Cease and desist: making false claims about the gateway effect

I am totally exasperated by spin about the so-called gateway effect. Unable to take any more, I decided to write […]

Gateway effect: maybe… but is it an entrance or exit?

I am totally exasperated by spin about the so-called gateway effect.

Unable to take any more, I decided to write to Professor Stanton Glantz and Dr Lauren Dutra, the authors of an analysis of teenage smoking and e-cigarette use based on the US National Youth Tobacco Survey:  Dutra LM, Glantz SA. Electronic Cigarettes and Conventional Cigarette Use Among US Adolescents. JAMA Pediatrics  online 6 March 2014. I hope the letter is self-explanatory. Update: reply from Professor Glantz and my response to his reply.

____________ LETTER TEXT _____________

Dear Professor Glantz, Dr Dutra

Misleading use of survey data has no place in professional public health practice

I had intended to blog about your recent paper, but decided instead to write an open letter and to put these concerns to you directly. So, I write to express dismay at the false, misleading and damaging conclusions you have drawn from your recent paper in JAMA Pediatrics and related media communications. The errors of reasoning are elementary, but have been used to draw conclusions that are relentlessly hostile to e-cigarettes and the important public health concept of ‘tobacco harm reduction’.  

It should be stressed that misleading information in this arena can cause actual harm to real people if they react to misplaced concerns in ways that cause them to continue to smoke. Further dangers arise as physicians and other trusted professionals give bad advice based on false information. Finally, there is the danger that policy-makers and legislators will be misled into making excessively restrictive regulations that protect cigarette sales from competition from much safer and better alternatives.  I believe your study and the subsequent media work owe more to misguided activism than to responsible academic investigation, and as such they have no place in professional public health practice or a reputable university.

I would like to address the claims made in three documents.

Document 1: Published article in JAMA Pediatrics

JAMA Pediatrics published article Electronic Cigarettes and Conventional Cigarette Use Among US Adolescents.  From the abstract:

Conclusions and Relevance  Use of e-cigarettes was associated with higher odds of ever or current cigarette smoking, higher odds of established smoking, higher odds of planning to quit smoking among current smokers, and, among experimenters, lower odds of abstinence from conventional cigarettes. Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among US adolescents

All of these findings stated in the first sentence can be explained by the idea that e-cigarettes appeal more to smokers – hardly a surprise given they both provide nicotine – and that smokers are trying them more than non-smokers because smokers have an intent to quit, cut down or otherwise protect their health, or that whatever causes someone to smoke also causes them to try e-cigarettes.  None of this is surprising, but somehow you have managed to position this study as showing there is a gateway from e-cigarette use to smoking. NOTHING in the study or the underlying data suggests this.  You would need information on how smoking, e-cigarette use and abstinence evolved over time to test these hypotheses, but your study does not have that.

There is no basis in this data to claim categorically that ‘use of e-cigarettes does not discourage […] conventional cigarette use among US adolescents‘.  In fact, despite the moral panic hyped up by CDC and FDA officials over this survey, there was a significant fall in current smoking among school-age adolescents in this survey between 2011 and 2012 (see CDC data: here and here). The relevant data are plotted below and are available to download [XLS]  ( done in association with Brad Rodu).

 US NYTS data

The data show a pronounced decline in cigarette smoking and in combined e-cigarette and cigarette prevalence between 2011 and 2012, as e-cigarette use increased (roughly as expected and in line with the growth in adult use). Of course, we cannot conclude from this that e-cigarettes are contributing to the reduction in smoking, but you certainly cannot rule it out in the way you have done.  It is quite possible, and consistent with the data, that e-cigarettes are being used to quit smoking and nicotine use altogether, to cut down on smoking or to convert smokers to vapers. It is possible also that dual users are on a path to either exclusive use of e-cigarettes or to complete nicotine cessation, and this is a snapshot of the early stages of a migration out of smoking.  The available data cannot demonstrate this is happening, but contrary to your unqualified assertion, it certainly does not demonstrate that: “use of e-cigarettes does not discourage, […] conventional cigarette use among US adolescents“. Nor is there any basis in your analysis to believe e-cigarettes ‘may encourage conventional cigarette use‘  any more than they discourage it.  So why has this statement been included?

You have included a caveat in the article, but then ignored it…

While the cross-sectional nature of our study does not allow us to identify whether most youths are initiating smoking with conventional cigarettes and then moving on to (usually dual use of) e-cigarettes or vice versa, our results suggest that e-cigarettes are not discouraging use of conventional cigarettes. (emphasis added)

This rather important qualification regarding the limits of the study is included in the full text of the article, not the abstract, but has not stopped you drawing causal inferences that the data and survey simply do not support for these reasons given above. In fact the caveat in the first part of this sentence should stop you making the assertion in the second part.  How do you justify both the caveat and the assertion within a single sentence?

Document 2: JAMA Pediatrics press release

E-Cigarette Use by Adolescents Associated With Higher Odds of Smoking. I will focus only on one part of this, as it otherwise mostly follows the abstract.

Background: E-cigarettes are marketed in much the same way cigarette manufacturers marketed conventional cigarettes in the 1950s and 1960s, including on TV and the radio where cigarette advertising has been banned for more than 40 years. Studies have shown that exposing young people to cigarette advertising can cause them to start smoking. E-cigarettes also are sold in flavors (e.g. strawberry, licorice and chocolate) that are banned in conventional cigarettes because they appeal to young people.

This is a one-sided and contentious framing of the issue, and none of it relates to the study in question.  Its most useful, and unintended, function is to reveal the bias of the authors.  You could equally have said: “E-cigarettes are eroding the market for cigarettes by helping smokers to switch to vaping, cut down smoking or stop using nicotine completely.  The edgy and skilful advertising of these products and imaginative range of flavours are essential to encourage as many smokers as possible to switch to low risk products.  These products may completely change the market for tobacco and become one of the most significant public health innovations of the century. However, policymakers need to be mindful of unintended consequences“.  But you didn’t. You chose to frame the issue in a way that suggests a strong predetermined belief, and not a that of a neutral investigator.

Document 3: UCSF press release

E-Cigarettes: Gateway to Nicotine Addiction for U.S. Teens, Says UCSF Study 

Given what the study says and the token attempt at a caveat in the published paper, the UCSF press release headline and most of the text of release is shockingly misleading.

E-Cigarettes: Gateway to Nicotine Addiction for U.S. Teens, Says UCSF Study.

