Category: opinion

  • Rodu: No Evidence to Support CDC ‘Nicotine Brain’ Claim

    Rodu: No Evidence to Support CDC ‘Nicotine Brain’ Claim

    ip-brain-patents

    The U.S. Centers for Disease Control and Prevention is out with a false advertisement telling kids that “Nicotine in e-cigarettes can harm brain development.” The headline says, “It’s not like you can buy a new brain.” To make it accurate, I’ve added “…for your pet mouse,” writes Brad Rodu in his blog rodutobaccotruth.

    Let me be crystal clear. The harm in brain development federal officials talk non-stop about only happens in laboratory torture of mice. Mouse studies are well known to be of questionable value in predicting human effects. There is absolutely no scientific evidence to support the claim that nicotine causes harm to human brain development, so it is astounding that federal officials traffic in this false narrative. This nonsense is an affront to 34 million adult current smokers and 55 million former smokers in the U.S., virtually all of whom started when they were teenagers. There is no evidence that their brain development was harmed, a fact that was specifically acknowledged by a prestigious nicotine researcher Dr. Neal Benowitz at an international tobacco meeting this week.

    Credit: Brad Rodu

    I have for years catalogued CDC misinformation campaigns regarding smokeless tobacco (examples here, here, here) and e-cigarettes (here, here, here, here).

    Today, CDC’s bungling of Covid-19 facts and guidance is pulling back the curtain on that agency’s tragic shortcomings and its readiness to disregard or “warp” the truth. Educated tobacco users have known the CDC has been lying about and to them for years.

  • Minton: The Double Standard for Nicotine and Cannabis

    Minton: The Double Standard for Nicotine and Cannabis

    The U.S. House of Representatives may soon vote on a historic measure to end federal prohibition on cannabis. Ironically, just as the public and political leaders realize the folly of prohibiting cannabis, we are rushing toward a new prohibition with many of the same pitfalls.

    Prohibiting nicotine vapor is unjustified by all the science so far, which shows health risks are low. Worse, prohibition would prove tragic for smokers, who will be deterred from quitting their deadly habit, Michelle Minton wrote for insidesources.com.

    When e-cigarettes entered the U.S. market in 2007, opponents argued there was limited evidence about product hazards. That implied opponents would relent if and when scientific evidence could establish e-cigarettes’ relative safety. Yet, as evidence mounted, incontrovertibly proving vaporized nicotine was much safer than smoking, efforts to prohibit vaping have only amplified.

    It should have been good news when research literature established nicotine vaping as a more effective for smoking cessation than traditional nicotine replacement therapies. It should have been good news that e-cigarettes didn’t prove a “gateway” for youth smoking that, in fact, youth smoking is at an all-time low.

    MIchelle Minton / Credit: Competitive Enterprise Institute

    And it should have been good news that research failed to link nicotine vaping with significant negative health outcomes, even for those who never smoked. Smokers who switch to vaping actually show rapid improvements in heart and lung health and reduced risk of smoking-related cancers.

    Thus, converting smokers to vapers could save millions of lives.

    But for opponents of e-cigarettes, this evidence isn’t enough. They demand proof that e-cigarettes are 100 percent harmless, an impossible benchmark for any product. The evidence on cannabis is not conclusive, either. For example, there is limited data on how THC impacts cardiovascular health or how cannabis use in adolescence affects future development.

    But that didn’t stop the public and lawmakers from supporting efforts to decriminalize or legalize the drug. Rightly so. Science has a hard time identifying small effects. Thus, after decades of research and centuries of use, of the failure to establish significant harms from cannabis use indicates the harms are marginal.

    That is, cannabis as typically used poses minimal risks for most people, though risks might be greater for certain subgroups or atypical use.

    Conversely, harms caused by prohibition are large and apparent. Not only did prohibition fail to stop people from using cannabis, it spawned a dangerous illicit market, cost billions in enforcement, fomented distrust of law enforcement, devastated communities, and ruined countless lives. Against these costs, concluding that it’s better to give adults access to a legal, regulated market, is obvious.

    That is the conclusion we should have reached for non-combustible nicotine. After more than a decade of intense research, science has yet to link nicotine vaping to any major negative health effects. Many studies claim to have identified potential risks of vaping, but there are an equal or greater number of studies with opposite conclusions.

    What this tells us is the risks of nicotine vaping are likely marginal. And, as with cannabis, there are clear benefits to use of nicotine vapor in terms of health and recreation.

    Conversely, attempts to ban, restrict and heavily tax vapor products have and will continue to inflict a great deal of harm. Banning flavors, restricting sales, and heavily taxing products pushes consumers toward illicit dealers, knockoff products and more dangerous substances. Such policies also drive people back to smoking.

    Yet opposition to these products has grown more extreme and widespread. Contrary to opponents’ rhetoric, their opposition has nothing to do with science and everything to do with morality. Cannabis use is no longer deemed socially unacceptable. But nicotine, thanks to its association with smoking, has only become more stigmatized and no amount of proof will change the minds of those morally opposed to its use.

    Anti-vaping activists will continue to pursue bans and outright prohibition of these products, no matter how safe the science says they are or how many people will die as a result.

    Michelle Minton is a senior fellow with the Competitive Enterprise Institute. She wrote this for InsideSources.com.

  • Opinion: Egypt’s Vapor Ban Driving Black Market

    Opinion: Egypt’s Vapor Ban Driving Black Market

    Credit: Bill Oxford

    Black market trade in e-cigarettes and associated products is being driven by smuggling. Regulating the category will protect consumers, secure much-needed tax revenues, and bolster Egypt’s free-market model.

    Restrictions concerning e-cigarettes, or ‘vapes’ as they are often referred to, have resulted in a myriad of illegal vape shops across the country that sell the product and its accessories, which are often smuggled into the country, according to an article on albawaba.com. Furthermore, they have been influential in online trading’s rise to prominence as people seek to acquire the products they require to quit cigarettes altogether.

