Over the past few years, a conga line of English tobacco control academics and e-cigarette barrow-pushers has been in Australia and contributed to parliamentary inquiries in the hope of convincing we ignorant colonials how critical e-cigarettes have been to tobacco control in the Old Blighty. Dummy spits have been rife when their gospel advice has been ignored. Colonial insolence has been decried when heretics pointed out that smoking affordability was rather more closely related to prevalence trends than was e-cigarette use.
So enter stage left a certain virus. Since March 2020 when COVID began its devastation, the number of English smokers who have tried to quit has increased sharply as has the proportion of those attempts that is successful (see purple line below). So how did they do it? Not in the main by vaping. The proportion of English smokers using e-cigarettes while trying to quit has continued a steady decline that began in late 2016, with a few temporary peaks around promotional events such as Stoptober.
In early 2016, English smokers trying to quit did it unassisted (cold turkey) in roughly the same proportion as those using e-cigs. Today, the rate of unassisted cessation is more than double that of EC use, all against a background of wall-to-wall high street vaping shops, an almost cult-like veneration of e-cigs by the English tobacco control establishment, long term demonisation of cold turkey (see illustrations below) and massive advertising and promotional campaigns by vaping manufacturers.
Their brethren in Australia valiantly continue to chant the English gospel but the annoying data just won’t go away.
Here is an English translation of a piece published on 14 April, 2021 in the French newspaper Le Monde. It is a profile of Derek Yach, the former senior WHO official who played a major role in establishing the global Framework Convention on Tobacco Control (the FCTC). Today Yach leads the Foundation for a Smokefree World, an “independent” organisation entirely funded by Philip Morris International.
It is illegal in Australia to buy nicotine for vaping, either separately or in an e‑cigarette, without a prescription. The sale, supply and possession of nicotine liquid is controlled under a mixture of national, state and territory laws that regulate it as a prescription drug when used for therapeutic purposes, and otherwise as a dangerous poison available to only those authorised to handle it.
From October 1, the law will be clearer. Changes to the Poisons Standard, following a review by the TGA last year, leave no doubt that nicotine liquid for vaping will be legally available only on a doctor’s prescription.
Pressure to loosen the law has been intense yet the majority report of a Senate committee on the regulation of e-cigarettes last November held firm. As only registered pharmacists can fill prescriptions, the laws preventing convenience stores, service stations and vape shops from selling e-cigarettes containing nicotine will remain. Few Senate committee members were convinced by hand-on-heart assurances from Ampol/Caltex that their service station staff would be highly trained if allowed to sell vapes.
The committee was chaired by Liberal Hollie Hughes. Hughes and Matt Canavan were rolled by all other members for their de facto anything-goes plan to allow nicotine juice to be sold almost anywhere, with any flavouring, in any quantity or nicotine concentration. A Financial Review exposé showed Hughes socialising with and being lauded by a British American Tobacco Australia lobbyist and vaping advocates with links to Phillip Morris, despite government guidelines about interaction with tobacco companies.
In June 2020, Health Minister Greg Hunt tried to stop vapers from importing liquid nicotine for personal use. This is allowed under the Personal Importation Scheme if the buyer has a prescription from a doctor registered in Australia. Backbench pressure from Nationals and some in the Liberal’s right flank saw Hunt’s attempt quietly dropped.
No nicotine products have been approved by the TGA. This means that doctors cannot prescribe them (other than under the Personal Importation Scheme) unless they have been specially authorised. It also means that the products have not been tested for safety, quality or efficacy. For users, the message is ‘buyer beware’.
Nearly all Australian health and medical groups are united that if nicotine liquid is to be available, it should only be via prescription and not sold over the counter. They also agree that the TGA is the appropriate regulator but there are limits on its controls, the advice it can give on the use of products that it hasn’t tested or approved, and which haven’t been established to have any therapeutic benefit.
