Tag: George Gay

  • Gay: Shuttering Public Health England Bad for Public Health

    Gay: Shuttering Public Health England Bad for Public Health

    Credit: Glassdoor

    The axing of Public Health England could have a lasting negative impact on public health.

    By George Gay

    Reading through the U.K. Vaping Industry Association’s (UKVIA) Aug. 28 statement on “the transferal of responsibilities from Public Health England [PHE] and the future of harm reduction,” I was reminded why the UKVIA has been successful in advancing the interests of vaping and, in doing so, encouraging smokers to switch to a less risky form of nicotine consumption.

    In the face of a move by the U.K. government that conceivably could cause a significant setback to vaping, the association refused to engage with the negative. It did what it had to do; it accentuated the positive by performing a well-choreographed verbal sword dance while mentioning only in passing that the blades on the floor could deprive it of a few toes and perhaps much else.

    The UKVIA statement was in response to an announcement by the government that, at the end of March, it was to axe Public Health England, an executive agency of the Department of Health and Social Care, and transfer some of its responsibilities, but not its smoking prevention and some other obligations, to a new organization, the National Institute for Health Protection (NIHP). PHE has for a long time supported the use of vaping as a method of helping smokers quit their tobacco habit, and its declarations that vaping is at least 95 percent less risky than is smoking have been widely and confidently quoted in recent years; so the government’s announcement was a significant and potentially negative development.

    The UKVIA acknowledged this risk in passing but concentrated on encouraging the government to ensure that the transition of responsibilities from the PHE to other agencies was as smooth as possible. It began its statement, issued under the name of its director, John Dunne, by saying it would like to place on record its thanks for PHE’s considerable contribution to harm reduction and smoking cessation in recent years.

    “The independent and progressive stance taken by PHE has undoubtedly improved the health of the nation and saved lives,” it said. “In particular, PHE’s support of vaping as a vital harm reduction tool ensures an admirable legacy of falling smoking rates in the U.K., with all of the associated benefits to public health and the NHS [National Health Service]. PHE’s evidence-based approach provided many adult smokers with the reassurance they needed to explore the full range of smoking cessation options available to them.”

    Deflecting attention

    Let’s halt the statement there for a moment because I’m sure that a lot of readers will be wondering why PHE is being axed when it has done such a good job. Well, as is mentioned above, PHE’s responsibilities go beyond smoking prevention, and part of its remit has required it, along with other agencies, to engage in the fight against the coronavirus pandemic and the resulting Covid-19 disease outbreak. And since the U.K. government has proved to be scarily incompetent in the face of the coronavirus pandemic but a dab hand at shifting the blame for its incompetence onto others, PHE, one of the more publicly recognizable health agencies, was always going to be at risk.

    On Aug. 28, The Guardian, in a leader column, described the decision to abolish PHE during a pandemic as reckless, adding that it was part of the government’s strategy of casting about for scapegoats for its failings during the pandemic. The leader was headed: “[Prime Minister Boris] Johnson’s donkeys have failed the frontline workers they lionized.”

    The Guardian wasn’t alone in condemning the government’s action. On Sept. 2, a piece by the newspaper’s health policy editor, Denis Campbell, described how Britain’s doctors and public health experts had warned the prime minister that the abolition of PHE would damage the fight against obesity, smoking and alcohol misuse. “More than 70 health organizations have written to Boris Johnson outlining their fears about last month’s controversial decision to axe PHE, which prompted claims it was an attempt by ministers to deflect attention from their own failings over the coronavirus crisis,” Campbell wrote.

    Rearranging the deck chairs

    There was no way that the UKVIA was going to be drawn into this dispute and, in its statement, it merely noted that many of PHE’s responsibilities would be overseen by the newly formed NIHP, “which will take a lead role in safeguarding the U.K. from novel health risks.

    “The UKVIA completely acknowledges the need for new ways of working in combatting modern challenges and supports the government’s prioritization of public health,” the association said.

    “It is further reassuring that Secretary of State for Health and Social Care Matt Hancock confirmed his ongoing commitment to health improvement while announcing the NIHP’s formation. This is a commitment which the UKVIA shares and thoroughly supports.”

