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

1. 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.
2. 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:

1. Criminal gangs are extorting Victorian tobacconists to stock their illegal tobacco and vapes
2. Refusal can result in their shops being firebombed and even death, presumably hoping news of this will persuade others to comply with their demands
3. If duty-not-paid tobacco and vapes could instead be sold freely everywhere, there would be no black market
4. 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

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

When our three children were growing up, we had a cavalcade of house guests who stayed for a few days and sometimes longer. I invited all of them, despite the first one badly overstaying his welcome and Trish chasing me around the house with murderous intent saying “don’t you ever do that again!”

My motivation was always an entirely do-unto-others thing. When I heard about someone I knew who was arriving in Sydney and needed a place to stay for a while, I ‘d think “well, I know just how they’d be feeling. They’ll be in a strange city, know no one, and will jump at an offer of short term accommodation until they find their feet and get a suitable place.”

I remembered how lucky I’d felt staying with an aunt and uncle in London the first time I travelled overseas. I’ve stayed at friends homes in San Francisco, Edinburgh, Washington DC, Istanbul and Tokyo. Having locals guide you around, explain how things like the subway worked, finding cheap good restaurants and telling you about tourist traps to avoid is a godsend. And the opportunity to immerse yourself in the routines of a family who speak a different language is almost always unforgettable.

I often think of the people who hosted me, their sincere joy and pride in showing me around their cities and their ease in appearing disheveled at breakfast time in the kitchen making breakfast with someone they had only known from conferences and email chat. I thought that putting my hand up first to signal to new guests that we were the sort of people who liked this stuff ourselves, so we’ve got your back in a new city, was the right thing to do.

So how did it all work out?

Geoffreyopoulos from Greece

Our first guest was a very old friend, Geoffrey. He’s been a neighbour in the early 1970s, and had turned his back on the usual grinding trajectory of job promotions and left a career in civil engineering to become a peripatetic resident of whatever port his 35 foot yacht found him in. I’d stayed with him in Rhodes harbour and stayed on his boat for a week with Trish in Dominica in the Caribbean’s Windward Islands (see Volcanoes, tsunamis, storms and near-death experiences in the Caribbean at p74 here ). He was one of the greatest raconteurs I’d ever known. I always called him Geoffreyopoulos because he’d lived so long in the Greek Islands.

Geoffrey had a house in Paddington and lived on the rent it provided. Every five years or so he’d be back in Sydney to do repairs, get medical attention for things like his eyes and catch up with old friends. So one day there was a tap on the door, completely out of the blue and there stood my old friend with his dilapidated backback. Geoffrey had almost no possessions, picked up cast off clothes and shoes in recycling shops and had no taste for the baubles of success.

“Could I stay for a little while?” he asked. Of course, we said. Nothing so proprietarily bourgeoise as “and for how long might that be for” ever crossed our minds.

Looking back, I imagine we thought maybe a week or two. But he left for Europe after three months.

Geoffrey was what Trish calls “a real man”. He could fix anything that needed fixing, and knew where to get second had parts to avoid being gouged. So in the first few weeks he fixed some loose roofing and guttering and rehung some wonky doors and supervised buying us a second car, helping us avoid some money traps. He’d often come home with a bottle of wine that was from the very lowest shelf in a wine shop. He’d help with the washing up and run small errands when we were at work.

We had many dinners late into the night where his inexhaustible supply of amazing tales from the Baltic, to Ireland, sailing solo several times solo across the Atlantic, North Africa and the Caribbean enthralled all who were there.

He had a teenage daughter who also lived on a boat in Cornwall. Every Friday night at the same time, he would use our phone to call a phone booth near her boat. They would speak for at least an hour. Let me know the cost when the bill comes, he said.

On the week he was due to leave, he said he’d like to take us out to dinner. And pay. This would be something. We went to a wonderful Shanghai dumpling shop in Ashfield where the bill for the three of us was all of $30. At the end of the meal, he was embarrassed to say that he’d accidentally left his wallet at home.  It can happen to anyone.

We covered it. On the  day he left we arrived home from work to find a note explaining that he’d worked out he’d spent more than the $30 farewell dinner he owed us on some fittings for our roof. We shrugged it off. But then a month later, we got a phone bill which was off the charts. Many hundreds of dollars. But Geoffrey’s ship had sailed.

Xisca from Barcelona

A close colleague from Barcelona contacted me with a small favour. His longtime cleaning lady’s daughter Xisca was coming to Sydney as the jumping off point for an Australian working holiday. She was only 19 and had never travelled abroad. Her mum was worried that she might be all at sea here, having only schoolgirl English. Would it be possible that she might stay with us for a short time to find her feet? Could we give her some tips about  getting casual work?

Sure. We’d just love to do that. So on the day of her arrival we opened the door to a petite, raven-haired pretty Spanish girl with a thick accent and a backpack. It would be remiss of me not to note that she also had very large breasts with unavoidable cleavage.

So our two sons, then aged 13 and 15 had their eyes popping out of their heads from the moment she came through the door. They would nearly knock each other over trying to get to her first to help with a question or advice on the Sydney night life they’d never experienced but were of course fully expert about.

Within days Xisca began arriving back home at 2am or later.  One night we peered out the window and saw her get out of a top end black Mercedes convertible driven by a man of Mediterranean or Middle Eastern appearance, as crime reports always like to phrase it.

This happened very regularly to the young woman we felt we’d been entrusted to chaperone by her anxious mother whom we’d never met. But was it any of our business? Did we want to start behaving like her mother and interrogating her about what she was going out late most nights? Should we ask her about the nice gentleman in the drug dealer type car who seemed to be seeing a lot of her? Nah, no. We suggested that she might like to find a nice share house. 

Indira from India

Indira was a young researcher I knew from India. She was coming to Sydney to study. She stayed with us for over a month, sleeping on a mattress in the lounge room. She cooked wonderful Tamil food and was polite and friendly to a fault. But there was one problem. At that time, we had one bathroom including a toilet that needed to be used by two adults and three teenagers, plus Indira.

We quickly discovered  that when she went into the bathroom, she rarely emerged for at least 30 minutes. We would hear the toilet flush, and we would hear the sound of the shower on the tiles. And then the shower would stop. There’d then be silence and then the shower would start up again. After the first time this happened, we explained that we all needed to use the bathroom in the morning before leaving the house, so would she mind being the last one to use it? This generally worked, but in lieu of a roll-call about whether everyone else had finished with the bathroom, there were often people missed who then had to wait for her bathroom marathons.

I and the two boys would go outside to fertilise the garden, but Trish and our daughter would be pacing up and down hoping she was nearly finished. No explanation was ever given. Did she have some body-oiling, washing and re-oiling ritual? Did she have major bowel  problems she wanted to keep private? Was there some sort of silent prayer thing happening in there? We didn’t feel we could ask.

David from Canada

David was a younger colleague from Canada. I’d met him a few times at conferences overseas. He was coming to Sydney for a sabbatical and asked if he, his wife and an infant child could stay with us for a short while when they had a gap between rents. They did and they were lovely.