    Egypt’s battle against counterfeit goods is an issue that is neither new nor recent. Unfortunately, no industry is safe from exploitation, and the Egyptian market is full of counterfeit products. Both local and international brands continue to be infringed, and the country is taking every measure possible to eradicate such activities.

    Last year, for instance, the Industry Committee of the House of Representatives in Egypt adopted a new legislation against fake branding and products, whether local or global, imposing severe punishments on producers, the article states. And more recently, Egyptian Prime Minister Mostafa Madbouly approved a draft presidential decree on “The Protocol to Eliminate Illicit Trade in Tobacco Products” to implement effective measures to control the supply chain.

    Now the popularity of vaping across the country has led to increased demand for products, these too have subsequently entered the realm of the country’s black market. E-cigarettes and associated products are smuggled into Egypt by air, sea, and land from the East and West, making their way into the country in containers, cars or trucks, hidden among other goods, and even concealed under clothing.

    The reasons for the restrictions on e-cigarettes being imposed were purportedly a lack of sufficient clinical studies to validate electronic cigarettes’ safety, the unknown long-term health consequences and effect of e-smoking when compared to regular smoking, and products containing toxic substances. However, many leading public health organizations have already acknowledged that these products are a healthier option for smokers who cannot or will not quit smoking, with e-cigarettes being been dubbed by renowned global public health institutions as better alternatives. Public Health England is a prominent example, maintaining its stance that vaping is 95% less harmful than smoking.

    The e-cigarette market in the Middle East and Africa alone is forecasted to reach USD 485 million by 2025[1], growing at a rate of 9.74 percent during this period. This is particularly relevant given that Egypt has consistently had one of the largest segments of tobacco smokers in the Arab world for years. As more and more people from this segment continue to adopt vaping, purchases through prohibited channels are also increasing substantially.

    Illicit trade of e-cigarettes has led to an underlying need for swift and appropriate regulation to counter black market activity. In addition to creating awareness concerning potential health risks and ingredients used in unregulated products, manufacturers, wholesalers, and retailers would be able to sell e-cigarettes and related products on the condition they meet set standards, undergo stringent quality checks, and carry relevant health warnings.

    The introduction of regulations in Egypt will not only boost efforts to combat smoking and the emergence of potentially related diseases; efforts to prevent the unpermitted circulation and distribution of these products without restrictions or controls will also be magnified.

    In other markets across the Middle East, including the GCC, suitable regulations for the entry of e-cigarettes into the market have been adopted, dispelling the need for consumers to acquire such products illegally.

    The UAE is a prominent regional example where new regulations and standards covering a wide range of electronic smoking products have been approved and brought into effect. The Emirates Authority for Standardization and Metrology (ESMA) announced early last year that the sales and use of e-cigarettes and similar smoking devices would be legalized, which came into effect in April 2019.

    Similarly, Saudi Arabia is another Gulf state where e-cigarette restrictions exist. According to Saudi legislation, vapes are classified as reduced-risk products (RRPs), those that have the potential to present less risk of harm to smokers who switch to these products as an alternative to smoking. Furthermore, vaping in the Kingdom is legal for citizens and tourists, although it is restricted in public places, including religious and cultural sites, among others.

    The regulations and restrictions enacted in the UAE and Saudi Arabia make a case for an Egyptian ban reversal. More importantly, regulations that would lower contraband trade levels in Egypt is a necessity to mitigate the ongoing tax revenue losses which the Egyptian treasury is incurring.

    Rather than smugglers, counterfeiters, and illicit traders pocketing money out of such illegal activities, the Egyptian government is urged to complement its previous decisions – adopting e-cigarette standards and a corresponding fiscal structure – by reversing the existing ban. Doing so will put an end to tax evasion schemes by placing this trade under the authorities’ umbrella, following suit with the majority of Arab, regional and international governments. At the same time, illegal activity and illicit trade, which is linked other forms of serious organized crime in several markets, will also be prevented.

  • Britton: Better Vapor Access Will Aid Cigarette Decline

    Britton: Better Vapor Access Will Aid Cigarette Decline

    Easier access to better smoking alternatives will usher the decline of smoking prevalence, according to a British physician and tobacco control expert.

    “Governments should make e-cigarettes easily available, introduce modest regulations to reduce the risk of irresponsible marketing and product safety approaches, and give a medical endorsement,” said Dr. John Britton, the director of the UK Centre for Tobacco and Alcohol Studies, adding that these are considered the key approaches for countries to adopt if they want to see smoking rates decline, according to an ar

    Dr. John Britton / Courtesy UK Centre for Tobacco and Alcohol Studies

    ticle in the Manilla Standard.

    A member of the Royal College of Physicians Tobacco Advisory Group and of the board of trustees of Action on Smoking and Health, Britton said, “clinical trials have demonstrated that vaping is probably the most effective way to quit smoking. The long-term harms of e-cigarette use are not known, but they will be substantially less than those of continued smoking or of attempting to quit unaided and then, as is usually the case, failing.

    “Electronic cigarettes are a game changer―there is no going back from that. The whole market in nicotine delivery has been revolutionized by these products and I just hope that there are even more exciting products on the way,” he said. “Smoking prevalence in the UK is falling fast, and faster than in the US and Australia where vaping is not endorsed by national authorities. Smoking decline in the UK will have generated savings to the National Health Service,.”

  • Canete: Flavored Vapor Ban Hurts Small Businesses

    Canete: Flavored Vapor Ban Hurts Small Businesses

    Credit: Tim Mossholder

    After enjoying economic growth for 10 years and record low unemployment, small businesses are feeling a disproportionate brunt of the COVID-19 pandemic. After California’s initial stay-in-place order and closure of non-essential businesses, the economic consequences have severely impacted nearly 4 million small businesses in the state.

    Even efforts by state legislators to address the state’s pandemic-caused budget deficit, too many of the policies aimed to close the gap will severely burden small businesses. That list includes Senate Bill 793, introduced by state Sen. Jerry Hill, a Democrat from San Mateo, a ban on the sale of all flavored tobacco products, which will profoundly impact California’s 12,000 convenience stores.