    You can see the UKVIA’s point. I mean, we are where we are, and there is little point in trying to reason a government with an 80-seat majority out of a position into which it seems not to have reasoned itself. But there is no reason not to have a parting shot, and I think the Liberal Democrats’ health spokesperson, Munira Wilson, had the situation nailed when, according to Campbell’s piece, she said: “Now is not the time to rearrange the deck chairs.”

    One of the dangers as I see it is that the government made its decision to axe PHE without having thought through what should happen to all of PHE’s responsibilities, including its role in preventing smoking. In other words, it was rearranging the deck chairs without any idea of where to put many of them; so the worry must be that some will wind up overboard as jetsam.

    And it was clear that the UKVIA too was concerned about this aspect of the government-announced changes. “To protect the many successes of vaping in U.K. public health, as well as empowering further positive change in the future, it is vital that this progressive, evidence-based culture continues,” the association’s statement said. “Whenever responsibilities are transferred, there is a risk that invaluable institutional knowledge and memory is lost. This would be to the detriment of the U.K.’s millions of smokers and vapers and cannot be allowed to happen in this case.

    “The UKVIA therefore calls upon the custodians of PHE’s former responsibilities, in the event that they are indeed reallocated, to continue their positive approach towards harm-reduction technologies. Independent reviews, studies and statements, all focused on facts rather than hearsay, have been a cornerstone of a successful British vaping industry which supports adult consumers to make a positive change for their health.

    “The UKVIA will continue to do its utmost to ensure that adult smokers and vapers have access to the high-quality products they need as well as the reliable information and advice needed to empower their choices. Assistance in this regard from public health bodies is vital to ensuring that the positive potential of vaping is not squandered in the U.K. We look forward to engaging constructively with all public health partners.”

    Hoping for the best

    I have no idea how this will pan out because there is much going on in the U.K. at the moment that will impinge on health issues. The U.K. government is in the process of breaking—I use the word with care—its final bonds with the EU and trying to sell off the last of the family silver—the NHS—to the highest bidders as part of a trade deal with the U.S., though it remains to be seen whether any nation will want to sign a deal with a country that, as this piece was being written, was openly talking about breaking international law so as to renege on part of the Brexit withdrawal agreement signed by Johnson in January with the EU.

    In part of his story, Campbell quoted Wilson as describing the axing of the PHE as “nonsensical.” She is right of course, but only if you assume that the aim of the government is to improve public health, and nothing I have observed in the actions of the government would lead me to believe that it is particularly interested in such munificence. I would guess that if the work of the PHE in supporting vaping and, therefore, smoking reduction, is continued, it will be down to luck, not to the deliberate actions of the government.

    Whatever happens, all is not lost in the U.K. vaping sector. The UKVIA is used to navigating the choppy waters of vaping rules and regulations. In March, it wrote to the government asking that specialist vape shops be allowed to stay open during the coronavirus lockdown and requesting support for the industry during and after the crisis was over. It made the point that because such shops had bucked the trend of high-street attrition, and because they provided much-needed specialist advice, they were the source of economic and health benefits to the communities they served.

    The UKVIA won the backing of Sir Kevin Barron, former MP and honorary fellow of the Royal College of Physicians, and further argued that closing vape stores would be a potentially counterproductive move that could place further strain on the already overstretched NHS. Due to the stress caused by the coronavirus pandemic, vapers who could not access their specialist stores and the advice available there were at risk of falling back onto cigarettes, which were more readily available.

    On this occasion, the UKVIA was not successful, in part I would guess because the government would have taken the view that closing specialist shops would not have prevented vapers from obtaining their products, or at least substitutes for their usual products, in the food and corner shops that were allowed to stay open, and, for those with internet access, via online suppliers.

    But though it was not successful, the UKVIA again chose not to embrace the negative. While continuing to lobby the government to review its decision on vape stores, it switched its focus to keeping its members informed about their obligations under government guidelines and the opportunities still open to them, such as online or home delivery services in the case of retail outlets. And following a report in a national newspaper that a vape shop owner had been arrested by police after keeping their retail outlet open despite the government directive, the association issued another note urging vape stores to adhere to government guidance to remain closed during the current lockdown.

    “We understand that we are talking about people’s livelihoods here, but it is paramount that the industry follows the government guidance,” said Dunne. “We have to wait until we get the green light to reopen.”