There is no basis for drawing this unequivocal ‘gateway’ conclusion from the data presented in the study.  None whatsoever – and the published study even makes this clear. In fact the data are consistent with the opposite hypothesis – that e-cigarettes are primarily used by smokers interested in quitting or cutting down. Indeed the observation  that users have a higher intention to quit smoking lends support to that hypothesis more than to your preferred explanation.  This headline error is compounded and elaborated thus:

But the authors noted that about 20 percent of middle school students and about 7 percent of high school students who had ever used e-cigarettes had never smoked regular cigarettes – meaning that some kids are introduced to the addictive drug nicotine through e-cigarettes, the authors said.

This is highly misleading. In an alternative situation in which e-cigarettes were not available, then the small proportion of kids that “are introduced to the addictive drug nicotine through e-cigarettes” may simply have started to smoke cigarettes and got their introduction via the much more dangerous and addictive route.  In that case it may be a good thing that their smoking onset has been diverted into e-cigarette use – please see my posting: We need to talk about the children – the gateway effect examined for more discussion on the likelihood that gateway effects will be positive for health, or exits from smoking.

In one situation where low risk nicotine products have radically eroded the market for cigarettes, that being snus use in Sweden and Norway, we see snus acting as alternative to smoking onset, diverting young people away from smoking,  with greatly reduced risks that follow from that.  If you are unaware of this experience, this paper might help: Ramstrom L., Foulds J. Role of snus in initiation and cessation of tobacco smoking in Sweden. Tob Control 2006; 15:210–4. I can provide further citations if you are interested in gaining a better understanding of the practical experience of market-based tobacco harm reduction and real-world gateway ‘exits’ from smoking.

Also, to note the insight offered by Carl Phillips, it is not the order in which initial use occurs that determines whether one behaviour causes another and there is a ‘gateway effect’.  We are interested in what determines whether someone becomes a smoker (i.e. adopts an enduring pattern of cigarette use), not what causes someone to use their first cigarette – these effects are obviously different and can have different causes.  It is theoretically possible for people to take their first nicotine through smoking, but only to continue to regular smoking because of the availability of e-cigarettes to provide ancillary support their smoking habit.  In that (unlikely) event, e-cigarettes would be the cause of the smoking behaviour, but not the cause of the first cigarette.   Equally, people who have smoked first may use e-cigarettes to quit.  People who first use e-cigarettes, may go on to smoke and then use e-cigarettes to to quit smoking.  The point is that your study has no data that can illuminate which, if any, of the these pathways is being followed, and by how many people.  However, that has not stopped you choosing the most negative and damaging (and unlikely) interpretation over all others for no credible reason, and then making a headline message of it.

I would like to draw out one further statement:

“Despite claims that e-cigarettes are helping people quit smoking, we found that e-cigarettes were associated with more, not less, cigarette smoking among adolescents,” said lead author Lauren Dutra, a postdoctoral fellow at the UCSF Center for Tobacco Control Research and Education.

The reasoning for claiming e-cigarettes do not help people quit smoking amounts to a crude non sequitur:e-cigarettes were associated with more, not less, cigarette smoking among adults“.  More, not less… but compared to what? The study found that more smokers were using e-cigarettes than non-smokers. However, this banal observation does not confirm that e-cigarettes do not help quitting any more than finding that NRT is used more by smokers would suggest NRT is not used for quitting. The real test of the impact of e-cigarettes is hard to gauge because it requires knowledge of what would have happened in the absence of e-cigarettes.  If you could show there is “more, not less” smoking than there otherwise would have been had e-cigarettes not become available, then that would definitely be a concern.  But of course the study does not and cannot do this, given the limitations of its methods and the available data.That doesn’t stop you claiming the following, which as far as I can see, is based on nothing at all:

“E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco”

Reaction from tobacco control and public health experts

The tobacco control community is often reluctant to challenge its priesthood and can be supine or complicit in supporting junk science that justifies its preferred policies. However, the distortions in this study and its media communications are so egregious that it has provoked criticism from public health establishment figures.  The New York Times report on the study contained the following welcome rejection of the key assertions by Tom Glynn of the American Cancer Society:

“The use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among U.S. adolescents,” the study concluded. It was published online in the journal JAMA Pediatrics on Thursday. But other experts said the data did not support that interpretation. They said that just because e-cigarettes are being used by youths who smoke more and have a harder time quitting does not mean that the devices themselves are the cause of those problems. It is just as possible, they said, that young people who use the devices were heavier smokers to begin with, or would have become heavy smokers anyway. “The data in this study do not allow many of the broad conclusions that it draws,” said Thomas J. Glynn, a researcher at the American Cancer Society.

… and David Abrams of Legacy Foundation also ridiculed the reasoning:

But David Abrams, executive director of the Schroeder Institute for Tobacco Research and Policy Studies at the Legacy Foundation, an antismoking research group, said the study’s data do not support that conclusion. “I am quite certain that a survey would find that people who have used nicotine gum are much more likely to be smokers and to have trouble quitting, but that does not mean that gum is a gateway to smoking or makes it harder to quit,” he said.

David Abrams elaborates further in the Huffington Post

The problem with Dutra’s conclusion, said Abrams, is that causality could run the other way; kids who smoke (because of genetics, or parents who smoke) could simply be more likely to engage in other risky behaviors as well, such as alcohol, marijuana or e-cigarettes.

“One does not lead to the other [in this study],” said Abrams. “The behaviors just travel together in vulnerable kids.” The only way to establish causality is a rigorous longitudinal study that follows a large number of people over a long period of time — something that would take decades. In the mean time, said Abrams, “the science doesn’t support panic or fear [of e-cigarettes] — yet.”

Best known for its “Truth Campaign” ads, Legacy’s vision is a society free of the death and disease caused by tobacco. And according to Abrams, e-cigarettes could be the key to achieving that society. “They are the first product in 100 years that might make cigarettes obsolete,” said Abrams. “That would literally wipe out the death cause to 5.6 million kids alive today, as well as 480,000 adults every year.”

Would you care to explain if you think Glynn and Abrams are incorrect in their assessment?  

Other commentators

There are several robust analyses of this study, all of which I have benefited from.  All of them are unflinching in their criticism:

Sadly, this is not the first time such irresponsible over-interpretation of data has been used as part of a media propaganda offensive against e-cigarettes.  The same model was used in this study of Korean school age adolescents (Lee S, Grana RA, Glantz SA. Electronic Cigarette Use Among Korean Adolescents: A Cross-Sectional Study of Market Penetration, Dual Use, and Relationship to Quit Attempts and Former Smoking. J Adolesc Health 22 November 2013).

