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.

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”.

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’.

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.

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.

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.

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.

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.

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:

• They won’t engage with anyone outside of the Rapid Response system
• They refuse to publish any tobacco industry research, no matter how good it is

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.

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.

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”.

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?

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.

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 the age for purchase is now 21 in some States.

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)

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.

Again with the history lesson. Do you know why the original idea for an alternative “smoking device” failed back then? Poor marketing, and timing. 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.

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 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.

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.

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 heavily biased and skewed.

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.

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.

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.

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.

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.

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.

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.

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“.

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.

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.

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.

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.

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.

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.

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.