    And the green light was triggered on June 15, at which point the UKVIA praised the U.K.’s vaping businesses for the responsible approach they had taken during the 10-week lockdown. In a statement issued at the time, the association said it believed that the entrepreneurial spirit that had seen many vaping companies transform their business models overnight would mean they would be well placed to bounce back.

    “The response from the industry to the challenging conditions has been both staggering and exemplary,” Dunne was quoted as saying. “I know that our members that make up a large share of the vaping market have been working around the clock to provide online and home delivery services to the 3.2 million vapers across the country.”

    And this strategy has apparently worked for both vapers and vaping businesses. Feedback from UKVIA members indicates that few stores closed permanently because of the lockdown. Overall, demand is said to have stabilized, though it is probably inevitable that some vapers will have returned to smoking, either temporarily or permanently. Part of that demand has almost certainly shifted permanently to different supply streams.

    Many retailers saw big increases occur in their online sales, and it must be assumed that at least some vapers who discovered home delivery services during lockdown will stay with such services. It is difficult to know how this will pan out over the long term, but there are reasons to be positive. The sorts of services offered by high-street retailers have probably appealed mainly to novice vapers, and with about 3 million vapers and 7 million smokers in the U.K., the potential for recruiting more vapers to high-street shops must be high.

    Having said that, the uptake of vaping in the U.K. has slowed in recent years and, for reasons that will be familiar to readers of this magazine, it is proving harder to persuade large numbers of smokers to move to vaping. Concerns around this situation can be discerned in at least two of the UKVIA’s four strategic objectives: to reassure smokers about vaping so they continue to see vaping as the best way to quit their smoking habit and to give confidence to existing vapers about vaping so that they don’t go back to smoking or other alternative ways to break their former smoking habit.

    Another objective is to heighten the understanding among the political/public health community of the positive impact that vaping has had, and continues to have, and highlight the potential adverse impact of vapers returning to smoking and smokers not transitioning across. This brings us back to the beginning of the story by raising the question of whether the realization of this objective will be made more difficult if the UKVIA has to start afresh with a new public health body.

    This story can be found in Issue 5, 2020 of Vapor Voice.

  • Gay: Tax Vapor Lower Than Cigarettes for Public Health

    Gay: Tax Vapor Lower Than Cigarettes for Public Health

    Credit: Phong Nguyen

    Encourage smokers to switch to vapor products by taxing them lower than traditional cigarettes.

    By George Gay

    Recently, I was intrigued by the following heading that appeared above the abstract of a scientific paper: “Flavors enhance nicotine vapor self-administration in male mice.” I guess that, as a nonscientist used to reading general stories, I was drawn to the fact that there seems to be no human agency in the activities described. The flavors seem to operate of their own accord and the male mice “self-administer” those flavors.

    Notice, too, how the flavors not only increase the uptake of nicotine vapor in male mice, they also “enhance” that uptake, presumably introducing some sort of measurable qualitative increase to the process. And what about this self-administering business? It seems to suggest that the male mice in question have personalities or egos, which I would be happy to accept but which raises the question of whether it was morally acceptable that these mice should have been used as a means to an end. I would say no.

    Of course, if the mice did display signs of selfhood, I hope the researchers took care in interpreting their reactions. There is a danger of significant error in drawing human-centric conclusions about the behaviors of nonhuman animals being made to take part in human-designed experiments since those behaviors might be driven by the ways in which nonhuman animals uniquely experience their lives and that we do not understand.

    Such experiments on nonhuman animals seem to me to be simply preposterous. Professor Sir George Pickering was apparently once quoted in the British Medical Journal as saying, “The idea, as I understand it, is that fundamental truths are revealed in laboratory experiments on lower animals and are then applied to the problem of a sick patient … It is plain nonsense.”

    In the abstract, the researchers sidestep this problem by dropping any mention of the male mice from their “Conclusions and Implications.” The final sentence of the implications states, “This suggests that flavors in electronic nicotine-delivery systems significantly increase the risk of addiction-related behaviors among users of vaping products.” Obviously, the researchers have moved from male mice to humans because mice cannot be seen to be “users of vaping products.” And this move cannot, to my mind, be justified.