A few years later he emailed asking if he might stay a few nights. He was a huge fan of the US band Wilco and had bought tickets for two of their Australian gigs. Sure, no problem. On the first night he took a shower. Sydney was having water shortages and David apparently thought having a shower meant staying in there for weeks.

Trish kept on coming up to me saying “he’s STILL in there! What the fuck is he doing!” These observations rose in intensity until she could bear it no longer and went up to the bathroom door and said “David, sorry mate but we have serious water shortages in Sydney. We only have very quick showers here.”

He was suitably sheepish when he emerged, so Trish took the opportunity to ask him to please also turn the lights off in the house before he left for the day. We’d noticed lots of people regarded lights as a free good, kindly donated by the government.  On the night he went to a Wilco concert, we heard him come in about midnight. About 2am Trish woke and said to me “Bloody David has left the lights on in the living room!!”.  She got out of bed naked and went down there to turn them off. David was lying on the lounge reading and copped a full gawk at his tormentor.

Mary from Canada

An old Canadian colleague emailed to ask if we might look after her daughter who had recently graduated. Mary wanted to live in Sydney for a bit to see how she liked it and whether she might later enrol in the graduate medical degree at Sydney University where I was in the faculty. “No worries! Our place is used to visitors. We love it!”

So Mary arrived. She was chatty and vivacious, and again, our boys thought they had won the lottery. Like others before her, she stayed and stayed. And paid no rent or keep.

One day she came home from Bondi Beach with a tale of how a photographer had chosen her to pose in her bikini holding a surfboad. It was for some high-end fashion magazine and as payment, she would get a pair of Manolo Blahnik shoes which we were all supposed to know were worth well over $1000. This seemed as likely as pigs flying. But it turned out  to be totally true. She clopped around the house in her terribly expensive shoes, with the magazine duly being published with a rear view of Mary in a bum-floss string bikini bottom lasciviously caressing a surfboard. The boys snuck it to school to show their mates evidence of the debauched life they led at home.

Aunt Rose from the Isle of Wight

When my dad was in his 80s and sliding slowly into dementia, we decided it would be a nice idea to fly his slightly younger sister Rose out from England to stay for a few months. She lived in the Isle of Wight and had never been abroad, except to Calais and back for the day.

When she arrived, it was summer. We explained that our then only bathroom was being renovated and it would take several weeks before it was ready. We showed her how we had rigged up a hose to the kitchen water tap. The hose went out to the back garden where it hung over a tree branch, with the water falling from a showerhead. We’d all been enjoying hot water outdoor showers in the privacy of the back garden. The rest of the family would all remain in the front of the house, we assured her. “When you holiday in Bali, you  pay extra for the luxury of a private garden shower”we told her.

But she went ashen, soon taking Trish aside and saying that she simply could not bring herself to shower like this. Or even think about it. So for the first month of her visit she moved in with my sister in a nearby suburb until out bathroom was complete.

We noticed that she enjoyed a sweet white wine with dinner. One night we went with my sister’s family and Rose to a local Vietnamese restaurant. My brother-in-law Paul was extremely attentive with topping up Rose’s glass. So much so, that she needed to be helped out of the restaurant and into the car afterwards. I doubt if she had ever drunk so much, even across a month. Back at the house, the room began spinning around and Trish had to sit for an hour mopping her forehead with a wet flannel, with a bucket beside the bed.

Her visit was wonderful for dad, He came over often from his nursing home and they would sit talking lucidly about their childhood and the war years before he immigrated to Australia. His long term memory was in fine shape.  She came out again once before he died in 2000.

When we recount these and many other stories to friends, they often say “I really couldn’t do that.” For some the sanctity of a home is inviolate. While we groan when we retell some of these stories, the net effect was undeniably  positive for the family. They have all been inveterate travelers themselves, all love food from all over the world and I think are all richer for the experience.

This week we are having a man from  Timbuktu in Mali and now living in Canberra staying for the weekend. I met him at an African festival recently. We talked music and realised we are going to the same gig. Come and stay I said.

Last week, the major global influencers conference, the Concordia Summit, was held in New York. Concordia, according to its website “ is a global convener of heads of state, government officials, C-suite executives, and leaders of nonprofits, think tanks, and foundations to find cross-sector solutions that address the biggest challenges of our time. The Concordia Annual Summit is the largest and most inclusive nonpartisan forum alongside the UN General Assembly.”

One speaker billed in the weeks leading up to the Summit was Philip Morris International’s (PMI) CEO Jacek Olczak. But on the cusp of his big moment he was swiftly cancelled from the program and the text of his planned speech removed from Concordia’s website. PMI was also removed from the list of patron members. The Concordia CEO announced a “new policy of not working with any tobacco companies, starting with the 2023 Annual Summit.” PMI had been patron member since 2020.

The removal and new policy followed a history of calls by tobacco control groups for Concordia to remove Philip Morris from its program. With Tony Blair and London mayor Sadiq Khan announced as also speaking in New York, Peter Geoghegan, author of  the Democracy For Sale newsletter renewed these calls on September 15. Within days PMI was shown the door and told never to darken it again. Olczak, whose company shipped more than a trillion cigarette between 2019-2021,  promptly moaned on youtube about the injustice of it all. The loved ones of the  two in three long term smokers who have died from their smoking would likely see it differently.

This snub was a weapons-grade, high-end humiliation by senior politicians, the world’s corporate giants, think tanks and foundations. It was an unambiguous, nose-holding “keep away from us” message to PMI. This was despite its decades-long rebirthing efforts promote itself as an ethical company supposedly now dedicated to combating with new highly addictive products the very problem (smoking caused disease) that its combustible products continue to cause at stratospheric levels.

It shows that nothing has changed since the publication of the Reputation Institute’s 2010 last place ranking of the tobacco industry as peerless reputational bottom-feeders.

 This is far from the first time Big Tobacco has been internationally spurned. To give just two examples: in 2004, Ethical Corporation magazine removed PMI from a business ethics conference in Hong Kong after protests from leading ethicists and withdrawals from other speakers. In the same year Australian Public Relations and Corporate Communications Summit “de-invited” Philip Morris after protests from health leaders.

PMI says ad nauseum that it wants to end sales of its tobacco products. Really? There’s an obvious comparison to be made here between the motor vehicle industry and tobacco companies. The inexorable growth of electric vehicles because of the existential threat of climate change has seen the following companies declare dates after which they will no longer manufacture internal combustion engines.

Alfa Romeo (in Europe, North America, China) by 2027

Audi 2026

Bentley 2030

BMW 2030

Fiat 2030

Ford (in Europe) 2030

General Motors 2035

Honda 2040

Hyundi 2040

Jaguar 2025

Mercedes 2030

Mini 2026

Nissan (in Japan, China, USA, Europe) early 2030s

Renault 90% by 2030

Rolls Royce 2030

Volvo 2030

Philip Morris’ response to questions about why it refuses to name a date when it will stop manufacturing tobacco products is to argue that if it did so, other tobacco companies would simply grab its tobacco customers. This response has all the ethical weight of criminals rationalising that they may as well keep selling stolen goods or drug dealers saying they have no qualms about selling narcotics, because if they didn’t sell them, there are plenty of others who would.