The TGA’s preferred prescription options are currently disturbingly minimalist in what they require of prescribing doctors. If things proceed as is, prescribing doctors may be exposed to potential legal liability and vapers to avoidable health risks, and the tsunami of illegal on-selling to teenagers without much stronger enforcement of the law will continue. The TGA would allow a doctor to simply write “nicotine liquid” or “nicotine salts” for three months supply. Just as no doctor would ever simply prescribe “methadone” or “codeine” without specifying a dose, so should it be equally unacceptable to do this on a prescription for nicotine.
Then let’s consider vape flavours. Some 2.3 million Australians have asthma and most regularly use inhalers for breathing relief. No nebuliser drugs anywhere in the world are sold flavoured because no regulatory agency, including the TGA, has ever declared inhaling flavouring chemicals to be safe. Those importing nicotine juice have 15,000 flavours to choose from which they inhale an average of 173 times a day – 62,780 times a year. This is a ticking chronic disease time-bomb across long-term use, unless properly regulated by the TGA with its brief of monitoring adverse reactions.
Here’s how some of these risks can be minimised.
First, Greg Hunt’s ban on personal importation of nicotine liquid should be urgently reinstated.
Second, if that fails politically, then reflecting a December 2020 recommendation of a WHO expert committee, the government should ban the importation, sale and possession of all vapable nicotine not in sealed “pod” systems which prevent users from altering the contents by boosting the nicotine dose and adding unregulated flavours.
Third, all prescriptions should be required to specify a particular product that has met minimum standards. The TGA has released for public consultation a draft standard setting out minimum requirements for labelling, packaging and contents. This should only be a starting point. Vapers importing from overseas may be unknowingly consuming products mixed in crude, unregulated “bathtub labs” by opportunist entrepreneurs. Any health problems arising may see vapers take legal action against doctors whose non-specific scripts opened the gate to use of these products.
Fourth, the TGA is putting no limit on nicotine concentration or volume of liquid: GPs can technically prescribe litres and litres of highly concentrated neurotoxin. This is a reckless loophole that could be easily closed.
Fifth, the TGA’s proposed standard for nicotine liquid should specify that the products must made with pharmaceutical grade ingredients and meet declared high product manufacturing standards.
And sixth, with federal border security staff able to inspect only a tiny fraction of incoming mail, and state health department inspectors having many other duties than checking if nicotine is being sold illegally away from pharmacies, fines for those exploiting the loophole provided by the Personal Importation Scheme to import without a prescription or sell to other people rather than use it themselves need to be set at seriously deterrent levels. The maximum penalty for illegally importing liquid nicotine products is $222,000. This maximum is likely to apply to large scale importing efforts by criminals, But fines for individuals importing without prescriptions need to be substantial too or many take their chances with what will be low risk detection rates.
Australian vaping retailers have shown widespread willingness to ignore the law and kids currently find it very easy to buy vapes like those shown below. Allowing personal importation to continue, already banned for tobacco, will see predatory on-sellers supplying and expanding this lucrative market. This seriously risks addicting hundreds of thousands of Australian teenagers to nicotine who would have never used it in any form and causing cardiorespiratory disease in years to come. Few doctors will issue nicotine prescriptions to minors.
What are we to make of the governments of 11 nations (Ireland, Iceland, Netherlands, Denmark, Bulgaria, Norway, Thailand and most recently, France, Italy, Germany and Spain) suspending the rollout of the AstraZeneca COVID-19 vaccine following as yet unspecific reports of “blood clotting” or thrombosis in what is a reportedly small number of those being vaccinated in Norway?
There are some basic considerations that all reading these news reports need to keep in mind. Foremost here is that blood clotting is far from uncommon. Around 30,000 people develop blood clots (venous thromboembolism (VTE) – in the deep veins of the leg (deep vein thrombosis) or in the lungs (pulmonary embolism), every year in Australia, with about 5,000 dying as a result. Many of these develop post-operatively in hospitals and account for about 10% of all deaths in hospitals.
The risk factors for developing thrombosis include:
High blood pressure (hypertension)
Lack of activity and obesity
Family history of arterial thrombosis
Lack of movement, such as after surgery or on a long flight
All of these risk factors are of course very prevalent in most societies, which explains why the prevalence of thrombosis is also significant. Aging is perhaps the single most important risk factor: thrombosis is very rare in young people (< 1 per 10 000 per year) but increases to around 1% per year in the elderly.
