Tag: George Gay

  • Vapor Voice Exclusive: Rotting Your Boots

    Vapor Voice Exclusive: Rotting Your Boots

    Credit: Hutpaza

    Vaping opinions may vary depending on a person’s experience and knowledge.

    By George Gay

    On Aug. 24, The Guardian, the daily newspaper to which I subscribe, ran an opinion piece about nicotine pouches and vaping devices in its Journal section, which carries its leaders, opinions, letters, birthdays and obituaries. I much enjoy reading this section, in which the letters are often informative and the birthdays throw up some oddities.

    The famous people listed as having birthdays on the day of the paper are always briefly described in relation to the jobs or activities in which they are involved or, in some cases, the jobs or activities in which they were once involved. For instance, politicians who are no longer active in politics might be referred to as former Members of Parliament, but the “former” label is not usually applied to sportspeople, and this can lead to some amusing results.

    A person celebrating their 60th birthday, for instance, might be described simply as a javelin thrower, but the most impressive birthday announcement I have seen was in an April 2022 paper in which a 91-year-old man was described as a rugby player. Respect.

    The Journal always bears as part of its masthead the assertion that “comment is free … but facts are sacred,” a lofty statement that seems not always to be lived up to, especially when the subject is tobacco or nicotine, subjects about which the paper is po-faced in the extreme and often ill-informed.

    The opinion piece on Aug. 24 told how the writer, a vaper, faced with a six-hour rail journey during which she would not be able to vape, decided to buy some nicotine pouches in the hope that they would make the trip more palatable, even though she had not previously indulged in such products.

    On boarding her train, she placed a pouch in her mouth, but, after 15 minutes, had thrown the entire pack, and presumably the pouch she had experimented with, in the bin. Apparently, she spent the rest of her journey, five hours and 45 minutes, feeling nauseous but not throwing up on the table in front of her. Respect.

    This outcome was somewhat surprising since she also wrote that she had lived for some time in Sweden, where she had come across snus but not used it because she had been warned by friends that first-time users usually were made to feel ill. At this point, I thought the opinion might examine the need for nicotine pouch packs to provide information about how best to start using this product, perhaps suggesting only very limited exposure in the beginning.

    In fact, as I understand it, some products do carry such information in countries where the consumption of oral products is not already established and where the provision of such labeling is permitted.

    Perhaps there might have been a discussion on whether there should be available beginners’ packs with pouches that offer only slow, low-level nicotine deliveries. Such a discussion could then have looked at the ethical issue of offering pouches that might be seen by some as being aimed at people who were not already tobacco or nicotine users.

    It might have been interesting to look, also, at whether, to overcome this issue, all nicotine pouch packs might offer a range of nicotine deliveries. After all, perhaps even long-term users might like to have a low-hit product now and again.

    But no, the writer, Imogen West-Knights, had other ideas. She apparently started thinking about “nicotine and addiction in general.” Although West-Knights did not define what she meant by “addiction,” she had already declared that she was “pathetically addicted” to nicotine and her vape, and later wrote in two instances of nicotine as being “mind-warpingly” addictive.

    She was interested in what she said was a moral quandary thrown up by the question of whether it was “… bad for people to have access to a mind-warpingly addictive substance if it has no health consequences?” In the end, she took a libertarian stance and declared that what others did was none of her business nor that of the government.

    To my way of thinking, she came to the correct conclusion, but she could have saved herself a lot of anguish in respect of nicotine if she had taken the trouble firstly to define addiction. In writing that nicotine had no negative health consequences, she was, in effect, declaring that nicotine was not addictive.

    To be addictive, a product or an activity must be indulged in compulsively, and that activity must have negative health consequences, otherwise, breathing unpolluted air, if such were available, would constitute an addiction.

    I wrote a letter to the newspaper pointing this out, but it didn’t cut any ice. Obviously, what was written came under the “comment is free” part of the declaration, not the “our opposition to tobacco and nicotine is sacred” part.

    I don’t blame West-Knights for her confusion because she had apparently looked up the U.K. National Health Service’s Quit Smoking webpage and found that it stated that “although nicotine is addictive, it is relatively harmless.”

    In other words, the NHS had squeezed nicotine into the addictive category simply by inserting the phrase “relatively harmless.” But, of course, such a fudge raises its own issues because it clearly drags into the addictive sphere all sorts of other products and activities. Indeed, the writer raised the cases of coffee and sugar.

    Which leads me onto another addictive product, water. If, as above, addiction is taken to be the compulsive consumption of a substance or involvement in an activity that causes harm to the consumer or participant, then, apparently, both cigarettes and water are addictive. This came to my notice when reading in The London Review of Books a review by Steven Shapin of a book by Christy Spackman, The Taste of Water: Sensory Perception and the Making of an Industrialized Beverage.

    Shapin made the point that there was a suspicion, if not yet solid evidence, that the toxic pollutants in water posed risks to human health that took in cancer, damage to the nervous system, liver and kidneys, and interference with fertility and development. Sound familiar?

    And there is another parallel. “It is thought that the monetary scale of American lawsuits against companies responsible for PFAS [perfluorinated and polyfluorinated alkyl substances] water pollution may eventually dwarf those involving asbestos and tobacco, considering that people are in a position to decide whether or not to smoke cigarettes, but everybody has to drink water,” Shapin wrote.

    He made the point too that there are potentially dangerous things in water that are difficult for the consumer to detect because they don’t taste, smell or look odd. He didn’t contrast water and tobacco in this instance, but it is the case that cigarette smoke doesn’t sneak up on you in this way because it has a particular smell and is highly visible.

    For the sake of my health, I think it might be time to try overcoming my long-term addiction to water. My grandfather, a beer aficionado of some note, warned me on many occasions that water rotted your boots. Respect.

  • Cognitive Dissonance

    Cognitive Dissonance

    Credit: Good Ideas

    Regulators often run a campaign of hypocrisy when confronting vaping.

    By George Gay

    “However, it is vital that we do not sit and wait for this data [on the long-term health impacts of using nicotine-containing products] and action is taken now to prevent any potential harms caused by vapes.”

    “However, it is crucial that any proposed regulations [on vaping] are based on robust evidence, ensuring they are effective as possible, and implemented without delay.”

    You could be forgiven for assuming that these two quotes have been taken from statements by people or organizations on different sides of the vaping debate because, on the one hand, it is said to be “vital” that action must predate the collection of data while, on the other hand, it is said to be “crucial” that the collection of data must predate action. But you would be wrong.

    The first is from the final paragraph of the Executive Summary of the August-published report from the British Medical Association (BMA: the trade union and professional body for doctors and medical students in the U.K.) titled Taking Your Breath Away: Why We Need Stronger Regulation of Vapes. The second is taken from the final paragraph of the full report.

    Would I be rude in suggesting that the BMA authors might be suffering from cognitive dissonance and that they should try healing themselves before handing out advice willy-nilly? After all, the authors, if not doctors themselves, are representatives of the U.K.’s doctors, people whose opinions those of us of the outer dark tend to accept without question in respect of matters of health.

    And this level of trust, I think, is perfectly reasonable when it comes to face-to-face consultations involving doctors and individual patients. But once doctors become involved in wider concerns, I think it is necessary to take a more jaundiced view of what they have to say.

    Once doctors stop seeing people as individuals and view them only as groups marking points on a graph, they lose that which makes them special, as when they pay more attention to your “body mass index” than to your body. At a populations level, their pronouncements are little more than opinions based not on their medical knowledge but, as in the case of the rest of us, largely on ideologies and prejudices. They become part of the “tyranny of experts.”

    In other words, it is important to keep in mind that once doctors step outside the surgery, they can be just as irrational as you or me—or you at least; let’s keep me out of this. Indeed, some time ago, I was at an event where, at the end of the evening, a person who I knew to be a senior medical doctor was doing the rounds, pouring any remaining wine from the bottles on the tables into his glass and drinking it. The event had attracted a wide range of people, from those in their early 20s to those in their 80s, and even a few teenagers.

    Sitting at a table watching this person, I started to wonder about him. Was he, for instance, an alcoholic or somebody who usually drank in moderation but was on this occasion letting his hair down? Did he understand, care, or was he too far gone to think about the example he was setting to the younger people present?

    Surely, I thought, he must be aware that any level of alcohol consumption creates health risks. Was he a hypocrite who would have been offended if I had smoked or vaped in front of the young people; was he dimmer than his qualifications would have me believe; or was he as heavily into cognitive dissonance as he seemed to be into drinking?

    I often think of this occasion when I read of medical professionals making pronouncements on smoking and vaping (but rarely on drinking). And I thought of it again when I read the BMA report, which should have been called the “however” report. You might have noticed that the two report quotes with which I started this piece both opened with the word “however.”

    Basically, the report could be summed up as one that reluctantly admits the important role that vapes can play in helping smokers quit their habit but then de facto goes on to say, “however,” we don’t like these products and therefore we are calling for them to be debased by regulation to the point where they will not appeal to anybody and smokers will return to smoking. After all, you know where you are with smoking because people have been doing it for a long time.

    The word “however” appears 16 times in the BMA report, whose text takes up only 12 pages. How many times have we seen doctors and researchers put their names to such “however” reports? Reports that purportedly aim at striking a balance between the need to keep vapes appealing enough to smokers so that they are encouraged to give up smoking while not appealing to young people but that, “however,” always come down in support of protecting from themselves a few misbehaving students from well-off families at the expense of trying to help financially impoverished smokers?

    Reports that complain about how smoking is the major cause of premature death worldwide but wind up unable to support the use of the one product that has come along that could make a real dent in the toll caused by smoking because the authors are ideologically opposed to people enjoying using nicotine.

    The authors of such reports like to sex them up by talking of an “epidemic” of vaping that is in part harming “children.” You can imagine them wringing their hands in anguish at what is happening to these middle-class, mischievous students while ignoring the fact that hundreds of thousands of children from financially impoverished families live in poverty, meaning they are undernourished, with all the negative impacts on their life chances that that entails.

    On Dec. 22, just three days before the major feast of Christmas, The Guardian newspaper led with a story titled “Revealed: huge rise in hospital admissions with malnutrition” while on page six it ran with “‘Heartbreaking’: Teachers tell of children with bowed legs and no winter coat.” The latter story, by Jessica Murray, quoted a headteacher as saying some children at her school had bowed legs because they were so deficient in vitamins.

    “We’ve had children so malnourished they’ve had heart murmurs,” the headteacher said. “It’s heartbreaking. It’s not how it should be. It’s the worst I’ve ever seen it. We’ve got two-year-olds coming in and trying to eat sand because they’re so hungry.”

    As the lead story pointed out, such deficiencies can interfere with brain and bone development and cause health problems in later life. But, despite this, there has been little follow-up of these issues since then, with space being given over rather to numerous negative stories about vaping. 

    The BMA reports on health problems visited on children by vaping but set against the damage caused by malnutrition (or any number of other causes, such as ketamine addiction), these problems are minuscule. “The NHS revealed that in 2023, 50 children were admitted to hospital with vaping-related disorders,” the report states “The U.K. has a population of more than 12 million children defined as those 0 years old to 17 years old, so 50 represents 0.0004 percent].

    “This is up from just 11 children three years previously, demonstrating the significant growth in prevalence of vaping in this age group. Vaping-related disorders can range from lung damage to worsening asthma symptoms, which include wheezing, coughing and chest tightness.”

    These numbers are tiny, and, in any case, I wonder if even they can be put down to vaping in the way that malnutrition can be put down to vitamin deficiencies. After all, we are not told how many of the children said to be suffering from the effects of vaping live in our highly polluted cities and/or in the many houses afflicted with damp and mold that are inhabited by impoverished families, but perhaps the doctors assumed that vaping children would live in comfortable houses in leafy suburbs.

    In any case, I don’t wish to sound cynical, but aren’t children suffering from asthma rather asking for trouble if they vape? After all, children who are intolerant or allergic to certain foods are taught to avoid them. We don’t seek to regulate such foods so they become unpalatable to children and adults alike.

    Why is there so much emphasis on children vaping but so little on their going hungry? There are a number of reasons, but, in my opinion, the main one has to do with the fact that coming down on vapers and smokers allows those involved to do some virtue signaling at little or no cost whereas making sure that children are properly fed needs an effort by those responsible that comes with a price tag that most are not willing to pay.