This has the ethical sophistication of 5 year olds who shoot back “but he’s doing it too” when asked by a parent or teacher why they persist doing something they know they shouldn’t be doing.

PMI has two feet firmly to the global floor: one accelerating its so-called reduced risk products, and the other continuing to do all it can to keep manufacturing and selling tobacco products for as long as possible.  Their business plan is obvious: they want to maximise sales of both.

The Bloomberg Philanthropies funded Expose Tobacco campaign has highlighted details from recent PMI reports to investors.

Recently, on its 2022 earnings call, PMI celebrated growth in revenues from cigarettes, saying: ‘In combustibles, we delivered a robust performance with a 3.7% growth in organic net revenues…’

The easiest way to see through PMI’s supposed “smoke-free” aspirations is to look at its thriving cigarette business. In 2022 alone, PMI shipped 621 billion cigarettes, according to its full-year results report. While cigarette shipment volume between 2021 and 2022 declined in some markets, shipments increased by nearly 5% in the Middle East and Africa, by about 2% in the Americas and by 1.5% in South and Southeast Asia. There’s nothing “smoke-free” about sending more cigarettes into these regions.

Despite claiming in its “smoke-free”-oriented corporate communications that it’s best to never start smoking, PMI continues to advertise cigarettes, including to populations that historically have low rates of smoking. A recent study of cigarette advertisements in Israeli newspapers found that 87% of the ads were targeted at the Haredi population, a group that has the lowest smoking rate in Israel.

PMI has also fought for the ability to advertise cigarettes. For example, in 2020, PMI’s Indonesian subsidiary, PT HM Sampoerna, wrote to a government official in Bali asking him to revoke a ban on outdoor cigarette advertising. The company also funded a counter-campaign in Switzerland to persuade people to vote against a tobacco advertising ban meant to protect young people. The purpose of advertising is to acquire new customers. If PMI genuinely believes it’s better for people not to smoke cigarettes, why do they continue advertising them?

In 2018, one year before it launched its global “Unsmoke” campaign  PMI opened a cigarette factory in Tanzania. It’s also opening a new $30m cigarette factory in Ukraine this year, replete with full self-congratulation on its support for the war-ravaged nation. However, it still does business in Russia.

British American Tobacco hasn’t so far had the gall to say it wants to get out of tobacco. Nup, it opened a new tobacco factory in Jordan and it’s been happy to break US trade sanctions with North Korea, being fined $US635.2m  this year for selling cigarettes to the bellicose hermit state via its Singapore branch.

Vaping cheer leader Alex Wodak, whom I’ve criticised many times in this blog, didn’t surprise with his reaction to the Concordia shafting of PMI. Here he is actually saying wide-eyed from his parallel universe that PMI is no longer “Old Big Tobacco [deserving] strongest condemnation” but actually deserves lots of praise.

So do we side with the authority of 182 nations which have ratified the WHO’s Framework Convention on Tobacco, with its Article 5.3 dedicated entirely to ways of preventing Big Tobacco from sabotaging tobacco control? Or do we join the applause with Wodak and his admirers in the tobacco industry, the Institute of Public Affairs, the National Party, One Nation and the NSW Greens?

Meanwhile in Seoul

Also last week, across the other side of the world in Seoul, Big Tobacco held its annual gathering of the clan, the Global  Tobacco and Nicotine Forum  where it grapples with how best to short circuit effective tobacco control after  wining and dining its latest little helpers at the BAT sponsored welcome reception.

This year the Australian participants included tobacco and vaping conference globe-trotter Colin Mendelsohn.  Mendelsohn has long embraced vaping theologies that vaping is all but 100% benign, that it’s peerless as a quit smoking route and that there’s almost nowhere that vapes should not be sold.  But Mendelsohn’s mission these days has dropped almost every pretence that he thinks any concern about vaping by kids is warranted and that nicotine is virtually a wonder drug (see two slides below from his Seoul spiel).

In Seoul among the big players in Big Tobacco and their extreme right libertarian acolytes, our champion reprised some of the main messages he published in August  in a school education  magazine article announcing his seven point la-la land plan to “address” teenage vaping.

In the magazine piece he left the very best bit until the last of his seven points, writing:

schools could consider a designated outdoor vaping area. This should ideally be out of sight, for example behind the toilets, and restricted to students who:

• Are ‘registered’ as vapers
• Are over a certain age (eg 16 years), and
• Have the written parental permission.

Vaping won’t be as appealing to teens if they are allowed to do it.

This proposal should not be seen as an endorsement of youth vaping, but as a pragmatic solution for the reality of nicotine dependence.

And not only designated vaping areas in schools. Mendelsohn wants regular vaping breaks for addicted vapers.

Some students are addicted to nicotine and need to vape at regular intervals during the day. Consider allowing addicted students to take short breaks to vape outside if needed during class hours.

All this comes after his earlier emphasis that most vaping in young people is transitory and experimental and that “most young people who try vaping do not get addicted to nicotine”.  He writes “a supportive and compassionate approach is more likely to be effective and acceptable” about a problem he also says seldom is a problem.   

Picture the scene every day in out-of-control classrooms when one kid after another pleads with the teacher to be compassionate and allow them to have yet another break so that they can get relief from the grip of nicotine withdrawal that, oh wait, Col has just told us is highly unlikely to be happening anyway.

With sales of nicotine vapes being illegal in Australia to anyone without a prescription, and all smoking banned on school grounds by anyone of any age, I wonder when Mendelsohn will also call for cocktail hours, and dope smoking and cocaine snorting areas in schools? All illegal too, but hey, schools need to be pragmatic and compassionate, right?

While Philip Morris and other tobacco companies continue unabated in their efforts to market tobacco products, rejoicing over any sales or profit increases in their reports to investors, their “we’re changing” charades are simply air cover for their business-as-usual of massively profiting from unspeakably deadly products.

They are like the owners of the White Star Line telling the public “we spent lots of money removing the splinters from the handrails of the Titanic.”  Those who fall for this while chiming in support for the industry’s PR events are reprising a version of the age-old Faustian morality tale. And we all know how that ends.

The sinking of the Titanic as depicted in Untergang der Titanic, a 1912 illustration by Willy Stöwer

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?

Updated Jun 4, 2024; 24 Sep 2024; 7 Dec 2024; 11 May 2025;19 Nov 2025

I’ve recently returned from a three-day meeting in Europe where the entire focus was on vaping and other novel ways of increasing nicotine addiction. There was no-one in the large room with participants from some 40 nations who did not want to know all about Australia’s move to outlaw all vape sales other than those transacted via a doctor’s prescription.

It reminded me of the fervid interest in plain tobacco packaging which Australia pioneered in 2012. Twenty-eight nations have now fully implemented or legislated for plain packaging with 16 more considering action.

