Public Health’s Useful Idiot

Public Health’s Useful Idiot

“Big Vape is copying Big Tobacco’s playbook” says Liza Gross in her recent article on The Verge. This isn’t the first time, nor I suspect will it be the last time, that a media outlet tries to conjure up images of a faceless, and evil industry by conflating the tobacco and vaping industries.

Even if a representative of the vaping industry is interviewed (which is rare), the journalistic hack tries to subtly (or not so subtle in some cases) taint the piece with the usual “shill” claims.

Folk will remember that the US held their first ever E-Cigarette Summit in Washington, DC this year. It went about as well as expected considering the hostile environment and given that the UK’s own harridan went along to extol the virtues of the Tobacco Products Directive. Needless to say, that didn’t go down well with those watching on social media.

Samir Soneji had no idea what he was getting into when he agreed to talk about the potential risks of vaping at the first US E-Cigarette Summit in Washington, DC this past May. His first clue was the booing.

Now, I’ve been to two UK E-Cigarette Summit events and unlike many others that went, I actually wanted some dissenting voices to present. Instead, what happened was the usual public health and tobacco control types along with some eminent researchers talking to a room full of, you guessed it, more public health and tobacco control types. Oh, and the token few consumers, such as myself.

Whatever you may think of the individual or the information he (or she) is presenting, booing is just bad form - if indeed it actually happened. According to one who was present at the event, one Greg Conley, Soneji wasn’t actually booed. According to Greg, Soneji’s presentation followed a keynote speech by Ken Warner that “indirectly exposed huge flaws in his interpretations”.

Having read Soneji’s recent articles (here and here), they are, indeed, flawed. A fact which I’ll probably cover in another post, this one will be long enough as it is.

Do you see how this works yet? A scientist makes a cock-up in not one, but two papers. Presents at, what he deems a hostile environment, people don’t agree with him so he goes running to an “investigative journalist” crying victim.

As a professor at the Dartmouth Institute for Health Policy and Clinical Practice, Soneji studies how gaps in tobacco regulation affect health. Two years before the conference, he’d reported in JAMA Pediatrics that young people who smoke hookah or use “snus,” a form of moist smokeless tobacco, are twice as likely to try cigarettes as kids who don’t. He suspected that e-cigarettes, with kid-friendly flavors like “Cinnamon Roll” and “Peanut Butter Cup,” carried a similar risk. And that’s exactly what he and several colleagues discovered in a recent review of studies that tested that possibility.

Ah yes, the interminable “gateway theory”, which I have written about a few times on this blog (notably here, here and here). Thus far, with a few exceptions, there is no conclusive evidence to prove (or even disprove) the claim that e-cigs lead teens (or anyone else for that matter) to combustible tobacco. The UK evidence, so far, doesn’t show this. The US shows something else entirely, but that is purely down to how the US measure “use” (and conflate it with ’experimentation’). Almost as if they want there to be a ‘gateway’.

Many people in the audience, Soneji would discover, had an emotional or financial interest in vaping — and they didn’t pay up to $1,100 a ticket to hear anyone question the benefits of e-cigarettes. “I didn’t realize just how many people would be from the industry, and whose job and livelihood is [tied] to e-cigarettes,” he says. “Hearing about the harms of vaping came across as threatening to their existence.”

No doubt there were a lot of people from independent businesses and actual consumers present, and if those people were there, then there is no doubt in my mind that they were there to hear both sides of the debate. The thing is, you chose the one topic that has been, and continues to be, thoroughly debunked by all the data collected to date.

Public health campaigns have so successfully tied smoking to lung cancer that people often don’t realize more smokers die of cardiovascular and metabolic diseases than of lung cancer. Soneji tried to tell the shop owner, and many others at the summit, that smoking significantly increases the risk of cardiovascular disease and that recent studies suggest e-cigarettes also increase heart attack risk. But they didn’t listen to him. They didn’t understand how anyone could question the value of a product they believe helps people quit one of the world’s deadliest habits.

Except that it really doesn’t. The “increased risk” measured is aortal stiffness, which is caused by a variety of influencers, such as a jump-scare in a film. This is why we question the value of research that shows “harms” as it is usually riddled with flaws.