    In fact, the BMA’s report came out at a rather bad time in respect of its attitude to at least some children. The day after publication, The Guardian newspaper ran a story under the heading “BMA accused of witch hunt after transgender care leak.”

    The piece, by health policy editor Denis Campbell, described how the BMA had been heavily criticized by key medical figures since it voted on July 17 for, in effect, rejecting a report by Hilary Cass on transgender care, which put it in the position of being the only medical organization in the U.K. not to accept, and to find fault with, her findings, findings that were accepted by the previous right-of-center government and its left-of-center successor.

    Campbell wrote that the Academy of Medical Royal Colleges, which represents all U.K. doctors professionally, had criticized the BMA’s refusal to accept “the validity of the evidence and consequently the findings of the independent Cass review of gender identity services for children and young people.”

    And ignoring the rule that when in a hole, the best idea is to stop digging, the BMA allegedly undertook a “witch hunt” to try to identify which senior figure leaked that it was set to oppose the Cass review. According to Campbell, critics described the BMA’s action in this regard as “disgraceful” and “Orwellian.”

    None of this will make the slightest difference, of course. Nor will the fact that, in my opinion, the BMA report is largely a rehash of stuff that has gone before many times over because the likelihood is that the government, like the general media, will merely read and relay the recommendations, not the thinking or lack of thinking behind them. They will probably not notice that though the report’s 99 references suggest a scientific accountability, in places it reads more like an essay in that it throws out unreferenced and vague statements such as “there are concerns that,” “there is no doubt,” “many health organizations” and “can also influence belief.”

    Some of what is said seems not to be supported by evidence and amounts to little more than urban myths while some is based on the lazy idea that what happens in the future will be the same as or similar to what happened in the past unless an intervention is made.

    And how does the BMA come up with a sentence such as this: “Novel products such as nicotine pouches are a growing class of noncombustible nicotine product that pose similar public health risks as [those posed by] vapes yet are not sufficiently regulated.” One would have hoped that doctors or their representatives would have figured out that the risks must be different. One activity involves inhalation while the other does not.

    The BMA report, like many such reports in the past, comes with a helping of emotional blackmail. The word “children” is used 55 times, and the phrase “young people” is used 23 times, but while these are not used as synonyms (on 16 occasions on which each of these terms are used, they are used in combination as “children and young people”), we are not told what the difference is between them, so we can assume only that “young people” refers to those people who are 18 years of age or older but who are not middle-aged or old. The word “youth” is used 15 times and the word “adolescent” four times.

    We are also treated to “people under 18” (the usual definition of a child in the U.K., though the National Health Service sometimes refers to children as those under 16), “children 11–17,” “young fashionable models” and even the impersonal “younger market.”

    And what of the “growing epidemic” mentioned in the first sentence of the Executive Summary? Well, this is what is said in the rest of the first paragraph: “Vape use by adults has risen significantly over recent years, but more worryingly, by children and young people. 7.6 percent of 11[-year-olds to] 17-year-olds are now vaping, either regularly or occasionally, compared to 1.3 percent in 2014.”

    I’m reluctant to go to bat against the BMA on the question of an “epidemic,” but what the hey? If the “epidemic” is supposed to refer to children as well as to adults (it’s unclear), under 8 percent seems a little short of a “widespread” outbreak, which is how my dictionary in part defines an epidemic. And this is especially so when you start to pull apart that 7.6 percent figure, which is from Action on Smoking and Health (ASH).

    It is made up of 4.6 percent of “regular” vapers, who, inexplicably, in my view,* are defined as those vaping more than once a week, and 3.1 percent of occasional vapers, defined as those who vape “less than once a week,” which means, I assume, they could vape only once a month, once a year or once a millennium. (*Imagine the reaction of your doctor when, on asking you whether you had regular bowel movements, you said, “Oh yes, more than once a week!”) 

    The truth of the matter is that, as part of this “epidemic,” “ever vaping” (a category it is safe to assume includes even those children who once looked sideways at a vape) fell between 2023 and 2024 in respect of all age groups examined. Of course, this is true only if the figures are correct. I guess the ASH figures are based on “self-reporting,” and it often puzzles me how those collecting data will accept the word of people, some of whom are breaking rules.

    The report seems to me to be poorly written. Take this sentence from the Executive Summary: “The availability of disposable vapes is clearly linked to the sharp rise in child use.” It seems that the BMA is mixing up cause and effect. According to it, the rise in the use of disposable vapes by children has caused the availability of disposable vapes. Well, not caused, because it clearly cannot state that, so it uses the word “linked,” which it hopes will do the same job as “cause” in the minds of the readers. Like I can say my bed is linked to my sleeping, and my knife and fork are linked to my eating.

    This linking business seems to be linked to an ASH graph that appears under the title “Rapid rise in youth vaping 2021–2023 associated with [not linked to, but associated with] growth in use of disposables.” But the graph seems to show nothing of the sort. Rather, as a subheading indicates, it graphs the “Proportion of vapers of all ages who mainly use disposable vapes, by age.” And the BMA does not mention that between 2023 and 2024, the proportion of 11-year-old to 17-year-old vapers who mainly used disposable vapes fell from 69 percent to 54 percent.

    This might come as a surprise, but I am on the same page as the BMA when it comes to one issue: the need, from an environmental perspective, to ban disposable vapes. Companies and consumers have proved time and time again that they are unwilling or unable to dispose of these and other consumer products and their packagings in a manner that does the minimum damage to the environment. They, like much of the rest of the population, seem to be so dim that they cannot absorb the simple but vital environmental message so eloquently expressed about another matter in the film Moonstruck: Don’t shit where you eat.

    Where I diverge from the BMA’s stance is at the point at which it is not willing to accept those products that have been designed by parts of the vaping industry to address these environmental concerns while still offering the positive usage characteristics of disposables.

    In fact, the report’s first recommendation is that the U.K. government bans “the manufacture for commercial sale and the commercial sale of all disposable vapes ….” I’m not sure how far the BMA imagines the U.K. government’s writ runs in such matters, but I would assume that at least a number of China-based manufacturers would be somewhat bemused by such an idea.

    But the BMA, while it is ready with its vaping advice, seems to be rather lost when it comes to the world of vaping. It bemoans the fact that the “nicotine contained in one disposable vape can be equal to [that in] two packs of cigarettes.”

    What is the problem here? It is not the quantity of nicotine in a device that counts but the amount of nicotine delivered to the user, and the amount of nicotine delivered is controlled by the vaper. And surely, if the BMA were really concerned about the environmental consequences of disposables, it would welcome bigger nicotine reservoirs.

    Bizarrely, the BMA also talks of vapes not containing tar. Well, no, but then neither do cigarettes; the tar is a product of the combustion process after a cigarette’s tobacco is set alight. And there is no tobacco in a vape and no combustion process.

    And finally, the BMA notes that “[a]s more young people are using disposable vapes and using them more frequently, there are concerns that they are at significant risk of addiction to nicotine.” Here the risk is probably being exaggerated. According to ASH figures, more 11-year-olds to 17-year-olds (9.5 percent) try vaping only once or twice than go on to become either regular or occasional users (7.6 percent), and 1.3 percent are classed as having been vapers but having quit.

    The question should at least be asked about how this 1.3 percent threw off this appalling addiction. Perhaps they returned to smoking, or did they just get bored with vaping? Young people get bored with things quite easily. That’s the main difference between old people and young folk. The former hang onto the past with a vice-like grip because they cannot compete in the present while the latter want to move on; they are hungry for the future. You can see this reflected in the charts of ASH and the dark forebodings of the BMA that are issued even as the young are moving on, beyond last year’s concerns.

    The report’s second recommendation and the one that has attracted most criticism calls for a ban on all nontobacco vape flavors. The BMA is clearly against vaping, and here at least the organization nails its colors to the mast but not without hitting its thumb in the process.

    Look at this sentence from the report, bearing in mind that the report is supposed to be a serious attempt at influencing government policy and presumably was read by any number of people before being loosed on the world: “However, like children, fruit flavors are the most popular with adults.” Hmm.

    Recommendation three, if implemented, would degrade the aesthetics of vaping devices and their packaging, which would make them less appealing to smokers, a move that would be simply vindictive since the BMA also wants, according to recommendation four, for these products to be kept out of sight at retailers.

    And just in case there were any doubt that the BMA is against vaping full stop, part of recommendation five calls for a government-funded and government-delivered “education campaign”—read propaganda—to warn the public “on the dangers of vapes to reduce appeal.” Again, an awful phrase, but we can figure out what is meant.

    Recommendation five includes some sensible ideas about policing the retail environment, but these are measures that the industry, at least in the form of the U.K. Vaping Industry Association, has been calling for for years. In fact, the recommendations do not go as far as the UKVIA has suggested, though there are signs that the government might be starting to favor the suggestion about licensing retailers that sell vapes.

    This is sensible. Most of the problems that vaping throws up have been caused by 14-years-and-counting of austerity under which the authorities responsible for overseeing retailing have been starved of funds so that checking the import, compliance and retail sale of these products has been nowhere near as vigorous as it should have been.

    But somehow, it is the smoker and the vaper who must be punished for these failures. Children are being naughty in using these products, manufacturers are putting noncompliant products on the market, retailers are selling vapes illegally, the authorities are failing in their duty to stop this abuse, but it is the people who are not doing anything wrong, the smokers and vapers, who are to be made to suffer.

    Recommendation six merely expands the report’s ideas, if you can call them that, to other nicotine products but not to traditional tobacco products.

    I think that one of the problems identified above is that the opinions of doctors should not be given too much credence when they are based on issues that go beyond their individual patients. We know that a lot of medical doctors still believe erroneously that nicotine causes cancer.

    And in a letter to The Guardian at the beginning of September in response to a government proposal to ban smoking in beer gardens, James Scott wrote, in part, “Tobacco is unique among the substances that humans use: When used exactly as intended by the manufacturer, it will harm and eventually kill its consumers. It is categorically different from alcohol and other drugs humans use and needs to be treated as such.”

    This completely ignores recent findings that drinking alcohol also harms and eventually kills its consumers when used exactly as intended. Writing in The Guardian on Aug. 21, Devi Shridhar, chair of global public health at the University of Edinburgh, pointed out that the World Health Organization had stated in January 2023 that there was no safe level of drinking. “The agency highlighted that alcohol causes at least seven types of cancer and that ethanol (alcohol) directly causes cancer when our cells break it down,” Sridhar wrote.

    But of course, it goes so much further than the direct harm caused by consumption. Smokers, unlike drinkers, do not go home and assault their partners just because they have been smoking. They do not start fights in the street just because they have been smoking, and they do not cause vehicle “accidents” just because they have been smoking.

    The problem is that you must have a wide view of society to see things clearly, in the round. On the same day that Scott’s letter was published about the proposed ban on smoking in beer gardens, there was a letter from Robert Lee, the contents of which anybody who has been involved in magistrate court proceedings would recognize as being right on the money.

    “The government’s almost evangelical crackdown on smoking contrasts sharply with its attitude to alcohol, which is responsible for more problems,” Lee wrote. “I sat as a magistrate for many years, and a huge proportion of offenses were directly or indirectly linked to alcohol. But I never heard a defense lawyer plead in mitigation that their client had smoked too many cigarettes.”

    And I cannot imagine that excessive vaping will ever be cited as mitigation in such proceedings. There is only one reason why smoking tobacco and vaping nicotine are under constant attack by all and sundry while drinking ethanol is not, and that is because the U.K. runs on hypocrisy. Let them eat sand.

  • Uphill Battle

    Uphill Battle

    Credit: Pormezz

    The motives behind successful quitting require ongoing efforts to understand those reasons.

    By George Gay

    Two Hong Kong news stories published in March provided examples of what, to me, is officialdom’s often muddled thinking around tobacco smoking issues. For instance, there is a belief system operating among some politicians that has it that though the consumption of cigarettes is “addictive,” smokers will quit smoking when the price of cigarettes is raised.

    Such beliefs seem to gloss over a few inconvenient facts. The first is that while “addictive” is a Humpty Dumpty word often used to mean whatever the person using it wants it to mean, most definitions include the idea of compulsion, and, bizarrely, politicians, egged on by tobacco control advocates, have hammered home the idea that smoking compulsion is extremely difficult if not impossible to break.