In the Abbott-Turnbull-Morrison years, Australian vaping advocates were on speed dial with go-to right wing political supporters to tap for favours. After the 2022 federal election conservative bloodbath, many of those supporters are now political feather dusters (Abetz, Wilson, Falinski, Sharma, Laming, Stoker, Zimmerman, McMahon) or political eunuchs like Matt Canavan and the unforgettable Hollie Hughes.

Above: Liberal Senator Hollie Hughes gets a squeeze from Legalise Vaping Australia’s Brian Marlow.

Australia’s vaping advocates are politically friendless, yet like the spectacle of the Black Knight in Monty Python’s Search for the Holy Grail, despite mortal wounds we see them gamely want to fight on against the heinous Labor government’s prescription access policy. But their ranks today are very thin indeed.

So here’s a quick look through those who’ve come and gone, and those not showing any vital signs.

Institute of Public Affairs

The IPA’s embrace of tobacco industry interests and its funding goes way back. In 1996 it flew out the late fake-credentialed Canadian tobacco industry consultant John Luik  for a lecture tour trying to discredit the science of passive smoking in a small book the IPA published (below).

The IPA spawned the political careers of staffers Tim Wilson and the funereal James Paterson. Wilson made an absolute goose of himself by writing a report which argued that if the Rudd government succeeded in introducing plain tobacco packs, courts would order the government to compensate the tobacco industry by $3billion every year afterwards (see the full saga in my book here at p144). Big Tobacco was comprehensively smashed in all three cases it brought against the Australian government over plain packs.

Vaping promoter Colin Mendelsohn fawned over Wilson and Paterson in what was surely one of the more heroic political predictions in the current century. The IPA have been very quiet on vaping, but they are to be taken seriously: in January 2014 they named me in the IPA Review  as one of “The Dirty Dozen” all-time Australian “opponents of freedom”

New Nicotine Alliance Australia (NNAA) Started a Twitter account in November 2017 with vapers Charles Yates (president) and Andrew Thompson (board member). Dr Attila Danko was also involved. He delivered this fire and brimstone rant at the 2015 Global Forum on Nicotine meeting in Warsaw. In 2024 the Victorian Civil and Administrative Tribunal made findings in a case brought by the Medical Board of Australia that Danko had engaged “in a treating relationship with a patient, a person with whom he had a personal relationship and pursued an intimate and sexual relationship, in circumstances that were avoidable, and making uninvited physical and sexual contact with a patient” and that he offered “to prescribe cannabidiol to the Patient, and prescribing Schedule 4 medications to a patient with whom he had a personal relationship, in circumstances that were avoidable.” In 2025 the Medical Board announced that Danko’s medical registration had been cancelled and that he may reapply after 12 months. NNAA announced it was closing in September 2019. The twitter page today shows 988 followers. No record of NNAA having made even a small impression in a soft cushion.

The Progressive Public Health Alliance  Set up in October 2019 in Melbourne with a current twitter (X) following of 175, and their most recent tweet on June 26, 2021, nearly three years ago. Ran a webinar on vaping in September 2020 with Alex Wodak, but no new seminars planned for its 50 dedicated subscribers.

Australian Vaping Association  Started up in June 2020 and managed 80 tweets until Oct 15, 2020 to its 146 followers. Never sighted since.

Australian Smokefree Alternatives Consumer Association The newest kid on the block thronging with all of 548 followers since Oct 2021 and not a tweet since May 2024. Not shaking the world.   Website https://asaca.org.au/

A.L.I.V.E (Australia Let’s Improve Vaping Education Set up in May 2024 by Pippa Starr (pictured below) who is ready and willing to do media interviews! 100 twitter (X) followers at June 4, 2024. That account closed then rebirthed as ALIVEadvocacy in the same month, now bursting with 493 followers as at 11 May 2025. Its battle cry is “The truth is coming to get you”. That truth appears to be that a homeopathically small proportion of Australian vapers is interested enough in all this to even make a mouse click to “follow”.

Pippa had earlier offered to represent Australian vapers in the media and to politicians.

In May 2025, after dramatic music Pippa breathlessly announced to the world on youtube that ALIVE had set up the “Colin Mendelsohn Medal Award”, although they seemed unsure of the spelling of his name. The award went to one of its stalwarts, Alan (Al) Gore the public name of vaper, advocate and submission writer Alan Gorley. Pippa described the award as “an amazing thing for you to wear around your neck, proudly … an unbelieveable and prestigious award.”

Responsible Vaping Australia (RVA)

Set up by British American Tobacco Australia, RVA’s goal in life is to sell the idea that there are many retailers out there who would never dream of selling vaping products to children or stocking heinous unsafe vapes sourced from suppliers with bathtub and kitchen sink chemical laboratories where the vape juice is mixed.

No-sir-ee, RVA’s members do not see themselves as criminal, law-breakin’ “black market” vape suppliers. They want to be card-carrying ‘regulated’ suppliers who only sell premium quality nicotine mixed with any of the tens of thousands of flavouring chemicals never passed by any regulatory body anywhere in the world as safe for inhalation.

RVA wants the dedicated health-conscious staff from tobacconists, vape shops, petrol stations and convenience stores to sell vapes. As we all know, such outlets have zero track record over decades of selling cigarettes illegally to kids, so what chance that they would sell vapes to them too? How very, very awkward it must have been for LVA when the TGA  recently published notice of massive fines to three TSG stores for allegedly importing illegal vapes. Stay tuned for more awkward moments.

Legalise Vaping Australia (LVA)

LVA appeared in 2017 out of the swamp of far-right libertarian boutique causes under the umbrella of the incestuous Australian Taxpayers Alliance (ATA), which in 2020 held out its begging bowl for funding to the Koch Foundation.

On  September 16, 2018 ABC-Online ran a piece about LVA’s lobbying campaign to legalise e-cigarettes. Michael Black’s report had LVA’s Brian Marlow saying  “his organisation had been making  [claims about e-cigarettes] for years”. Well, perhaps for two years.  LVA’s Twitter account was set up on September 20, 2016 and the Wayback Machine’s earliest record of LVA’s website dates from July 1, 2017.

Above: Australian Taxpayers Alliance President Brian Marlow looking tres presidential

When Marlow referred to “his organisation”, he was likely talking about the Australian Taxpayers Alliance (ATA), where he was a member of the “team” before taking the reins as its “president”. LVA is just one of several campaigns run under the umbrella of the ATA. As shown in this tweet posted just after the death of right-wing cartoonist Bill Leak in 2016, identical tweets were posted by five ATA-affiliated groups.

This incestuous arrangement has also seen one group (@MyChoiceAust) replying supportively to a tweet from LVA. Nothing like having those in the same office talking to each other or perhaps one person to him or herself using different account names?

So who funds them?

In January 2018, amid much fanfare, LVA launched the portentous “Vape Force One” tour of NSW, Southern Queensland and Victoria where a large Winnebago visited 28 towns. The purchase or hire, signage and running costs of the van and any food and accommodation costs of the seven volunteers involved would have not been insubstantial. I wonder who picked up the tab for all that?