The failings in the Korean analysis and media approach were bluntly pointed out at the time, and it is therefore all the more troubling that they have been repeated in the new paper.

An approach that abuses and erodes trust

It appears there is a malign system at work here. The original paper has a modestly phrased, but incorrect and unsupported, statement suggesting that e-cigarettes do not reduce smoking and may increase it. This is surrounded a barrage of statistics and protected by what appears to be a responsible caveat, though that is actually ignored in practice.  This gets past the inattentive journal peer reviewers and into a publication with an important sounding name. Caveats are then jettisoned and hype is developed in the JAMA press release and, above all, in the UCSF press release. The media work seems to be free of any academic integrity and aimed at creating a media storm irrespective of the quite dull and predictable findings of the actual analysis.   The media, which is still used to trusting famous universities and well known public health academics, obliges and repackages the hype relentlessly – including, annoyingly, in the UK.  The distinction between association and causation is lost, as journalists read the press release and quite reasonably assume that the association must be causal or there would be no point or justification in making the ‘gateway’ headline with it.

Once in the news media, and widely propagated via wire services, it is uncritically repeated in maybe hundreds of regional and local outlets and goes world wide.  Then it enters the political sphere.  Here is an example – no doubt one of many – of an elected representative, Philadelphia City Councilman and Majority Deputy Whip, Bill Greenlee being mislead by the study and press release, and so tweeting the bogus story:

Greenlee tweet

You are responsible for this, and it is not something to be proud of. It is not the proper role of a university to introduce this sort of propaganda into democratic debate on public health, nor is it right for you and UCSF to abuse the trust of citizens, journalists and politicians like Mr Greenlee.  Will you contact Mr Greenlee and explain that he has been misled?

Please put this right and reconsider your approach

I really hope you will reconsider your approach – it does not serve public health or the public interest.  It is wrong simply to assume that e-cigarettes will play no part in reducing the expected one billion 21st Century deaths from smoking.  The evidence that there is, taken as a whole, is actually very encouraging, and certainly not a reason to mount a ‘dirty tricks campaign’ against these products.  In any event, there is never a case to mislead the public, policy-makers and legislators  even if you are convinced the end justifies the means, which in this case it does not. 

I would welcome your responses to the points raised in this letter.   If I have misunderstood your work I will of course acknowledge and correct.  I trust you would wish to do the same for false or misleading statements in your own work.  As you know, UCSF expects adherence to the highest standards of integrity in proposing, conducting and reporting research.  I do not think the highest standards have been met in this case, do you?  Do you agree that you should now withdraw the paper from JAMA Pediatrics and circulate a substantial correction to the UCSF press notice?  If not, what is the alternative?

Yours sincerely

Clive Bates
London, UK

___________  END OF LETTER ____________

Updated 15 March 2014.

News coverage: see examples displayed on Professor Glantz’ blog.

Post script.  A number of people have commented along the lines: “nice work, but nothing much will come of this…” and I agree a letter from me isn’t likely to make much difference in itself.  There are however other, more forceful, options, if people feel strongly:

1. The authors’ responsibility. First, it is important to let the authors have their say. They may make a good case and I may be doing them a disservice.  That is possible, but I have yet to have a criticism of the substance of this case and others have drawn similar conclusions. If these complaints are justified, the preferred resolution is that the authors put it right themselves. It is their paper and press release, and their responsibility.

2. Challenge from within public health. The most significant development on this has been, in my view, the welcome comments made by David Abrams and Tom Glynn to the NYT – and I gather others who made statements but were not quoted.  By speaking up, more of the ‘heavyweights’ in tobacco control and public health can show they do not wish to see this sort of propaganda in tobacco policy-making or tolerated within the academic discourse in this field.  There are may ways to do that: comment in the media; write to rogue authors directly; comment on this letter on my blog or support and circulate the excellent critiques made by others; write to correct misleading media reports that have come from bad research; respond to legislators or officials who cite bad research; tweet, blog or otherwise publish critical views; suggest to tobacco control activists that poor papers should not be used in campaigning…. to name a few.

3. Challenge in the formal literature. Established academics can undertake a peer-reviewed, critical response to the paper submitted to JAMA Pediatrics or published in another journal.

4. Challenge through the JAMA Pediatrics editorial board. Ask the editor for the paper to be withdrawn on the grounds that it contains glaring non-trivial errors or otherwise engage with the editorial governance at JAMA – this could be done by anyone, but could be done effectively following publication of a formal critique, as in 3 above.

5. Challenge through UCSF.  Approach the Office of Ethics and Compliance at UCSF, and make a complaint.   UCSF requires adherence to the highest standards of integrity in proposing, conducting and reporting research.  This means compliance with general ethical standard for scholarship set out in the University of California Faculty Code of Conduct at Part II B and the UCSF Campus Administrative Policy 100-29 on Integrity of Research:  Research misconduct is defined: fabrication, falsification, or plagiarism in proposing, performing, or reviewing research, or in reporting research results. Research misconduct does not include honest error or differences of opinion.The most obviously egregious violation is the way the survey was spun in the UCSF press release – to me this looks like a case of ‘fabrication in the reporting of research results’. The university says it is responsible for investigating, so it is up to them to decide where, if at all, there has been a breach.  Such a complaint would probably be better coming from a senior American academic or public health leader than from me.

It all depends on how keenly people feel about this, and for me, how well the authors respond.

Update: Professor Glantz replies as follows:

On 31 Mar 2014, “Glantz, Stanton A” wrote:

If you would like to engage in correspondence about our paper, I suggest that you send a letter to the journal.  We will respond in that forum should the editors deem your letter worth publishing.

Update: I reply to his response on 31 March 2014, explaining that I don’t think this is appropriate – it is his responsibility to put  this right.

Dear Professor Glantz

I am disappointed but not surprised that you would choose to avoid engaging directly.  I can see why you might prefer me write to the journal: this would allow you to respond by dismissing the criticisms without addressing them, leaving limited recourse for your critics to challenge your response. It would impose paywalled restrictive visibility, shutting out the wider world with interests in this work, and it would impose more months of delay to the reckoning this work deserves.  I’m not going to be diverted down that course for these reasons and for the reasons below.

1. The letter I sent you and Dr Dutra covers ground beyond the JAMA Pediatrics article, in particular the press release and hype from UCSF, where most of the distorting damage was done.