    So the question arises: What leads politicians to believe that raising the price of cigarettes will overcome this compulsion, which is unrelated to price?

    Another pertinent question would be why so many politicians, apparently convinced that nicotine addiction is almost unbreakable, are not willing to accept the concept of tobacco harm reduction (THR), whereby users continue to consume the addictive nicotine, which is what they crave and which, alone, does not cause harm, but without the harmful products produced during the burning of tobacco.

    This question was raised a long time ago by the availability of vapes, but it has surely been elevated to another level by the arrival of nicotine pouches. What appeared to be a blinkered attitude by some politicians and tobacco control advocates has been raised to the level of pigheaded obstinacy.

    Why? Muddled thinking again, perhaps brought on because of the science, if you can call it that. According to a study by the Ohio State University Comprehensive Cancer Center, nicotine pouches do little to curb smokers’ nicotine cravings. A university press note from Nov. 21 said that researchers had “found that current smokers had a much greater spike of nicotine in their blood levels and much sharper relief from craving symptoms when smoking than when using both the low-dose and higher dose nicotine pouches.”

    I ask you, what is the average politician going to make of this? They are going to say that given these pouches do not work, we may as well ban them and prevent another nicotine product from entering the market, and, without mentioning it, support the continuing use of cigarettes.

    They will not stop to ask themselves whether the science here might be somewhat askew. They will not stop to ask themselves why, if nicotine pouches do not work, there is purportedly a “problem” with increasing sales. They will not stop to ask themselves whether judgments about the efficaciousness of these products are best left to the market rather than the laboratory. And they will not stop to ask themselves whether consumers need scientists to tell them whether nicotine pouches work for them.

    Of course, they will not ask these questions because they are unlikely to see beyond the heading: “Pouches do little to curb cravings: Study.” And this a pity because the press note about the study was not totally negative regarding nicotine pouches.

    “Our challenge is to approach regulation of nicotine pouches to limit their appeal among young people while making them more appealing to adult smokers who would see health benefits by switching from cigarettes—which have the most severe health impacts with long-term use—to nicotine pouches,” the lead study author, Brittney Keller-Hamilton, was quoted as saying.

    I say not totally negative because what is being called for here is a balance between designing nicotine pouches. Hence, they are effective in getting smokers to quit while not allowing them to become attractive to the underaged. This is the self-same quest that has been pursued in the case of vapes, always with the same result: that the products are made less attractive to adult smokers than they need to be to encourage wholesale quitting.

    What comes out of the university worries me also because of an email I received on Oct. 6 from Mediasourcetv, which said the university was continuing its commitment to helping the U.S. Food and Drug Administration better regulate tobacco products. “The Ohio State University was one of seven centers across the United States selected to conduct research aimed at gathering scientific evidence needed for these decisions,” the email said.

    Don’t get me wrong. I am all in favor of the FDA making better decisions about tobacco and nicotine products. In fact, I shall wait with baited breath for this to happen. No, the problem was what came next in the second paragraph.

    “Historically, the tobacco industry has manipulated nicotine in combustible cigarettes and smokeless tobacco products, like chewing tobacco, to sustain dependence among existing users but also to increase their appeal and addictiveness for young people and nonusers,” the email said.

    Firstly, I don’t like the starting point that says, historically, the tobacco industry has manipulated nicotine. This seems to indicate the university, assuming it was the source of the story, is starting from a rather strange position from which it will be difficult to generate objective scientific evidence. How can it be that what happened “historically” can impinge scientifically on the present situation?

    Either you are a scientist or a historian. It is quite possible that nobody still works for the tobacco industry who was involved in manipulating nicotine, so the question arises as to what the link is between the industry of yore and that of today.

    Secondly, I get caught up with the finale: “… but also to increase their appeal and addictiveness for young people and nonusers.” How can it possibly be the case that manipulating nicotine increases the appeal and addictiveness of tobacco products to nonusers? This is utter nonsense.

    These might seem like minor points, but you have a responsibility to take care of what you say when you are writing about what is generally thought to be the product whose consumption causes more preventable disease and death than the consumption of any other consumer product. Otherwise, you cannot be surprised if people dismiss everything you say as gibberish.

    On which point, let me flip back to the middle of the sentence: “like chewing tobacco.” The word “like” here is misleading because it seems to mean something similar to but not the same as. What should have been written, I guess, is “such as chewing tobacco.”

    But I digress. The second inconvenient fact about the worth of raising taxes and, therefore, cigarette prices is that many of the smokers who would otherwise be further impoverished by cigarette price rises probably know where they can buy illicit products that undercut the price of tax-paid cigarettes.

    Indeed, one of the stories on the English-language news website RTHK.com quoted Hong Kong politicians as saying that it was common to see people on public housing estates handing out flyers promoting illicit tobacco products.

    Of course, legislators and the tobacco industry get on their high horses and condemn the purchase of illicit products as somehow morally wrong, but if you are involved in promoting a system where a licit, “addictive” product is deliberately made unaffordable to many of the people within the minority group comprising smokers, you can hardly take the moral high ground. You are the problem.

    The third inconvenient fact is that some smokers, probably a minority of them, can afford to pay the increased prices. And this raises an odd question: Do price increases discriminate against the well off? Let me explain. If politicians really believe that raising the prices of cigarettes will cause people to quit smoking and that quitting will improve the former smokers’ life chances, unless those price rises are enough to cause the richest smokers to quit, then the wealthiest smokers are being discriminated against; they are not being forced into improving their life chances as are poorer smokers.

    Clearly, the only way to bring in a fair system would be to ask all smokers to pay for their cigarettes a price that would be unaffordable even to the richest among their ranks, and, perhaps, to stop nonsmokers from being tempted to take up the habit, the price would have to make cigarettes unaffordable even for the wealthiest person in the country. I think this is called prohibition.

    This might seem like a phantasmic approach, but I do not think it would be much more unreasonable than what happens in Hong Kong, where the authorities during the past couple of years have worried about the damage caused by smoking, used the taxation system to raise the prices of cigarettes and then worried about the increase in sales of illicit cigarettes.

    And when I say “worried,” this is something of an understatement if newspaper stories are anything to go by. The trade of illicit cigarettes is an obsession with endless stories about the quantities and the so-called values of seizures and the incidents of fines and prison sentences handed out to those seen to be breaking the law, even to individuals importing a few cigarettes on which local duties have not been paid.

    One suggestion put forward to help combat this trade has been to require that cigarettes bear customs department labels to show that duty has been paid on them. But this would surely be a sticking-plaster response. Those involved in the illegal trade could knock out labels capable of fooling most people.

    Only those with specialist knowledge and equipment who got up close and personal would know the difference. Clearly, consumers would know the labels and the products were not genuine—they could tell by the product’s price.

    What I find so odd is that authorities will go to all this bother when there is a way of encouraging smokers to quit their habit rather than bludgeoning them into submission—of working with consumers rather than against them. All that needs to happen is for the authorities to remove the ban on alternative, less-risky nicotine products.

    This would make sense—a lot more sense than is to be found in current policies because to try to use pricing to force people to break cigarette smoking addiction when they are not allowed to access acceptable alternative products and when there is a ready supply of illicit products seems to be the triumph of hope over experience.

    The pity is that I sense there are people in authority in Hong Kong who, while they might not be advocating THR yet, could be persuaded that this is the way ahead in the 21st century. I say this because the two stories mentioned at the start of this piece quoted rational voices alongside those of politicians who clearly would never have the courage to admit they had been wrong.

    Some politicians, while aiming to encourage people to quit smoking, obviously understand the difficulties involved and the necessity of treating smokers as ends in themselves, not as a means to an end. The RTHK.com story had two politicians pointing out that government efforts to combat the illegal trade in cigarettes were inadequate given two consecutive years of tax increases on these products and the difficulty in dealing with the trade in illicit products, especially that conducted through overseas websites.

    At the same time, a voice from the retail and wholesale sector quoted in The Standard made the point that the government should focus on better education about the harmful effects of cigarette smoking rather than relying on duty increases alone.

    And a politician also quoted in The Standard called on the government to enhance assistance to people wanting to quit smoking. Calls to a smoking cessation hotline, she said, had increased significantly since the latest tax increase, which had probably caused stress among some smokers. She added that there was a need for continuous efforts to understand the reasons behind successful quitting and the challenges faced by those who failed.

    There is hope, but it will be an uphill battle.

  • Irrational Math

    Irrational Math

    Credit: Pavel Kant

    The portrayal of tobacco mathematics is often guided by unreasonable theories.

    By George Gay

    When, toward the end of last year, I was invited to attend the preview of a documentary titled How Sweden Quit Smoking, it struck me that the title was rather odd because Swedish people had not quit smoking tobacco nor, as far as I was aware, had they stopped inhaling any of the other forms of smoke that are produced in that country.

    The documentary’s title was, I guess, based on the odd notion put about in recent years that 5 percent, or thereabouts, equals 0 percent. Once smoking rates come down to about 5 percent, they might as well be regarded as being 0 percent. This, to me, is irrational, but it seems to have been generally accepted, so I shall move on—reluctantly.

    After the showing of the documentary, which was directed by Tomasz Agencki on behalf of We Are Innovation and which explored the success that the use of snus had had in replacing smoking in Sweden, thereby hugely reducing cancer rates, a few invited speakers expressed incredulity that, given this success, snus and its derivatives were not being promoted more widely in the world and, indeed, were banned in many places. I, on the other hand, was incredulous at the incredulity expressed because we do not live in a rational world.

    Look at it this way: If you are willing to accept the irrational notion that 5 percent equals 0 percent, you should not be surprised when others also hold irrational beliefs. If you live irrationally, you will possibly die that way. Or perhaps not, given that many tobacco commentators believe that certain deaths are “preventable.” Welcome to life through the looking glass.

    During the event, hope was expressed that the documentary, which was undoubtedly well made, would change the minds of those in authority opposed to promoting or even allowing the use of snus to help smokers quit their habit. I share that hope, but I have one reservation.

    If the documentary does change minds, what does it say about the people, for instance, those in authority in the EU where snus is banned outside Sweden, who were deaf to previous evidence-based approaches around the efficaciousness of snus but were swayed by a documentary, no matter how good? That they are irrational people driven by their passions?

    The irrationality that surrounds discussions about smoking and vaping was in full flow today, Jan. 29, as I was listening to Today, one of BBC Radio’s main morning news programs. A story was introduced announcing how the U.K. government intended to bring in a blanket ban on the sale of single-use vapes, purportedly mainly for the sake of protecting young people.

    The person who introduced the item said that within months, the sale of single-use vapes to anyone of any age in England, Wales and Scotland should be impossible because of what the government was announcing.

    Let’s unwrap that a little. Although it is illegal already in the U.K. to sell vapes to those under 18 years of age and though the story was devoted almost entirely to the issues raised by single-use vapes being sold willy-nilly to young people, the interviewer did not seem to be interested in delving into the reasons why this illegal activity was occurring. And no question was raised as to why, when the law banning the sale of single-use vapes to young people was apparently being flaunted, it was believed that another law would stop sales to young people—and to all and sundry.

    Once again, we were being asked to accept the irrational. The news item, as many before it, did all it could to blame vape manufacturers for the sales illegality. It was because the manufacturers were making the packaging of single-use vapes attractive to young people. But it doesn’t take a second’s thought to realize that it doesn’t matter whether the manufacturers paint their packaging sky-blue with pink polka dots, it is illegal to sell those packages to young people. The problem must lie elsewhere.

    And, of course, it does. It lies with successive Conservative governments. What we have at present is a proposal that is based on a moral panic stirred up by the media and used by a grateful government that, in an election year, is desperately trying to win kudos and votes by acting to reverse the problems it has created during the past 13 years, one of which is down to its having slashed the budgets of the agencies charged with policing the import and retail sale of vapes.

    The four-minute to five-minute BBC item included a one-minute statement by John Dunne, director general of the U.K. Vaping Industry Association, who warned that the proposed ban on single-use vapes would simply drive the business underground, exposing young people to unregulated products. The rest of the time was allocated to an interview with Glyn Potts, the head teacher of Newman Catholic College at Oldham, which has more than 1,500 pupils aged 11 to 16.