This means that, regardless of whether there is any COVID-19 vaccine program being rolled out in any nation, we should expect to see many cases of thrombosis. With the aged and those with chronic disease being prioritised in vaccine rollouts, we would therefore expect the incidence (new cases) of thrombosis to be considerably higher in these groups than in segments of the population who have been given lower priority in the rollout queue.
But this may have nothing to do with the vaccine.
Epidemiologists investigating whether reports of possible rises or clusters in the incidence of diseases always look first to what the “expected” or background incidence is, and then statistically compare this with the current “observed” rate. If the observed rate is significantly higher than that which earlier data would suggest should be expected, and comparable ages are being considered, then focus quickly shifts to investigating possible plausible other causes.
I’ve yet to find any reports that this point has been reached in the Norwegian investigations.
Reasoning that just because symptoms of disease occur after exposure to some agent (drug, vaccine, contaminant etc), that one of these agent must have caused the symptoms, is known as the post hoc ergo propter hoc (after, therefore because of) fallacy.
During my career I’ve seen many examples of media and community alarm bells going off because of this reasoning. For example, when nicotine replacement therapy (NRT) first became available in the early 1990s, there were claims that some people using it were having heart attacks. It was not rocket science to point out that all who were using NRT were smokers, and that smoking is a major risk factor for cardiovascular disease and heart attack. Of course there would have always been smokers using NRT and trying to quit who were already at high risk of heart trouble, regardless of whether they were using NRT.
I used to start an early lecture to new public health students by saying that about 90% of drivers involved in serious road accidents in their commute to work, had eaten breakfast. Was it therefore reasonable and sensible to suspect that eating breakfast increased your chances of being injured on the road shortly afterwards? Obviously not.
Nearly all of the suspending nations have many advanced epidemiologists . These nations are also not known for imprudent policy shifts based on knee-jerk reasoning. Their decision to suspend the roll-out is therefore significant. We should expect a thorough analysis of the issues raised above and of each of the Norwegian cases.
[this blog was updated twice after publication to increase the number of suspending nations from 4 to 11]
In 2006, we lived in Lyon in a 17th century apartment, just up Montée de Chemin Neuf about 300m from the old town, Vieux Lyon, with its cobbled narrow streets, subterranean traboules and gastronomic restaurants. I was on the first sabbatical I had ever taken in more than 25 years as an academic. I had a desk at the WHO’s International Agency for Research in Cancer and wrote a textbook on public health advocacy across 8 months of one of the best years of my life.
We became great friends with some neighbours, Claire-Marie and Phillipe. Two years after returning home, we returned to Europe on a holiday and decided to fly first to Lyon and spend time with them again.
We decided to take them a really good Australian wine. I bought a Penfolds St Henri. I fretted about it being smashed in the stowed luggage, even if packed in rolls of clothing in the centre of the suitcase. So I packed in it in my hand luggage.
The luggage scanning camera picked it up as we went through customs, just after immigration and of course it was confiscated. In the excitement of the departure, I’d totally forgotten about the liquids ban. “Are you some kind of moron, Simon?” Trish said to me loudly as the uniformed customs man placed it in the box where all the confiscated perfumes, cosmetics, and nail files so often used by terrorists to hijack aircraft were stored for destruction each day. I had visions of the loud guffawing in the customs officers’ staff room and scissors-paper-rock rounds being played to find which one would take my bottle home.
“Well, you idiot, we’re now going to have to buy a replacement in the duty-free area here and so pay all that money all over again” my sanctimonious wife delighted in telling me. “And don’t think you’re going to get away with buying something cheap. I know you!”
So, a second St Henri in hand, ensconced in its sealed thick plastic see-through duty-free bag, we set off for Frankfurt, where we’d change planes for the flight south to Lyon–Saint Exupéry Airport airport.
At Frankfurt we had to collect our stowed bags and go through customs to board the internal EU flight to Lyon. So of course, with my luck, the second St. Henri was confiscated again.