After the e-cigarette summit, a media outlet called Vaping360 described Soneji as “the speaker with the most tedious and pedestrian boilerplate anti-vaping agenda,” and attacked him and his co-authors as “a who’s who of terrible vaping researchers.”

Thing is, we keep an eye on researchers. For good reason. As many of you who are regular readers will know, the so-called “science” that is produced that ‘proves’ vaping is supposedly harmful usually has predetermined outcomes and the data is manipulated to suit the narrative. Or the study is poorly executed. Or suffers from one or more bias factors.

It’s hard to overestimate the power of personal experience. But personal anecdotes, no matter how plentiful or powerful, are no substitute for scientific evidence derived from rigorously designed studies that test alternate hypotheses and control for confounding factors. Scientists are just beginning to test the effects of vaping on the human lung. A recent review of studies concluded that e-cigarette use may cause “significant” toxicity to the lung, but noted that more research is needed. Long-term studies clearing e-cigarettes as reasonably safe alternatives to cigarettes have not been done. But that hasn’t stopped some vaping advocates from claiming they have.

I’ve read the paper linked in this paragraph, and it suffers from the same flaws as Stan’s “e-cigs don’t help cessation” meta-analysis. Full of conflicting bias, selection bias, limited sample sizes, over-exposure (in vitro), misleading information and host of other conflicts which render many comparative analysis papers meaningless.

And they can easily find compromised or less-than-complete studies to support their case. In April, British American Tobacco, or BAT — a major player in the vaping market and the largest tobacco company in the world — reported that vapor from its Vype e-pen barely affects disease-related genes in a simulated human airway. In a previous study, BAT asserted that the device produces 95 percent fewer toxic chemicals than a conventional cigarette. In 2015, a report from Public Health England, an executive agency of the UK’s Department of Health, deemed e-cigarettes 95 percent less harmful than cigarettes. But the conclusion was based partly on research funded by organizations and scientists with ties to tobacco and e-cigarette companies. Two years earlier, a study funded by CASAA reported that e-cigarettes pose minimal risk to users and bystanders.

This is pure hubris. Not one tobacco control paper has ever tried to replicate or invalidate research conducted by the tobacco industry. Instead, tobacco control and public health just cry “industry funding!” and ignore it. I’ve read papers from the tobacco industry, and while their conclusions are often biased in favour of their own product, the methodology is usually sound. The same cannot be said for a lot of the research from public health.

And we know, thanks to once-secret documents released through leaks and litigation, that tobacco companies spent billions of dollars to undermine evidence that cigarettes harm smokers and bystanders. In the infamous Whitecoat Project, Philip Morris hired law firms to find scientists, aka “whitecoats,” who would help “resist and roll back smoking restrictions,” a plan detailed in a formerly confidential 1988 memo, and keep the controversy about the hazards of secondhand smoke alive.

Again, referring to historical documents to “prove a point”. Yet neither tobacco control or any researcher loosely affiliated has bothered to replicate the papers produced by tobacco industry research. Not one. We’ve seen recently how editors of the tobacco control activist magazine have clearly stated that:

Just a decade ago, the vaping industry — which includes devices that typically heat nicotine-containing liquids to produce inhalable vapors — was largely the province of small businesses. Today, the market, which is valued at over $10 billion and expected to be worth $34 billion by 2021, is increasingly dominated by tobacco companies such as Reynolds American and Altria (formerly known as Philip Morris).

So what? This may come as a surprise to many, but I couldn’t give a flying fuck who sells the products. PMI are on record saying they want to phase out combustible tobacco, while BAT, JTI and RJR are also moving in the same direction. David O’Reilly from BAT provided Clive Bates with a guest blog on the disruption of the tobacco industry, which I suggest you read. This disruption, thanks to the timely device from Hon Lik (inspired by earlier attempts at such a device), is already happening, and now the tobacco industry is scrambling to catch up.

The easiest method? Acquisition. Buy up enough talent to get a foothold, then throw a lot of cash at R&D. And it is working. The tobacco industry doesn’t sell its products in independent stores, they are sold in large chains. Gas stations, supermarkets and corner shops. They have the distribution channel in hand, and the financial power to shift product quickly and get it to places where the independent vape shops can’t reach.