    I have two other gripes with this research as it was described in the abstract. One is that it cannot be morally acceptable to conduct experiments on nonhuman animals so that human animals can pretend to learn a little more about the silly—pleasurable, but nevertheless silly—habit they have invented called vaping. If they want to learn about the effects of vaping on themselves, they should gird up their loins and carry out the experiments on themselves. And, of course, ditto all the other silly things that humans like to get up to.

    The second gripe is that the research is pointless. Basically, it ends up suggesting that flavors are attractive—at least to some, I presume. I mean, doh! And despite this, the researchers have the cheek to mention as part of their conclusion “the need [my emphasis] to continue investigating the role electronic nicotine-delivery system (ENDS) flavors play in vaping-related behaviors.” I don’t think so. I think the researchers are confusing “desire” with “need,” which is a little worrying if the object of the exercise is to study addiction.

    But let’s leave the scientific world behind because, while I was intrigued by the heading quoted at the start of the abstract, I was astonished by one introducing a recent general story: “Illicit cigarette smuggling could be key to fighting PPE fraud.”The heading seems to imply there is a form of cigarette smuggling that is not illicit, that is licit, an idea I firstly dismissed as daft. But the heading kept nagging at my brain and I started to wonder whether the headline writer had a point.

    My confusion arose, I think, because I realized that whereas licit can mean lawful, it can have a softer meaning—something like “allowable.” So, if I were entering a country with 1,000 cigarettes on which I had no intention of paying duty even though the country in question required local duty to be paid on personal imports of cigarettes greater than 100, I would be smuggling or attempting to smuggle 900 cigarettes.

    I would be committing an unlawful act and liable to the penalties imposed by that country for such breaches of the law. But, as I understand things, I would be in the clear if I were a diplomat from another country and those cigarettes were in my bags, and in this case, I think that it would be arguable that I was smuggling in a licit or allowable way.

    And perhaps we could take this further. It might be stretching a point, but let’s extend the meaning of “licit” through “allowable” to “reasonable.” In fact, it’s not that much of a stretch; after all, the U.S. Food and Drug Administration uses the word “adulterated” as a synonym for illicit, and therefore, I presume, uses the word “unadulterated” as a synonym for licit, so, as I understand it, a cigarette is licit if it is unadulterated—if it contains nothing not declared in its list of ingredients—even though consumption of that cigarette will have you inhaling no end of toxins—unadulterated toxins presumably.

    In any case, let’s say my status has fallen on hard times and I’m no longer a diplomat but a gig worker being paid starvation wages so as to keep the multibillionaire owner of the company I work for in the luxury to which she has become accustomed. And let’s say that despite my lowly financial status, the government—with the help of the World Health Organization and its track-and-trace system (property, not people)—requires that I pay the same taxes on a pack of cigarettes as does the owner of the company. Might it be reasonable or licit in these circumstances for me to say, “you can stick your tax-paid cigarettes where the sun doesn’t shine” and take advantage of the services of my local smuggler?

    After all, it cannot be reasonable—dare I say licit—that each of us pays the same level of tax on our cigarettes, and here’s why. Cigarette taxes are there, we are told, to discourage people from smoking, but it would be absurd to suggest that the same level of taxes would discourage me, the gig worker picking up $10,000 a year, and the multibillionaire, picking up $100 million a year.

    If the powers that be reckon that taxes of $5 per pack of cigarettes are going to deter me, they should make the multibillionaire pay $50,000 per pack in taxes. Anything less would not be fair on the multibillionaire because she would not be discouraged from smoking and her health would be endangered. And I care deeply about the well-being of multibillionaires.

    To my mind, not only is the heading odd, but the story is too. At one point, we are told that the same networks developed to smuggle cigarettes and tobacco are now being used to perpetuate medical and personal protective equipment (PPE) fraud. This seems to imply that existing cigarette smuggling networks reach into the places where PPE is used: hospitals and care homes, for instance, and, frankly, I find this implausible. Surely, the networks that would be used, at least those at the sharp end of the supply chain, would be those that reach naturally into those facilities—perhaps those providing counterfeit drugs.