2. It is not me who should be writing to JAMA Pediatrics, but you, the authors, to request that the paper, or its false conclusion, is withdrawn.  Likewise, the egregiously false and misleading press release should be withdrawn.  You did not find a gateway, but you claimed to the world’s media that you did.  It is your responsibility, not mine, to put that right.

3. Having published your paper, the journal itself has a conflict of interest. If I and many others are correct, then its peer review system and editing discipline has failed.  It has incentives not to have that failure paraded across its own correspondence pages in the straightforward terms that are justified. So I don’t think that is a suitable place to challenge your work.

4. The criticisms herein are broader than an academic disagreement – they relate to the academic-media-political nexus of this work, or, more plainly, the propaganda offensive you appear to be mounting against e-cigarettes and tobacco harm reduction, and it applies to more than just this paper. I had hoped you would read my letter carefully and recognise that this is an ethics and research conduct issue. It is not merely the failure in a single instance of a journal to moderate properly the excesses of its authors, though it is clearly that as well.

I think there are many on this list, and beyond, who would like to see a candid and direct response from you to the points raised in this open letter.  You promoted the paper on your popular blog along with the press coverage and press release, so I see no reason why you should now become more formal and reticent about direct discussion with your critics.   Once again, I invite you to make a substantive ‘well thought out response’, as Dr Dutra suggested you would in her e-mail of 14 March.

Please let me know what you intend to do.


Clive Bates

London, UK

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175 thoughts on “Cease and desist: making false claims about the gateway effect”

  1. Bravo ! Clive
    I also considered to respond to this study, but you have put it so nicely that I have no further comment to add. Would you submit it to the JAMA? Or should we collectively write a letter supporting your analysis? If the authors do not respond or retract their paper, it should be said loudly.
    Well done.

    1. Thank you Jacques

      I am hoping that some seasoned scientists will write to JAMA Pedriatics and put a proper response into a peer reviewed journal… but I think that can be shorter than this.


  2. The ordinary man on the London omnibus may observe it’s less dangerous to keep smoking than venture into tobacco control!

  3. Well done, Clive
    I agree with Jacques that it is important to also get this to JAMA. I can’t imagine what the reviewers must have been smoking for them to support publishing this mockery of a study. I once tweeted to Glantz reminding him that “correlation does not mean causation”, I suppose he also needs reminding that the conclusions of a study must be based on the results.

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  5. Dear Clive Bates I think you will never get an apology our recognition of your letter. The man has a fixation regarding smoking and will not change his personal crusade.
    I am amased that UCSF have not yet terminated his position at their university.
    There can only be 2 conclusions why he has not been fired.
    1. He brings substantial sponsorship grants to the UNi.
    2. They are no better in their analysis,regarding the subject matter.
    Hopefully one day they will wake up to this `professional` scare-monger er.

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  7. You are brilliant with words and this is another great post You have defended vaping (and snus use) courageously. We thank you.

    Your discomfort at the way “science” is turned into junk science by the members of the tobacco hate industry surprises me. Surely you know that the same was done with “science” to engineer society into supporting the world tobacco control pogrom. The science on second hand smoke is very shaky and the mantra that one in every two smokers die from smoking is simply not true. These ideas are repeated constantly by those against tobacco, without investigation or thought and no critical analyses. We cannot predict the numbers of people harmed by smoking or second hand smoke, until we actually admit the science is fiddled in the first place. Funded science is mostly suspect and, like a bribed judge will find in favour of the funder, it produces the desired result. Laymen simply accept what they are told by “the experts”. There is no funding to scientists to challenge that which has been dished up by tobacco control. In the current climate of tobacco fear, who would DARE to prove them wrong?

    Interestingly, nicotine is being vindicated for the first time because of the new electronic cigarettes. Before, we were told lies that it was the addictive and cancer causing demon in cigarettes by tobacco control. This alone should expose the movement as being dishonorable!

    The situation with electronic cigarettes simply highlights what I see as tobacco control industry in action. Vaping is modern smoking. Smoking cannot be allowed. The insanity of it all is clear to thinking people. I really hope that some in tobacco control will realise how corrupt and immoral the “smokefree” industry they promote is. How many lies it has told will become clear as they proceed on their mission against vapers and vaping. I watch with fascination and the hope that one day, tobacco control in all its guises, will disappear into the mist of inglorious shame.

  8. This also needs to be brought to the attention of Politicians and Policy Makers across the US. E-Cigs appear to be under attack in all 50 States thanks to fraudulent research conclusions by the ilk of Dutra and Glantz.

    What they have perpetrated goes beyond malpractice and borders on Criminal.

  9. David goerlitz

    Clive, You are the man… I’ll stand with you shoulder to shoulder anytime……anywhere !

  10. Juliet Kelly

    Thank you Clive Bates, you certainty are a saviour for us the vapers. I love your honesty and persistence :)

  11. Phil MacRrevis

    One has to only wonder about the evil intent of these recent electronic death dealing, ‘Tobacco Barons’ OBVIOUSLY aiming these products at kids. Strawberry flavour?? Chocolate Mint?? Bubblegum and Cool Leather Jacket??? and the rather obvious: ‘Raspberry Syrup Guaranteed Virginity Loss With Favourable Discourse The Next Day At School. You The Man. Woot’.

    Recent authentic scientific BS Research performed on a Nintendo 64 games console with one conscious test subject has strongly indicated that children “grow out of” enjoying such “childish” flavors such as cherry Mango and Banana Chocolate. Adults, however, only ever desire/purchase flavours that are truly adult.

    The adult tongue has been proven to age with the rest of the person’s body and thus, taste becomes severely diminished and limited due to age. Adults ONLY EVER purchase E-Liquid flavours labeled as; ‘asphalt’ ‘concrete’ ‘Office Smells’ ‘Promotiononal failure’ and ‘Just Let Me Die, Please!!! Why Won’t You Let Me Die’. They never, ever, ever purchase the fruit flavours they may have bought in their youth.

    In conclusion – and in light of the evidence – I am against Electronic Cigarettes. I don’t understand them and they scare me. So just stop it. OK? I didn’t break the world, it was like this when I got here and I hate change. Change scares me.

  12. Good effort, Clive. Excellent work. Only problem is, Glantz (the mechanical engineer) and Dutra won’t care a toot and will not even pause for a minute in what they are doing. I can totally see why so many people view Glantz as a very nasty joke. And the worst of it is that they, and others like them (in the WHO, for example), seem to be winning the battle for hearts and minds in the political arena across the USA, and also influencing politicians and public health “experts” (aka gullible sheep) across Europe. I can only echo the hope that these tobacco control extremists will be exposed for the fraudsters that they are some day and that they will then become the object of public rage. They appear to feel no shame and not to care whom they harm.