Taking the UK as an example, there are 3 Million vapers in the UK (a proportion of those are dual-users, but so what?) there’ll be a large percentage of those who buy off-the-shelf tobacco industry kit because it’s located in a more convenient place. I would suspect that the ratio of industry vs independent kit would be somewhere around 70/30, with the industry winning out.

Does it matter? No, it doesn’t. The fact is, those people are not smoking (or not smoking as much) which is what tobacco control and public health want.

Many vaping advocates say they’re competing with Big Tobacco, which they fear will stifle innovation. They say that taxes on e-cigarettes will penalize smokers trying to quit and that regulations requiring companies to disclose the ingredients in e-juice and conform to quality standards will bankrupt small entrepreneurs. Some may well be trying to put the tobacco industry out of business. But others have joined forces with some of the same actors and have deployed the same tactics the tobacco industry used to stoke doubts about smoking’s dangers while marketing “safer” delivery systems. They’re enlisting veteran tobacco industry law firms to contest federal oversight in court and partnering with tobacco-funded libertarian groups to fight regulation in states and cities, and they’re rallying armies of ex-smokers who believe vaping saved their lives.

It is known that Altria and RJR wanted restrictions on open systems, so it is fair to say that ‘big tobacco’ isn’t the best friend of the vaping industry, and it isn’t a stretch to say that some in the tobacco industry is actively trying to coerce measures that would damage the independent sector which would hand them the reduced risk product market. Who cares what law firms are being hired? If a firm is an expert in a particular type of legislation, it doesn’t actually matter who they are.

But for a harm-reduction argument to be valid, policy makers need strong evidence that vaping improves smokers’ health without creating a new set of risks — to both users and nonusers. So far, the evidence for quitting is mixed, while long-term safety remains unknown. A systematic review of studies of e-cigarettes and smoking cessation published last year reported that two clinical trials offer evidence that vaping leads to quitting, but cautioned that they were too small to have confidence in the results. Meanwhile, another review published last year, which included a broader range of studies, concluded that people who used e-cigarettes were actually less likely to quit smoking.

Who said anything about quitting? We’re talking about use, not cessation. Short-term safety is known and isn’t anything to worry about - as highlighted by both Public Health England and the Royal College of Physicians. Thing is, these folk want “long-term” data, yet there aren’t any long-term studies - as far as I know.

The trials mentioned, are actually covered by the Cochrane Review, which stated the quality of evidence was “low”, not that they didn’t have confidence in the results. While the other review is, of course, from Stanton Glantz which was roundly and thoroughly debunked. If the Cochrane evidence base is cited as “low” than the base that formed Glantz’s review would, therefore, have to be classified as “abysmal”.

Several studies have detected a range of toxic chemicals in e-cigarette vapor, including diacetyl, which is associated with the severe respiratory disease known as “popcorn lung”; aldehydes, which are probable carcinogens; acrolein, a potent irritant often found in air pollution; and the cancer-causing tobacco-specific nitrosamines that are also found in cigarette smoke. The few studies of people working with theatrical fog machines found that those working closest to the machines had reduced lung capacity — and they weren’t repeatedly sucking propylene glycol into their lungs like vapers do. What’s more, several studies report that heating propylene glycol and glycerin under normal vaping conditions can produce an array of toxic chemicals, including benzene, a known human carcinogen, and fine particles, which can cause heart disease.

Good grief, bullshit bingo right here. The “popcorn lung” shenanigans is thoroughly debunked. A risk is still present, sure. But there is no convincing evidence that “popcorn lung” has actually occurred in smokers as it is usually masked by other problems from inhaling burnt tobacco. Never mind the simplest of facts; the dose makes the poison. There are “safe” limits for pretty much everything, including the supposed “cancer-causing” tobacco-specific nitrosamines, which, by the way, are either not found at all in the vast majority of e-liquids tested, or found in trace amounts. Need I go on?

“Theoretical benefits are not evidence,” says Jonathan Klein, scientific director for the American Academy of Pediatrics Julius B. Richmond Center of Excellence, which studies tobacco. To get evidence on relative risks, at a minimum you’d need to track the disease rates of separate groups of people using different products to see if vaping reduces disease outcomes, Klein says. And if you want to protect public health, you’d prevent nonsmokers and young people from getting addicted, he says. “But that’s not the way it’s been approached.”