    In answer to a question, Potts said he believed about 10 percent of the school’s students had tried vapes but that fewer than 30 of them vaped regularly, which could mean that none of them did. But let’s take it that the upper figure of 30 is correct and the school has exactly 1,500 pupils: Now children, 30 divided by 1,500 and multiplied by 100 equals two: 2 percent.

    Two percent is less than 5 percent, and 5 percent is 0 percent. Therefore, 2 percent is less than 0 percent. The interviewer, feeling perhaps that the item wasn’t going to plan, chimed in with what appeared to me to be a less than objective observation, saying, “It’s 30 sets of young lungs, isn’t it?” Hmm. Perhaps mention could have been made about the air quality or lack of it outside the school gates.

    Two percent is hardly the “youth vaping epidemic” The Guardian newspaper referred to on the same day when writing about the same story, a piece of about 600 words that included the words “youth” three times, “children” five times, “underage” once and “young people” once, all references being to the same group of people as far as I could tell.

    But then I should add that the paper said 9 percent of 11-year-olds to 15-year-olds were now vaping, and the proportion of 11-year-old to 17-year-old vapers using single-use vapes had increased almost ninefold during the past two years. How could one take a rational account of the situation from these figures, the only vaping figures presented?

    Without details, the second statement is meaningless to the point of being misleading. We are not told how a “vaper” is defined and, often, those opposed to vaping will count young people who have tried to vape just once. Additionally, we cannot tell what the starting point was two years ago. Were there just two vapers and now there are 18? And notice how with the 9 percent figure, we are faced with the opposite problem because we are not told whether that figure has been on the rise or is going down.

    If I were feeling really cheeky, I would point out, too, that 9 percent is less than twice 5 percent and therefore less than twice 0 percent, making it 0 percent. Come on, keep up.

    Neither does 2 percent reflect the concern about vaping’s becoming “endemic,” apparently expressed by the prime minister, Rishi Sunak. “As any parent or teacher knows, one of the most worrying trends at the moment is the rise in vaping among children, and so we must act before it becomes endemic,” The Guardian quoted Sunak as saying.

    Well, a lot of financially well-off parents might feel that way and so might some moderately well-off parents, but the increasing number of parents impoverished by the Sunak and previous Conservative governments probably have more pressing worries.

    Kamila Hawthorne, chair of the Royal College of General Practitioners, was quoted in a Dec. 22 front-page story in The Guardian, headed “Revealed: Huge rise in hospital admissions with malnutrition,”as saying: “As a nation, we shouldn’t be having malnourished children. We shouldn’t be having children with rickets. We should not be having people with iron deficiencies or low folic acid …. There’s that sense of this isn’t right; what’s happening here.”

    Later in the story, it was said that nutritional deficiencies are particularly concerning in children, with iron and B12 being critical for brain development, which may be compared with the vape story that said only that “doctors are concerned about the unknown [my emphasis] long-term health impact of vaping on young people and their developing respiratory systems, including nicotine addiction, which can cause anxiety and withdrawal headaches.”

    The Guardian’s malnutrition piece bled to inside pages, where another story was headed “‘Heartbreaking’: Teachers tell of children with bowed legs and no winter coat,” and where a pull quote had a head teacher saying, “One child came in so malnourished, I had to carry them to the doctor myself.”

    Despite such shocking news, the malnutrition story did not quote Sunak as saying this was a most worrying trend and, indeed, he might not have been asked to comment. But it is clear that the Conservative government, which has been in power since 2010, has a chilling record on child poverty and owns this state of affairs. It certainly seems not to be intent on bringing in quick-fired legislation on nutrition as it is in the case of single-use vapes. 

    Further, it seems that consecutive Conservative administrations, having disabled the U.K.’s ambulance service and most other public services with its backward-focused austerity program, are now relying on head teachers to carry or otherwise get patients to hospitals. It seems that the head teacher who carried the child too weak to walk was not alone.

    Potts had his own story to tell after he was asked the somewhat leading question: “Have you seen any serious complications or problems arising from the use of vaping, because there have been children, haven’t there, who’ve been hospitalized?” Fortunately for the interviewer, Potts has a good memory. He said that two and a half years ago, a pupil entering the school grounds on a bus, egged on by friends, took a huge “gulp” on a vape he had “stolen” from an older brother and, on leaving the bus, collapsed and was taken to the hospital.

    Two children collapse at different schools, and the reasons behind those collapses provoke different reactions from the government. In one case, indifference; in the other, panic. What is going on here? Well, this is an election year in the U.K. I would speculate that the parents of the 18 young people spluttering over their vapes could well be persuaded to vote for Sunak’s party. In contrast, the parents of the young people without enough to eat have possibly been disenfranchised by the government’s recent changes to electoral requirements.

    The term “moral panic” is bandied about often, but I think it is not without justification in this case. Let me return to the school where less than 2 percent of students are said to vape and where, by the way, none are said to vape at school because of the sophisticated fire alarm system and CCTV. Potts said it was known that vapes, particularly disposable vapes, were being repurposed to contain cannabis derivatives and even spice and sold to young people. If something were not done, young people could die, he added. Now I looked online at his school, and it seems to be the sort of establishment where many parents would aspire to send their children and where those children would have the opportunity to develop their various talents.

    It did not look like the sort of establishment that would be twinned with a crack den. So even if he were also talking about the school’s environs, an area that I do not know, I cannot help thinking that his comments, in this instance, were over the top and, therefore, unhelpful.

    Some people might think it strange that, given the above, I am not necessarily opposed to a ban on single-use vapes, but if such a ban is to be imposed, I believe that it should be based on a rational, quickly performed analysis of the pros and cons of these products, especially as they relate to the environment, and then only with guarantees that the necessary policing of the ban will be fully funded. It should not be the result of preconceived ideas, anecdotal evidence, dodgy data, moral panic and political shenanigans.

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  • Lack of Enforcement

    Lack of Enforcement

    The UKVIA forum offered insight into the most significant threats to the U.K. vaping industry.

    By George Gay

    The U.K. vaping industry, which has benefited from some progressive government policies in the past, nevertheless found itself with the sword of Damocles hanging over its head as participants met in London for the annual forum of the U.K. Vaping Industry Association (UKVIA) on Nov. 10. And I am not being overly dramatic here.

    As part of his forum presentation, the Conservative Member of Parliament Adam Afriyie warned attendees that the U.K. “could go the way of Australia in the blink of an eye”—and he wasn’t talking galahs and wombats; he was referring, I assume, to a generally very restrictive vaping environment, though not necessarily to the specific prescription-based medicalization of vaping in that country.

    What was at the back of everybody’s mind on Nov. 10 was a government consultation on smoking and vaping issued in October and due to end on Dec. 6, which made the theme of the forum, “Accelerating action: Securing a world without smoking,” something of an object lesson in being careful what you wish for.

    The consultation includes a proposal to make it an offense to sell any product containing tobacco to those born on or after Jan. 1, 2009, which would raise the legal smoking age by a year annually until it applies to the whole population. The government claims this has the potential to almost completely phase out tobacco smoking among young people by 2040.

    Worryingly for the vaping industry, some might suggest this policy would be a way of single-handedly ensuring a U.K. without tobacco smoking, eliminating the need for products that can substitute for combustible cigarettes, such as vapes. And for those wedded to the idea that vapers should be drawn only from the ranks of smokers, it would mean the vaping industry had a limited future, one where, within a predictable timeframe, it would simply be managing decline.

    On the other hand, some might argue that with one of the UKVIA’s goals being to support the government in reaching its 2030 smoke-free target, and given the government’s claims about the damage caused by tobacco smoking being so alarming, timing is of the essence and that vaping can help things along, though the idea that it is necessary to act speedily is perhaps undermined by the facts that the risk of cigarette smoking has been known about for more than half a century, and substitute products have been around for even longer.

    Credit: Fotolia Premium

    On the other hand, if I haven’t run out of hands, the future might not look this bleak because there is the usually unspoken argument, with which I would agree, that vapers need not be recruited only from the ranks of smokers. We must be grown up and realize that some people will, for the foreseeable future, seek recreational drugs, and nicotine delivered through vaping must be a better, less risky candidate than many others on offer, especially alcohol, which surely must be the subject of the next government consultation.

    But I digress. There are proposals in the consultation that forum participants will likely have considered to be more directly threatening than a creeping tobacco smoking ban. “The U.K. government and devolved administrations [those in Northern Ireland, Scotland and Wales] have a duty to protect our children from the potential harms associated with underage vaping while their lungs and brains are still developing,” the consultation says in part. “So, the U.K. government and devolved administrations are consulting on several proposals on youth vaping, including restricting flavors, regulating point-of-sale displays, regulating packaging and presentation, considering restricting the supply and sale of disposable vapes, whether regulations should extend to non-nicotine vapes and taking action on the affordability of vapes.

    What I find a little concerning about the above is that, unless the consultation document was put together by people who started messing with nicotine before their brains had fully developed, it seems to have been written in something of a rush. The fourth proposal is apparently about “consulting on … considering restricting,” which seems a mite convoluted. And the fifth proposal goes into passive mode whereby the regulations might extend, seemingly of their own accord. That is creepy.

    These might seem to be minor semantic matters, but I’m not sure they are because they reflect on how much time and effort went into producing the consultation document and, more worryingly perhaps, suggest that not enough time will go into examining the submissions. Afriyie, who is the vice-chair of the All-party Parliamentary Group for Vaping, suggested the U.K.’s civil servants were well informed and committed to the U.K.’s principle of harm reduction and would make a good job of reviewing the consultation, ensuring submissions were evidence based and making pragmatic recommendations to ministers. I wish I were so confident.

    Civil servants presumably wrote the consultation, which is not in my view objective but comes with an agenda. The sixth paragraph kicks off with an almost meaningless statement: “No other consumer product kills up to two-thirds of its users.”

    Glossing over the fact that no “product” had been identified by this stage of the text and that, therefore, to refer to “no other product” was meaningless, it is the case that “up to two-thirds” could mean none, which was perhaps not what the writers had in mind. And the word “kills,” though almost universally used, is clearly misleading. This is not to denigrate civil servants, just to point out that they are probably too few in numbers fully to perform the tasks assigned to them.

    Credit: WavebreakMediaMicro

    I worry the government believes that what it is dealing with here is not a health matter but a political one, especially given that a general election is likely to be called next year. Addressing the attendees about vaping by those underage, Afriyie, who is not standing at the next election, said, “… if any of your products, I mean any of them, have fancy colors or have packaging or have names or have flavors with names that would even vaguely appeal to young people, can I just say, just stop.

    Because if next year I come to this conference and we’ve gone the route of Australia, do you know, it will be your fault. It will be your fault for not policing the industry and ensuring that you are absolutely responsible in your new role of healthcare.”

    Of course, the UKVIA has no powers to police the industry. The association can encourage and cajole its members to ensure their products do not specifically appeal to those underage, but then it is unlikely that its members will be the ones to step out of line.

    There is no doubt that vapes are getting into the hands of those who are too young legally to buy them, but, for a long time, the UKVIA has been telling the government about this trend and suggesting remedial actions that could be taken, including the licensing of retailers and heavy fines for those who recklessly sell vapes to those underage. Not only have such suggestions fallen on deaf ears, but successive Conservative governments have run a ruthless and reckless decade-long program of austerity that has, in part, decimated the organizations charged with policing retail activities.

    According to a press note issued by Arcus Compliance on Nov. 9, the day before the forum was held, a leading academic at Imperial College London had reported that the budgets of one of those organizations, Trading Standards, had been halved: cut by an estimated £200 million ($254.04 million) since 2010.

    Data gathered through Freedom of Information requests by Arcus Compliance reportedly showed that across 11 major provincial U.K. cities, which have a shared population of more than 5.5 million people, just 21 successful prosecutions had been made against retailers for underage/illicit sales between 2021 and early 2023. Further, the total amount of fines handed down across these cities over the same period was £2,188.

    The managing director of Arcus Compliance, Robert Sidebottom, who was co-chair of the forum, said the concerning lack of enforcement in the form of prosecutions and penalties demonstrated the system was in serious distress.

    “The government has now pledged £30 million to help intercept illegal tobacco and vaping goods at the border and to tackle youth access,” he was quoted in the press note as saying. “While this is a welcome development, we can’t just slap a multimillion-pound Band-Aid on the issue of underage and illicit vape sales and call it a day—especially if parliamentarians move on considerations to restrict the sale of disposable vapes.”