The tour launch, held in Primrose Park in Sydney’s Cremorne, looked like being bigger than Ben Hur, with LVA’s website showing 367 guests having registered to attend, but rather fewer turning up.

Above: Unprecedented crowd of supporters at launch of Vape Force One (subtract cricketers waiting to bat)

Their Facebook events page showed single-digit numbers registering interest in 9 of the 28 stops listed, with a whole 0 at the Byron Bay event. Throughout the month of the tour, LVA tweeted its best photos of the crowds which besieged the Vape Force One van. Local politicians were invited to come down and get informed. I may have missed seeing how many took up those invitations.

The size of the ATA’s support base appears to be rather fluid. Its website on 17 September 2018 showed 4,186 “supporters”. But one click away on its “who we are” page we see it reports “over 75,000 members”, a mere 17.9 times more.  My public request to the ATA to clarify these differences was never answered.

Apart from appeals for donations, neither the ATA or the LVA website provide any information about funding sources. This is standard practice with far-right bodies who try to make a virtue out of their lack of transparency, arguing that their goals, policies and arguments owe no provenance to those with vested interests who might provide financial and in-kind support.

The ATA boasts “academic fellows” as if it was some sort of credentialed research institution. But all academics at legitimate research institutions know that a fundamental tenet of  research and publication ethics is full disclosure of all relevant competing interests.

The LVA and the ATA have made cute little awards to political supporters who support the LVA’s efforts. These include David Leyonhjelm (whose Liberal Democrats party had a record of accepting funding from the tobacco industry), Cory Bernardi, Eric Abetz, and Tim Wilson (former Institute of Public Affairs staffer), Andrew Laming and Peter Phelps (NSW parliament). Anyone discern any political complexion among this group? It’s an interesting phenomenon how e-cigarettes have become a signature policy for some in the far-right of Australian politics.

Above: The sartorially elegant LVA crew rubbing shoulders with politicians Tim Wilson  and James Paterson, with Colin Mendelsohn along for the fun. Brian, didn’t your mum tell you should take your hat off indoors?

In 2018 federal by-elections LVA campaigned to support the election of Liberal Democrat candidates and an Australian Conservative (in Victoria), where these candidates secured the desultory primary votes shown below, sourced from the Australian Electoral Commission.

Batman, Victoria: Australian Conservatives: 6.41%

Longman, Qld: Liberal Democrats: 1.99%

Braddon, Tas: Liberal Democrats: 1.32%

Mayo, SAust: Liberal Democrats: 0.91%

Perth, WAust: Liberal Democrats: 6.69% (note: no Liberal Party candidate ran).

Fremantle. WAust: Liberal Democrats: 14.1% (note: no Liberal Party candidate ran).

It’s held poorly attended rallies in Perth, Melbourne and Sydney.

Above: Crowd control not needed at Perth supporters rally

In December 2020 Marlow claimed, without ever showing a data source or any calculations, that 500,000 Australian smokers had “quit smoking for good” by vaping. Strangely, neither the Australian Bureau of Statistics nor any health agency specialising in tobacco control have noticed anything remotely like this had occurred. Such a fall would have been the largest ever recorded in any nation’s smoking prevalence.

Marlow seemed very confused about what message he wanted to send on vaping and COVID. Noting that ATHRA had claimed there was “No evidence that vaping increases the risk of COVID-19” Marlow then spelled this out as meaning “It is important to know vaping increases the severity of #COVID19 in vapers or bystanders” (see below) Whoops!

In February 2021, Neil Chenoweth put the LVA and its director Brian Marlow’s “colourful” background in real estate under the blowtorch in the Australian Financial Review.

On 30 November 2022, the Therapeutic Goods Administration invited public comment on its proposed regulations for vaping, allowing 48 days until submissions would be closed. LVA apparently had so little to contribute that it made no submission.

In May 2023, Marlow announced the formation of “the first political party dedicated to the rights of vapers” the Legalise Vaping Party. But the party never ran a single candidate in May 2025 elections.

Pippa Starr from ALIVE reminded us on X that “Australian’s vape and we vote!” and pointed to political candidates who opposed Australia’s vaping laws. The election saw the biggest victory ever to Labor, architects of the loathed pharmacy access policy, with ARISE-approved parties like the Libertarians attracting a trickle of votes.

Australian Tobacco Harm Reduction Association (ATHRA)

ATHRA was registered on October 12, 2017 as an “advancing health” charity with the  government’s Australian Charities and Not-for-Profits Commission.

ATHRA has no staff and when it folded on Dec 1, 2024 (below) ,  three board members: Perth GP Joe Kosterich (with the grandee title of “chairperson”), Dr Alex Wodak and  Ean Alexander, a Perth businessman with interests in the medicinal cannabis industry. Kosterich is Medical Adviser to Little Green Pharma cannabis company. In 2022, the company was fined $372,960 by the Therapeutic Goods Administration for 28 instances of alleged “unlawful advertising of medicinal cannabis products on their websites and social media platforms”.

From at least  7 December, 2021 ATHRA’s website has stated (below) that its Board consisted of three “medical practitioners”. Director Ean Alexander’s background is not supplied nor his photograph shown. However, he is not a medical practitioner, so this statement is false and has been so for at least 20 months.

Kosterich informed a 2019 Western Australian parliamentary select committee on Personal Choice and Community Safety  to which he gave evidence that “ATHRA has no members”. Its website has provision for “supporters” to register, but curiously does not appear to have released any data on the size of this supporter group. We might expect that if this support was large, ATHRA would have likely told us about this many times.

Dr Colin Mendelsohn was the founding chairman of ATHRA (the Australian Tobacco Harm Reduction Association) from 2017. He then resigned from the ATHRA board, taking effect from Jan 4, 2021 according to ASIC records. He thereafter referred to himself many times as being “the founding chairman of the Australian Tobacco Harm Reduction Association” often without adding that he was no longer on the board. 

After doing a “Nellie Melba” and announcing his retirement from vaping advocacy in Dec 2023 only to soon rescind it, he again announced a retirement in November 2024.

ATHRA spokespeople have long campaigned for nicotine vaping products (NVPs) to be designated a minimally regulated “consumer product”, available from almost any outlet. They are implacably opposed to the medical prescription approach. In this, they are in lockstep with all tobacco companies which manufacture NVPs and almost the entire vaping industry.

This has not stopped vaping advocates repeatedly making the argument that the prescription access model will benefit the tobacco industry and that those supporting the prescription model are “helping big tobacco”. So, if you support the prescription model, you are nothing but a useful idiot greasing the wheels for the tobacco industry: the very same industry which is inexplicably  lobbying tooth and nail against this model. So how does all that work?

ATHRA’s recent inactivity on social media

ATHRA has a twitter account which has not published anything since 28 June, 2022. It also has a website which includes a section on media releases  and a blog, The most recent media release visible on its current website is dated March 6, 2020, over three years ago.  