Well, it has over in the UK at least. Studies are underway that are tracking that (finally), but in the US researchers are intent on finding anything that can support the prohibitionist ideology.

Soneji says you could classify e-cigarettes as a net population benefit if the devices were better than cold turkey at helping adult smokers quit, and they didn’t attract children. Then they’d resemble conventional nicotine-replacement therapy, otherwise known as NRT (think Nicorette gum or Chantix pills). “No kids are really interested in NRT,” Soneji says. “And NRT is better than cold turkey for smokers interested in quitting.”

And though e-cigarette lobbyists compare vaping to needle exchange or methadone treatment, there’s a critical difference, Soneji says: unlike e-cigarettes, methadone isn’t designed to attract people who aren’t already addicted. “It’s not like you can buy mint-flavored methadone.”

Thing is, Soneji is completely missing the point here. These products aren’t solely for cessation. Like cigarettes, they are pleasurable for many. There are also plenty of former smokers that now vape, and have no intention of stopping vaping. NRT, on the other hand, has an abysmal failure rate (93%) for multiple reasons, but predominantly because NRT is not enjoyable. There is no such thing as NRT-fest.

Unlike NRT, e-cigs are being treated in much the same way as cigarettes with age restrictions on purchase. Harm reduction doesn’t start at 18, and there are a number of under-age smokers out there - even more in the US where theage for purchase is now 21 in some States.

E-cigarettes, by contrast, are mass-marketed in flavors that appeal to kids, who can buy them online by clicking a link that says they’re 18 or older. In 2011, at least four years after e-cigarettes hit the US market, just over 3 percent of 6th through 12th graders had tried e-cigarettes. By 2013, over 8 percent had tried vaping. More than a quarter-million kids who’d never smoked cigarettes had tried vaping that year, researchers reported in Nicotine and Tobacco Research; they were nearly twice as likely to start smoking conventional cigarettes as kids who didn’t vape. By 2015, e-cigarette use among teens had skyrocketed to 27 percent, surpassing the use of every other tobacco product. In 2017, e-cigarette use among teens dropped for the first time, according to the latest survey by the Centers for Disease Control and Prevention, though e-cigarettes are still the most favored tobacco product.

Again, missing the point entirely. As I’ve discussed before, kids who try stuff will try stuff. The key factor missing from the US survey data being used in this paragraph is whether or not those kids who tried vaping, progressed to regular use. Fortunately for Soneji and his wild claim here, there isn’t enough granularity in the US survey data to say in either direction.

The final part of that paragraph misses the point, simply because when the ecig rate declined, the combustible rate increased. I know, correlation isn’t causation, but it is clear from survey data since 2010 that increasing ecig use has contributed to a steady, and in some cases, an increasing decline in combustible use. No doubt there are other factors. Unlike the UK:

H/T Christopher Snowdon

H/T Christopher Snowdon

A number of policies from 2006 failed to make any significant impact to the smoking prevalence, until 2011 when ecigs appeared on the mainstream market.

In 1962, British American Tobacco-contracted scientists began work on a “smoking device” to deliver nicotine without tar, a review of once-secret documents by Stanford historian Stephan Risi shows, “avoiding the well-known disadvantages inherent in actual cigarette smoking.” Top brass ultimately deemed the device a hard sell and abandoned it. Another tobacco company, Brown & Williamson, had “made solid progress” on “radical smoking products” that impart flavor “in the absence of tobacco combustion” by 1989, but ditched the project to avoid infringing on a patent held by Reynolds. Philip Morris explored electronic nicotine delivery technology in 1990, scientists reported in the journal Tobacco Control last year, hoping to address health concerns and the proliferation of smoke-free laws. But after the FDA announced in 1994 that it was studying nicotine’s pharmacological effects and whether the industry intended cigarettes and smokeless tobacco to deliver these effects, executives decided the project “complicates our efforts to resist the FDA’s attempts to regulate the tobacco industry,” and dropped it.

Again with the history lesson. Do you know why the original idea for an alternative “smoking device” failed back then? Poor marketing, timing and technology. The world wasn’t ready for such a device either. Smoking rates were still high, and no-one was really interested. Not to mention the early devices were abysmal.

Hon Lik may have simply built upon the original idea with some of his own innovations, but the world was “ready” for an alternative.