    This was a theme addressed by John Dunne, the UKVIA’s director general, in his forum presentation. While acknowledging that it was necessary to urgently address what he described as the unintended consequences of sales to those underage, the sale of illicit products and the environmental damage caused by vapes, he pointed out that while current regulations were not being enforced, it made no sense to add further punitive regulations to the industry’s operations.

    John Dunne

    Dunne, whose job must have been made hugely more difficult in recent times by the almost constant churning within ministerial departments caused by the unstable, almost unhinged, turmoil within the ruling Conservative Party, expressed concern that the contents of the vaping consultation had been swayed by the court of public opinion, driven in turn by click-bait journalism, and therefore threatened “to undo all of the good work that our sector has done in being the most disruptive force in history in addressing the most preventable cause of death, which is smoking.”

    The forum, which apparently is now the biggest business-to-business event in the U.K., was well organized and held within a comfortable, well-run venue, the QEII Centre in Westminster, London. There was a program of practical panel discussions and presentations, which included an address by Weinuo Ao, the secretary general of the China Electronic Chamber of Commerce, which, in cooperation with the UKVIA, organized the first trade delegation of Chinese companies to attend a UKVIA forum.

    There was a panel session on the thorny, seemingly unresolvable, problem of trying to change public perceptions about vaping for the better and one on the equally thorny and divisive subject of addressing the environmental impact of vapes. It is almost painful to see how both of these issues, like the enforcement issue, are largely out of the industry’s hands.

    Enforcement is in the hands of the government, and changing perceptions would require those currently spreading misleading information about vaping to stop what they are doing, while it is consumers who should, in their own interests, take the environmental issue in hand by not carelessly discarding their vapes.

    One panel discussed the future of vaping, another looked at the future of retailing and yet another examined whether in the future it would be possible or even desirable to take harm reduction to a new level—perhaps beyond the 95 percent less risky figure normally quoted in the U.K.

    Alongside the forum was a mini-exhibition, and an awards dinner followed, co-compared by Marina Murphy, senior director of scientific and medical affairs at ANDS, and Sairah Salim-Sartoni, founder of Salim-Sartoni Associates. Sixteen awards were up for grabs, including one for most supportive parliamentarian, which went to Afriyie.

    Finally, whereas my take on the forum was that the most significant threats to the vaping industry in the U.K. were being caused by a lack of enforcement of current regulations, there was hope. For instance, from my observations, the government could take its enforcement activities to a new level simply by taking some lessons from Sidebottom and his co-chair, Jeannie Cameron, the CEO of JCIC International and the first woman to chair a UKVIA forum.

    Sidebottom, who is ex-military, and Cameron ran the show like a military operation, and I don’t mean a retreat. Presentation timings were policed strictly with Sidebottom threatening stragglers with being grasped in a headlock and dragged from the stage and Cameron saying something about a whip. Unless I was mistaken, at least one participant was stopped mid-sentence …

  • Wasted Time

    Wasted Time

    Credit: Proxima Studio

    Time has not been used effectively to lower smoking rates using proven THR policies.

    By George Gay

    No truer statement about tobacco harm reduction (THR) could ever have been made than this: “Too much time has been wasted.”

    This blunt assessment was attributed to Jacek Olczak, CEO of Philip Morris International, in a September press note heading that had him challenge “governments across the globe to embrace smoke-free alternatives to end cigarettes faster.”

    I take it that what Olczak was referring to is the time that has not been used by societies to good effect to bring down tobacco smoking rates using proven THR policies. But he might well have had in mind, too, the cumulative time cut from the lives of individuals said to have died “prematurely” from smoking-related diseases—diseases that could have been avoided by employing THR strategies.

    The press note includes much that is interesting, but my eye was particularly drawn to a passage where it was said that, according to a new international survey conducted by independent research firm Povaddo for PMI, 82 percent of respondents agreed they would be somewhat or very angry, frustrated or upset to learn that a breakthrough that could help address a societal issue was not made available to the public due to government inaction.

    Even very angry doesn’t cut it for me, partly because we are not talking only about government inaction but about government action in undermining such breakthroughs. Later in the press note, Sweden was said to have one of the lowest smoking rates in the developed world, at just 5.8 percent, largely due to the availability of snus, which Swedish men began switching to decades ago. “… The Swedish Snus Commission (SSC) estimates that more than 350,000 smoking-attributable deaths among men could have been avoided each year if the other EU countries had matched Sweden’s tobacco-related mortality rate,” the note said.

    If the SSC is correct, and given that the EU has banned snus outside Sweden since 1992, we must reluctantly accept that about 10,500,000 men have, because of the action of the EU authorities in banning snus and then their subsequent, continuing inaction in not unbanning it, died prematurely in about a 30-year period.

    OK, so 10,500,000 might be something of a stretch because the EU was smaller in 1992 than it is now, and I don’t know whether the 350,000 annual figure is an average or is based on a single year. But it is clear that we are talking about a big number and that no such number would have been allowed to have occurred in a 30-year war. A truce would have been called long ago and compromises made. But not in respect of the war on snus, and yet nobody will be called to account over what has occurred in the EU because of the ban on snus.

    And the question arises as to whether such a calamity, such an outrage, would have been allowed to go almost unnoticed, unremarked in any other field. I think not, but I struggle to understand why this is the case, and the only reasons I have managed to come up with so far are that 1) smokers tend to be financially less well-off than the average person and to have little or no public voice or power, and 2) smokers have been deliberately denormalized by anti-tobacco activists. They have been placed beyond societal norms, so the problems they face are not regarded as being societal issues. People will not be very angry, or even upset, if governments don’t take the problems of smokers seriously.

    These are not wholly convincing arguments, are they? And I must be concerned when I cannot even convince myself. I mean, individuals, companies, organizations and governments do worry about smokers, don’t they? At the first opportunity, everybody with the closest or flimsiest connection to tobacco or nicotine will lament that, according to the World Health Organization, 8 million smokers die prematurely each year because of their habit. Ask yourself how many times you have seen that statement written or heard it articulated.

    PMI says it used WHO data, estimates and methodologies, along with third-party data, to calculate the potential public health impact of the world’s smokers switching from cigarettes to less harmful, smoke-free products.

    “The hypothetical model shows that if smoke-free products are assumed to be 80 percent less risky than cigarettes and if people who currently smoke were to switch to them completely, then over their lifetime, there’s a potential for a tenfold reduction in smoking-attributable deaths compared with [those that would have occurred under] historical tobacco control measures alone,” the press note said.

    This is impressive and worthy of note, but the problem here is that in using and, dare I say it, extolling the data and, especially, the methodologies of the WHO, PMI rather shoots itself in the foot.

    “For over a decade, PMI has championed a smoke-free future,” Olczak is quoted as saying. “Having invested more than $10.5 billion to scientifically research, develop and commercialize smoke-free products—which today account for more than a third of our total net revenues—we are living this future. Yet, inexplicably, there are countries stuck in the past where smokers can easily access cigarettes—the most harmful form of nicotine consumption—but not the better option of smoke-free alternatives.”

    This situation is not universally inexplicable. Imagine for a minute that you are the health minister in a country whose economy does not allow major investments to be made in nation-specific health research. When the WHO comes knocking and tells you that your country has a smoking problem that is draining its finances and that THR is not the way to address it, what are you going to do?

    You might notice that PMI is advocating THR, but you also notice that it is relying on WHO data and methodologies. That is, the methodologies are the same, the only difference is the interpretation of the data, so who are you going to believe, the international health organization or the international tobacco/nicotine company? It’s a no-contest.

    I don’t want to seem to be an anti-expert or a conspiracy theorist, but I believe that we need to rely less on numbers, which are impersonal and which can be, intentionally or not, highly misleading, and more on values when it comes to addressing the problems caused by smoking. There is certainly something wrong with the ways that health data are manipulated by some, and the situation is getting worse by the day. Let me provide a current example from the U.K.

    The ruling Conservative Party, nervous of a general election due next year, is reverting to type and aligning with a former prime minister’s reported policy of cutting the “green crap,” supposedly to help it appeal to its older voter base. And as part of this strategy, some are opposing certain policies aimed at cutting outdoor pollution by pointing out that the word ‘pollution’ has appeared only once as a cause of death on a death certificate.

    I cannot say whether this is correct, but it wouldn’t surprise me because it could be argued that, for instance, people don’t die of heart attacks caused only by the inhalation and ingestion of pollutants, which is perhaps one factor—one major factor—among others that might include lifestyle choices.

    But in conceding this, I must ask myself why people are so ready to attribute deaths to smoking. By the same reasoning, I take it, people don’t die of heart attacks caused only by the inhalation of tobacco smoke, which will be one factor—one major factor—among others that might include lifestyle choices and pollution.

    Of course, we know the answer to this. It’s because of the way the system is set up to focus on smoking but not on pollution. There are certain diseases that are defined as smoking-related, and if a smoker dies of one of these, her death is recorded as having been caused by smoking.

    The fact that these diseases could also be defined as pollution-related diseases seems to be glossed over. To get an idea of the contribution of pollution to disease and deaths, it is necessary to listen to the information provided by people such as the U.N. secretary-general, Antonio Guterres, who is not afraid to speak out.

    Interestingly, Sept. 7 was International Day of Clean Air for Blue Skies, and if you look at the U.N. website, you will see that air pollution is described as a twofold problem:

    1. “Health impact: Tiny, invisible particles of pollution penetrate deep into our lungs, bloodstream and bodies. These pollutants are responsible for about one-third of deaths from stroke, chronic respiratory disease and lung cancer as well as one quarter of deaths from heart attack. Ground-level ozone, produced from the interaction of many different pollutants in sunlight, is also a cause of asthma and chronic respiratory illnesses.”
    2. “Climate impact: Short-lived climate pollutants (SLCPs) are among those pollutants most linked with both health effects and near-term warming of the planet. They persist in the atmosphere for as little as a few days or up to a few decades, so reducing them can have … almost immediate health and climate benefits for those living in places where levels fall.”

    It is good to see this emphasized because air pollution, which is generally invisible and is visited upon everyone, even those, such as children, who don’t cause it directly, is a more insidious risk factor than tobacco smoke, which is visible and largely affects only those who consume it. In fact, my newspaper this morning, Sept. 21, has a heading: “Almost all Europeans breathing toxic air.”

    Clearly, the figures of one instance of pollution being recorded on a death certificate and 8 million smoking-related deaths annually are both misleading, but they are allowed to guide us because they point us in the direction that we have already determined we want to go. They provide the comfort of confirmation bias. But what we should be doing is determining that direction based on values, not suspect figures, even though such a quest might lead us into difficult places.

    And one of those places is, of course, environmental pollution, which, in my opinion, is still not taken seriously enough by the vaping industry, especially when it comes to disposables. I fail to understand how we might be able to justify the proliferation of disposables on the grounds of values.

    How can we justify disposables when, clearly, the conversion of all smokers to the consumption of disposable vapes would not be something we could defend—would not, if you like, be something we would wish to become a universal law unless we are seeking to accelerate the end of humanity. And neither can they be justified on the grounds of the good of most people.

    In fact, up to a point, I think the same might be said for nondisposable vapes, and so perhaps the time has come for THR advocates to start winding back on vaping devices and concentrating more on products such as snus and nicotine pouches, which are much easier to justify on the grounds of nicotine-user health, the environment and society at large.

    A lot of people, including, probably, most of the readers of this magazine, will not agree with this, and they may well be right in not doing so. But I think it is important to have these discussions. THR fails, in my view, if it does not comprise a progressive signpost.

    I said at the start of this piece that, in my opinion, Olczak had made what is possibly the truest statement about THR in saying that too much time had been wasted. But he said something even more important that I quoted above and part of which I shall repeat here: “… We are living this future ….”

    He’s right: We need to look to the future, not the past, which can be a guide only for those reactionaries not wanting to face the future.

  • Quitting is Easy

    Quitting is Easy

    Credit: Ivelin Radkov

    It seems to be very difficult for many politicians and think-tankers to change their minds.

