Fiona Patten (left) shares the stage with Moira Gilchrist, Philip Morris International, (right) in 2023, Warsaw

The former Victorian state politician Fiona Patten who failed to be re-elected in 2022 and again in the 2024 federal election for a Senate seat, is a dedicated advocate for vaping. She’s been a regular attender at the Global Forum on Nicotine (GFN), held annually mostly in Warsaw. In 2025 she was awarded the top gong at what is typically a modestly attended conference of the vaping faithful including those from Big Tobacco.

In the Sydney Morning Herald yesterday, she wrote an opinion piece calmly titled Australia has become the global village idiot on quitting smoking.

I spent 17 years editing the world’s first dedicated research journal on Tobacco Control. I handled 1000s of research manuscripts across that time. I also spent over 20 years teaching and marking Master of Public Health student course assignments at the University of Sydney for a unit I taught, Tobacco Control in the 21^st Century.

So let’s imagine Fiona had submitted her piece for review and assessment. Here are my restrained comments on 13 issues. Read her piece in full here.

1. “When it comes to reducing harms from smoking, Australia finds itself cast as the global village idiot … we are now the cautionary tale.”

Comment: Smoking prevalence is the leading indicator of reducing the harms of smoking. This report shows the worst performing nations. Australia is not mentioned.  In fact this map from the report shows Australia colour coded at the best level. So who’s really a village idiot?

2. “At present, 66 Australians die every day from the effects of smoking – not from an addiction to nicotine, but from the toxic delivery mechanism of cigarettes.”

Comment: If cigarettes did not contain nicotine, few if any people would smoke. Nicotine in itself is far from benign as these papers show, but it is the essential highly addictive cheese that baits the deadly mousetrap. Nicotine is the sina qua non of smoking. And we are steadily becoming aware of an increasing number of health problems from vaping (see reviews here).

3. “Legal cigarettes are taxed at rates so punitive that they have become virtually inaccessible to many, while vaping devices … are rendered unobtainable through deliberately restrictive access avenues.”

Comment: The corollary of the argument that cigarette tax is “punitive” is that making them less expensive would be somehow … compassionate? Tobacco companies engage in price discounting and have always fought tobacco tax rises because they are acutely aware that high price depresses demand. I’m aware of no government which has ever reduced tax on cigarettes to make them more affordable, a truly perverse step that would encourage uptake and depress quitting. It would be literally killing with  kindness. And vapes being “unobtainable”? Any of Australia’s 5800+ pharmacies not already selling them can order them in.

4. In Australia only a “handful of well-intentioned but misguided health groups” support the government’s policies on vapes. “Nearly everyone else” opposes them.

Comment : Below are two columns. The one on the left shows the “handful” of “misguided health groups”. The other, “nearly everyone else”. Notice any pattern here, Ms Patten?

The graph below from the latest AIHW National Drug Household Survey shows support for action on vaping in the Australian community. There are few hot button issues in Australia that attract higher public support than vaping control (see here for comparisons and the lame efforts of vape lobbyists to demonstrate that night is actually day).

5. “Around the world, doctors, scientists and governments have embraced harm reduction and acknowledged that prohibition does not and cannot ever work”

Comment: Here is a VERY long list of doctors and scientists around the world who have major concerns about the safety and effectiveness of vapes. And here in great detail is information about the many nations which either ban vapes completely  (33) or regulate them in ways that many vaping advocates oppose. 

Predictably and very tediously, the boo-word “prohibition” makes an  appearance. If vapes are “prohibited” but available in pharmacies, then by the same reasoning, Australia “prohibits” the 1000s of prescription drugs also only obtainable via pharmacies. Tell that to the millions of Australians who used some 335.8million scripts which were filled in a recent year in a population of 26 million people (and that’s not even counting the number who go to pharmacies for non-prescription items  … including vapes with <20mg/mL nicotine which are OTC).

In any event, the idea that “prohibition” never works is contradicted by considerable evidence (see here). Most governments, including Australia, have prohibitions on goods and substances for a plethora of reasons including biosecurity, public safety (eg fireworks, laser pointers, flick knives, explosives, asbestos, DDT, leaded petrol and paint) and intellectual property. In 1996 Australia prohibited semi-automatic rifles and pump action shotguns and saw a sustained halt to mass shootings.   The death of a friend’s son from adding caffeine powder to a drink, saw it banned. While “everyone knows” alcohol prohibition failed, Australian drug and alcohol expert, Wayne Hall, has documented in detail the considerable benefits that  flowed from the US alcohol prohibition (1920-1933).

6. “And in countries where these products are promoted, smoking rates have plummeted.” Britain has seen smoking “drop steeply in the past five years, from 18 per cent to 11.6 per cent.”

Comment: In England, e-cigarette use rose sharply from 2021, but this increase was not accompanied by a faster decline in smoking rates between 2016 and 2023 among 18–24 and 25–44 year-olds. Even worse, among those aged 45 and over, the decline in smoking actually slowed._

Australia which has tighter regulation of vapes than Britain, the UK, Canada and New Zealand, has also seen smoking prevalence fall in recent years. Here are the most recent official statistics on smoking prevalence for several comparable countries.

