CHEST journal point and counterpoint – E-cigarette use for harm reduction in tobacco use disorder: Yes/No?

A debate about the merits of e-cigarettes for tobacco harm reduction

The September 2021 edition of CHEST, the respiratory journal, features a point/counterpoint debate on the value of e-cigarettes for tobacco harm reduction.  I am making the case in favour (the Point) and Dr Hasmeena Kathuria (Boston University) and Dr Frank T. Leone (University of Pennsylvania) are making the case against (the Counterpoint).  We each provide a shorter rebuttal to the arguments made by the other.  We also recorded a 30-minute podcast to air these arguments face-to-face.  Recognising the broader interest in the subject, CHEST has kindly made this content open access so far.

Whatever you think of the respective arguments, it was refreshing to find a forum willing to air them in a respectful and measured way, I am grateful to Drs Kathuria and Leone for engaging and making their case and to CHEST for providing the platform.  I wish we could have much more debate like this.

For ease of access, I have added the relevant links below.

Continue reading “CHEST journal point and counterpoint – E-cigarette use for harm reduction in tobacco use disorder: Yes/No?”

Holding the Bloomberg anti-vaping propaganda complex to account

An investigative report criticising Bloomberg’s anti-vaping stance draws a petulant response – we review the case

Bloomberg scrutinised. Unusually, a journalist decided to take a sceptical look at Bloomberg Philanthropies and its many proxies and the impact of their war against vaping.  The result is an excellent must-read piece by Mark Gunther (@MarcGunther) in the Chronicle of Philanthropy: Bloomberg’s Millions Funded an Effective Campaign Against Vaping. Could It Do More Harm Than Good? (web archive) (23 March 2021).

It is first-class public-interest journalism, with some hard messages for Bloomberg but plenty of balancing comment too.

The response. The interesting thing is that this drew a joint response from Kelly Henning of Bloomberg Philanthropies, Matthew Myers of the Campaign for Tobacco-Free Kids and Robin Koval of the Truth Initiative. See Vaping and Philanthropy: Debating Strategies That Work (web archive).  There is a substrate of anger and panic in the letter that suggests that Gunther hit a raw nerve.

What is unusual about this letter is that Henning, Myers and Koval actually try to defend their positions.  Normally, they don’t defend their positions, they just assert them with millions of dollars of amplification. It offers a rare opportunity to provide a critique of their stance.  So I have taken their response letter, broken it down into 15 propositions, and provided a response to each.  Each section starts with a quote from the letter pulled out in a quote box in bold dark-blue. The letter is analysed in its entirety.
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Will the Netherlands become the next casually negligent ally of the cigarette trade? Twenty-four experts advise a rethink

So let’s make the e-cigs less appealing and see what happens… what could possibly go wrong?

The Netherlands is proposing to ban e-cigarette flavours – what could possibly go wrong?

The government of the Netherlands,  led by Paul Blokhuis, State Secretary for Health, Welfare and Sport, is in imminent danger of fooling itself into becoming an unwitting ally of the cigarette trade.  By taking measures to make vaping less attractive (notably by proposing a ban on all non-tobacco flavours for e-cigarettes), it threatens to degrade the appeal of a low-risk rival to cigarettes, provide regulatory protection to the cigarette trade, prolong smoking, obstruct quitting, and add to the burden of disease and death. All this in the name of protecting youth, while managing to harm both adults and adolescents. Quite a feat for any politician.

The problem is hubris – believing that the world responds to regulation in the way the regulator thinks it should. Experience suggests foreseeable perverse consequences will be the result of the ill-conceived prohibitions of much safer alternatives to smoking, including flavoured e-cigarettes.

It really isn’t difficult to understand why and how this would happen – I can only assume the State Secretary received very poor advice, which would not be unusual in this field.  Nevertheless, twenty-four international experts have set out the arguments and evidence in detail in a submission to the Dutch government, hoping to spare Mr Blokhuis later embarrassment and, even more importantly, to avoid yet more death and disease from smoking in the Netherlands.  It should also be a wake-up call to like-minded politicians and naive policymakers in the United States, European Union, and the World Health Organisation who continue to fail to grasp the impact of low-risk products in the real world.

The case is set out in 30-page submission to a Dutch government consultation on the measure.  The relevant documents are:

To provide a more digestible version of the submission, I have included below the twelve sections of the summary below with a link to the corresponding twelve sections with more detail and references.

Continue reading “Will the Netherlands become the next casually negligent ally of the cigarette trade? Twenty-four experts advise a rethink”

The past is not the future – what lies ahead for tobacco and nicotine?

“Prediction is very difficult, especially about the future” – Niels Bohr, Physicist

Let’s have some debate on the future of tobacco, nicotine, tobacco control and the tobacco and vaping industry. Here are three provocative pieces to get things moving. Continue reading “The past is not the future – what lies ahead for tobacco and nicotine?”

International experts in tobacco policy say WHO is blocking innovation and wasting opportunities to save millions of lives

WHO NCD poster
WHO Tobacco Free Initiative and Framework Convention on Tobacco Control – you have one job!

As the World Health Organisation’s World No Tobacco Day takes aim at low-risk alternatives to smoking, several international experts have made critical comments in response. Continue reading “International experts in tobacco policy say WHO is blocking innovation and wasting opportunities to save millions of lives”

US vaping lung injury outbreak was a public health fiasco or worse – comment to FDA

Public health actors are now routinely more manipulative than Big Tobacco ever was

Update: I subsequently published a detailed rebuttal of the claim that nicotine vaping is implicated in these lung injuries: The outbreak of lung injuries often known as “EVALI” was nothing to do with nicotine vaping, Qeios, July 2021.