The idea then, as now, was to develop a product that reduced the harm of smoking. And as part of that effort, the tobacco industry then, like the vaping industry today, denied the harmful effects not just of tar — which is not present in e-cigarettes — but also of nicotine, which is.

I wondered when nicotine would come up. Nicotine is a mild stimulant, similar to caffeine albeit delivered in a different form. I went through some history on tobacco on this blog a while ago and discovered, much to my surprise that early smokers weren’t your current-day 20-a-day smoker. Back then, they’d smoke forty or less per year. This is, of course, before the various additives and treatment processes now used in modern day cigarettes. Some of which actually enhance the reinforcing properties of nicotine - which, by the way, aren’t that strong on their own.

As GGOOB vowed to “protect Americans from the regulators’ heavy-handed tactics,” tobacco companies hashed out what would be the largest civil litigation settlement in US history. Forty-six state attorneys general, five US territories, and the District of Columbia sued the companies for deceptive and fraudulent practices under consumer protection and antitrust laws to recover the substantial health care costs associated with smoking. The so-called Master Settlement Agreement dismissed existing and future suits against the companies in exchange for billions in annual payments to compensate the states.

We should all know the history of the Master Settlement Agreement, specifically how some US States have not used the cash for public health programs, but rather it’s been used to fund other, less salubrious initiatives. Some States are even starting to fail in repayments.

It’s impossible to tell whether the tobacco industry’s efforts to cause dissension among tobacco control experts accounts for the polarized debate on vaping today. The industry has a history of destroying documents that might have revealed whether they carried out their plans. What’s clear, however, is that the industry continued to call on “credible third parties” like the Competitive Enterprise Institute and Americans for Tax Reform to fight regulations by attacking inconvenient research results and highlighting “abuses” of government-funded anti-tobacco programs. And now the same third parties are helping vaping interests protect e-cigarettes.

Given that many tobacco control “experts” are full-time activists that see a potential threat, I’d hazard a guess that the mere existence of ecigs polarised the debate, regardless of historical documents (which some still use to try and justify their existence).

As for “attacking inconvenient research results”; don’t make me laugh. They aren’t “inconvenient” at all, they’re ridiculous.

E-cigarettes are the latest in a series of products tobacco companies have claimed reduce the risk of smoking. Public health officials have long urged independent testing of the tobacco industry’s reduced-harm claims — just as they are for e-cigarettes today — earning the wrath of reduced-harm activists who see their calls for evidence as condemning smokers to “quit or die.”

I’ll say it again, public health officials and their independent researchers have not, and probably will not ever attempt to replicate tobacco industry science. For one, simple reason. It doesn’t contain the same methodological flaws as their own. By replicating the science, it validates the tobacco industry claims, and simultaneously topples the tobacco control house of cards. This is why reduced-harm activists use the “quit or die” mantra against tobacco control because that is their exact mindset.

David Sweanor, a lawyer with a track record of successful lawsuits against the tobacco industry who considers vaping a public health breakthrough, had similar hopes for Eclipse, a “reduced risk” cigarette made by Reynolds. The tobacco giant claimed in media talking points, outlined in a formerly confidential document, that the “heat not burn” technology used in Eclipse — which looks like a cigarette but doesn’t burn down, much like an e-cigarette and Philip Morris’ new iQOS — reduced levels of carcinogens by 80 percent. Reynolds hoped to get Sweanor’s support for its new product, a 1999 plan to build “positive awareness” shows. Sweanor was anxious to promote the concept of reduced harm. “I have already done 12 radio interviews on your Eclipse announcement so far today,” he wrote at one point in an email to Reynolds’ head of product development. “It is certainly getting attention. Now, hopefully, it can also be tied into both public health goals and commercial realities.”

Once again, the veiled “shill” commentary of a respected lawyer and public health advocate with many successful lawsuits against the tobacco industry. His aim is harm reduction wherever possible, and therefore will support actions that further that goal. He has an impressive array of publications on this exact topic.