    By George Gay

    Ever since they were mentioned in a Guardian newspaper leader in the U.K. in February, I have been fascinated by sea squirts. These tiny creatures start off as eggs and then develop into tadpole-like entities that swim around seeking a suitable rock or piece of coral on which to make their homes for life. But this is the good bit: Once they have attached themselves to their homes-for-life, they no longer need to swim or seek out suitable habitats, so they devour their own brains.

    The rest of their lives is spent blissfully drawing in sea water through one orifice, removing the nutrients they need and then squirting out what they do not want through another orifice—all without having to contemplate tricky meaning-of-life questions.

    Do these little creatures remind you of anything or anybody? To me, their way of life mirrors that of many politicians and employees of ideologically rigid “think tanks.” I mean, once these people have swum away from home, school or university and attached themselves to their political party or ideology of choice, they no longer need their brains, just a couple of orifices, one of which takes in information that is scanned for the nutrients that will feed their political or ideological prejudices and the other to squirt out the indigestible, inconvenient facts.

    You might laugh at this, or you might find it outrageous, but it would explain something that to me is otherwise inexplicable: the fact that it seems to be enormously difficult for many politicians, think-tankers and people in thrall to the aforementioned to change their minds.

    It is not unusual to hear a person who has always voted for a particular political party to say, while acknowledging that their party has been in power for years and proved itself to be incompetent, corrupted and lacking ideas, that they will continue to vote for it because “imagine what another party would have done if it had been in power during the same period,” something that, obviously, cannot be known. This is your individual as a sea squirt, operating to her full potential with two orifices while comfortably attached to her easy chair.

    In a similar vein, there is no end of people willing to tell you that tobacco smoking is the worst thing that anybody could do, but who will then add that, nevertheless, “can you imagine the awful things that vaping could usher in in the long term.” These two-orifice people look for nothing new, listen to nothing new and say nothing new.

    This resistance to doing things in new ways, even putting one foot in front of the other, was highlighted by John D. Barrow in The Book of Nothing when he quoted Francis Cornford. “Every public action, which is not customary, either is wrong, or, if it is right, is a dangerous precedent. It follows that nothing should ever be done for the first time.” Crazy as it might seem, this is where we are with vaping. Traditional tobacco products are customary, so they are OK, but vaping devices could set a dangerous precedent.

    It must have been the case that sea squirts or their relatives were in charge at Suring School in Wisconsin, USA, recently. According to a Vaping360 story relayed by Tobacco Reporter, Wisconsin legislators have had to propose a bill that would make certain invasive searches of students illegal.

    “The proposed law follows searches of students aged 14 to 17 last year in Suring, Wisconsin, in which the students were made to strip down to underwear in order for the superintendent to search for vapor devices,” the story reported. “The students were not told that they could decline the search, and parents were not informed until after the searches were completed.”

    At first, I found this story difficult to believe because it requires your accepting that somebody, or some people, thought that one way of protecting students, who might or might not have been carrying vapes, would be to humiliate them. They apparently thought that theirs was a proportionate response to student vaping.

    The students were 14 to 17, at a time of their lives that many find difficult to navigate, when they should be able to rely on the adults running their school to set an example of rational, humane behavior. Instead, they seem to have been confronted by adults obsessed with enforcing petty rules even to the extent of carrying out strip searches, which most people probably associate with prisons.

    I would suggest that even if those students vape for 50 years, it will do them less damage than the memory of being strip searched. I salute the legislators who are seeking to stop such incidents occurring again.

    An issue that seems to me to arise from the above story and one from Sheridan, Wyoming, USA, is that a lot of adults need to grow up. Their ideas on rules and discipline seem to be aligned with those of your average 13-year-old, which often tend to be inflexible. According to a Sheridan Media story relayed in TR, the city council in Sheridan was due to consider an ordinance pertaining to vaping and tobacco use by minors in the city.

    “Under the proposed ordinance, any minor [I assume, anyone under the age of 21] found possessing tobacco or electronic cigarettes (vaping devices) would be subject to a tiered system of fines through municipal court,” the story reported.

    Credit: Olly

    It’s none of my business, I suppose, because I don’t live in Wyoming, but, nevertheless, perhaps I could respectfully suggest that there should be some consultation on this. Perhaps the authorities might do well to draw on the expertise of people informed about comparative risks and gun laws in Wyoming, where I gather from the internet that just about anybody in the state who is above the age of 18 may carry a gun.

    As elsewhere, in clamping down on vaping devices, the authorities in Wyoming seem to be more concerned about things that people can protect themselves from, such as vaping, than about things that it is difficult if not impossible to protect themselves from, like being shot. At the outbreak of the Covid-19 pandemic, the World Health Organization seemed more intent on putting on an anti-tobacco/anti-nicotine conference than protecting us from a deadly virus that, unlike tobacco smoke, could and did sweep unseen across borders.

    By the way, the Centers for Disease Control and Prevention (CDC) rank Wyoming as having a firearm mortality rate of 25.9 per 100,000 people, which places it third highest, below Mississippi (28.6) and Louisiana (26.3). And, as another aside, this raises an interesting question about whether the CDC believes that gun ownership is a disease, but that is not for discussion here.

    Although, having said that, language does matter, according to Johanna Cohen, Bloomberg professor of disease prevention and director of the John Hopkins School of Public Health’s Institute for Global Tobacco Control. Cohen stars in a video that seems to be an advertisement for language purity by scientists and academics working in the field of opposing new-generation products (NGPs).

    It is a rather confusing video to my way of thinking because, while the voice-over makes the point that language evolves, Cohen seems not to be a Darwinist. She seems to lean toward genetically modified language, where such modifications are controlled by people such as her to avoid language developing adjectival diseases helpful to the tobacco industry.

    This all becomes rather silly in fact. At one point in the video, according to a piece by Alex Norcia writing in Filter magazine [I quote Norcia because, though I watched the video, I did not transcribe it], Cohen says that “words like ‘novel’ and ‘emerging’ are really misrepresentative by nature as a product is only new for so long.”

    I mean, come on, I know that a lot of people who like to go on about tobacco cannot resist dredging up the past, but what is she trying to do here, reignite the 1920s debate between Albert Einstein and Henri-Louis Bergson on the nature of time? As a bit of a diversion, is she seeking the illusive equation that will define for us the “now” moment? Cohen seems to want to set up an Academie Anglais when the object of the NGPs exercise should simply be to make it as easy as possible for those people who want to do so to switch from traditional combustible cigarettes to these less risky products.

    As always, if you want to make sense of something, it is best to seek out the experts, and by that, I don’t mean the scientists and academics. I mean the people who smoke and who use NGPs. At the bottom of a TR news report on the Filter piece, a viewer of the video was quoted as saying, “WE use these devices. WE define the terms. You need to stop talking and start listening.” Sixteen words that say it all.

    But Cohen is right in one way: Language is important, and those who support tobacco harm reduction (THR) should not be lulled into picking up and repeating whatever ideas the anti-tobacco/anti-nicotine activists put out. And there is a tendency to do this, especially within the tobacco industry, which is forever issuing mea culpas in an effort to curry favor with its enemies. One obvious example of this is the way in which just about everybody applies the word “addiction” to smokers and vapers without bothering to define what exactly is meant by addiction, something that I try to point up in another piece in this magazine.

    Another example can be seen in the otherwise useful World Vapers’ Alliance Policy Primer featuring case studies of the most successful countries that have embraced alternative products as a means of combating traditional smoking. It is unfortunate, in my view, that the primer at one point had this to say: “Quitting smoking is one of the hardest things to do, and smokers need all the support they can get instead of being stigmatized.”

    I find it hard to believe that anyone whose aim is to get people to switch from smoking to vaping would make this point, which I don’t think is even correct. For one thing, the hardest thing to do would vary from person to person, but it is easy to imagine that, for some people, obtaining a doctorate in quantum physics, playing Hamlet well, knitting a jumper with two arms in the right place, playing Wagner or listening to The Ring Cycle right through … might all come higher up the scale of difficulty than giving up smoking.

    I gave up smoking without recourse to any replacement or alternative products, and many of my peers did so, too, and I don’t for a minute believe that we were a particularly strong-willed bunch. Indeed, the figures showed that countless numbers of people did so at the same time.

    And even if this were not the case, I would find it difficult to understand under what circumstances any sensible person would try to encourage another person to do something by telling them it was difficult. It is time to take advantage of some corporate speak. For years now, no company worth its salt has faced problems; it has instead faced challenges. Note, the obstacle hasn’t changed, just the way of looking at it.

    The worker faced with a problem is entitled to hold her chin and shake her head. The worker faced with a challenge is set up to measure the height of the obstacle and the length of the run-up needed to clear it.

    We of the THR persuasion should not perpetuate the myth that quitting tobacco is difficult. We are not sea squirts attached to the anti-tobacco/anti-nicotine rock and being force-fed its solutions. It is not in our interests to perpetuate such myths, though it could be seen as being in the interests of those in the anti-tobacco camp. After all, if smokers came to know that it was not difficult to quit, they might do so and put those employed to be anti-tobacco out of work.

  • House of Cards

    House of Cards

    Credit: Nakul

    If you improve the way that you implement bad policies, you are still left with bad policies.

    By George Gay

    Yet another report has demonstrated that the quest to encourage cigarette smokers to switch to the consumption of less risky tobacco and nicotine products is being subsumed under what now seems to be seen as the loftier aim of counting how many anti-tobacco policies and strategies can dance on the head of a pin. Constantinople is under attack.

    The report, Operational Evaluation of Certain Components of FDA’s Tobacco Program, was drawn up by an Independent Expert Panel convened by the Reagan-Udall Foundation at the request, in July, of U.S. Food and Drug Administration Commissioner Robert Califf.

    I should point out, however, that the direction the report took was not due to some gratuitous decision on the part of those serving on the panel but was rather determined by the terms of reference they were given. According to the report, issued in December, the panel members were charged with conducting “an evaluation of the FDA Center for Tobacco Products (CTP) with the aim of addressing immediate issues and providing recommendations to position the center for greater success in the future.”

    But the key to the direction the panel took was provided in the following sentence. “This report focuses on operational issues; it does not address tobacco policy.”

    In other words (my words), the panel members were given the task of addressing the symptoms afflicting the CTP, not the causes of its malaise. Their task resembled that undertaken by engineers charged with halting or slowing the collapse of the Leaning Tower of Pisa. Theirs was not to ask whether the tottering tower was fit for purpose. Theirs was to underpin the edifice.

    Of course, there was a major difference between the engineers working beneath the tower and the academics working to prop up the CTP. The former had the joy of working on a beautiful, if foundationally flawed, Romanesque campanile that each year attracts countless tourists. All panel members had to work on, however, was the CTP edifice, whose superadditions rival those of a Gaudi building while lacking the charm or joie de vivre.

    But I have digressed and, in doing so, skipped over something mentioned above that might have puzzled—even angered—some readers. I can assure you, however, that I detected no implied irony in the statement that the aim of the report should be, in part, to provide “recommendations to position the center for greater success [my emphasis] in the future.”

    Indeed, the report says that, since its creation in 2009, the CTP has accomplished a great deal. “Between 2009 and 2022,” it says, “CTP published 16 proposed rules, 16 final rules, 35 draft guidances and 50 final Level 1 guidances.” And the report continues in that vein, listing such things as the number of applications the CTP has dealt with, the manufacturing and retail inspections it has carried out, the number of warning letters it has sent out and the amount of money it has collected from retailers in civil monetary penalties.

    There are two things that strike me about this. The first is that it seems as though the tasks listed as having been carried out are merely part of the job description and therefore hardly worthy of remark.

    The other point is more important, I think. There was no mention within the paragraph on CTP achievements as to how many smokers the center estimates it has encouraged to quit their habit or how many it has encouraged to move, either partially or wholly, to less risky tobacco and nicotine products.

    Credit: Postmodern Studio

    This is significant because the CTP’s stated mission is to protect people in the U.S. from tobacco-related disease and death, and you’re a million miles from the coalface of such an undertaking if you’re sitting in your office sending out warning letters to retailers. In fact, we seem to be talking mission impossible. “The lack of clarity about CTP’s direction, its priorities and its near-term and longer-term goals and objectives hinders CTP’s ability to effectively carry out its mission,” the report says.