    Even during years of economic growth, many small businesses operated on relatively tight margins, leaving them poorly positioned for a financial setback from COVID-19. Yet, the state budget attempts to squeeze even more out of battered businesses, including $4.4 billion in tax increases.

    Julian Canete /Credit: CalMatters

    They will also feel the downward pressure of a gas tax increase that will increase distribution and production costs, and for those selling gas, they will likely see a decrease of customers at the pump. To top it all off, these businesses are also feeling the impact of new minimum wage, family leave and other mandates and environmental regulations.

    For convenience stores, SB 793 presents an even greater risk. The threat of a sales ban on flavored tobacco products, which includes menthol, coupled with Gov. Gavin Newsom’s decision to enact a second wave of shutdowns could spell disaster. With individuals encouraged to again stay home and businesses unable to open, this potential ban on a high revenue generator – flavored tobacco products – could spell the end for many of small businesses and the thousands of jobs they provide.

    What’s worse is this ban penalizes otherwise law-abiding, compliant business owners. According to FDA data, California’s statewide compliance rate of selling tobacco to legal age adults was 95%, 97% in Sacramento. Yet, lawmakers seem to trust the internet over hard-working men and women who would do anything to keep their business open and profiting.

    The most recent analysis by the Mackinac Center found almost 50% of the cigarettes consumed were smuggled in, or acquired through tax avoidance or evasion. Furthermore, the Centers for Disease Control and Prevention found the strange string of vaping deaths in 2019 was caused by products illegally obtained on the black market, not from regulated products sold in stores.

    If lawmakers want to curb youth vaping – their stated goal of this legislation – putting more faith in illegal, predatory online vendors over vigilant store owners and their trained employees does the exact opposite: it puts children at risk.

    The National Federation of Independent Business July jobs report shows the small business labor market has continued to weaken. Firms reduced employment by 0.28 workers per firm in June, weaker than the decrease of 0.17 workers per firm in May. These figures are not likely to improve as data was collected well before the recent renewal of state-imposed business shutdowns. And with the money provided by the federal government’s Paycheck Protection Program loans essentially used up, coupled with the unknown length of shutdowns, who knows how long convenient stores can weather the storm.

    There’s no doubt we need to address the rise in youth vaping. But to water down the problem and propose a unilateral flavored tobacco ban as the solution is at best a half-hearted approach. Convenience store owners have proven to be responsible sellers – they are not the problem. It’s not too late for legislators to go back to the drawing board and, with input from the small business community, find a comprehensive solution to tackle a community problem without putting key members of the community out of business.

    Julian Canete is the president and CEO of the California Hispanic Chamber of Commerce, canetej@cahcc.com. This commentary was originally written for CalMatters.org.

  • Andrews: Bogus Vaping Study Puts Millions of Lives at Risk

    Andrews: Bogus Vaping Study Puts Millions of Lives at Risk

    Despite the United States weathering the most severe healthcare crisis in generations, some elected officials are pushing policies that would push death rates even higher.

    On August 11, Rep. Raja Krishnamoorthi (D-Ill.) the chairman of the Oversight Subcommittee on Economic and Consumer Policy, wrote to Food and Drug Administration Commissioner Stephen Hahn demanding a complete ban on the sale of reduced-risk tobacco alternatives such as e-cigarettes throughout the United States.

    This is a misguided and dangerous move because these harm reduction products are proven to be 95 percent safer than combustible cigarettes, and twice as effective as conventional nicotine replacement therapies.

    The key is the lack of smoke and corresponding carcinogens that lie in combustible tobacco. Since their inception 10 years ago, these products have provided a lifeline for smokers previously unable to quit their deadly habit.

    According to the most comprehensive peer-reviewed research coordinated by the George Washington University Medical Center, if a majority of smokers in the United States quit smoking through the use of e-cigarettes over the next 10 years, there would be 6.6 million fewer premature deaths — one of the biggest public health breakthroughs in generations.

    Despite the overwhelming scientific evidence on the benefits of smokers switching to vaping products, Krishnamoorthi has decided to use the COVID-19 pandemic as a pretext to support Big Tobacco and drive vapers back to smoking.

    The lawmaker is using junk science to argue that vaping and smoking were somehow responsible for COVID-19 spread. Unfortunately for Krishnamoorthi, 763 studies published in the world’s most prestigious medical journals such as the European Respiratory Journal and Lancet have concluded otherwise.

    These analyses have examined the medical records of millions of people in dozens of countries around the world and have completely and utterly debunked the representative’s spurious claims.

    Not one to let “science” or “evidence” get in the way of his ideological agenda, Krishnamoorthi nevertheless was able to find one study he claimed supported his viewpoint. But the study presented is a study in itself on how not to analyze and interpret data.

    The study conducted in May was limited to one online survey, with a relatively small number of respondents. Unlike the 763 credible studies that actually examined medical data, this particular analysis was limited to self-reporting by people who chose to engage in a survey on a website.

    Even more important, the study does not even say what Krishnamoorthi claims it does. In fact, the study finds vapers — whether current or former — have no statistically significant higher rate of contracting COVID-19 than people who have never used this product.

    The “spike” occurred only with dual users. But clearly, if neither smoking nor vaping increase your risk of developing symptoms, then there is no mechanism by which dual use would increase coronavirus risks, making the result a logical impossibility.

    That is not the only bizarre thing about the results. The study contends that previous use of cigarettes increase risk, yet consumption over the last 30 days has no association whatsoever with COVID-19 incidence. Unfortunately, the empirical malpractice does not stop there.

    The paper fails to adjust properly for the fact that more vapers chose to have a COVID-19 test than the population as a whole. This isn’t too surprising given most vapers are more health aware and health conscious, hence would be more like to opt for voluntary testing.

    Clearly, this “study” — the only justification Krishnamoorthi has for his calls for prohibition — is worse than useless. The lawmaker leans heavily on an analysis that excludes all medical data and instead relies solely on a self-reporting online survey.

    The results contradict 763 credible studies, rely on methodological pyrotechnics, and torture the data so brutally it would make a Bond villain blush. Yet it still doesn’t say what Krishnamoorthi wants it to say and has the unavoidable conclusion that e-cigarettes do not lead to higher rates of COVID-19.