Australia (2022-23 14+) 10.5% current and 8.3% daily  — all combustible tobacco products

Canada (2022 15+) 10.9% current in last 30 days, 8.2% daily, cigarettes only

Europe (all EU members 2019 15+) 18.4% daily, cigarettes only

New Zealand (2022-23 15+) 8.3% current and 6.8% daily –all combustible tobacco products.

UK (2023 16+) 10.5% current cigarettes only

USA (2021 18+) 14.5% any combustible product, 11.5% cigarettes

Clearly, free-for-all vaping policy is not necessary in getting smoking down.

7. “in the short and medium term, vaping poses a small fraction of the risks of smoking”

Comment: In the “short and medium term” are very carefully chosen words here. Smoking, like asbestos, doesn’t typically kill or even manifest in symptoms in the short term — in days, weeks, month or years but in decades. As 15 presidents of the Society for Research into Nicotine and  Tobacco wrote 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 in adults is difficult because most adult vapers are former or current smokers.” 

8. Because of the uptake of  so-called harm reduced products “Japan, too, has reduced its smoking rate by more than 30 per cent in seven years”

Comment: For cultural reasons, there have long been huge differences in smoking between Japanese men, (currently 24.8%) and women (6.2%). Australia has not seen male smoking rates as high as 24.8% since 2001 – nearly a quarter of a century ago.  Japan might well look to Australia to learn a thing or two about how to really get smoking down, not the other way round.

9. “New Zealand’s progressive policies on vaping and nicotine have it poised to join Sweden as a smoke-free nation.”

Comment: New Zealand has Patten-approved vaping policies (it also has the least affordable cigarettes in the world (see graph below) which almost certainly explains some of the country’s declining smoking rates).  But New Zealand’s youth vaping rates are of great concern. 

The only study to compare adolescent smoking trends before and after e-cigarettes became available in New Zealand found that progress in reducing adolescent smoking significantly slowed following the emergence and rise of vaping. The most recent data show that NZ had the first increase in a decade in daily smoking among adults (age 15+ in NZ health survey) from 6.8% in 2023 to 6.9% in 2024, despite daily vaping continuing to rise rapidly from 9.7% to 11.1% over the same period.

10. “The message is clear: when governments allow and encourage safer alternatives, lives are saved and deadly smoking rates decline. They are also not experiencing illicit tobacco wars.”

Comment:This is a sweeping generalisation. Where are the data on changing death rates (“lives are saved”) since vaping commenced? Why is it that smoking rates are also declining in Australia despite laws not being like Fiona wants them?

Sorry, it is patently untrue to say that there is no criminal involvement in illegal tobacco and vapes in nations like the UK and USA which have liberal vape access policies. See details here.

11. “Vaping, the most successful smoking cessation tool on record, is met with the harshest prohibitions.”

Comment: “Prohibitions” again ….zzzzz. Claims that vapes are the most successful way of quitting smoking disguise the fact that this “success” is pretty dismal. If any doctor tried to tell me any “successful” drug she was prescribing me had a 90% failure rate, I’d look for another doctor. But this is the language of success favoured by vaping advocates. Unequivocally, the most successful way of quitting, if your key criterion here is the sheer numbers of successes year in and year out, is unassisted quitting –cold turkey. But quitting has become dominated by commodified solutions pushed by vested interests. If you can’t sell it, don’t mention it.

12. “Australians are increasingly turning to black market tobacco and vapes; overall smoking rates are stagnating, even increasing in some disadvantaged communities and preventable deaths continue to mount.”

Comment: Smoking rates are not stagnating in Australia. The latest data point (2022-23) shows that compared with the previous survey data year (2019) the absolute falls in the prevalence of daily smoking (-2.7%), of current smoking (-3.5%) and the growth in quit proportions (+7.7%) were all at record levels. These are hard measures of smoking declining in the population and of quitting increasing.

12. “The mere possession of a vape in many states attracts thousands of dollars in fines, and even prison terms. In the ACT, the possession of a nicotine vape means you can be jailed for two years and fined $32,000.”

Comment: Correct, Both the ACT and Vic do not provide exemptions for possession of non-therapeutic vapes for personal use. Unless state legislation specifically says something else, these provisions just follow whatever arrangements were in place with regard to all S4 medicines in the jurisdiction.

In ACT, the penalty is 200 penalty units ($32k for an individual or $162k for a corporation), imprisonment for 2 years, or both.

In Victoria, the penalty is 10 penalty units ($2,035.10).

But significantly, what Patten doesn’t tell us here is that in order for these penalties to arise, the person would have to be charged by police and convicted by a court. Neither police in Victoria or the ACT are charging individuals for possession of non-therapeutic vapes. Searches of case law indicate that no jurisdictions appear to be charging for individual possession. So this is just bluster.