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  14. I just want to say thanks to Clive for all his efforts on our behalf. I’m sure most of us haven’t the time, stamina or necessary eloquence to counter the seemingly endless torrent of complete BS and pseudo-science that seems to be directed at the “electronic cigarette” industry and it’s customers.

    As an ex. 40/day smoker (now “vaper”) myself I can personally testify that these products stopped me smoking, nothing else did. In fact it was easy! I smoked my last Rothmans on Boxing Day 2013 and can’t think of any reason why I should ever want to smoke one again, unless of course I am prevented from using the products I have recently come to enjoy (which seems to be precisely what the obvious vested interests & nanny state health Nazis actually do intend).

    Before I tried vaping even 24 hrs without a nicotine fix from a cigarette would have me climbing the walls. Nicotine chewing gum just doesn’t cut it as an alternative. It’s just so hard when you know that all you need to do to relieve your craving is take a stroll down to the local newsagent.

    But more fundamental than all this is the whole civil liberties argument. Even if there was no evidence that vaping helped cut smoking rates, is there any reason why people should be prevented from enjoying these products? It’s a free world (or at I least it used to be as far as I can recall) and there’s no evidence that they harm anyone at all.

    Why not treat consumers of wine or beer or doughnuts the same way? People can (and some do) destroy their own livers with alcohol, so shouldn’t all ethanol containing beverages be banned or regulated as medicines? We don’t know precisely what chemicals are in any of these either!

    If you took Article 18 of the TPD and replace words like “nicotine” with “ethanol” and “e-liquid” with “wine” and “electronic cigarette” with some suitably named approved wine imbibing device (commonly known as a “glass” at present) I think any reasonable person would understand just how absurd the whole thing is.

    1. Oh silly me. I see Article 18 became Article 20 in the TPD text that was finally approved. Must try to keep up!

  15. Adam Williams

    “Experts” Now there is a word that is miss-used by so many media outlets when it comes to EC’s that I’ve lost count. Experts in what exactly? If they [the experts] “don’t know what’s in them” how the frig can they call themselves / be referred to, as ‘experts’!!!!? They nearly always admit to “not knowing”
    Personally, I’d like to see these people vetted before their ‘opinions’ are blurted to the unknowing public.
    Far better that they refer to real science but then, that wouldn’t suit their ‘adgenda’

  16. Kurtis Sunday

    Glad you took this up. A second look at most of the ‘conclusions’ of these ‘studies’ shows how illogical they are.

    Next we’ll have claims that e-cig use has contributed to past smoking, because 99.9% of e-cig vapers once smoked tobacco cigarettes …

  17. Great work Clive

    Due to this policy -based evidence research
    rather than evidenced based policy quite
    a lot of people I am helping to quit initially
    believe e-cigs to be worse than smoking.
    The propagation of propaganda is becoming
    so ingrained now that many believe it
    Is better to smoke 40 cigarettes a day than
    use an e-cig, I kid you not!! These ideas
    are now becoming very intrenched and
    will be hard to eliminate.
    Also, due to the ‘very effective’ EU policies
    on tobacco Control having spent time in Prague
    Italy and Germany I can tell you the young
    are smoking like ‘troopers’ especially young
    Women – more so than when I went
    to these countries 20 years.
    It is quite clear to me that many of the powers
    that be either do not care about public
    and / or are complete morons.

  18. While my brother phoned me to wish me happy birthday the other day, he asked me what else is happening… I asked him if he was still smoking… He said yes. I mentioned that I’d given up a month ago using ecigs (his birthday is coming up so I was testing the ground to see if it would be worth buying him a starter kit). At the time, he was walking to the shop to buy tobacco and was wheezing.

    To my utter surprise and horror, he reacted angrily to my simple question.

    I can’t work out whether it was guilt or fear or something else because he just kept stating that he would never try it, he doesn’t like it and that he’d rather smoke.

    Of course I asked him how he knew he doesn’t like it if he’s not tried it, and then he told mehe had tried it.

    I can only assume that he is starting to pick up on the negative propaganda percolating through the media.

    It is really sad because he’s got Graves Disease and fairly recently had his thyroid removed. His consultant said he had to give up smoking.

    He will never give up smoking.

  19. Yes, these reactions are becoming the norm
    due to propaganda taking on a ‘folk law’

    Perhaps, you could convince your
    Brother by saying modern e-cigs were
    Invented by smokers for smokers: it’s
    about smokers taking control, putting
    2 fingers up to tobacco cartels
    and not lining their pockets
    with ‘extortion’ money!

    I never thought when I was young
    and idealistic that the powers that
    be would be so pro tobacco
    either advertantly or inadvertantly!

  20. vereybowring

    I often wonder if tobacco and electronic cig users have acted as harm reduction in a different way.
    I think how disastrous the mechanics work ethics would have been had he stayed in mechanical engineering.
    How much death and destruction would his slapdash and frankly childish attitude to science caused with machines ?
    I get images of cars that self disintegrate on roads or planes that have wings fall off.

    I think we took one for the human race and our misfortune has been the saviour of engineering.

    1. It’s a good amusing theory. But it also prompts a serious response… I’m not sure that your conclusion is correct though for two reasons…

      1. The estimated premature death toll from smoking in 21st Century is one billion. Glantz is one of the most influential advocates (especially with WHO) in thwarting a highly positive market based development that would reduce this death toll. A mere one tenth of one percent change in pattern of usage puts one million lives at stake. Few engineers could cause carnage on that scale either deliberately or through incompetence.

      2. Engineering in general and automotive and aviation engineering in particular have high professional standards – but they also have strong systems of peer review and professional challenge, and are not vulnerable to ideologically led research findings. The really significant failure here is not the paper itself, but the system of challenge in public health – formal peer review, professional culture, media and political credulity etc – that tolerates or even celebrates this stuff.

    2. Yes, you are absolutely right.
      This policy based ”science” reminds me unfortunately
      a little of Nazis ideology on a number
      of levels.

  21. That’s why I do no longer consult doctors, if an illness doesn’t cure itself it will be my time has come. I completely lost trust in a profession (a couple exceptions aside) that is represented by so called ‘health care’ organizations (leaded by the WHO) that have been making lying into an art form for decades (all my adult life).