    For Krishnamoorthi to deny the science and condemn Americans to a preventable death just to fulfill a personal vendetta against reduced risk products is simply repulsive. There is absolutely no doubt that any ban on the sale of reduced risk tobacco alternatives would lead to countless easily preventable deaths as people once again take up the deadly habit of smoking.

    The FDA must ignore this nakedly political letter, and instead act in accordance with the evidence. Millions of lives depend on it.

    Tim Andrews is the executive director of the Taxpayers Protection Alliance. He wrote this for InsideSources.com.

  • Lokman: GFN 2020 Centered on Harm Reduction

    Lokman: GFN 2020 Centered on Harm Reduction

    Regulation of e-cigarettes and other smoke-free nicotine products became a major topic during the virtual Global Nicotine Forum 2020 (GFN 2020) this year as advocates seek a more promising solution for smokers to quit.

    The forum, themed “Nicotine: Science, Ethics and Human Rights,” was held on June 11-12, saw 30 experts across the globe speak, all with one common goal; to provide a safe and transparent industry for both smokers and those planning to make the switch to alternative tobacco products.

    Discussions started with how attacks on the THR (tobacco harm reduction) movement has been intensified with fake news, misleading studies and unethical media campaigns. All speakers agreed that action needed to be taken immediately before things worsen and that the technology needed to be regulated, not restricted or banned.

    Adult consumers should have access to their choice of regulated devices and liquid as it can substantially reduce the risks suffered by smokers from the tar, which is the byproduct of smoke. The THR advocates also highlighted that consumers needed to be truthfully and wholly informed of the life-saving potential of vaping.

    Credit: Tasnim Lokman

    Anaesthesiologist Dr John Oyston spoke on the importance of a patient-centred approach where he spoke of patients who needed removal of their lungs or amputation of the leg due to their smoking habit.

    He said that if these patients did not smoke or had stopped smoking at middle age, such procedures were unnecessary.

    “I’ve seen the damage cigarettes do to the human body or to the human lives. I believe tobacco is the real pandemic,” he said.

    “Even in this plagued year, tobacco is on track to kill five times as many people as Covid-19. E-cigarettes are far many times safer than combustible cigarettes and it makes no sense for us to allow people to continue smoking cigarettes.

    “Banning e-cigarettes is an infringement to people’s right to choose a safer alternative and to make their own healthcare decisions.”

    Oyston, who has nearly 40 years of medical practice under his belt, said e-cigarettes could save about six million lives in the United States and yet some people are trying to ban it and prevent them from being utilised.

    “The global tobacco industry makes US$62 billion (RM264.1 billion) in profit and at the cost of 7 million deaths every year. They accept the death of half of their customers as sacrifice they have to pay in order to make money,” he said.

    Conference director Professor Gerry Stinson said nicotine was among the top three most favourite drugs globally and calling the traditional cigarette “a dirty nicotine delivery system,” highlighting that it was the combustion that causes the problem.

    Stinson, who is from Imperial College London and formerly part of the London School of Hygiene and Tropical Medicine, stated that if the nicotine was separated from the cigarette itself, such as what vaping, snus and Heat-Not-Burn products, it gave smokers potential to switch away from smoking.

    Dubbing these new technologies as a “free gift to public health,” Stinson, however, admitted that many smokers globally continued to be misled by major campaigns against THR.

    Meanwhile, Professor David Sweanor echoed the same idea, saying that these new nicotine products had the potential for the biggest breakthrough in public health. He said advocates, experts and stakeholders needed to use the principles of reason, science and humanism to look at what is available and work out what could be done.

    Stinson and Sweanor both touched on the role of taxation, stating that consumers would likely switch to vaping if it was cheaper and more accessible compared to the cigarette.

    “Safer nicotine products have to be cheaper but there’s more we can do to make them accessible. No doubt countries will be concerned about the loss of tax revenue — but please think of this and how important it is.

    “The opportunity we have is to fundamentally change the course of public health history, relegating cigarettes to history’s ashtray,” Sweanor said.

    He also reiterated that separating nicotine from cigarette was safer and less harmful to body as it removed the deathly ingredient; tar. He quoted Michael Russel, “People smoke for the nicotine but die from the tar.”

    The forum also agreed that regulation for the nicotine products was vital to avoid a repeat of the national outbreak of e-cigarette, or vaping, product use-associated lung injury (Evali) crisis that took over the United States last year.

    Director of Pro-Vapeo Mexico Dr Roberto A Sussman said the certain parties had taken advantage of the Evali crisis to spread misinformation and fear on vaping which did not only affected the States but globally as well.

    “This was seen in many polls. For example, 66 per cent of Americans thought incorrectly that Evali was caused by Juul (an e-cigarette brand) and other vaping devices.

    “Unfortunately, only 28 per cent thought correctly that this surge of disease was caused by the illegal THC vape pens,” the physics lecturer at National University of Mexico said.

    The United States Centers for Disease Control and Prevention, after completing investigations in February, recommended that people not use THC-containing e-cigarette or vaping products since it has identified vitamin E acetate, often used as an additive in THC-containing products, as a chemical of concern.

    More than 30 countries worldwide have banned e-cigarettes as of 2020 including Thailand, Singapore, Brunei and Indonesia. As of April last year (2019), Malaysia’s former Health Minister Datuk Seri Dr Dzulkefly Ahmad announced a new bill whilst pointing out that at present tobacco cigarettes and e-cigarettes are regulated under different directives.

    Cigarettes are regulated by the Control of Tobacco Product Regulations 2004 under the Food Act 1983, while e-cigarette liquid containing nicotine, falls under the Poisons Act 1952. He stated that the new bill will underline all regulations and controls on e-cigarettes and vapes, including the sales guidelines.

    However, there has been no news or updates following the change in government back in March and Covid-19 pandemic.