The most recent ATHRA blog is dated May 28, 2021 (although there is a promotion for Mendelsohn’s book posted Dec 10, 2021. The book was published by the pay-to-publish Aurora House. Check out their many other fascinating titles here.

Now flying solo, Mendelsohn has recently had a bumpy ride with the media. In December 2022, 2GB’s Ben Fordham pushed back hard on Mendelsohn’s claims that “there’s  a lot of panic [about teen smoking] which is exaggerated”. Western Australia’s radio 6PR has given him some coverage in the past, but in  February 2023 he was savaged by respected journalist  Gary Adshead when he defended the Philip Morris funded Foundation for a Smokefree World.

Television Channel 7’s Sunday night current affairs program Spotlight interviewed Mendelsohn on May 28, 2023 where the compare advised viewers at 25m55 that they were “about to see why he is a friend of Big Tobacco”.

Like LVA, neither ATHRA nor any of its current directors made any submissions to the 2022-2023 Therapeutic Goods Administration’s call for submissions on proposed vaping regulations, the biggest policy change to have happened with vaping in Australia. 

ATHRA would appear to be comatose, showing no vital signs.

A recent longitudinal study (2016-2021) published in JAMA of children who had used any form of nicotine found, using neuroimaging outcomes, “a significant association … of early-age initiation of tobacco use with lower crystalized cognition composite score and impaired brain development in total cortical area and volume. Region of interest analysis also revealed smaller cortical area and volume across frontal, parietal, and temporal lobes” in children who had smoked. Importantly, the study controlled for socio-economic factors and other substance use.

A key tenet of vaping theology insists that when claims about nicotine harming cognitive development are made, the dismissive “pure speculation” flag must be rapidly run up the pole. Vaping advocates have a lot of fun pointing out that the abundant evidence about this has almost come from animal studies, particularly with rats like this, this and this.

Unlike in animal studies, experimental exposure of children to nicotine to assess cognitive or other impacts would never be accepted by human ethics research committees, so observational cohort studies like the JAMA study above are the best data we have.

In this piece from 2018 , local Aussie vaping apostle Dr Colin Mendelsohn weighed in on this issue stating “There is no evidence so far that nicotine harms the human brain in adolescence. Concerns of harm to brain development from nicotine are based on rat and mouse studies. … As one review concluded, animal tests generally ‘fall far short of being able to predict human responses.”

Dr Col, as he likes to call himself, must have spent a good while searching for an authoritative reference to bolster that claim.  The first author of the paper linked above gives his affiliated organisation as an outfit dedicated to opposing the use of animals in research called Americans For Medical Advancement, listed by Quackwatch as a possibly “questionable organization”.

In 2023 Dr Col doubled down on this in a video where at 2m30s he claims: “Teens who smoke don’t have significant differences in adulthood in IQ, educational achievement or cognitive function compared to those who’ve never smoked.”

Oh really? This prospective cohort study examined the association between early to midlife smoking trajectories and midlife cognition in 3364 adults  (1638 ever smokers and 1726 never smokers) using smoking measures every 2–5 years from baseline (age 18– 30 in 1985–1986) through year 25 (2010–2011). Five smoking trajectories emerged over 25 years: quitters (19%), and minimal stable (40%), moderate stable (20%), heavy stable (15%), and heavy declining smokers (5%). Heavy stable smokers showed poor cognition on all 3 measures compared to never smoking. Compared to never smoking, both heavy declining and moderate stable smokers exhibited slower processing speed, and heavy declining smokers additionally had poor executive function.

In this Finnish longitudinal cohort twin study data (n=4761) from four time points (ages 12, 14, 17, and 19-27 years) “were used to estimate bivariate cross-lagged path models for substance use and educational achievement, adjusting for sex, parental covariates, and adolescent externalizing behaviour.”

Smoking at ages 12 and 14 “predicted lower educational achievement at later time points even after previous achievement and confounding factors were taken into account. Lower school achievement in adolescence predicted a higher likelihood of engaging in smoking behaviours … smoking both predicts and is predicted by lower achievement.”

Against the  authority of Dr Col on the doubtful relevance of animal studies for humans, we can look at the track records of all 225 Nobel Prize winners in the Medicine and Physiology category between 1901-2021. Of these, 188 (83.6%) used animals in their research.

So across 120 years, the judges of the most prestigious global prize in medical research seem to think animal research is of immense importance in understanding of human health. But Dr Col, a former Sydney GP with no masters or PhD and a very slim track record in publishing  research with original data in peer reviewed journals (search for “Colin Mendelsohn” in Google Scholar) claims to know different.

One such  Nobel Prize winner is Columbia University neuroscientist Eric Kandel  (2000) who in 2014 with his wife (who orginally conceived of the gateway hypothesis in 1975) published The molecular basis for nicotine as a  gateway drug in the New England Journal of Medicine where they set out molecular experimental evidence for the gateway hypothesis in mice.

In a likely throw to the Kandels’ work, as shown above, Dr Col wrote (see below) that “it is also theorised that nicotine may sensitise the brain to other drugs and increase the risk of substance abuse. However, there is no evidence to support this theory in humans.” This is of course because experimental and randomised controlled trials involving introducing nicotine naïve human subjects to nicotine would never be ethically acceptable.

Eric Kandel summarised his paper this way:

“The results we obtained by combining epidemiologic and biologic studies suggest a model in which nicotine exerts its priming effect on cocaine by means of HDAC inhibition and provide a molecular explanation of the unidirectional sequence of drug use observed in mice and in human populations. Nicotine acts as a gateway drug and exerts a priming effect on cocaine in the sequence of drug use through global acetylation in the striatum, creating an environment primed for the induction of gene expression. Long-term potentiation in the nucleus accumbens is blocked when long-term exposure to nicotine is followed by cocaine use, which presumably lessens constraints on dopaminergic neurons in the ventral tegmental area and leads to the enhanced release of dopamine.¹⁹ For all the measures we studied — locomotor sensitization, conditioned place preference, long-term potentiation, and FosB expression — reversing the order of nicotine and cocaine exposure was ineffective: cocaine did not enhance the effect of nicotine. The priming effect of nicotine depended on its being given for 7 days before cocaine. Priming did not occur when nicotine was given for only 24 hours before cocaine.”

LD₅₀

One of the most basic measures in toxicology is the LD₅₀ measure. This is “a standardized measure for expressing and comparing the toxicity of chemicals. The LD₅₀ is the dose that kills half (50%) of the animals tested (LD = “lethal dose”). The animals are usually rats or mice, although rabbits, guinea pigs, hamsters, and so on are sometimes used.”

Substances with LD₅₀ below 5 mg/ kg are classified as highly toxic while substances with LD₅₀ above 15,000 mg/kg are deemed relatively harmless. 

Perhaps Dr Col has forgotten about the LD₅₀ measure from his undergraduate days and that this fundamental measure of toxicity, so central to safe dosage in prescribing, is derived from animal testing. It’s been around since 1927 and is being phased out today due to animal welfare concerns.