    Once again, we seem to have a story that attempts to blame smokers for the evils of the world. And to me, this makes no sense because it allows us to ignore, and therefore not address, the real causes of PPE fraud: the inappropriate and often cruel interactions of human animals with nonhuman animals that give rise to zoonotic diseases; globalization and the free flow of goods and people from centers of such interactions to the rest of the world, which ensures the “efficient” spread of these diseases; the overreliance on the market economy that in the case of the current coronavirus pandemic meant that not enough PPE was available or obtainable at quick notice; and the poor or nonexistent due diligence performed by governments left exposed, by their own policies, to such shortages.

    Address these issues and you are on your way to preventing PPE fraud. Approach the problem by trying to eliminate tobacco smuggling and you are at best going to put a dent in such trade, but you will leave yourself open to PPE fraud—and much else.

    What has this got to do with you, a reader interested in issues about vaping? Well, the story seems to imply that not only are some smokers indirectly responsible for PPE fraud but that their actions could lead to a spike in the U.S. in the illegal trade in electronic and heat-not-burn cigarettes. I’m not sure, but I think the argument goes something like this: Tobacco regulation is causing more people to quit smoking, and some of these quitters are turning to vaping, which is the subject of a crackdown in the U.S. that will make licit vapor devices harder to obtain. Hence the predicted spike in the illegal trade in such devices.

    Overall, the message seems to be that smokers should keep smoking but only tax-paid cigarettes because the illegal tobacco trade funds groups such as ISIS, the Irish Republican Army, Hezbollah and al-Qaeda. Once again, the smoker gets it in the neck for events that are so far out of her control that she might as well be blamed for sunspots.

    There is not even an aside to suggest that the actions of ISIS, the Irish Republican Army, Hezbollah and al-Qaeda might be down to politics, ideology and the desire by governments, companies and shareholders to promote the sale of arms. There is no question raised about how much of the tax paid on a pack of cigarettes goes toward governments promoting arms sales. And there’s not even a whisper that religions might be playing a part in the activities of these groups. It’s all down to smokers who buy illicit cigarettes.

    Is it? Of course not. Smokers are the victims. Many smokers are paid starvation wages in the gig economy and, we are told, are addicted to tobacco, so they are forced into the arms of smugglers when they can no longer afford the unreasonable tax and increased pricing demands made of them by governments and manufacturers. It is deeply unfair, or illicit, for manufacturers making billion-dollar annual profits to introduce several cigarette price increases in a year and then blame impoverished, addicted smokers for turning to the illegal trade and thereby supporting ISIS, or whatever. They need to examine their own actions.

    In a fair or licit world, the solution would be clear. We don’t have to drag ISIS and the Irish Republican Army into the fight. And we don’t have to send researchers out with a brief to prove that sunspot activity is particularly prevalent directly above where smokers congregate outside pubs. We just have to charge a fair, or licit, price for cigarettes.

    Of course, if your moral compass is able to lead you around experiments on nonhuman animals but runs you into a brick wall when it comes to allowing others to enjoy a cigarette, there is another answer—apart from trying to reset your moral compass, that is.

    Encourage smokers to switch to vaping and other low-risk nicotine consumption, and definitely don’t discourage them from making the switch. And don’t get into the same fix with vaping as you did with smoking by piling on high levels of tax and creating a highly monopolized industry that is able to increase prices without due regard for the consequences of such actions.

    What are the chances that things will change? Poor, I would say. I go along with whoever said that the one thing we learn from history is that we learn nothing from history.

  • Changing the Tune

    Changing the Tune

    Credit: Mika Baumeister

    Authorities should create independent bodies to evaluate the science behind vapor—and base their policies upon the most credible evidence.

    By George Gay

    June 19, the Australian federal government announced a ban, from July 1, on the import of nicotine for vaping. The ban reportedly amounted to a de facto prohibition on vaping with nicotine because, while it provided for an exemption for imports made on the basis of a doctor’s prescription, the Australian Tobacco Harm Reduction Association (ATHRA) said that using such an exemption would have been complex, time-consuming and ultimately unworkable.

    But temporary relief was granted when, on June 26, the government announced that it was suspending the implemen-tation of the ban while it conducted a review and consultation around the classification of nicotine. At the same time, how-ever, it said that a new version of the ban with a “streamlined” [but at the time unspecified] method for people to obtain prescriptions would be brought in from the start of next year.

    There might be a good reason why the government is going to conduct this review when it has already decided to reintroduce a modified ban within six months, but it wasn’t immediately obvious to me what that reason might be. Having said that, perhaps there is no good reason. The government seems to have form in putting the cart before the horse.