  • Minton: U.S. Spreads Fake Fear Over Vaping Dangers

    Minton: U.S. Spreads Fake Fear Over Vaping Dangers

    The international health profession is rightly focused on the SARS-CoV-2 virus threat at the moment. Meanwhile, another multinational threat has insidiously spread: Alarmism about nicotine vapor products (aka e-cigarettes) has infected a growing number of governments around the world, causing authorities to eschew science, logic, and human nature. Out of blind panic, they are disregarding the indisputable evidence that giving smokers legal access to nicotine vapor can save millions of lives. Instead, they embrace prohibitionist policies that will keep people smoking and dying. The main culprit behind spreading this mass psychosis is, sadly, the United States.

    MIchelle Minton / Credit: Competitive Enterprise Institute

    I have written extensively about agencies, health charities, and activists who have orchestrated the campaign of fear and doubt around e-cigarettes—products that even notorious anti-vaping advocates, like University of California San Francisco Professor Stanton Glantz, admit are substantially less toxic than smoking. I and others have dissected the financial and professional benefits that drive the campaign to ban nicotine vapor products even while deadly cigarettes remain freely available. Here, I will discuss the methods by which these entities cultivate and export e-cigarette alarmism worldwide.

    The three main players in the tragicomedy public discourse on e-cigarettes are: representatives of government agencies, public health activists, and the media. The media has acted mostly as a megaphone for government agencies and activists, parroting and amplifying the narrative disseminated by government actors and activists. This post will focus primarily on how anti-tobacco activists, in and outside of government, created and sold those narratives.

    Statistical Sleights of Hand

    Authorities in the U.S. have become pioneers in the art of statistical hocus pocus. They managed to transform limited evidence about shifting trends in vaping among young people into supposed proof of a full-blown nicotine-use crisis. And, like any good magician, performing this trick often involves misdirection. In the case of statistics, such misdirection is often achieved by:

    • Focusing on the scariest-sounding data;
    • Using the scariest language to describe data; and
    • Ignoring or downplaying details that put the data in a less scary context.

    A good example is the way government, media, and anti-vaping activists used the results of the 2018 National Youth Tobacco Survey (NYTS), a survey of middle and high school students, administered annual by the Centers for Disease Control and Prevention.

    Months before the 2018 NYTS data were made public, the Food and Drug Administration (FDA) announced that the results showed youth vaping had become an “epidemic.” The media repeated the information, as dictated by the FDA, over and over again so that, by the time results were actually released, it hardly mattered what the survey really showed. The narrative had been set in the public mind: Teens were now vaping nicotine in epidemic proportions. Of course, once researchers were finally able to analyze the data, they found little more than smoke and mirrors.

    Highlight the scariest dataMedia outlets from Fox News to National Public Radio ran headlines with some variation of the talking point that between 2017 and 2018 youth vaping had doubled and now one in five youth were users of nicotine vapor products. This generated public concern and interest in solving the problem, which, of course, was the goal.

    What neither the FDA nor the media highlighted, however, was that this data point only referred to the number of students who reported any vaping in the 30 days prior to the survey. While it could mean some of those youth were vaping nicotine every day, it also meant some portion may have only vaped once, perhaps for the first time, and never again. That’s what a later examination of the data found. The vast majority of youth who reported “vaping” on the NYTS did so on a handful of days. In fact, less than 1 percent of underage students who never smoked reported vaping regularly. 

    Use scary language. In 2017, 11.7 percent of students reported any past-month use of e-cigarettes in the NYTS. In 2018, that number rose to 20.8 percent, a 9 percent increase year over year. But a 9 percent increase in youth vaping just doesn’t sound as scary as youth vaping “doubled.” Again, that’s the point. The use of relative versus absolute numbers is often employed specifically to make something appear more important.

    Downplay mitigating details. Within weeks of the FDA’s announcement, the existence of a youth vaping epidemic took on the status of indisputable truth. And the matter of how e-cigarettes impact youth health eclipsed considerations about the products’ potential benefits for adults and the hazards that always accompany any sort of prohibition. The national survey had, after all, shown a doubling in the numbers with over 20 percent of students (one in five) now vaping nicotine. Except, in addition to ignoring the fact that most youth were not vaping regularly, both the FDA and the media ignored the fact that the survey did not say what youth were vaping.

    The NYTS questionnaire asked students about their use of “e-cigarettes,” which it describes as “battery powered devices that usually contain a nicotine-based liquid that is vaporized and inhaled.” However, researchers have found that most of the students who report “vaping” on surveys about e-cigarettes don’t use nicotine. For example, a study from 2016 found that approximately 65 percent of the 12th, 10th, and eighth grade students who used e-cigarettes reporting using “just flavoring” without nicotine. More recent research indicates that a substantial portion of youth who report “vaping” also use cannabis. In fact, 50 percent of students who reported any e-cigarette use and 70 percent of those who reported frequent use on NYTS also said they had used marijuana in e-cigarettes.

    Arguably the most important detail ignored in panic over youth vaping was the fact that, despite fears about vaping leading to smoking, youth smoking rates were continuing to decline. In fact, the rate of smoking among both adolescents and adults hit a record low in 2018 and have continued to decline since. But the FDA and most media outlets paid little attention to the details about how often youth were vaping, what they were vaping, and what effect it might be having on health because these details might not produce the same level of alarm as the idea of an “epidemic,” which again, is the point. And it worked.

    Over the following years, not a day would pass without some new headline about the problem of youth vaping, the evil e-cigarette companies targeting teens, or the need for authorities to do something. As a result, counties and states have begun to prohibit e-cigarettes, the federal government raised the national minimum tobacco purchasing age to 21, banned non-tobacco flavors for pre-filled vaping devices, and is currently considering a bevy of additional restrictions to make these products less attractive, harder to obtain, and more expensive for adult smokers. Given that e-cigarettes, particularly flavored e-cigarettes, are the most effective means of helping smokers quit smoking, this should not be hailed as a victory. But, at least among those morally opposed to nicotine use, it was. Now they are seeking to export that “successful” strategy to the rest of the world.