Animal studies were critical in early understanding of the pathogenesis of diseases now well-established as being caused by smoking. In 1962, Bock et al demonstrated that painting cigarette tar on mice skin produced  tumours in 41 of 76 mice painted with tar from  unflitered cigarettes and in 15 of 60 mice painted with tar from filter-tipped cigarettes. In every group of mice, some of the skin tumours progressed to cancers within the 1-year period. Guinea pigs develop emphysema from tobacco smoke. Mice get hypertension, increased oxidative stress, impaired NO bioavailability, endothelial dysfunction, and cardiac remodeling when chronically exposed to  cigarette smoke and pregnant mice produce low birth weight offspring when exposed.

So in all these examples, we have unchallenged strong evidence that tar and cigarette smoke harms lab animals in the same way that it harms humans. Yet witness the rush to blithely dismiss concerns about the relevance of animal evidence on nicotine exposure and brain development.

In this earlier blog, I listed a long series of studies mostly but not always  involving animals looking at the role of nicotine in a range of diseases and disease processes. Vaping advocates often seem to have a kind of religious zealotry about nicotine being a benign and indeed beneficial substance in the levels found in inhalable nicotine products. Their rush to shut down concern about nicotine’s impact on young brains is a disturbing sign of their irritation that community concern about the impact of vaping on kids should in any way interrupt adult access to these products. Their regular sarcasm about “won’t someone please think of the children” sees this in full flight.

Other blogs in this series

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ten years ago in May 2013, around the time when vaping changed gears in the USA from a fringe to a mainstream activity, the body representing US chemical companies which make and extract flavours for foods and beverages, the Flavoring and Extracts Manufacturing Association (FEMA) published and publicised its position on flavours in vaping products. Here was an industry that stood to earn billions by having a massive new door of opportunities open if flavours in vapes were ever to be given a green light by regulators.

But rather than embrace flavours in vapes, FEMA did not mince words. It stated that anyone representing or suggesting that inhaling vapourised flavours was safe was engaging in false and misleading conduct. Unambiguously, FEMA said it “does not support the use of flavors in vaping products” despite these chemicals often having been assessed as “generally recognised as safe (GRAS)” for ingestion in foods.

In March 2020, FEMA revised and reiterated its statement, which remains in place today

It is difficult to overstate the significance of FEMA’s long-standing position. This is an industry whose sole revenue lies in developing and refining flavours that make food and drinks more palatable and appealing, differentiating identical products by adding flavouring associations that evoke whole new vistas of gustatory experience. Opening the door to vapes could have been like opening the doors to whole new holy grail.

How are flavouring chemicals used in different product groups?

With so much at stake if a flavouring chemical compound was found to be toxic when consumed in food or drink, FEMA has for years put 10,000 watt arc lights on the importance and credibility of its scientific assessments. A food producer hoping to tinker with experimental flavouring chemistry and simply put it out there for sale would collide with massive regulatory walls in all but chaotic, impoverished nations with perfunctory food standards.

 As it should, the US Food and Drug Administration has taken a similar position with vaping chemicals.  By mid 2021, the US FDA had issued Marketing Denial Orders for some 55,000 flavoured vaping products.

Everyone eats. And with the possible exception of small groups like tribespeople deep in Andaman Island jungles, everyone eats at least some (and usually lots) of commercially processed foods.  So food flavourers have a massive sandpit in which to play.

But it is not difficult to imagine boardroom or greenfields thought experiments at flavouring company retreats where imaginations were let off the leash and ways of expanding the use of flavourants encouraged.

There are five routes where commerce has found its way into our bodies with chemicals: swallowing by mouth, inhaling into lungs, injectable medicines , topical medicines absorbed through the skin and rectal insertion. With the rectum lacking taste buds, flavoured suppositories would be stillborn in any brainstorm. Equally, there’d be no point in flavouring injectables or topicals  for any market advantage. Swallowing across taste buds, of course, has long been the flavouring industry’s bread and butter. So what about inhaling?

Here we have the air freshening industry where combusted incense is the outlier unhealthy bad boy when it comes to respiratory impacts. Air fresheners including the increasingly popular use of essential oils add to indoor air pollution. Insect repellent sprays are also often inadvertently inhaled, but are generally regarded as safe when used as directed.

But two other very common product groups are inhaled: some medicines and tobacco and inhalable nicotine products. 

Inhalable flavoured medicines?

Far and away the most commonly inhaled therapeutic medicine are the puffers used by people with asthma.  In Australia in 2020-21, in a population 25.77 million,  2.7 million people had asthma – one in 10.65 people – with one in three using asthma medication daily.

Everyone diagnosed with asthma is advised to always carry an inhaler which come in two broad types: relievers and preventers. The main ingredient in relievers is the bronchodilator, salbutamol (also known as albuterol). The most common adverse reactions to using this drug are taste alteration (bad, unpleasant and unusual taste).

So with one in 10.7 Australians living with asthma, and one in three of these using salbutamol daily, and unpleasant taste being the most commonly reported adverse side effect it would be understandable if these inhalers came with flavourings, perhaps causing adherence to recommended use to increase, particularly among children with their aversions to taking medicines.

So why is it that there is not a conga line of pharmaceutical company applicants banging on the doors of the world’s therapeutic goods regulation agencies begging to be allowed to add flavourings to asthma puffers? The answer here reflects FEMA’s position I described above: there is no acceptably safe way of inhaling flavour chemicals into your lungs every day. Or as in the case of vaping, many, many times a day. So salbutamol pharmaceutical companies don’t bother applying and neither do companies selling vaping products. The latter think they are too important to suffer the indignity of regulation rejection, so they just don’t apply.

How many times a year do vapers baste their lungs?

If you have ever been near someone vaping, you may have formed the impression that they pull vapour into their lungs an awful lot. Your impressions are not wrong. This has been studied using different methods. Here are three examples.

This early (2016) study using a device for recording cigarette puffing topography found vapers taking an average of 32 puffs across 10 minute observation periods. Two studies have used ad libitum observations (where subjects are asked to vape in the way they felt like doing). In one (2016), researchers observed vapers using their normal vaping equipment ad libitum for 90 minutes. They reported the median number of puffs taken over 90 mins was 71 (i.e. 0.78 puffs per minute or 47.3 per hour). Another (from 2023) found those using pod vapes took an average of 71.9 puffs across 90 minutes, almost identical to the 2016 study number.

But of course vapers do not vape across only one continuous 90 minute period each day. No studies appear to have calculated average 24 hour vape puff counts. But if we (conservatively?) assume 8 hours of sleep and four waking hours of no vaping, then a person vaping for 12 hours a day at this 47.3 puffs per hour rate, would pull 568 puffs across a 12 hour day 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 is 10.7. Unobtrusive observations of smokers smoking in outdoor leisure settings (beer gardens, 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 6 times the rate that daily smokers inhale. This is an almost frantic rate.

Most studies which have reported on puff topography have focussed on comparing nicotine intake between smokers and vapers, with interest on the way in which people titrate their use of nicotine delivery devices to obtain blood nicotine levels that satisfy their craving. Most studies conclude that cigarettes deliver the most nicotine and from this, researchers conclude that the much higher puff frequency rates with vapes are explained in this way.