    Indeed, far from mission-judged achievements, the report is clear that things are not going well. “Tobacco is the leading preventable cause of death in the U.S., with cigarette smoking accounting for more than 480,000 deaths annually, according to the Centers for Disease Control and Prevention (CDC),” the report says. “Despite efforts to curb tobacco use, the smoking epidemic continues to contribute to an enormous, avoidable public health catastrophe.”

    And the report then goes on to provide some statistics on smoking and vaping and their outcomes in respect of U.S. adults and young people. With the exception of the references to vaping, that same summation, including the huge death toll, could have been made before the formation of the CTP. It would seem that no progress has been made.

    On the other hand, the report seems very good given the limits of the panel’s mandate, which saw it address four CTP program areas: regulations and guidance, application review, compliance and enforcement, and communication with the public and other stakeholders. As far as I am able to judge and given the time restraints involved, the panel members seem to have consulted widely, summed up the situation well and presented a host of necessary recommendations to improve the performance of the CTP.

    I would worry, however, that in trying to implement the recommendations, the CTP would simply take on more work at a time when it is said to be overworked and almost overwhelmed to the point of being regularly reactive rather than proactive. Whereas the recommendations, if implemented, would no doubt be timesaving in the long run, it is difficult to see how the CTP can put those recommendations into place in the short term without additional resources, which we are told are in short supply.

    Surely, the only way out of this vicious circle is to go back to basics and trim the policies to the resources available. This would be no bad thing in any case. The level of complexity of the CTP’s proffered solution to the problem of tobacco consumption is out of all proportion to the problem, or how do we put it now? The “challenge,” or, more recently, the “solution opportunity.” Concentrating on operational aspects means that the CTP, having lost sight of its objectives, is going to redouble its efforts.

    While the panel was robust but diplomatic in its presentation, the report will not have made easy reading for those at the top of the CTP. Reading between the lines, I came away with the impression that the performance of the center has been unnecessarily bureaucratic, confused on the question of the interaction between science and policy, verging on the chaotic and, in large part, ineffective. But, in fairness, I must say that this was broadly my opinion before I read the report, so I cannot claim that my reading was impartial.

    In what I thought was the most important aspect of the report, the panel addressed the tricky issue of science and how it informs the CTP’s work. The report notes that some issues before the CTP were fundamental policy questions that had to be informed by science but were not, themselves, scientific issues. “Rather, they are policy issues with profound societal impacts,” the report said.

    And then it went on to make what is a vital point about an issue that, to my way of thinking, has tripped the CTP up on its mission path. One such question that scientific analysis alone would not resolve, the report said, was how to weigh the public health benefits achieved through smokers using electronic nicotine-delivery systems (ENDS) to completely quit smoking combustible tobacco products against the public health harms that might occur if young people used ENDS and thereby acquired a lifelong addiction to nicotine or proceeded to use combustible tobacco products,

    Again, in fairness, I don’t believe that all the problems that have beset the CTP since it was set up as part of the FDA following the passing in 2009 of the Tobacco Control Act can be laid solely at the door of the center. The decision to hand to the FDA responsibility for the oversight of products whose consumption was known to be risky was fraught, especially given the tendency of politicians to use tobacco as a way of burnishing their often tarnished credentials in the eyes of populations made up overwhelmingly of people who do not use tobacco products. Putting the boot into smokers is generally a vote winner.

    The CTP has been confronted, too, with legal challenges, but here it must be prepared to take a large part of the blame because important aspects of what it has done have been characterized by a lack of consistency. The report is awash with stakeholder comments about a lack of clarity, transparency and communication regarding its priorities and its decision-making processes.

    Application processes were said by stakeholders to be extremely cumbersome and time-consuming, with submission requirements vague, frequently changing and favoring established companies. Application reviews were said to be inefficient and unpredictable, which is unsurprising given that FDA employees described the past several years of application review programs as full of ad hoc troubleshooting and abrupt shifts in direction.

    What will have particularly exercised the minds of most of the readers of this magazine are those sections that deal with tobacco harm reduction issues, though much of what was said will have been widely known. At one point, the report notes that the agency announced its intention to apply a harm reduction strategy designed to move tobacco product consumers down the continuum of risk: switching from using combustible tobacco products to noncombustible products.

    “However, stakeholders observed the agency’s more recent marketing authorization decisions appear to reflect a policy shift—specifically a reluctance to authorize any … ENDS other than those that are tobacco flavored,” the report notes. “If such a policy shift occurred, the agency did not specifically announce it in a regulation or guidance, leaving stakeholders to glean it from documents posted on FDA’s website such as a Technical Project Lead (TPL) review of PMTAs [premarket tobacco product applications], MDOs [marketing denial orders] posted in abbreviated form, or from heavily redacted documents provided in response to Freedom of Information Act (FOIA) requests.”

    There are two main points in the report with which I would take issue. My main gripe concerns the following sentence. “Although CTP has a critical mission to protect the public health from tobacco-related disease and death and is regulating products that have no inherent benefit and huge societal costs, it is a government regulatory program with a duty to run efficiently, fairly and transparently.”

    “No inherent benefit”? Unless I am misunderstanding what is being said here, and I hope that is the case, I have to ask how such a distinguished panel can have arrived at this idea. How can the panel say that a product consumed by, we are told, more than 30 million people in the U.S., often at great financial sacrifice, has no inherent value? Is the panel saying that these people have no agency—are zombie consumers?

    The other issue has to do with enforcement of the various rules laid down by the CTP, which were seen by some CTP staff and stakeholders as being cumbersome. There seemed to be a suggestion that a task force should be formed of half a dozen or so agencies, including the Bureau of Alcohol, Tobacco, Firearms and Explosives, and the Department of Homeland Security.

    Wouldn’t this be somewhat heavy handed? Whenever such issues arise, surely it is incumbent upon us to take a step back and ask, is enforcement really the problem? Is it time to increase penalties as some apparently suggest, or is it time to say that perhaps the rules are the problem? And, in this case, it seems to me that the rules are the problem, or rather that the problems arise because the rules are changed without warning and are therefore difficult to follow.

    Overall, given such circumstances, I cannot see how this report will help smokers, even indirectly. The problem lies in the CTP’s policies. If you improve the way that you implement bad policies, you are still left with bad policies.

  • Step by Step

    Step by Step

    Credit: Balint Radu

    Embracing tobacco harm reduction involves more than words, and consumers should be involved.

    By George Gay

    Earlier this year, I received a press note headed, “Recommendation: Seven steps for the new Italian government to reduce smoking”—a note that also carried the subsidiary heading, “World Vapers’ Alliance presents seven steps toward harm reduction in Italy as the new government takes office.”

    This was all very well, but there was something odd about the note because the text gave the first step in the strategy as “embrace tobacco harm reduction.” It seemed that the “seven steps toward harm reduction” had been reduced to one, “embrace tobacco harm reduction.”

    This is not meant as a criticism. I’m certain the people at the Alliance know the new Italian government better than I do, and if they decided it was best to keep things simple, if they deemed the government incapable of following a complex, seven-step strategy, who am I to argue? After all, there is no way that I would propose a seven-stage strategy to the U.K. government. Four would be the upper limit:

    1. Choose a new leader.
    2. Try not to crash the economy.
    3. Oh dear, never mind.
    4. At least try to embrace tobacco harm reduction.

    Okay, I lied. I might have a tiny criticism of the press note. One of the people who sat alongside Michael Landl, the Alliance’s director, when the strategy was announced in Rome, was the Italian MEP (Lega party), Gianna Gancia, who said, in reference to the proposed revision of the EU’s Tobacco Products Directive, that it was necessary for the Italian government to insist on some fundamental points concerning legislation on electronic cigarettes.

    “In particular, Italy should maintain a wide range of flavors, which would help the consumer in the transition from traditional to electronic smoking …,” she was quoted as saying in part.

    To my mind, the reference to “electronic smoking” was unhelpful and unnecessary. It will have played into the hands of the vaping industry’s opponents, who will be whispering into the government’s other ear, “see, they’re both smoking; there is no difference.”

    Why, if she wanted to advance the cause of vaping, did she not say, “… which would help the consumer in the transition from smoking to vaping, and in this way, attempt, rightly, to put clear water between smoking and vaping.”

    After all, the need for that division is well understood by the Alliance. The strategy announced in Rome is part of a Europe-wide campaign presented under the slogan #BackVapingBeatSmoking.

    Words matter. It was unfortunate, though understandable in some respects, that vaping devices were first referred to as electronic cigarettes, but we are where we are. There is no need to hand more ammunition to those opposed to vaping and tobacco harm reduction.

    Although I never write headings, I am fascinated by them to the point where I keep pinned to the notice board above my desk one of my all-time favorites, a heading cut from a years-old issue of the London Review of Books, which simply says: “They treat us like shit.”

    You could complain that this heading isn’t a good one because it’s not obvious who “they” and “us” are, but, my goodness, it makes you want to read the piece. In fact, it was about those in power in an authoritarian state, the “they,” and the ordinary citizens of that state, the “us.” The heading has about it an air of whimsy on the point of turning violent. It seems to pour from the lips of the downtrodden, who are finally plotting revolution. Of course, it is lifted by the final scatological note, but, above all, to my way of thinking, it is blessed with brevity.

    The trouble is that, in going for brevity, you need to be careful not to wind up following the path of reductio ad absurdum, which, I’m afraid, is the route this one from opinion.inquirer.net took: “Harm reduction for tobacco?” When I first read this heading, I was excited because I thought that what was on offer was a forward-looking opinion examining ideas about plant consciousness and whether it is morally wrong to tear leaves off living tobacco plants, process and burn them.

    Surely, at the very least, the heading should have read, “Harm reduction for tobacco users?” because that was what the piece was about. Or perhaps not. After all, many of us constantly use the expression “tobacco harm reduction.”

    One final point. Since when has it become OK to put a question mark at the end of a heading introducing an opinion piece? An opinion writer surely provides her opinion; she doesn’t pose questions and ask for the reader’s opinion.

    It’s little wonder that I’m fascinated by headings. Look at this one from theguardian.com: “Australian teenagers are readily accessing illegal vaping products. Here’s how Christina Watts, Becky Freeman and Sam Egger for the Conversation.”

    This, I assume, was written by somebody who believes that it is not only acts that are illegal, a point of view that has made common the hideous phrase “illegal immigrant,” meaning somebody who by their very existence is illegal. This unfortunate person might, in desperation, have committed illegal acts in order to get to what she hopes is a country that will not persecute her, but she is not illegal.

    Is this sort of heading just a mistake? I hope so, because otherwise, it is purposely trying to shift the blame from the teenagers to the perfectly innocent vaping products. It is the teenagers who are committing the illegal acts, possibly in cahoots with sellers acting in an illegal manner.

    I shan’t comment on the second sentence of the heading, which is simply too awful to contemplate.

    I’ll give the headline writer at ctpublic.org her due because it seems she was embarrassed enough to put the phrase, the more lethal product, inside inverted commas: “New Yale study suggests higher e-cigarette taxes could push vapers to smoke ‘the more lethal product.’”I guess she, but not the person responsible for the quote, is aware that there are no degrees of lethal. Something is either lethal or it is not; just as something is unique or it is not, despite the common use of phrases such as “really unique.” But I must say that I would have been more impressed if the heading had been cut after the word “smoke.”

    Otherwise, it would have been less coy to have replaced “the more lethal product” with “combustible cigarettes,” or have we become so sensitive that we can no longer refer publicly to combustible cigarettes?

    When is a sobriety test not a sobriety test? How about, for instance, when the test is being applied to discover whether you are under the influence of alcohol? That would surely be a drunkenness test.

    I started to wonder about this on seeing a Eurekalert news story entitled “Can vaping cause you to fail a sobriety test?” Talking of a sobriety test seems to me to assume that drunkenness is the default setting of the human animal, who has to be tested whenever she displays signs of sobriety: talking coherently, acting rationally and driving in a straight line on a straight road.

    But this is nonsense. I mean, no matter what the gleaming adverts might want to make you believe, you don’t go along to your local hospital or clinic to have a wellness test. You go along to find out whether you are suffering from some disease or other. Even if you go along for an annual checkup, the tests are looking for early signs of disease, not early signs of wellness.