  22. To LVD. Not all doctors are equal. Many GPs support e-cigs. Also, the public health profession is not the medical profession. Many “experts” in public health are not even medically qualified. For example, Stanton Glantz qualified as a mechanical engineer yet has ended up being regarded as an expert in public health. In his work in the Centre for Disease Control (CDC) in the USA – how did he get that post??? – he used many of the same tactics in the fight against smoking that he is now employing against e-cigs. These tactics were designed by the World Health Organisation and basically consist of saying and doing anything to win the cause – in other words they believe that the end justifies the means. Very like all the dictators of history. And watch out – because the WHO is now setting their sights on alcohol and sugar. Expect to see similar tactics used against those.

    1. localpeasant

      The “WHO” and all its sycophants (or is that PHSYCO’S)is the disease of the century, the cancerous growth that is spreading !

  23. Pingback: Cease and desist: making false claims about the...

  24. This is now an old post, but is still receiving a few comments. That encourages me to post this:


    If you read that article, you will see that the Council of Bolton, Lancs, has, it appears, banned ecigs in its places. What you will see is an apparent justification based upon ‘the unknown’, being the vague possibilities of unknown future possibilities of possible harms from ecigs. The construction of that sentence, in itself, indicates the nonsense of the argument. “Unknown possibilities of harm” are no reason to ban anything. That which should be banned must depend upon known dangers. Unknown dangers do not justify bans.

    People like Glantz (aka Grantz)rely upon incredibly silly logic. For example, it would behove the Government to fill all holes in the land in case a person falls into a hole. Holes represent danger, and they must be filled in. What is wrong with that logic? Actually, there is nothing wrong with it, provided that you assume that people are blind.

    The same applies to almost all tobacco control. There is an assumption that people are blind, and that the stumble into the hole of smoking. Tobacco Control offer a ladder out of the hole which is not always long enough. Only the tallest people can reach the ladder. The ladder is patchy/gum. What about the people who are not tall enough, and need a longer ladder, aka ecigs?

    Well, NO. If you are not tall enough for patchy/gum, you must perish. Sod you, you disgusting, pathetic, filthy, stinking, detritus.

    That is the attitude of the WHO and the EU. There is the agenda, and nothing must stand in the way. The agenda is an aristocratic Europe. If such a thing is ever attained, then you can be sure that there will follow the mother and father of civil wars. Signs are already evident. Scottish Independence is a case in point. Parts of Spain are demanding to be independent. Parts of Italy, such as Venitia, are demanding autonomy – not only from Italy, but also from the EU. They want to form their own interdependencies. Who can blame them?

    I have yet to hear Cameron, Clegg, Milliband to declare that the UK is an independent nation. I do not think that any of them can so declare. These political wafflers are happy agree to ignore what they do not understand. Much better and easier to condemn smokers and vapers.

    When your MPs and Councillors abandon you to the corruption of organisations such as the Tobacco Control Industry, you can be sure that, eventually, there will be ructions. It has always been so. At least tobacco companies compete with each other. Tobacco Control is a monopoly.

  25. Clive

    Great job, as usual. I have been amazed that the SRNT listserve has been so quiet about this debate. I would encourage you to post a shortened version of this on the SRNT listserve.


    1. Thanks John – I don’t have SRNT membership or posting rights, but it should be something debated in SRNT…


  26. Stan Shatenstein


    I think you can make an argument that the wording in the abstract lacks the nuance in the full text, and there were subsequent news reports that misstated or overstated the findings, but what a load of verbiage, and supported by the words of Phillips and Rodu, both in the pay of the tobacco industry. Not your finest hour, Clive.

    People, myself included, who urge caution on e-cigs are neither deluded nor blinkered. There is clearly the potential to help some individuals quit, and it’s clear that in a binary choice, e-cigs are quite certain to prove safer than conventional ones. But bigger questions are being asked and your answers are very much found wanting. If the Stanford e-cig ad collection doesn’t give you pause, especially as we see the tobacco majors taking over the field (regardless of the mooted threat of regulation so burdensome that only Big Tobacco can withstand it), I don’t know what will.


    And, oh, just how child poisonings are acceptable ‘collateral damage’ in this e-crusade?

    Jump in youth e-cigarette poisonings prompts state health warning

    And I’m sorry, your indulgence of a “good amusing theory”, notwithstanding your “serious response” is quite the indication of the company you keep. We need good, thoughtful policy, not a cult.

    1. -‘news reports that misstated or overstated the findings’

      Hardly surprising given the UCSF press release was entitled ‘Gateway to Nicotine Addiction for U.S. Teens’

      -That’s 50 reported poisonings in a population of 5 million, none serious. More people are injured by their own house keys, perspective please

      1. localpeasant

        In UK 1999 there were 37 serious injuries from “TEA COSY’s, but I don’t see excessive regulation on them, lets keep some perspective

    2. Hi Stan -it’s been a while. Thanks for this contribution. However, I am not sure what points you are making.

      Glantz/Dutra paper. Are you arguing that the conclusion of the paper is justified by the data and analysis? I don’t think it is. Are you claiming that the headline and text of the press release is a true and fair reflection of the analysis? It’s not an accident that the media thought a gateway effect had been discovered, as you imply. My view is that the data does not support conclusions and cannot support conclusions of this nature. Are you arguing that this may well be the case, but the pre-determined objective (positioning e-cigarettes as a threat rather than opportunity, and pressing for restrictive regulation) justifies the means (dissembling about data and analysis and hyping up made up conclusions)? Can you point to the ‘verbiage’ or anything you actually disagree with in my letter. One of the problems with the field of ‘tobacco control’ is that it is prone to group think and has very weak internal challenge – to the point where you feel it appropriate to ridicule someone trying to do that carefully.

      In response to my reasoned, if long, letter about gateway effects, you dismissed the concerns and raised points about advertising and poisoning of children, which I have not discussed.