As of September 2017, eight states and the District of Columbia have passed laws to tax e-cigarettes. Every state except Michigan has at least one law on the books specifically regulating e-cigarettes, and in many states, including Michigan, local governments have adopted stronger rules. Where public health experts see taxes and regulations as proven strategies to reduce the use of tobacco and its alternatives, vaping advocates view the measures as an assault on their livelihood and individual rights. Their campaigns to fight taxes and regulations have been taken up by far-right libertarian activists like Grover Norquist, founder of Americans for Tax Reform, which has received over $1 million from Philip Morris and Reynolds since the mid-1990s. Norquist praised vapers on his podcast for helping to defeat the 2014 reelection bid of a New Mexico state representative who proposed taxing e-cigarettes as tobacco products, and for beating back tax increases in 26 states.

Taxation on tobacco, especially in the UK and Australia, is the highest globally and hasn’t led to the dramatic reductions that tobacco controllers wanted. It isn’t wrong of anyone to stand up to regressive taxation, which is why Norquist and vapers celebrated the defeat of a state representative that proposed taxing a reduced risk product at the exact same rate as combustible tobacco. Pennsylvania is another prime example of what happens when state legislatures decide to go heavy handed with regressive taxation. By the way, we’re still waiting for payments on that tea you tossed into Boston harbour…

What happened there was avoidable had the legislature actually listened to the businesses that would bear the brunt of the tax. Instead, they just saw the projected figures of income. What happened next was blindingly obvious. Stores closed up. Vapers went out of state for their supplies. The state got next to nothing.

Last year, Americans for Tax Reform’s Paul Blair joined the Consumer Advocates for Smoke-Free Alternatives Association and the American Vaping Association on a multi-state “Right to Vape” tour to “raise awareness” that the FDA’s proposed regulations on e-cigarettes would destroy the industry. At a stop in Wisconsin, the rally’s emcee introduced an “activist and warrior for the cause,” Aaron Biebert, director of the cinematic valentine to vaping A Billion Lives. In the movie, named for cigarettes’ projected death toll over the next century, Biebert lays out a conspiracy to discredit vaping among puritanical “prohibitionists” who insist smokers “quit or die,” corrupt federal health officials addicted to revenues from tobacco industry taxes and lawsuits, and drug companies intent on quashing their competition.

Once again, nothing wrong with rolling around the country with fellow enthusiasts and representatives to bring information to the masses. The only reason it was done this way is that SFATA and the AVA don’t have the kind of budget that the CDC, NIH, FDA or any State Public Health group have to broadcast information across TV, radio, billboards and educational establishments. So to reach the widest possible group of people, like-minded or otherwise, the only option is a relatively low-budget “tour”.

As for A Billion Lives, well I would guess that Liza Gross hasn’t actually seen it. The name is aptly co-opted from the World Health Organisation’s own estimate (it’s also the title of a conference/workshop run by UCSF) and, unlike Ms Gross, Aaron Biebert actually did his own in-depth research into the history of the tobacco industry, the MSA and the events surrounding the vaping industry.

Glosses on this theory echo across blogs, social media, vaping forums, and right-wing media channels. Biebert’s vilification of the federal government earned him spots on the Herman Cain Show, hosted by the 2012 Republican presidential candidate and Tea Party favorite, and the podcast of the Heartland Institute, the free-market think tank that took money from Exxon while attacking the science of climate change. Perhaps less well-known is that the Heartland Institute, which took at least $325,000 from Philip Morris in the 1990s, also helped the tobacco industry deny the evidence that secondhand smoke harms bystanders — and that Philip Morris targeted kids with its Joe Camel cartoons.

Again with the attempted smear. Biebert, as far as I know, hasn’t taken any industry money directly in the making, or promotion of the documentary. It was however, used as a valid tool to talk to representatives around the world. There’s nothing wrong in doing that, after all that is exactly what various public health bodies already do. The difference here is that the documentary goes against the narrative.

On Cain’s show, Biebert explained his movie’s central premise: e-cigarettes would save a billion lives if not for corrupt public health officials who lie about the risks of nicotine and vaping to promote innovation-destroying regulations that will kill an industry. “You can tell it’s kind of crooked, because it just doesn’t make sense,” Biebert said. “There’s no science to back it up and here they are shutting down 20,000 businesses, and they don’t care.” (Vapers’ estimates of vape shops tend to run higher than public health officials’.) Biebert went on to say that, time and again, studies show that the air around vapers is no different from “regular air.” Cain, who fought indoor smoking restrictions and took money from Reynolds as head of the National Restaurant Association, wrapped up the interview saying, “Big Brother has lied again to the American people.”