My empathic wife this time unloaded audibly and unmercifully “Don’t you ever think anything through? I can’t believe your stupidity!” I gently reminded her that it was she who had insisted I buy the new bottle at Sydney. “So aren’t you the one who travels all the time for work? Didn’t you stop for a second and think that this might happen?” she continued.
Never her fault.
“We just can’t arrive bare-handed. You’re just going to have to buy them another bottle. And DO NOT be mean – get them something really good.” I knew I had to do this. Third time lucky.
But of course, the world famous Australian wine section in Frankfurt’s duty-free section was nowhere to be found. If I wanted a French grand cru or an Italian Brunello, there were row upon row to choose from. But I couldn’t take coal to Newcastle, so settled on an aged litre of single malt, which almost melted my credit card.
So we made our way toward the gate to board our flight to Lyon. Not 20 metres from the duty-free cash register, the bag holding the whiskey split and with an almighty crash, Scotland’s finest pooled all over the hard tiled floor. I took the sodden split bag back to the cash register protesting the bag I had been given and wanting a refund. There was talk about me waiting for the duty manager to get back from some far flung part of the airport to make a decision. But our flight was leaving in 20 minutes.
We flew to Lyon empty-handed. Claire-Marie and Phillipe laughed and laughed and said they didn’t ever really drink whiskey anyway. They opened some superb Condrieu and Haut Medoc.
In 1989, the now long defunct Tobacco Institute of Australia’s West Australian spokesman Ron Berryman advised us all to relax and simmer down on nicotine, saying:
Ron’s excitement was all about the fact that the tobacco plant is related to other members of the solanaceae (nightshade) family. These include tomatoes, aubergines (eggplants) and potatoes. Nicotine alkaloids occur naturally in all of these, but in … shall we say … rather different concentrations.
Thirty two years on, this week Alex Wodak, the gift who keeps on giving to my series on Vaping advocates say the darndest things (see here and here), did not disappoint, posting this reprise of an old tobacco industry meme.
So let’s run through how nicotine in cigarettes and e-cigarettes compare to that in vegetables.
Both cigarettes and e-cigarettes contain a wide range of nicotine, depending on the brand and concentration of nicotine found in different vaping delivery systems. But when you smoke 20 cigarettes, you’ll inhale somewhere between 22-36mg of nicotine, so a midpoint of say 30mg a day. This study found that across different e-cigarettes, 15 puffs delivered between 0.5 to 15.4 mg of nicotine. The average vaper pulls on their e-cig 172 times a day, meaning that across a day they inhale between 5.7 to 176.6mg of nicotine. Let’s take the midpoint of that range (85.5mg) as an average.
Now let’s look at what sort of dose you get from eating vegetables containing nicotine alkaloids. Let’s first pause to emphasise that nicotine in cigarettes and e-cigarettes is measured in milligrams (mg), but in vegetables nicotine alkaloids are much, much less concentrated and are measured in nanograms (ng).
Now let’s work this through for the potato option to see how many potatoes a 172 puff-a-day vaper would need to eat to consume the same amount of nicotine from vaping.
Remember what we learned in first year high school science?
1000 nanograms (ng) = 1 microgram (mcg or µg)
1000 mcg = 1 milligram (mg) or 1,000,000ng
1000 mg = 1 gram (g) or 1 billion ng
1000g – 1 kilogram (kg) or 1000 billion ng
1000kg = 1 tonne
A typical potato weighs 150g and therefore contains 2,250 nanograms or 2.25 micrograms of nicotine. So if your daily potato-sourced nicotine target equivalent is the 85.5 milligrams a vaper inhales each day, a ballpark of a mere 13,000 potatoes per day will get you there. So your Hello Fresh daily delivery order will be for a paltry 2,000 kg, every day. Two tonnes.
Keep ‘em coming Alex!