While vaping promoters have sought to whitewash nicotine as being almost vitamin-like in its virtues and all-but-benign risk profile, nicotine is obviously a critical component in assessing the net risks of both smoking and  vaping with a recent report in Nature on the mass population exposure to nicotine via vaping concluding:

“This continuing population experiment, combined with a growing number of cell and animal studies, could begin to dissipate the fog surrounding nicotine’s impact on health. “I’ve been more and more surprised at the changes I’m seeing when I expose cells to nicotine,” says Crotty Alexander. “We’ve underplayed the role that nicotine has in the health effects of tobacco products.”

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 galactic frequency of point-blank lung bastings of the chemical cocktail that is vapourised nicotine, thousands of unregulated flavouring chemicals, propylene glycol and metal particles sloughed from heated metal coils in vapes.   But thank goodness we have the 3 person Australian Tobacco Harm Reduction Association around to assure us that there is just nothing at all to worry about here.

With the average age of diagnosis of asbestos-caused mesothelioma in Australia being 77 and that for lung cancer being 71, latency periods for chronic diseases like cancer, respiratory and cardiovascular diseases take decades to reveal their bitter harvests. Taunts from vaping promoters that “there has never been a documented death from vaping” have all the scientific weight of  an asbestos industry spokesperson in the 1940s saying “there have been no asbestos deaths” (Asbestos was mined in Australia from the 1930s before Australia finally started regulating asbestos products in the late 1970s). The wave of nicotine addiction we are seeing in young people today will reveal any consequences in the decades to come, not in a few years time.

The Australian government’s 2023 decision to outlaw all vapes unless dispensed via prescription at a pharmacy will involve the outlawing all but a very limited  range of flavours. There is growing momentum for this to happen in other nations like New Zealand, the UK and Canada experiencing the same growth in youth vaping.

Study after study has confirmed a recent bullet-paced entry into the infamous “no shit Sherlock!” archive, that flavours are a major reason that children are attracted to vaping. Who could have ever guessed!

Vaping advocates shoot back that adults like flavours too, and that their widespread availability must never be impaired. Out of the other side of their mouths we then hear their pious concerns that children simply should not vape. You see, the health consequences of vaping apparently only occur in people under 18 years old, and magically stop when they turn 18 and 1 day.  Their ghoulish indifference for the collateral roadkill preparation they are helping foment is beyond contempt.

Some months ago, 89 year old Susan died alone in her Sydney nursing home at 1.30am. Susan had been living there for 13 years and had moved into the room next to my wife Trish’s mother Mollie a few days after Mollie’s husband Alf had died.

In nursing homes, couples are often housed in separate rooms as most rooms are big enough for only one person. So Alf slept in the room next to Mollie, and during the day they watched television together, sat in the garden on warm days and visited their children’s houses on weekends. They both loved the Balmain Tigers. They were inseparable and Mollie was bereft when her husband of over 50 years died.

Susan and Mollie rapidly soon became best friends, with Mollie telling her three daughters that Alf had sent an angel in Susan to take his place.

When Mollie died in 2014, Trish and her sisters regularly visited Susan. When she was still mobile, they’d go to a local café for lunch. They bought her an iPad and taught her to use it. Across the last six years, they were like the daughters she’d never had. I made her compilation music CDs from musicals and the 50s, which she played constantly.

Susan had only one other visitor, Enid, a woman of her age with whose family she had been unofficially fostered as a child. She was her next-of-kin. As she became more fragile with age, Susan became unable to leave the nursing home because of her greatly impaired mobility. She effectively was alone except for the weekly visits from Mollie’s daughters and less often, from Enid. Then COVID put an end to that for nearly two years.

As COVID restrictions relaxed, permission to visit again was given. Susan had aged a lot, her breathing was laboured and she was unable to move much at all without a frame. She ate like a sparrow and often talked about how there was nothing left for her to look forward to in life. More than once, she spoke about being “ready to go over the cliff”. Trish made her comfortable, held her hand and showed her photographs of our kids and grandkids.

About four weeks before she died, she was taken to a large Sydney hospital after frequent seizures. Oh mercy, this looks like it, Trish said, going in seven times before Susan finally died. Trish and Enid had daily calls and visited Susan twice together. Enid would interpret the slightest movement or sound as a good sign that Susan was perhaps recovering.

Susan soon became semi-conscious for days, fitting frequently as she sank neurologically, and being fed through a tube. Trish told Enid that Susan had often spoken of wanting to die. “I’m sure she would not have wanted to be artificially kept going, unconscious like this” she ventured a few times.

One day about two weeks in, Trish went to the hospital and the unconscious Susan was being was being washed by nurses. “She was like a skeleton. Murmuring incoherently, unable to speak. She’s like the living dead, and she’s still being fed. Why can’t they do something? She’s dying. The doctors and nurses have said this repeatedly!”

One day, a doctor visited while Enid was with Trish. Trish seized the moment and asked the doctor questions in front of Enid, knowing what they answers would be. “If Susan gets through this, is it likely she will be able to feed and dress herself? Will she be able to speak? Will she be able to get herself out of bed to the toilet? Will she be able to turn over easily in bed by herself?” The doctor said no to all of these.

Enid told Trish after the conversation “Susan will go when Susan chooses to go”.

A week before she died, Susan briefly regained consciousness. Trish went in to say goodbye. She could recognise her and tried to say “how are you”. With barely any energy left, she tried through tears to pull the tubes from her arms and the oxygen tube from her nose. She managed to say “get me out of here … home”.

She went back to the nursing home. Trish went to see her again. Susan again removed her oxygen line, and said “Am I dead?”

We talked every night about what to do. Not having next-of-kin status, despite being a frequent visitor and comforter, Trish had no legal standing in how she should be looked after in hospital. Susan couldn’t speak for herself, and Trish sensed very strongly that Enid, a Roman Catholic like Susan, was avoiding any talk about end of life.

Preparing an advanced directive was not something that Susan would probably been ever aware of. Trish sensed strongly that Enid was entirely uncomfortable about any discussion of what directions she might give the hospital and nursing home staff about end-of-life matters like sedation or withdrawing feeding. She may have felt this would have been profane and against her church’s doctrine.

Trish, with no legal status, was powerless to be an advocate for her interests. So Susan lived on for weeks when she expressed that she desperately to die.

I’ve no doubt that tonight, and every night  across Australia there are dozens of elderly and dying people like Susan who have not lived in company with friends and relatives who actively encourage discussion about advance directives, let alone voluntary assisted dying. Many have few if any visitors.  They are alone with no one speaking up for them. Only 14% of Australians have prepared advanced directives.

As the population ages, it is terribly important that a major awareness campaign be launched designed to inform people in their sentient final years about what their end-of-life options are. Any humane and compassionate society owes this to those who are alone and unsupported or who are under the legal governance of people who would just rather not talk about any of this.

You can read about and download advanced care directives here.

• Susan and Enid are pseudonyms