    American Panic Down Under

    Despite the irrefutable evidence that non-combustible forms of nicotine are vastly safer than combustible tobacco, a long and growing list of countries now ban the sale, importation, or even possession of such products, like India, Brazil, Thailand, Singapore and Uruguay. Whenever the debate about such bans arises in any new country, invariably it is followed by attempts to infect that debate with American-style vape panic.

    A recent example has unfolded in Australia over the last few months, where, though nicotine vaping is banned, the country’s estimated 300,000 vapers have managed to skirt the prohibition by having nicotine shipped from overseas. This June, however, Health Minister Greg Hunt threatened to close that loophole by banning the importation of nicotine beginning in July—weeks before Parliament returned from their summer holiday. The justifications for the ban were the youth vaping “epidemic” in America, rising incidence of nicotine poisoning in Australia, and increases in vaping among young adults.

    Highlight the scariest data with the scariest language. In announcing his proposed ban, Hunt pointed both to the “78 percent increase” in youth vaping in the United States and a claim that nicotine poisonings in Australia had doubled since 2018, which according to him, was caused primarily by “imported products of dubious quality and safety.” Never mind that the only reason Australians must import nicotine of dubious quality is because the country banned nicotine vaping. The relative language Hunt uses about poisonings certainly sounds scary. But, as you might guess, the absolute numbers seem far less dire.

    Downplay mitigating details. The source for Hunt’s claim comes from the Victorian Poisons Centre, which as Hunt noted in a press release, reported 21 cases of nicotine poisoning in 2018 and 41 cases in 2019. A look at the data for 2018 (2019 is not yet publicly available) shows that there were actually 100 calls made to the Centre related to “antismoking products,” which it defines as nicotine gum, lozenges, patches, Chantix, and e-cigarettes. What this means, assuming Hunt’s figure is correct, is that while 21 calls were related to e-cigarettes, 79 calls were related to other products. To put that in panic-speak, products that are legally sold over the counter in Australia caused almost four times as many poisonings as e-cigarettes, which Hunt wants to ban. 

    Thanks to backlash from vapers around the world, as well as members of his own government, Hunt was compelled to back away from his proposed ban, at least temporarily. But this seems to have inspired anti-vaping advocates to try harder in copying successful, panic-inducing tactics employed in the United States. Most recently, it appears they are trying to replicate exactly the slight of hand American activists pulled off with the 2018 NYTS.

    When All Else Fails: Lie

    On July 16, the Australian Institute of Health and Welfare released the 2019 results of their national survey on drug use, which is conducted every three years. According to news reports, like this one in The Guardianit found that e-cigarette use among young Australian non-smokers had quadrupled since 2013! Furthermore, a shocking 65 percent of adolescents and 39 percent of young “report using e-cigarettes despite having never smoked.” As is the point, stories like this are sure to shock Australians and spur efforts to keep or even strengthen the country’s nicotine vaping ban to get this problem under control. Of course, as with the youth vaping “epidemic” in America, the problem doesn’t exist; it’s statistical hocus pocus.

    The data released by the Australian Institute of Health and Welfare is, admittedly, confusing. So, it is at least possible that the author of The Guardian article simply erred in stating that 65 percent of non-smoking adolescents reported “vaping.” Nonetheless, this isn’t just misdirection; it’s outright wrong. What the data show is that among the respondents who said they had ever used an e-cigarette in their life, almost 65 percent of those aged 14 to 17 said they were non-smokers at the time they first tried an e-cigarette (table 2.27.) First, this doesn’t mean they were “never smokers,” only that they hadn’t smoked more than 100 cigarettes in their lifetime, nor does it mean they continued using an e-cigarette. The survey, in fact, indicates that only 8 percent of youth, aged 14 to 17, ever tried an e-cigarette (table 2.19), and among all respondents who ever tried an e-cigarette, most—87 percent—tried it only once or twice and never again (table 2.28).  So, how many non-smoking youngsters in Australia are actually currently “vaping?” From what the survey reveals, almost none.

    The survey perplexingly defines “current use” as using e-cigarettes “daily, weekly, monthly, or less than monthly.” [Emphasis added] Functionally, it seems as if any use in the last 12 months counts as current use. But, even with that broad definition, the proportion of non-smoking youth who currently use e-cigarettes has remained strikingly small at 1.3 percent among those aged 14 to 17.

    As for the statement about “quadrupling” e-cigarette use among non-smokers, you can see from the numbers that this is false. They could accurately say that current use of e-cigarettes among non-smokers increased 75 percent among adolescents and 50 percent among young adults. But it would still be misleading, a prime example of how using relative terms can exaggerate insignificant changes to extremely small absolute numbers. And that is exactly how unwarranted panics are generated. It’s not clear if the author of The Guardian article meant to mislead or simply misunderstood the data. But we can certainly expect more of this sort of statistical sleight of hand if and when the debate over whether Australia should continue to deny smokers a life-saving alternative takes center stage.

    Michelle Minton is a senior fellow at the Competitive Enterprise Institute. Minton specializes in consumer policy, covering regulatory issues that include gambling, tobacco harm reduction, cannabis legalization, alcohol, and nutrition.

  • Wheeler: Vaping Regs Will Crush Small Businesses

    Wheeler: Vaping Regs Will Crush Small Businesses

    Amanda Wheeler / Credit: RMSFA

    The Trump Administration recognized an opportunity to save thousands of small businesses across Colorado. The president issued an executive order requiring federal agencies to identify burdensome regulations hindering economic recovery and propose modifications or waivers “for the purpose of promoting job creation and economic growth.” One Food and Drug Administration (FDA) regulation that must be on the list to alter per this executive order is the pre-market tobacco application (PMTA) that would destroy approximately 125 small vapor businesses, like mine, across Colorado.

    We can all acknowledge that over-regulation can be the death knell for many small businesses. At no time in our history is that more evident than right now.

    The gist of the regulation lumps small businesses in with big tobacco. Their incongruous approach falls under tobacco regulation although nearly no vapor products actually contain tobacco. Most, if not all, small vapor businesses view themselves as a safer alternative to big combustible tobacco. We are dedicated to getting adults off combustible tobacco and stopping youth access.