The Food and Drug Administration of the United States has requested information on “Vaping Products Associated With Lung Injuries” – see Regulation.gov and Docket FDA-2020-N-0597 to make a submission or read the views of others.

In my view, the sly attribution of this problem to e-cigarettes and nicotine e-liquids by activists, academics and supposed public health agencies has been as bad as the worst ‘merchants of doubt’ operations of Big Tobacco in the 1970s.  I have labelled it a mere “fiasco” only out of politeness because the word implies that only incompetence and negligence lay behind it.  But I think it was much more deliberate than that – and we know that because virtually nothing has been done to correct misperceptions that were created and spread across the US and worldwide from July to December 2019.

I don’t wish to indulge this propaganda operation by providing straight-up evidence to the FDA on this.  Pretty well everything that needs to be known is already known about the cause and consequences. What is missing is a truthful account of the response.  So instead, I would like to take the opportunity to speak truthfully and directly about what was done here. So here is my brief response to FDA’s call for information.

Continue reading “US vaping lung injury outbreak was a public health fiasco or worse – comment to FDA”

Vaping is still at least 95% lower risk than smoking – debunking a feeble and empty critique

An empty and feeble critique misses its target and adds nothing

This paper turned up in my weekly search of PubMed.

Invalidity of an Oft-Cited Estimate of the Relative Harms of Electronic Cigarettes.
Eissenberg T, Bhatnagar A, Chapman S, Jordt SE, Shihadeh A, Soule EK.
Am J Public Health. 2020 Feb;110(2):161-162. doi: 10.2105/AJPH.2019.305424.

The commentary claims to show the “invalidity” of the statements made by Public Health England (PHE) and the Royal College of Physicians (RCP) regarding the relative risk of vaping and smoking – in short that vaping is likely to be at least 95% lower risk than smoking.  As this is an important harm-reduction risk communication, it is worth asking: how valid is this critique?

I thought this might be a better critique than it actually is. But somewhat to my surprise, it is very poor indeed.

Short version

At best, the authors try to show the absolute risk of vaping is not zero and that some harm is plausible. In doing so, they are refuting a claim that neither PHE or RCP make and challenging an argument not used by anyone sensible in tobacco harm reduction. However, not a single word of their paper addresses the supposed foundation of their critique – that PHE/RCP are wrong and the risks of vaping are likely to exceed five per cent of those of smoking. As well as a number of baseless assertions that are not even relevant to the “at least 95 per cent lower” relative risk claim (gateway effects, smoking cessation efficacy and second-hand aerosol exposure), there is just nothing in the paper about the relative magnitude of smoking and vaping risks. No analysis, no data, no evidence – nothing that discusses relative risk and why PHE/RCP are supposedly wrong. Niente. Nada. Rien. Nichts. Nothing.

New (20 Jan 2020). See concise comment on PubPeer here: A critique that does not even address its target

Anyway, despite being an empty and feeble piece of work, it does provide an opportunity to discuss some of the issues raised, so I will proceed with a critique.

Longer version

The authors’ supposed refutation of PHE/RCP rests on six propositions.  You can read the article here and I will respond to the authors’ main points in the order they make them. Continue reading “Vaping is still at least 95% lower risk than smoking – debunking a feeble and empty critique”

Vaping policy – rapid questions and answers

Vape shop in Manila, Philippines Vaping House Manila Play,Chill & VAPE

I just filed a submission with the Philippines House of Representatives for its Joint Trade & Health Industry Committee hearings on e-cigarettes, to be held 10 December.

The full submission (PDF) starts with an introductory Q&A and then goes on to provide more detail about specific issues with some backup material. I thought the 15 questions and answers might be of more general interest, so I have reproduced it below.

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Vaping risk compared to smoking: challenging a false and dangerous claim by Professor Stanton Glantz

This blog examines an extraordinary claim by Professor Stanton Glantz that the US public is right to believe that vaping is as harmful as smoking and that science is now catching up with public opinion. This claim is profoundly and dangerously false, and it demands a challenge.   This is a 13,000-word review looking in detail at Professor Glantz’s 700-word commentary and its supporting citations, examining thirteen claims that form the basis of the overall claim relating to cancer, heart attacks, stroke and respiratory illness, impact on smoking cessation and population smoking.

…and VAPING IS SMOKING

This is a 13,000-word critique of 700-word commentary by Professor Stanton Glantz: The Evidence of Electronic Cigarette Risks Is Catching Up With Public Perception. Read or print this blog as a formatted PDF.

In this blog, I examine an extraordinary claim by Professor Stanton Glantz of the University of California at San Francisco. Professor Glantz claims that the US public is right to believe that vaping is as harmful as smoking and that science is now catching up with public opinion.

This claim is profoundly and dangerously false, and it demands a challenge.  Professor Glantz makes his claim in a commentary in response to a substantive paper on perceptions of the relative risk of smoking and vaping. Both articles appeared in the American Medical Association’s JAMA Network Open.  This is an in-depth blog looking in detail at Professor Glantz’s short commentary and its supporting citations, examining thirteen claims that form the basis of his overall claim.  I am hoping the critique provided here will be a useful primer to some of the arguments in this controversial field.

For navigation, there is a table of contents. Continue reading “Vaping risk compared to smoking: challenging a false and dangerous claim by Professor Stanton Glantz”

Looking back, but forwards too – guest posting by Louise Ross

Out there, on your side – Louise Ross puts the public back into public health

As she retires a hero to many in the field of tobacco harm reduction and public health, Louise Ross has penned this blog, which starts below… Continue reading “Looking back, but forwards too – guest posting by Louise Ross”