    According to ATHRA, the June 19 announcement of a ban was made before the publication of a report that was based on a scientific inquiry into vaping commissioned, at a cost of aud750,000 ($529,403), by the health minister last year.

    I was reminded by all this of the nonsense song: “You put your left arm in / You take your left arm out / You do the hokey cokey / And you shake it all about.” I mean, even if you assume that vaping policy decisions in Australia are made on the basis of “two-up” and therefore might not always make a whole load of sense, that doesn’t explain the change that took place. Unless, that is, Australia is only partway through a best-of-three-throws series. In which case, before I get to the end of this piece, the policy might have changed again.

    Despite, like the rest of us, being fully paid-up members of the club of sentient animals, Australian smokers and vapers may be allowed to import nicotine for vaping only if they have a prescription from their doctors, a certificate from their spiritual advisers and a letter signed by their mums. For goodness’ sake, these are adults who are allowed to buy and consume any amounts of cigarettes and alcohol, which are surely the two most toxic consumer products on the market.

    I don’t want to trivialize what is a deathly important debate on vaping, but I find it difficult to take seriously such a rapid change of direction, even given that a week is a long time in politics. Of course, an argument can be made that the government acted responsibly in reacting to the opposition that quickly arose in respect of its June 19 nicotine ban—that it listened; that it had an open mind.

    But it must be of concern that the government apparently didn’t listen before it made its announcement. And there has to be concern that the government might have suffered the same fate as many of those who attempt to maintain a completely open mind—that is, its brain fell out.

    In fairness to the government, however, you have to say that the mess it got itself into was simply built on some fairly strong foundations already established by federal and state governments. For instance, as I understand things, even before the new ban was announced, nicotine for vaping was classified in Australia as a poison, and its import was illegal unless approved by the Therapeutic Goods Administration. Though, depending on the laws of individual states, nicotine could be bought over the internet provided it was for personal use. “You put your right arm in,” etc., etc .…

    There are many arguments to be made against a ban on the import of nicotine for vaping, most of which will be familiar to the people who read this magazine, and those arguments are being well made in Australia by individuals, organizations such as ATHRA and politicians, even some within the ranks of the ruling coalition.

    But one of the major problems for those opposing the ban is that it is irrational and, as has often been stated in the past, it is pretty well impossible to reason somebody out of a position that they didn’t reason themselves into.

    And there could be significant negative consequences if the government persists with its policy of banning nicotine for vaping. Despite the best efforts of the World Health Organization (WHO) to ensure that smokers continue to smoke rather than switch to vaping, the smokers of Australia, who, unlike the WHO, don’t exist in a bubble that protects them from unauthorized ideas, know that vaping might be their best route to harm reduction. And some of them will continue, despite the ban, to try to remain on that harm reduction route by obtaining nicotine through whatever means possible.

    This will inevitably create risks because some of that nico-tine will no doubt be produced in unlicensed premises and all of it will be mixed with other e-liquid ingredients by users with no training in such enterprises. Goodness me, to take another example, surely no government would encourage its untrained citizens to start producing their own alcohol?

    And it seems obvious that the Australian government recognizes the risk of homebrewing e-liquids because, as part of its original ban, it set the penalty for infringements at aud220,000. The severity of the penalties set for laws reflect a number of things and, it seems to me, in some cases, one of those is the likelihood that people will break the law because it is unreasonable. And nothing could be more unreasonable than introducing a law that makes it more difficult for an individual to try to improve his or her own health.

    URGENCY TO ACT

    But there are many people better qualified than I am to make the case against the ban and who will be using the time to the end of this year to do so. I am interested in a more general question that arises out of the shambles that was the ban and its suspension—a question that pops up in other countries, that has global repercussions but that is less often addressed.

    Why haven’t countries around the world and even the inter-national community arrived at a working consensus on vaping that leads us down a rational, clearly defined pathway with direction that can be adjusted as new information is received about the best way ahead?
    Why do we persist with performing the vaping “Hokey Cokey”? After all, you would imagine, I think, that this issue would be viewed by authorities around the world as a matter of the greatest urgency.