    It is one thing for our industry to believe our products are safer, but we are not alone. First on the list is the FDA, the very government regulatory agency that lumps small vapor businesses in with big tobacco. They want to regulate vaping like tobacco but think vaping is a safer alternative for adults.

    The FDA said they view “products like e-cigarettes and other novel forms of nicotine-delivery to provide a potentially less harmful alternative for currently addicted individual adult smokers” than combustible tobacco. The list of organizations echoing this notion includes the American Cancer Society, National Academy of Science, American Association of Public Health Physicians, Royal College of Physicians, British Medical Association, British Lung Foundation, and more.

    Despite the FDA’s position, it still plans to enforce PMTA this fall. Unfortunately, the inconsistent and arbitrary regulation of PMTA compels vapor and e-liquid manufacturers to submit a new application for every nicotine product they want to continue selling. If any product does not submit a PMTA by the September deadline, it must be pulled from the market.

    While vapor manufacturers are required and actually do adhere to the highest safety standards, we also want to provide the safest and best products possible for our customers. Regrettably, PMTA applications cost, on average, $2,000,000 in legal and other fees. For my business, which has over 1,800 products, the cost to comply with this regulation would surely put all of us out of business. The FDA is asking small businesses to foot the bill again, in spite of the fact that they have endorsed the safety of a master list of the products and their ingredients. Talk about over regulation; the FDA is merely saving big tobacco because it can afford multiple tests. Small businesses lose.

    My business, with two stores in Colorado, is no different than the 125 vapor owners, who employ 1,100 people throughout the state. But the very regulation meant to control tobacco or vapor use, regardless of how you feel about it, merely puts the small guys out of business while strengthening big tobacco. One-size PMTA is an effective ban on small businesses and their employees as big tobacco will not replace those jobs or businesses. But this is about more than just dollars, it’s about our health.

    This obstacle that small businesses in the vapor industry face with this regulation makes David and Goliath look like a comparatively fair fight, wiping out roughly $50 million in annual economic activity.

    It seems counterintuitive, however, nearly 350,000 Coloradans have found vaping products critical to reducing and stopping combustible cigarette use. It is working as cigarette use continues to plummet across nearly every American demographic. Effectively banning vapor products by destroying the industry through regulation would only drive adults back to smoking cigarettes.

    Ours is an industry worth saving and, now, there is an easy way to do so. It is highly unlikely that my two little vape shops in Colorado will put the big guys out of business, but the regulation the FDA is considering only goes one way; it saves big tobacco and kills small business. I believe this runs counter to the president’s recent executive order. Our industry is asking President Trump and his administration to acknowledge that one size does not fit all when it comes to the PMTA. Our families, our businesses, our employees and our customers are looking for certainty and solutions as we are one answer to continued harm reduction, tax revenue and better health.

    This opinion was first published on ColoradoPolitics.com Amanda Wheeler is the vice president of the Rocky Mountain Smoke Free Alliance, an owner of five vape shops and a vapor manufacturing facility, and a mom.

  • A Costly Failure: How The WHO Lost American Funding

    A Costly Failure: How The WHO Lost American Funding

    By Patrick Basham

    Amid the Covid-19 pandemic, imagine the top global health body instructing governments to shun a particular vaccine should it be found. An unimaginable scenario? Alarmingly, it did happen.

    The rationale for the World Health Organization’s (WHO) April 13 edict was the WHO’s disapproval of the specific industry—tobacco—working to develop the would-be vaccine. A loyal servant of the global anti-tobacco lobby, the WHO clearly abhors Big Tobacco more than it wants to save lives.

    The WHO told governments to have nothing to do with any tobacco-generated vaccine. Nonetheless, the tobacco plant remains a logical vaccine source as it is comprehensively researched and understood, cheaper to grow than animal-based vaccines and faster to scale up than traditional methods, which could yield a large amount of vaccine quickly.

    Consequently, Medicago, a biotech firm partly owned by Philip Morris International, and British American Tobacco are respectively developing potential vaccines grown in tobacco plants. Such a vaccine would enable several billion people to reap technology’s benefits.

    The WHO’s anti-tobacco industry prejudice, epitomized by its illogical Framework Convention on Tobacco Control, should be, but is not, among the reasons for America’s May 29 exit from the WHO. The Trump administration withdrew its $500 million yearly contribution for other interwoven, equally legitimate reasons, namely the WHO’s catastrophic failure on the Covid-19 file and the WHO’s pro-China bias.

    While China is culpable for the global pandemic, the WHO is complicit in the attendant public health debacle. Here is a synopsis of the WHO’s documented unpreparedness and the policy mistakes, factual errors and medical misstatements underlying the U.S. decision.

    On Dec. 31, the WHO was informed of China’s coronavirus outbreak. Absent WHO pressure to be transparent, China did not publicly report its first death until Jan. 11.

    Also, on Dec. 31, Taiwan told the WHO about human-to-human transmission of the virus. The WHO did not warn the world about this critical development. Instead, two weeks later, the WHO declared the virus was not contagious as there was “no clear evidence of human-to-human transmission.”

    On Jan. 20, the WHO acknowledged human-to-human transmission was occurring yet assured the world China would contain the virus. But Chinese cities had already exported coronavirus cases to America and Europe. Consequently, the pandemic was unpreventable.

    Chinese laboratories had sequenced the coronavirus genome by the end of last year, but Beijing ordered researchers not to publish their crucial findings. China did not share this data with the world until Jan. 12. Subsequently, the WHO Director General Tedros Adhanom Ghebreyesus publicly praised the speed with which China shared its genome research.

    The WHO endorsed China’s extremely draconian coronavirus response. Centered on a literally brutal quarantine regime, China’s heralded “defeat” of the coronavirus came at an incredibly high human and economic cost. Not having built herd immunity among its population, China was in the throes of a second wave of infections.

    Mid-January found the WHO playing down the rising coronavirus caseload outside China. Hence, at a Jan. 22 emergency committee meeting, the WHO refused to declare the coronavirus—all available evidence to the contrary—a formal public health emergency, which would have better prepared the world in all facets of its response.