      Poisons. Let me go on the record now and say that I am not in favour of poisoning children with e-liquids, or bleach, drain cleaner, cosmetics, tobacco and medicines for that matter. That’s why I support some sensible regulation of these products. In practice we already have what we need – in Europe we have the Classification, Labelling and Packaging Regulation, which provides all the necessary safeguards, if properly implemented and enforced. I also think it is important to keep the poisonings in perspective: these reflect calls to a helpline not adverse health impacts, and none of the incidents caused serious injury. In any case, what do you think should be done with products that register calls to the Minnesota poisons help line?
      Top five causes of calls from Minnesota Poison Centre 2012 annual report
      1. Cosmetics, personal care items
      2. Household cleaners
      3. Foreign bodies, toys, silica gel packets
      4. Alcohols
      5. Pesticides
      1. Analgesics
      2. Sedatives
      3. Antidepressants
      4. Cardiovascular drugs
      5. Antihistamines

      “E-crusade”. You can dismiss it as an ‘e-crusade’, but my view is that e-cigarettes are giving thousands, maybe millions, of smokers a new and better option, helping them to escape the lethal grip of smoking, while letting them keep some of what they like about it. I fear that the tobacco control community is remote from the people it is supposedly trying to help – I would urge you to look carefully at what people say about it… often heartfelt testimony of lives transformed.

      Advertising. Whether you are scandalised by that e-cig advertising should depend on what effect you think it will have. I’m quite in favour of edgy, slick marketing of these products and I am not surprised it sometimes bears a resemblance to tobacco advertising of old. They are, after all, selling an e-cigarette to smokers. The more successful they are in this, the better the result for health.

      Rodu and Phillips. Both of them write very insightful blogs (Tobacco truth and AntiTHR lies) and in my view both have a rigorous public health ethos grounded in a compassionate concern for the welfare of smokers – I am happy to endorse and draw on their work on its merits. I’d rather have insightful people telling the truth even if funded by tobacco companies than activists misleading people with money from cancer agencies.

      I don’t understand your point about a ‘good amusing theory’ so can’t respond. If you look at my web site you won’t find much to suggest a cult at work, but an effort to discuss what would constitute ‘good,thoughtful policy’. I am of course always open to challenge – so do let me know if you think there are errors or fact or reasoning.

    3. When someone writes “in the pay of the tobacco industry” he might as well write “I can find nothing wrong with what they are saying”. And that is at the best of times. In this case it is LOL funny. Are you so seriously wedded to your ad hominem attacks that you cannot even see when they do not apply. Exactly why would “the tobacco industry” care, one way or another, whether e-cigarettes were restricted as the result of lies about there being a gateway effect.

      Geez, I realize you tobacco control people do not like to read the real science, but at least try to read what you are writing yourself.

    4. “We need good, thoughtful policy, not a cult.” I totally agree with that, many do, that being said almost every utterance whether literary or aural in nature from Glantz on the topic of ecigs or harm reduction is harmful not helpful. Remember there is no authority in Science. Show the proof and back it up with repeatable falsifiable experiment. What you mustn’t do is bury and hide the data that conflicts with the puritanical bigoted ideology.

      let’s get the psuedo out of science once and for all. Charlatans, there will always be but with a bit of consciousness raising perhaps they will cease to be listened to, respected nor receive funding.

  27. Stan Shatenstein


    Aiming to be succinct yet cover a fair bit of ground…

    I thought I was clear that, whatever I think, and I don’t have time for a detailed analysis of the paper here and now, I did not argue against the case you were making, but that, even if you took the word ‘verbiage’ as unkind, you had composed a long post to say little more than that the PR was an over-reach. Point made, but my point was not that the end justifies the means. I did enlarge the discussion, and you are again making a fair point if you wanted the discussion not to veer anywhere outside the narrow bounds of your Dutra/Glantz criticism but, if for no other reason than a glance at the comments on your blog, it was both valid and, I think, necessary to do so.

    I am not trying to win you over w/flattery, but I know absolutely that you know absolutely the lack of credence due the views of those in the pay of the tobacco industry. We can get lost in the weeds of ‘what about Big Pharma?’, etc, but Phillips and Rodu are not credible and I maintain it weakens your case if you need rely on them.

    Your listing of poisons is facile and frankly beneath you. Reminds me of the great old Alan Arkin film, Little Murders. E-cigs are relatively new and not that widely used, they will move up the league table, and no matter where they land, how many deaths (one 2-yr-old confirmed in Israel) and poisonings are tolerable? Please don’t school me on relative risk and ‘the dose makes the poison’. This is just not something to be discussed as an innocuous inconvenience. It merits v. serious consideration.

    I think you’re profoundly wrong on the marketing issue. We have generations of addicted smokers and youthful wannabe’s and they cannot be ‘stovepiped’ away in some different column, unreached by the sex appeal of e-cigs.

    I may have been unclear, but the intent was not to label you an e-crusader but you’re in bed w/those who are, as seen in your comments. You missed my specific reference to your own response to one of the posts, but you wrote “good amusing theory” to someone who actually wrote, of Stan Glantz: “How much death and destruction would his slapdash and frankly childish attitude to science caused with machines ?” Really, Clive? Good and amusing?

    This is where you have crusaders utterly off the rails and you humour their comments and dignify them w/a serious response. I tell you bluntly, that was shameful of you. Disagree all you want w/Glantz on this or any other specific issue, but do you think he’s not made a valuable and considerable contribution to public health w/both his research and his advocacy? I was being nice, but your response had me embarrassed for you. You do know better.

    Ultimately, I think the vaping community has crafted an instant Ptolemaic Universe and you’re indulging it. Now, you may think Dutra, Glantz, myself and many others are the ones w/the orthodoxy that proves wrong, but I’m saying clearly that there is a possible medicinal role for e-cigs but not an open market free-for-all. (I’m aware the genie-out-of-the-bottle, cow-out-of-the-barn aspect of all this, but it makes the need for extremely restrictive regulation all the more urgent.) Taking a stick of anything, a cigarette or a vapestick, is a pathetic, juvenile act, and in the former case, one w/truly profound, deleterious consequences. As I’ve said already, I have no doubt of the sincere testimonials of individual smokers who’ve been helped to quit, but there are risks of terrible societal consequences to e-cigs and your dismissal of the marketing concerns is proof you’re really not getting the bigger picture.

    And that’s my Ptolemaic reference. There is a construct by which the e-cig is now the Earth at the centre of the tobacco universe and everything should revolve around it. But there is no evidence that it’s so. Ok, my analogy bobbles as, in this case, the Copernicus and Galileo of good TC policy predate Ptolemy but I think you get my point. It’s a cult, it’s dogma, and the attacks on people questioning the validity of e-cigs come off as a modern Inquisition. Fortunately, if we get burned at the e-stake, there’s no fire, just a little dangerous nicotine juice spilled on the ground…

    Sorry, no time to be more succinct, must move on, will stay tuned…

    1. Hello Stan
      I think you are being slightly unfair to Clive in the context of the real world. The reason the ‘e-cig crusaders’ exist if at all is that almost invariably only one side of the argument is put forward that is usually incredibly negatively bias. If there was not a need for such blogs they would not exist. Out of around 30 newspaper articles on e-cigs in the last couple of years only 2 have not been negatively bias. Many of them claim the e-cigs could be or are worse for you than Traditional cigarettes! Clive Bates is rarely mentioned in these articles and when he is his arguments are not put forward! The ‘e-cig Crusaders’ are just exasperated. A lot of the media coverage is simply factually incorrect, if you know anything about the area.