Amusingly, Ms Gross is trying to say that vapers are numerically challenged with the vape shop estimate. Whereas, in reality it is actually public health officials’ estimates that are often incorrect. New stores open regularly wherever there is a demand for them.

The central premise of the film is about how e-cigarettes can “save lives”, it’s kind of the whole point. But to explain that, the film has to explain the history surrounding the debate, starting with the debate on smoking. The funny thing is, while the film highlights some of the poor science on vaping, it also highlights the inescapable fact that the very same people involved in the debate on vaping, were also involved in the smoking debate. If they’re manipulating science on vaping, then it is possible (and we know they have, and do) that they manipulated the science on smoking also.

A Billion Lives calls on veteran anti-smoking activists to attack the “anti-tobacco industry” for not promoting vaping as a public health “miracle.” By presenting an alternative to cigarettes, contends David Sweanor, adjunct professor at the Centre for Health Law, Policy and Ethics at the University of Ottawa, vaping offers the “opportunity to do something that would rival the eradication of smallpox.” Godshall, an ardent defender of vaping, describes his idea of the perfect solution to the cigarette epidemic: it would be 99 percent less hazardous than cigarettes, wouldn’t be addicting nonsmokers, wouldn’t encourage anyone to switch to cigarettes, and would help lots of people quit smoking. “And it’s called vaping.”

See, I had the pleasure of talking with Aaron (as did many others) and one of the reasons Aaron wanted to do this film because it was a) an important story, and b) it became personal once he met the thousands of people who had their lives changed. There is plenty of evidence that e-cigs do change lives, and for the better in a lot of cases.

Public health officials in the UK, and some across the globe agree with that. The benefit to public health could be huge. Stanton Glantz has previously called the UK “an experiment” with regards to vaping and saying that “these guys are going off a cliff”, the general response to that is - “it’s working”.

But are e-cigarettes a clean nicotine delivery system? That’s not what the scientific evidence shows, Soneji says. “Maybe e-cigarettes are 50 percent safer, or 25 percent safer, or maybe they are just as bad as cigarettes in ways that we do not know.”

The concerted efforts to discount evidence from studies finding cause for concern about vaping echo the tactics of tobacco industry-funded scientists who questioned the link between cancer and smoking, Soneji notes. They sowed confusion and skepticism to undermine a growing body of evidence of smoking’s harms, which helped delay regulations on cigarettes for decades. The research on e-cigarettes is just beginning, he says, yet advocates are simply dismissing potential harms while cheerleading the benefits of vaping far beyond what the science supports.

Unlike Glantz that praises “junk science” as “another well done study”, real ‘well done’ studies suggest that the risk associated with e-cig use is likely to not exceed 1% of the risk associated with smoking. The studies that “find a cause for concern” are usually poorly executed, such as this one as a prime example. There’s plenty of others.

Having now seen how legislation is made with policy based evidence, don’t you think it’s natural that we would start questioning everything about the subject that interests us? The thing is tobacco control research is so badly done that someone like me, an IT geek with a passing interest in science, can both read, understand and later dissect it to illustrate exactly what is wrong with it.

Point me in the direction of some “well done” (not a Glantzian level of “well done” either) tobacco control research, that debunks some of the benefits of vaping. I dare you.

Godshall, in contrast, insists the science is settled. He blames the “left-wing” media and government-funded scientists for spreading misinformation about the benefits of vaping. “The headlines and the news are confusing and deceiving the public about the science,” he says. “Many of the people who are being paid to conduct the science have been knowingly and intentionally manipulating their results, omitting results, selectively cherry picking and basically misrepresenting their own findings because they’re getting federal funding.”

Where did Godshall get the evidence that vaping is 99 percent safer than smoking? “Basically every study that’s ever been published,” he told me.

Bill Godshall isn’t the only one that believes vaping is 99% safer than smoking either. I could name a few dozen others, because like Bill, we’ve taken the time to read and understand the science being published.

Godshall also actively partnered with vaping companies. “I was the person who got the two owners of NJOY and Smoking Everywhere together and helped coordinate their legal team,” he told me. NJOY and Smoking Everywhere hired the same firms that helped the tobacco industry evade regulation and defeat smokers’ liability claims for years. And their allies, including CASAA and Godshall, hired law firms that had successfully defended tobacco companies Brown & Williamson and Philip Morris against class action lawsuits brought by smokers seeking compensation from an industry they said lied about its products’ lethal nature.