    The idea of a sobriety test seems to smack of a police state in which people are pulled over for acting in what I would describe as a normal way. And for those people concerned with human rights and the fear generated by slippery-slope theories, it could lead to anxieties over whether people could be pulled over for other normal behaviors: breathing, thinking and being happy.

    The heading is also misleading, in my view, because it implies that the fault lies with vaping whereas it lies with the testing, as is almost made clear in the story’s introduction. “While ethanol [alcohol] is often a hidden ingredient in e-liquids, a new study finds vaping won’t trigger a false positive sobriety test—but only if police employ a proper waiting period [between stopping the driver and testing],” the introduction states. It is important to make clear that the “proper” waiting time referred to is in fact the standard time used in a DUI (driving under the influence) roadside stop.

    Note, too, how we’ve gone from the possibility of vaping’s causing a person to fail a sobriety test, according to the heading, to the possibility of its causing a “false positive sobriety test,” according to the introduction. What is this “false positive sobriety test?” To me, this means that the person being tested has gotten away with it when she should have been charged with DUI, but according to the context, a person who is positively sober is in fact drunk.

    A heading on a recent BBC news story asked the question “Should disposable vapes be banned?” Any thoughts anyone? No?

    As is often the case with stories with headings that end in a question mark, no answer was given, though one person, perhaps two, were quoted as saying “yes.” It makes you wonder whether the person who wrote the heading read the story.

    Still, I mustn’t grumble. I think the BBC did well to give the issue of disposable vapes an airing, even if the story provided little more than an opportunity for people to complain about how carelessly discarded, disposable vaping products were littering the U.K. and an opportunity for everybody to blame everybody else for this state of affairs. This debate has not been encouraged nearly enough.

    There is clearly a need to go back to basics and ask whether vaping devices, disposable or otherwise, are a positive. This means honestly addressing the question of whether we should, in trying to reduce the harm caused to smokers by their consuming combustible cigarettes, allow the further degradation of the environment. Yes, vaping devices might help individual smokers avoid the harms they would otherwise have suffered, but should this be at the expense of the environment and, therefore, everybody?

    The answer to this question probably depends on how many smokers can be switched to vaping devices and what is the level of environmental damage that will be suffered. And, of course, into that equation will have to be factored the environmental gains that will accrue because smokers who switch will no longer be discarding cigarette butts.

    Other factors will have to cover what percentage of vaping devices are likely to be disposed of properly if widespread recycling systems can be put in place and how efficient will be the recycling processes. It has to be remembered that some things cannot be recycled while others might require huge amounts of energy to recycle them.

    A major factor in my view concerns consumer attitudes. The blame for the abundance of cigarette butts that litter our streets and waterways is often heaped on cigarette manufacturers, and I would say that, despite the huge profits they have made over the years, they have never properly got to grips with this problem. But there is no getting away from the fact that it is consumers who drop butts on the ground. If they had been willing to put their butts in designated bins, it would have been a reasonably easy task to have them collected and recycled into pallets and whatever. But too many consumers have never proved amenable to doing this.

    The BBC story quoted one former vaper as saying that she had had no idea disposable vaping products were recyclable, adding that the messaging on the products could definitely be improved. “If the vape companies ran social media ads letting people know how to dispose of them, it would grab our attention,” she was quoted as saying.

    Now I don’t want to be harsh, but this sounds a bit flaky to me. People shouldn’t think it’s OK to consume an e-cigarette without taking some responsibility for doing so. If you Google “can vapes be recycled,” there is no end of information available. I’m not saying that this information will answer all your questions, but it will answer enough to allow you to dispose of your vaping devices in a way that will cut out much of the environmental damage caused by throwing them on the street.

    We should not let consumers get away with not acting responsibly. Otherwise, more people will be answering the heading’s question in the affirmative.

  • Gay: Rules Must Change for Seized Illicit Vapor Products

    Gay: Rules Must Change for Seized Illicit Vapor Products

    Credit: Innovated Captures

    By George Gay

    In the recent past, three stories have come to my notice that have recorded how vaping products have been seized by various authorities: in Hong Kong, where such products are banned; in Australia, where they are prescription devices; and in the U.K., where they are freely available. In Western Australia (WA), the ABC reported, WA Health recently seized 950 e-cigarettes, bringing the total seized for three years to about 16,000 “nicotine vaping products.”

    In Hong Kong, the HKFP reported, about 360,000 products had been seized since the implementation on April 30 of a ban on alternative smoking products including e-cigarettes. And in the City of Westminster (population an estimated 250,000), the U.K. Vaping Industry Association (UKVIA) reported, 4,500 disposable vapes were seized because they did not conform to local standards along with 420 counterfeit vapes and 2,366 snus products “with no English labeling.”

    The three stories were different, but they had one thing in common: None of them indicated what became, or what was to become, of the seized products, and I find this extraordinary and worrying, especially given that the three stories cited are probably the tip of the worldwide seizure iceberg.

    We are deeply into a global existential crisis caused by, among other things, climate change and pollution, so you might imagine that the first questions to come up would concern, among others, the carbon footprint of the manufacturing processes that produced the seized products, and how we can prevent these products, which will include batteries, from ending up in landfills.

    It would be hugely damaging if the products seized in the U.K. were just disposed of, even if they were recycled, but in Australia and Hong Kong, where, respectively, a ridiculous restriction and a ludicrous ban are in operation, disposal would simply heap one act of stupidity on top of another.

    If no such mechanism exists already, a way should be found to allow seized products to be diverted from markets where, for one reason or another, they have arrived but are unacceptable to other markets where they are acceptable. This, admittedly, would prove difficult, though not impossible, where counterfeit products were concerned, but otherwise should not be beyond the wit of those skilled in marketing and distribution.

    For instance, products seized in Hong Kong could be sent to countries that don’t ban them and where they comply with domestic standards, keeping the carbon footprint of the shipping as low as possible and selling them at the cost of the shipping to local suppliers to compensate for any market displacements.

    Credit: Earnest Tse

    A similar scheme could be applied to the disposal of vapes seized in the U.K., which apparently had “excessive levels of nicotine.” They could be shipped to someplace where such restrictions are not in place, once again keeping the carbon footprint of the shipping as low as possible and selling the products at the cost of shipping to local suppliers to compensate for any market displacements. Otherwise, in this case, simply change the rules.

    As far as I am aware, nicotine-level restrictions are usually based on arbitrary figures devised by bureaucrats who have never smoked or vaped and whose scientific advisers probably couldn’t justify such restrictions on a rational basis. I think I am right in saying that the EU imposes delivery limits on traditional cigarettes while, at the same time, denying that there are any health benefits in doing so. In fact, probably the only significant effect of imposing such delivery limits is to make it easier for young people to start smoking.

    In the past, policies based on irrational ideas were frustrating; now, faced with a mounting existential crisis, we simply cannot afford to allow rank stupidity to prevail because, applied on a wider basis, as they are, such policies are driving the planet further and further down the tubes.

    In my view, it is time to face the facts, but I’m not sure that everyone agrees. As part of the UKVIA story, Raj Mistry, executive director of environment and city management at Westminster City Council, was quoted as saying the raid that uncovered the illicit goods showed the local authority’s commitment to keeping Westminster clean and safe.

    “We are putting these questionable traders on notice that they will not be tolerated in our city,” he said in part. “We’ll continue to take action against such unsafe trading activities in order to keep our residents and visitors safe.”

    This emphasis on clean and safe makes nice newspaper copy, but it is a bit misleading. As far as I can see, none of the seized vaping products could be seen as being unclean, whatever that might mean, and there was no suggestion that either the off-standard or counterfeit products were unsafe, though that couldn’t be ruled out in the case of the latter.

    Credit: Adobe Stock

    On the other hand, London, of which the City of Westminster is a part, is certainly not clean or safe because air pollution throughout the capital is a huge public health issue, causing the premature deaths of thousands of people each year.

    In fairness, I should point out that Mistry’s comments would have concerned all of the illicit products discovered in the raid that uncovered the tobacco and nicotine products, which included, as well as the tobacco and nicotine products already mentioned, counterfeit mobile phone covers, counterfeit Apple AirPods, counterfeit Sony PS4 consoles, USB chargers with no safety labeling and unlabeled packs of shisha tobacco. Even so, the potential safety problems raised by all of these products would be infinitesimal compared with those associated with pollution, which is where I would concentrate my efforts if I really wanted to keep things clean and safe.

    I wrote the above just ahead of the arrival on May 31 of the World Health Organization’s World No Tobacco Day (WNTD). Normally, I pay no attention to this annual event, which I have always assumed is observed only by those who have no positive interaction with tobacco during the rest of the year as well. But this year, something has changed.

    This year, it seems to have come to the WHO’s attention that it is supposed to be a body concerned with health issues that cannot, like smoking, be dealt with at a national level— issues, such as those to do with pandemics, that don’t observe borders. So, this year, the theme of its WNTD is “Tobacco: Threat to our environment.”

    To my way of thinking, this represents a smart move and a good move. It is a good move, I believe, because it pushes at the door of reality. It doesn’t say so, but it offers the slightest of hints that the biggest threat to the health of the world isn’t tobacco or smoking but environmental collapse. At the same time, it is a smart move from the point of view of those implacably opposed to tobacco because it helps to underline the growing alignment between health and environmental activists.

    The tobacco and nicotine industry needs to be aware of this alignment and to take action wherever it can to ameliorate the negative effects it is having on the environment, and, wherever possible, to publicize what it is doing. It needs to do this because of the historical problems it has created through its lack of significant action in respect of such issues as deforestation and the careless disposal of cigarette butts and in respect of the more contemporary problems associated with e-cigarettes and some other lower risk products. And there should be no greenwashing. The industry should address these matters because it is the right thing to do, and it possibly needs to address them if it wants to keep on operating.

    Credit: Kulichok

    Ahead of WNTD, Action on Smoking and Health (ASH) in the U.S. issued a report titled “Tobacco and the environment: Case studies on policies to protect our environment and our health from tobacco.” As the title suggests, the report looks at how, in ASH’s view, the tobacco industry passes to society in general the health and environmental costs it creates. And it talks up possible remedies, such as that based on the “polluter pays” principle and the application of extended producer responsibility, and even the shuttering of the industry through policies such as those concerned with what is known as the tobacco endgame.

    Much of the report is based on the problems caused by traditional tobacco production and consumption, but e-cigarettes are included. “From mining to manufacturing, using and disposing, each stage of the e-cigarette product lifecycle presents novel environmental harms compared with traditional cigarettes,” the report says in part, quoting the American Public Health Association. “Tobacco companies already recognize that e-cigarettes pose new environmental burdens, necessitating them to manage new areas of impact due to the increasing use of electronics and batteries in [their] products.”

    I don’t agree with all aspects of the report, but it is impossible, in my view, to disagree with the underlying message that the industry has a duty to act decisively to greatly reduce the impact it has on the environment—a duty that, as far as I can see, supersedes any other duty that it might have.

    But let’s return to the Australia story and what might turn out to be a more positive outcome than is suggested by the seizures in WA. The story gets off to a depressing start with a WA Health spokesperson, Michael Lindsay, saying e-cigarettes are a major concern for health officials.

    “It’s very uncontrolled; the sorts of things that have been found in e-cigarettes include heavy metals and volatile organic compounds,” he was quoted as saying. “Several of these chemicals are known to cause damage to human cells and DNA and cause cancer. These are not chemicals that people should be breathing in or inhaling, and it’s really important that they are removed from the marketplace to protect public health.”

    Readers of this magazine will not be surprised that Lindsay did not mention that e-cigarettes were used largely by people as a low-risk substitute for high-risk traditional cigarettes or that he made no mention of pollution. But there is hope because a recent federal election in Australia saw a change of government. “Unfortunately, the outgoing Health Minister Greg Hunt was a fierce opponent of vaping, and let’s hope future health ministers are much more sensible and rational,” said a director of the Australian Tobacco Harm Reduction Association, Alex Wodak.

    Earlier in the piece, Wodak was quoted as saying that in Australia, e-cigarettes were disproportionately regulated compared to traditional cigarettes. “We know that the overwhelming majority of people who vape in Australia are current smokers or, even more so, former smokers, and they’re doing it to reduce the harm from smoking,” he said.

    “We’re trying to enforce laws which are really stupid.”

    Amen to that.

    This article first appeared in Vapor Voice 3, 2022.