See also in this series:
Vaping advocates say the darndest things. 1: The Cancer Council Australia takes huge donations from cigarette retailers. WordPress 30 Jul, 2020
Vaping advocates say the darndest things 2: Tobacco control advocates help Big Tobacco. WordPress 12 Aug, 2020
I’ve written before on this blog about the efforts of Alex Wodak, a director of the Australian Tobacco Harm Reduction Association, to smear the Cancer Council by alleging, completely falsely, that they receive money from tobacco retailers and are therefore hypocrites.
I block many trolls and obsessives on Twitter for a variety of reasons. I block Wodak because I don’t give the time of day to those who post unabashed “doctor knows best” arrogant tweets like these:
# at the end of the blog, see a list of prominent non-clinical supporters of vaping who despite their great handicap of not having a medical undergraduate degree, are apparently able to comprehend biological publications.
Wodak often tweets with unctuous certitude about the importance of politeness
Yet Wodak has now joined with some semi-literate vaping troll, “Jerome Laguerre” (“Its all there in plain site … they not even hiding it”) whom I block on Twitter, in trying to imply that I am funded by “China”.
So let’s look at how they arrive at all this. Laguerre probably googled my name, perhaps with “Sydney University” in the hope of hitting paydirt on some nefarious, scandalous, secret information about my shameful connections. He may have found this:
If he had bothered to then click “China Studies Centre” he might have noticed that the CSC is entirely funded by Sydney University and that 300 scholars at the University, including me, are “members” of the CSC. But Lageurre knows that I have “an official post”.
What does “membership” mean? When the CSC was established at the University of Sydney in 2011, all staff with any research interest in China (in any field) were invited to register their interest with the CSC. This would facilitate communication and perhaps shared projects between staff, students and those external to the University sharing information and collaborating. All those with such interests are listed as “members”.
I had long had research and teaching collaborations in tobacco control with Fudan and Zhejiang Universities. I’d also edited a supplement on China for the BMJ’s Tobacco Control journal. I had guest lectured at Zhejiang University once in 2010, and been to Fudan in Shanghai several times, to lecture and work with colleagues there on projects that eventually produced six publications (all listed in my CV here). Chinese universities often confer honorary roles on international staff who assist them with teaching and research. That happened to me with both of these universities.
In none of these collaborations was I paid anything. My air travel was paid for from $50,000 prize money I was awarded in 2008 for being NSW Cancer Researcher of the Year. I think it’s likely, although I don’t recall, that my hotel costs were paid for by the two Chinese universities. This is of course always customary when guest lecturers need to travel away from home.
So from that reality, Laguerre tweets, and Wodak retweets and responds (thus republishing the same utterly false tripe) that I “take money from China and Bloomberg through the Uni he is working for” to “produce bogus studies”. And predictably, this false news causes the intended reaction
Wodak has also recently published tweets stating that Maurice Swanson, the CEO of the Australian Council on Smoking and Health, is somehow being funded indirectly by “Bloomberg” (by which he presumably means Bloomberg Philanthropies).
But ACOSH has never received any funding or support of any kind from Bloomberg. It has long been funded the West Australian government’s Health Promotion Foundation, Healthway, something that basic searching could have established.
Wodak’s on-going attempts to smear Australian tobacco control agencies, charities and individuals and to insinuate that they are being secretive about who is funding their work in relation to efforts to have governments seriously regulate e-cigarettes, are just disgraceful.
#some prominent non-medical researchers and advocates who are pro-vaping:Linda Bauld, Ron Borland, Jamie Brown, Coral Gartner, Marewa Glover, Peter Hajek, Wayne Hall, Ann McNeill, David Sweanor, Ken Warner, Robert West
See also in this series:
Vaping advocates say the darndest things. 1: The Cancer Council Australia takes huge donations from cigarette retailers. WordPress 30 Jul, 2020
Vaping advocates say the darndest things 2: Tobacco control advocates help Big Tobacco. WordPress 12 Aug, 2020
Vaping advocates say the darndest things 3: Australia’s prescribed vaping model privileges Big Tobacco WordPress Feb 15, 2021
Vaping advocates say the dardnest things 4: Many in tobacco control do not support open access to vapes because they are just protecting their jobs. WordPress 27 Feb 2021
Vaping advocates say the darndest things 6: There’s nicotine in potatoes and tomatoes so should we restrict or ban them too? WordPress 9 Mar, 2021
Just when you think you’ve met peak stupidity in the vaping debate, you find a new verse in vaping advocacy theology that makes you spray your coffee.