    We are told by the WHO that tobacco consumption, largely in the form of cigarette smoking, comprises one of the biggest public health threats the world has ever faced, killing more than 8 million people a year worldwide. At the same time, it is indisputable that some cigarette smokers have used vaping to purge themselves of their tobacco smoking habit.

    And, according to a timeline published by the Consumer Advocates for Smoke-Free Alternatives Association (CASAA), the idea of electronic cigarettes has been around for about 90 years, and the first commercial unit was pro-duced 17 years ago.

    In other words, there is clearly a need for urgency here, and there has been time to act. But as can be seen from the Australian experience—and Australia is by no means alone in this—17 years on, many countries are still at the most basic of consultation stages; or, to put it in the Australian vernacular, we’re still running around like headless chooks when it comes to vaping.

    FEAR OF THE NEW

    Why is this the case? I don’t know the answer to that question, but there are a number of possibilities that occur, some, unfortunately, that tend toward the sorts of conspiracy theories that tell you Covid-19 is spread by 5G and that you would be better off forswearing a Covid-19 vaccine, should one be developed, and protecting yourself instead by sitting in a darkened room with a mixture of cow dung and honey on your head while listening to recordings of the narwhal daring us to be free.

    Credit: Obi Onyeador

    But much as I like a truly bonkers conspiracy theory, I think I need to keep this piece on a reasonably even keel and, the more I think about it, the more I tend to the view that the major problem the world has in embracing vaping is that it is different to what we are familiar with—good old smoking. In The Book of Nothing, John D. Burrow quotes Francis Cornford as saying, “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.”

    Perhaps because it is not much into irony, the WHO seems to have taken seriously this reasoning in its approach to vaping. While acknowledging that much has been written about the potential of electronic cigarettes to help tobacco users quit, it says the evidence is inconclusive and goes on to advise against e-cigarette use.

    OBJECTIVE EXAMINATION

    Given the enormous differences between the constituents of tobacco smoke and those of e-cigarette vapor, and given the evidence that points to the ability of vaping to substitute for smoking for a significant number of smokers, the WHO’s position seems to take the precautionary principle to absurd heights. And one of the problems here is that the WHO exerts enormous influence over the health policies of many countries.

    But there is no need for governments of the world to slavishly follow the WHO line. There is available to governments a huge amount of information on vaping from which they can make their own judgements and decisions. At the same time, however, there is a problem because while some of the information available is reasonable, some of it is questionable and some of it is unreasonable.

    And since this information is being made available in a constant stream, there is probably little wonder that governments announce policies that within a week have to be suspended. To my way of thinking, what is needed, therefore, is for countries to establish taxpayer-funded bodies that are isolated from lobbyists and that are staffed with scientists who can examine objectively any scientific papers produced in respect of vaping and vapor devices.

    Such bodies would examine all such papers and exclude any, no matter what side of the debate they supported, that did not meet the required standards of methodologies and results interpretation.

    These bodies could then make precis for politicians of the papers that were found to advance the vaping debate. In this way, governments would be able to make decisions on the basis of facts, they would not be continually pulled this way and that by the latest bungled interpreta-tions of the results of biased research, and they would have no excuse for inserting their own biases.

    Of course, some would complain that this would be an expensive exercise, but given what we are told are the extremely negative health, economic and social con-sequences of the continuing smoking epidemic/pandemic, such expenditure would surely be repaid many times over.

    Others might complain that the U.S., for instance, already has the Food and Drug Administration (FDA) to oversee research in this way, and there is some truth in this. But the FDA also makes and enforces regulations, it interacts with those carrying out research and its decisions are subject to court challenges.

    Credit: Vaporesso

    The bodies I envisage would act sim-ply as filters that let through to regula-tory bodies only the research results that have passed close scientific scrutiny. They would perform peer reviews as part of a process that was properly funded and fit for purpose. They would not make policy recommendations and, importantly, their decisions would not be open to challenge, though the workings of these bodies would be subject to scrutiny by a suitable organization.

    Surely it would be worthwhile putting in place such bodies so that, if vaping has the potential that many people believe it has to prevent a significant number of smoking-related deaths, that potential can be fully realized. And, of course, if it were found that that potential did not exist or could not be realized, it would allow us to move on. Such a process has got to be better than doing the “Hokey Cokey” on a loop. V