Bringing in veteran tobacco industry lawyers paid off. Nine months after Smoking Everywhere filed suit, a federal judge ordered the FDA to stop seizing e-cigarette shipments.

Those of you that were around at the time this was all kicking off in the US will remember this better than I. Who represented NJOY and Smoking Everywhere is by the by, they were the best choice for the job at hand. If they had failed, we wouldn’t even be in this situation right now. Ever since that defeat, the FDA have been looking at ways of reclaiming their authority over the products. Fortunately for the industry, there’s a stay of execution with a postponement of the date of effect.

In the absence of federal oversight, state and city officials proposed their own measures to regulate vaping. In spring 2014, the Philadelphia City Council proposed adding e-cigarettes to indoor smoking laws and prohibiting their sale to minors. CASAA quickly issued a call to action and distributed talking points to help vapers oppose the measures. CASAA describes itself as a grassroots organization devoted to ensuring the availability of reduced harm alternatives to smoking. Yet former board members have received research grants from Philip Morris, R.J. Reynolds, British American Tobacco, US Smokeless Tobacco Company, and Swedish Match, which also makes smokeless tobacco.

Instead of total prohibition from the FDA courtesy of their defeat in 2009, cities and states took it upon themselves, at the behest of organisations like The Campaign for Tobacco Free Kids, American Cancer Society Cancer Action Network, American Lung Association, American Heart Association and Americans for Non-Smokers Rights began what turned out to be the biggest propaganda war since prohibition.

And as vaping advocates fight regulations in public hearings, tobacco companies work the halls and back rooms of the capitol. Philip Morris, Reynolds American, and its allies paid lobbyists nearly $1.2 million over the 2013–14 election cycle to fight Corbett’s bill and other tobacco legislation, a review of campaign filings shows, while NJOY kicked in an additional $88,105. When the bill emerged from the Assembly Governmental Organization Committee — which tobacco control advocates call the “place where tobacco control bills go to die” — e-cigarettes were no longer defined as tobacco products. The bill died after many health advocates reluctantly withdrew their support.

Vaping advocates fight regulations in public hearings because the people proposing these regulations haven’t a clue about the products they are trying to regulate. In most cases, they deliberately conflate vaping with smoking. They do this to confuse the general public when it comes to garnering support in the polls.

The scope of tobacco industry spending to influence policy is no surprise to Samir Soneji, who’s well-versed in the industry’s tactics. He remains troubled that tobacco-control allies who once exposed the tobacco industry’s deceptions seem to accept the same actions by the e-cigarette industry. “It might be the same playbook but they don’t make that connection.”

Thing is, both industries have to spend vast sums of money; and from the vaping industry point of view, it’s money they have to raise by donations from interested individuals. They have to do this to counter the relentless, tax-payer funded campaigns which not only distort the truth, but on occasion they outright lie. There’s a lot of reasons for this, some to do with MSA payments (follow the money!), but the biggest reason is all down to ideology. They don’t like e-cigs. It’s that simple.

Even so, the summit made him think differently about the concerns of people whose lives and livelihoods are tied to vaping. It helped him understand why adult smokers who can’t quit despite repeated attempts are willing to try e-cigarettes before there’s conclusive evidence that they work. He’s even thinking of returning to the meeting next year so he can “rile up some more animosity,” he says, recalling the boos his last appearance provoked. He’s curious if anyone will change their view of vaping in light of new studies, which are “coming out constantly.” Recent research shows that e-cigarette users have more carcinogens in their urine than nonusers, for example, in contrast to studies presented at the summit that “heavily discounted” their toxicity.

By all accounts, Soneji wasn’t booed and you know what? I would much rather have a relatively equal split of for and against at the next US Summit. You know why? The UK Summit, once a fairly hostile environment towards e-cigs with the majority of speakers being against them, has fostered a better listening environment. UK researchers and public health bodies took the time to listen to the arguments and the science, then discovered what vapers have known for a long time.

Given time, the US Summit will follow a similar pattern. It’s a way of encouraging debate and allowing minds to be opened to the possibility that they might indeed be wrong.