Here’s a proper doozie that often gets an outing from those with a taste for conspiracy theories. It runs like this.
“The obvious reason why there’s so much opposition among people in public health to all the regulatory reforms being advocated, is that these people are just trying to protect their jobs. Vaping is driving smoking down so fast that tobacco control people can see the writing on the wall. If there are no smokers left, they won’t have any problem left to deal with. So no wonder they are desperate to try slow down the inevitable.”
It’s an argument that some have used for many years
The deranged fraternal twin to this argument invariably then pipes up with “And those working in tobacco control are paid absolute fortunes and massive grants by governments, so they have huge incentives to attack anything which might really drive down smoking.” This recent blog by a Queensland vaper with recent form in getting things completely wrong (see below) ticks both these boxes, and plenty more besides.
I recommend you try to read the blog right through to get a feeling for the depths of claptrap these people can plumb when they let their fantasies off the leash. But let’s here focus on a few passages.
Where to begin with this batty nonsense? First up, if public health workers really didn’t want smoking rates to fall, why have they kept successfully advocating ever since the late 1960s for policies and programs that have caused the brakeless train to head south almost continually for 40 years? Here’s a graph of falling smoking prevalence in Australian adults, from results from two different survey series.
So what’s driving this disaster for the tobacco industry? Chance? Luck? How about synergies between the full suite of tobacco control policies and campaigns that’s made Big Tobacco long describe Australia as “one of the darkest markets in the world”? Mass reach public awareness campaigns (with beautiful irony, the very same ones that motivated many vapers to try ecigs); tax rises; total advertising and promotion bans; smokefree public spaces, public transport, bars, clubs and stadiums; retail display bans; graphic health warnings on packs; and plain packaging?
So the fruitcake wing of vaping advocacy would have you believe that those of us who across 40+ years have worked to hold high success in achieving every policy and law reform we ever fought for; who saw millions of smokers quit and still more never take it up including record numbers of Australians today who have never smoked ; and who caused smoking to be utterly denormalised from an aspirational, glamourous thing that happened in every setting you ever entered to one where 90% of smokers today regret ever starting; who saw smoking rates fall to where they have never been lower; and who drove lung cancer incidence rates down to a level last seen in the early 1960s …. well, of course anyone can appreciate that we were making all this happen because secretly, we really didn’t want smoking to keep falling.
Secretly, we wanted everything we did to fail because in the words of our incisive, shrewd commentator cited earlier “You see as any shrewd person would realise, if you are getting paid big money for eliminating a problem and you eliminate it entirely, then the job is over, it’s done and therefore you have nothing to justify putting your hand out for.”
Presumably it’s just the same for COVID-19 specialists, those trying to reduce domestic violence, skin cancer, road deaths … in fact anyone trying to solve any problem. We need to understand that none of these problems have ever been eliminated because all involved are busy stomping on the brakes so they can keep their jobs.
Perhaps it’s more subtle than that. Perhaps we all secretly agree that the galloping uptake of vaping will be so furious and so amazingly successful in slashing smoking rates, that the bottom will fall out of all remaining smoking. Conversion to vaping will be all but total. When the miracle of vaping came along, the penny finally dropped and we all suddenly decided that enough was enough, saw the looming unemployment we all faced and called for e-cigarettes to be seriously regulated into prescription status.
But hang on. Neither of those assumptions are true: nowhere has vaping caused major declines in smoking prevalence, and vaping is quite dismal in its effectiveness in smoking cessation. In England, where vape shops wallpaper high streets and vaping theologists dominate policy forums, the proportion of smokers who vape, according to the latest data summary from Robert West’s Smoking In England project, e-cigarette use in adults has been stable since 2013, plateaued in smokers and recent ex-smokers, and the majority of e-cigarettes users are still smoking (dual users).Vaping may well be holding far more in smoking than it tips out of it.