    Following the meeting, Tedros visited China. He praised China’s response even as Beijing was persecuting medical whistleblowers, destroying virus samples, expelling foreign journalists and spreading anti-American disinformation about the virus’ origins.

    The next day, the WHO confidently predicted the coronavirus would be less deadly than SARS in 2002–2003, which caused 774 deaths. At the time of writing, Covid-19 had killed 464,000 people.

    On Jan. 30, Tedros advised (and influenced some) governments against introducing travel bans. The next day, the WHO condemned the Trump administration’s new Chinese travel ban, which public health experts credit with saving tens of thousands of American lives. On Feb. 4, the WHO declared that asymptomatic individuals cannot transmit the virus. Again, the world received incorrect information about a crucial medical element.

    In mid-February, the WHO stated that China’s response had bought the rest of the world valuable time to prepare. According to a University of Southampton study, if China had informed the world three weeks sooner, 95 percent of global cases would have been prevented.

    On Feb. 27, the WHO said the virus was “controlled easily” and therefore community spread was not a serious issue. Adding insult to injury, a March 2 WHO publication claimed the stigma emanating from attaching a geographic label (say, “Chinese” or “Wuhan”) to the virus was more dangerous than the virus itself.

    On March 8, after the WHO refused, at China’s behest, to declare the coronavirus a formal pandemic, the Chinese government gifted the WHO $20 million. The WHO finally declared a pandemic on March 11. Without shame, on April 9 the WHO asked member states for an additional billion dollars (the WHO’s annual budget is $2.3 billion) to help fund its Covid-19 campaign.

    Of all global institutions, the WHO should be the least political yet it continues to act as Beijing’s global public health spokesperson. Revealingly, the WHO Goodwill Ambassador Peng Liyuan is Chinese dictator Xi Jinping’s wife.

    The WHO should be renamed the Chinese Health Organization, quipped Japanese Deputy Prime Minister Taro Aso in late March. The WHO’s illogical treatment of Taiwan is Exhibit A.

    From the onset of the pandemic, Taiwan stood out as a model of successful public health policy. Taiwan’s experienced a comparatively low number of Covid-19 cases and suffered few deaths. The island nation’s success is based upon a travel quarantine, massive testing and contact tracing and the mandatory isolation of potential carriers. As such, Taiwan is an important case study for other governments.

    Taiwan is not a U.N. member therefore it cannot be a WHO member. Since 2017, China has blocked Taiwan from receiving observer status at the World Health Assembly (WHA), the WHO’s annual decision-making meeting, a status it previously enjoyed.

    The Trump administration petitioned the WHO to allow Taiwan to gain entry to the WHA held May 18–19 so that the rest of the world could benefit from Taipei’s real-time knowledge and expertise. The brave souls ensconced within the WHO’s Geneva headquarters declined to take a position on whether Taiwan’s participation may be beneficial.

    The WHO’s tragic Covid-19 performance is unsurprising. The WHO’s awful track record on SARS, Ebola and the H1N1 flu is well documented. The rot at the WHO extends beyond and predates an unsavory relationship with Beijing. It involves both mission creep and the misallocation of precious funds.

    In 1948, the WHA inaugurated the WHO with a mandate to control and prevent the spread of epidemic disease and to coordinate the global response to pandemics. This required a “vertical” focus upon specific diseases, which found success in the WHO’s battle against malaria, for example.

    Over time, the WHO’s vertical approach evolved into a “horizontal” approach that attempts to deal with all aspects of health. In 1979, for example, the formal mandate was expanded to “primary care” and “health for all.”

    In a 2009 report, the American Enterprise Institute’s Roger Bate and Karen Porter explained that, “[the] WHO would now promote health ‘development’ more broadly by improving health systems, building infrastructure and fighting chronic diseases. The WHO expanded into many highly political areas where it had less technical ability, managerial competence, or experience, duplicating the efforts of other organizations.”

    The WHO was desperately unprepared for this pandemic. One reason for such inexcusable incompetence is the financial ramification of mission creep. According to the Heritage Foundation’s Brett Schaefer, only 15 percent of the WHO’s $2.3 billion annual budget goes to pandemic response. An Associated Press investigation found that, in 2018, the WHO spent more money on high-end staff travel and personnel junkets than on programs combatting disease.

    The WHO consistently prescribes statist, top-down, anti-market solutions, from government-run healthcare to an ever-expanding menu of politicized “problems,” which now include tobacco, nicotine, obesity, sex education, mental health and domestic violence. Yet, persuasion and policymaking on these topics is the purview of national governments rather than an elitist bureaucratic body.

    This year, the WHO faced its most serious challenge—a once-in-a-century pandemic—and failed miserably. The WHO has been worse than useless; the WHO literally has been a deadly failure. Surely, there must be consequences for its poor performance, argued the Trump administration.

    Cost-benefit analysis informs us that, by allocating its WHO funding to other health organizations, America will receive a better rate of return on its public health investment.

    The WHO needs root-and-branch reform not merely technocratic tweaks. The Wall Street Journal recently concluded, “One way to ensure future pandemics are less deadly: reform or defund the WHO.” Can the WHO be reformed? There are few grounds for optimism that this option can succeed.

    China’s organized and concerted influence over the WHO is paramount. As Beijing holds tremendous sway over many African, Asian and Latin American members, Chinese funding clearly trumps the will to reform.

    On April 14, President Trump placed American funding on a 60 day to 90 day hold dependent upon the WHO’s willingness to reform itself. The WHO chose to ignore the threat, with last month’s WHA enacting no reform measures. The U.S. concluded that, as reform would not occur, America should stop hitting its head against this bureaucratic wall.

    Financial threats do not work because the WHO possesses a Bank of China ATM card. American funds will be replaced by a commensurate increase in China’s contribution.

    The WHO resembles too many peer organizations: anachronistic, complacent and incompetent. The WHO’s predicament is part of a pattern of decline among international institutions from the United Nations to the European Union to the World Trade Organization.

    National governments need to choose between supporting public health or politicized institutions. Defunding the WHO is a down payment on the public health side of the ledger.