tobacco Harm Reduction (yes, there really is such an account).

Wodak used a tortured analogy to declare that Dr Sandro Demaio, the CEO of VicHealth, was a “leading Baptist”. During alcohol prohibition in the USA, both Baptists and liquor bootleggers campaigned for restrictions on alcohol for different motives. But they should both be thought of as similarly misguided, the argument runs.

VicHealth and Sandro Demaio, along with all the groups shown on the left of the table below, support the provision of nicotine vapes via prescription, and therefore only through pharmacies. To call this “prohibition” as vaping theology decrees, makes as much sense as calling prohibition the regulated supply of statins, blood pressure drugs, antibiotics, oral contraceptives and indeed, all prescription drugs. The most recent available data show 315m prescriptions were filled in a year in Australia in a population of 25 million. Pharmaceutical “prohibition” is clearly getting lots of drugs to lots who need them.

Wodak wants to see vapes made as equally available as cigarettes, as if he had been in a tobacco control cave all his life and learned nothing about the unmitigated historical disaster that followed making cheap cigarettes available almost everywhere, promoted by massive advertising.

The Northern Territory Seniors tweet proposed that Demaio ought to be thought of as a valued Marlboro (a Philip Morris brand) employee because, presumably, they would just love his efforts to support the prescription-only access to vapes. Philip Morris International sells its IQOS NVPs internationally and wants nothing to do with prescription access.

A few days later, Wodak doubled down and retweeted the picture again (below).

Vile US troll retweeted by Wodak

Another who responded to the Northern Territory Seniors tweet was @vapelawguy from the USA, a brave anonymous keyboard vape warrior with all of 535 followers. Wodak republished it in a retweet (see below)

Mr Vapelawguy was apparently very excited by the brilliance of his tweet, trolling it five times earlier naming the Campaign for Tobacco Free Kids Matt Myers ) (”two of them in his mouth”), US Food and Drug commissioner Scott Gottlieb, the tobacco control Truth Initiative, the ParentsvsVape movement and the vapers’ anti-Christ Prof Stan Glantz.

So let’s parse the message in Mr Vapelawguy’s tweet that Wodak passed on to his 11,000-some followers. The illustration shows a vape with the acronym PENIS for Personal Electronic Nicotine Inhalation System. Sandro Domaio does not vape, so it’s clear that he’s not being called out as a hypocrite by claiming he not only vapes, but puts two or three vapes in his mouth at once. Instead, it is obvious what they are plainly suggesting that Demaio “often” has in his mouth.

Tweeted and retweeted in response to the context of the purposefully insulting “Marlboro Employee of the month” tweet, the penis tweet was intended to add an extra dimension to that insult.

Sandro Demaio was clearly playing deep inside Wodak’s head. Demaio is an articulate, evidence-based advocate with vast experience in advocacy. Wodak did not seem to realise that Philip Morris (Marlboro) is implacably opposed to NVPs being available only through prescription access. Philip Morris have never submitted an application to sell their NVPs via TGA authority. They and all Big Tobacco companies are fully committed to the “consumer model”, in lockstep with Wodak and those shown in the right hand column of the table above.

So why then, would Philip Morris make Demaio — a potent advocate for the very policy they virulently oppose — their employee of the month with the imminence of what they then faced under Australian government vaping reforms?

Wodak would probably say “because it will drive vapers back to smoking“. But there at least two small problems with this glib answer

A huge proportion of those who vape are also smokers (dual users). So this group would not be “driven back” to smoking: they already smoke.
In the latest national data available (2020-21), 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 still smoke). The overwhelming number of these lapsed vapers are not smokers who vaped then quit for good, but smokers who tried vaping but then quit vaping and continued smoking. And guess what? All this happened before prescription access policy was introduced.

Sandro Demaio replied to this vileness:

Wodak’s retweet was utterly shameless. He should delete the tweet, and prominently apologise to Demaio and to the public.

His righteous tweets about polite, civil and respectful dialogue need to be seen against the foreground of his regular unapologetic offensiveness.

Update: 31 Jan 2024

The doyen of decency, civility and respectful debate was at it again in late January 2024 tweeting the nasty and frankly unhinged little contribution below

His reasoning seems to go like this:

Criminal gangs are extorting Victorian tobacconists to stock their illegal tobacco and vapes
Refusal can result in their shops being firebombed and even death, presumably hoping news of this will persuade others to comply with their demands
If duty-not-paid tobacco and vapes could instead be sold freely everywhere, there would be no black market
Those named in the tweet are among many who have advocated for prescription access to vapes and for increased tobacco tax as a critical component of potent tobacco control. They are therefore culpable in causing the current spate of criminal extortion and standover violence

There are just a few small problems with this analysis. Criminals have long and often stood over a wide variety of enterprises throughout the last century (eg illicit drugs, firearms, liquor, prostitution, land development, car rebirthing) using bribery, corruption, extortion, violence and blackmail. Moreover, open supply is no barrier to black markets developing, usually via tax avoidance where smuggled goods can be sold at much lower prices than those where duty and sales taxes are paid. We have seen this for years with cigarettes, freely sold everywhere all around the world.

The view that criminality would disappear from the nicotine addiction industry if strong taxes were reduced or eliminated and vapes sold “responsibly” by the very retailers who have been openly ignoring the law for several years is beyond naive and would see smoking skyrocket commensurate with the fall in prices that would occur.

So this is all very inconvenient to his simplistic and childish narrative.

See this extended blog on this issue

Also in this series

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