Smoking seems to have even kicked up a little in the very latest English survey.
“Millions upon millions of dollars of grants via the federal department of health”
According to our Queensland blogger, those whose assessment of the evidence on e-cigarettes the government trusts have been rewarded with lavish grants from the Department of Health. This is curious, because it’s the NHMRC which awards research grants to successful applicants each year, not the Department. I stopped applying for grants well before I retired in 2016. And neither of my co-authors (Mike Daube and Matthew Peters) of the submission to the recent Senate committee on harm reduction which was frequently cited in the published majority report have any recent grants either. Perhaps I should go and check my letterbox or one of my many Swiss and Caribbean secret bank accounts?
But, interestingly, look who have recently been awarded a very large ($2.5m) grant to look at tobacco endgames. Why, it’s a list of excellent researchers which includes several who have often been praised by vaping advocates. So something seems to be not quite right here with the claim that vaping skeptics are being duchessed by the government.
But oh, I forgot. As our Queensland blogger told us, it’s also New York billionaire Michael Bloomberg’s small change via Bloomberg Philanthropies which is secretly showering Australian vaping skeptics with funds.
ATHRA director Alex Wodak seems to know this too, tweeting this week that the Australian Council on Smoking and Health in Perth (directed by Maurice Swanson) is funded via Bloomberg money apparently routed through “a few [of course nameless] organisations”. Very odd indeed, that neither Maurice nor Bloomberg know anything about this.
In November 2020, I was lead author with Emeritus Professor Mike Daube AO and Professor Matthew Peters AM of a 32 page submission to the Australian Senate Committee on Tobacco Harm Reduction. Our submission was cited many times in the final majority report of the Committee. I’ve since received many requests for a copy of the submission which are continuing, so am re-publishing it here for ease of access.
Robert Beaglehole is a veteran public health leader from New Zealand. He was professor of public health at the University of Auckland between 1988-1999, before joining the World Health Organisation in Geneva in 2000, heading its chronic disease prevention and health promotion division until 2007. He started New Zealand’s Action on Smoking and Health in 1982 and chairs its board today.
I’ve known and admired Robert’s work for many years, and have spent some very pleasant time in his company.
One of the most persistent memes in vaping advocates’ creed is the profoundly silly argument that anyone who expresses any scepticism about any of the pillars of the case for vaping is helping Big Tobacco. I explored this argument in an earlier blog here.
Recently, Beaglehole was interviewed for a short video produced by CAPHRA (the Coalition of Asia Pacific Harm Reduction Advocates).
Australia’s Therapeutic Goods Administration has ruled that from October 1, 2021 anyone wanting to import or purchase nicotine for vaping will be required to have a doctor’s prescription – see here. This is in effect a quasi “license to vape”, that has some of the reasoning in common with that I set out in a paper in 2012 on the idea of a “smokers’ licence”, later adapted by Coral Gartner and Wayne Hall in a paper on a “vaping licence”. The prescription route is now causing apoplexy among those who want to see e-cigarettes containing nicotine sold in almost every conceivable retail outlet (I’ve not yet seen this include crèches, tuck shops or back-to-school sections of stationery shops … but nothing would surprise me here).
Asked to comment on this recent decision to implement what the interviewer calls “a medical model” for vapouriser access, Beaglehole says at 2m35s:
Well, basically going that route privileges the tobacco industry. By making vaping less accessible and more difficult for smokers who smoke cigarettes and want to quit, making it more difficult for them to access nicotine is privileging Big Tobacco. That’s the last thing we want to do. We should be treating nicotine as a consumer product. Let the market innovate. Let people make their own choices as to what they do.
So, what do the main tobacco companies selling tobacco in Australia and hoping to be able to sell their vapourised and heated nicotine products here have to say about their impending “privileged” position said to arise from prescribed access?
We are discouraged by recent moves from the Department of Health to ban the import of nicotine containing EVPs [electronic vaping products]… We believe NGPs [next generation products] are more likely to succeed at transitioning adult smokers if they aren’t perceived to be medical treatments for smoking, unlike NRTs [nicotine replacement therapies].
A practical and regulated solution that allows Australian smokers ready access to nicotine containing e-liquids (along with other potentially reduced risk alternative products to cigarettes) without the need for a prescription, is urgently required.
And Philip Morris International? PMI applied unsuccessfully to have the poisons schedule amended to allow its IQoS heated tobacco product to be openly sold in Australia. But has not submitted an application to the Therapeutic Goods Administration to have it scheduled as a therapeutic good (as has long been the case with nicotine replacement therapy). So it too, does apparently not share Beaglehole’s understanding of how prescribed access would privilege it.
So all three Big Tobacco companies operating in Australia, which are all hoping to market their so-called harm reduced products here, are not exactly popping champagne corks at the thought of how privileged they will become in 2021. In fact just the opposite: they are all implacably opposed to access via a doctor’s prescription.
And what should that tell us?
It tells us that they all know that the “consumer product” classification that Robert Beaglehole supports will see the companies able to avoid any of the controls that therapeutic regulation would bring. For example, very, very few doctors would be willing to issue a nicotine vaping license to a child, while 45% of US vaping retailers and 39% of English shops operating under a “consumer product” model sell to underage customers. In New Zealand, vaping by kids is booming. And no tobacco company would ever want to see that happen …
Quite amazingly, at 7m26s into the video, Beaglehole picks up two nicotine delivery systems strategically placed on a coffee table in front of him. One at a time, he carefully inspects them, with the brand names clearly visible. Irony of ironies, the two brands are BAT’s Vype and PMI’s IQoS: the two flagship new generation nicotine products of two of the biggest Big Tobacco companies in the world. You know, the ones that he thinks it’s a bad idea to “privilege”.
He also says that access via prescription will make it “more difficult” for smokers wanting to get vapable nicotine than if these products were sold in shops with open access.
An how enormously difficult is it in Australia for people to access prescribed medications? In 2018-19, in a population of some 25 million, 205.1 million prescriptions for 900 subsidised drugs in 5,455 brands were dispensed via Australia’s Pharmaceutical Benefits Scheme. There can be few people in Australia who, in any year, are never handed a prescription by a doctor.
“All of it is incorrect”
Beaglehole also has some choice words about those who have drawn attention to emerging evidence about harms of vaping. At one point he refers to “the supposed harm of nicotine and vaping”, theatrically gesturing quotation marks around “supposed harm”. He then says “A lot of that information is incorrect. All of it is incorrect. And based on very poor science and vested interests.” (my emphasis)
All of it is incorrect? All of it? So any published evidence that has concluded that there are any concerns about vaping being harmful or not very effective in helping smokers quit is all wrong? In our submission to the 2020 Senate enquiry, we referenced 11 expert reports and meta-analyses of smoking cessation via vaping published since 2017 which all concluded there was weak evidence that ecigarettes are useful ways of quitting smoking. We also listed (on pp 23-24 of our submission) a small selection from many recent papers on harms from vaping.
Such categorically dismissive language from a person with a seriously impressive public health background is quite remarkable.
He continues “The misinformation which is coming from a rather limited number of people with strong vested interests in traditional tobacco control approaches”.
My scepticism of the turbo-hyped claims for vaping is shared by many of the world’s peak health agencies. Here’s how Australian agencies line-up. Notice a pattern?
If there is anyone helping Big Tobacco in the vaping policy debate, it is of course all those who are doing all they can to enable its ambitions to see a repeat with vaping of the disastrous historical failure to regulate tobacco and cigarettes. I’ve never met anyone in health or medicine who thinks it is wonderful for public health that cigarettes can be sold anywhere. Australia’s decision to require a prescription will put a significant barrier between kids and vapes, but will not constitute a barrier for adults who smoke to access vapourised nicotine under the care of a GP.
Update 20 Feb 2021: two excellent investigative pieces published this morning in the Australian Financial Review, on how two tobacco companies (BATA and Philip Morris) have been lobbying to stop the “prescription” regulatory model.