      In addition, with regard to regulation why should e-cigs be much more tightly regulated than real ones (I am not against loose regulation which we sort of have)? If cigarettes were banned then eventually one would not need e-cigarettes anyway? I do feel people are too prone to attaching e-cigs when they should be doing more to stop real smoking, then there may not be a need eventually for eicgs. Again this is the context so often ignored: pushing out the good with the perfect. Energy is being wasted as it is not saving lives in fact it could do the reverse.
      Logically e-cigs are much saver and there is now a systemic review providing evidence for this:


      On the matter of toxicity there has been the ‘mantra’ banded around that e-cig users don’t know what they are inhaling – relative to cigarettes the opposite is the case. Most people would not be able to name even 8 of the chemicals in traditional cigarettes, 64 of which are carcinogens (there is approximately 10,000 chemicals in cigarette smoke). With some liquids made to a medicinal purity (one is due to get MA), the liquids contain little more than 4 chemicals (so not worse for you than NRT). In addition, you do not absorb anything like the same amount of nicotine from vapour as you do from smoke dependent on the device, liquid concentration of nicotine and biodiversity. Thus, on average you will only absorb 50% of the nicotine in the solution. With cigarettes it is a 100% and more due to blocking holes on the filter etc, and errors in cigarette testing machines. You actually would have to have approximately 50mg /1ml of nicotine to equal that of a cigarette which is way beyond that permitted by the new EU directive (i.e. To equal a cigarette puff for puff).

      It would seem that Clive did need to list the poisons as you mention a death of a child in Israel that was 2 years old which is most unfortunate. What is a 2 year old doing with an e-cig – using it, eating it? How many children have died in Israel from alcohol, bleach or other poisons Clive mentions including drugs – I bet more than 1? Does this mean that there should be tighter regulations on alcohol and bleach. Sounds like the 2 year old had bad parents? Again this is in the context of tobacco being estimated to cause 1 billion deaths in the 21st Century. So there is I am afraid a ‘relativism’ argument here in the context of the real world which is not very nice one. Obviously any death is most unfortunate.

      There are approximately 10 million e-cig users in the world now (4 million of these just in the UK and Germany now) so think there maybe more users than you release, which just goes to show how few ‘adverse incidents’ have been reported.

      You have to see bloggers comments in context of constant attacks against devices that have stopped them smoking or good, to which the health benefits are blatantly obvious to the user: they can do much more exercise, they have much more energy, look better their cough stops, their sperm count goes up, the list is endless.

    2. Stan:

      “Taking a stick of anything, a cigarette or a vapestick, is a pathetic, juvenile act”

      This succinctly sums up, to me, the driver behind the “Public Health” argument against e-cigs.

      Enoying a recreational drug is NOT pathetic or juvenile. It is one of lifes pleasures. The state has no business nannying it’s citizens and telling them what they can and cannot do with their own bodies, provided that they do not harm other people in doing so.

      Alcohol and caffeine are two drugs which both are acceptable to partake of. If nicotine turns out to be about as harmful as caffeine in the doses consumed by an average vaper then why should the state need to get in the way?

      Tobacco control advocates would do well, I think, to divorce themselves from the view that nicotine is a problem. It’s not and more and more credible science is backing this up. Smoking is a problem and rather than embrace smoke free alternatives like snus or e-cigs, Smoking control advocates in general and Glantz in particular seem to conflate smoking and nicotine all too often.

      If adults who enjoy nicotine, can get their nicotine from smokefree sources that are many times safer than smoking, isn’t this a good thing? Left to their own devices, smokefree alternatives look likely to all but eradicate smoking tobacco inside of 20-30 years. With appropriate regulation this could happen without the state spending much either.

    3. Larry Fisher

      “It’s a cult, it’s dogma, and the attacks on people questioning the validity of e-cigs come off as a modern Inquisition.”
      Pot, meet kettle.

      1. To Larry Fisher

        An element of what you say is true but the only people’s opinions that have influence are those those that are opposed or at least negatively bias. The EU are effectively going to ban e-cigarettes despite no evidence of them being dangerous but substantial evidence that they are much safer. Thus smokers will only have the opinion of the lethal product. Pretty silly really?

    4. Stan
      Nicotine, in the forms of chewing gum , patches,inhalers and so on has been a very common feature of many homes for a long time, incidences of serious poisonings are quite rare. (In fact the official LD 50 figures for nicotine are not well grounded, at all.)

      Second thing is that consumption of nicotine, in itself -I.e without creating combustion products,is not a safety issue, for non users. Use of this drug does not cause car crashes, nor does it cause people to act in violent ways.

      Therefore its use by consenting adults, is not a matter for legal regulation , in a civil society.

  28. Stan Shatenstein

    To Guy Eaton: I sincerely respect your motivation, but I disagree w/your reading of the news and literature. I don’t see evidence of a campaign to demonise e-cigs, but rather, a lot of voices, mine included, urging caution. If anything, my argument is that those in your camp are demanding free, unfettered markets for e-cigs when the precautionary principle speaks to the need for another approach.

    One can do no less than find a 2-yr-old’s death “most unfortunate” (ingestion of liquid nicotine) and surely some sad fault lies w/the parents, but this is really not trivial stuff and, in my view, far more importantly, nor is the marketing of e-cigs and the attendant renormalising of smoking behaviour.

    It is when you speak of “health benefits [that] are blatantly obvious to the user”, my respect is, as I said, sincere. I’m not doubting your experience and I don’t think any thoughtful individual would. If you read my posts carefully, you would know I acknowledge potential e-cig cessation benefits. But as a marketplace commodity, there are much deeper issues, of far broader reach, than your or anyone else’s anecdotal experience.

    To Carl Phillips: I reject your characterisation of my comments as ad hominem. You surely know the body of literature indicating that tobacco-industry funding influences and taints results. I’m not analysing any specific work of yours in any particular detail. I am maintaining, to Clive, that reliance on works of authors who acknowledge tobacco industry funding, as you do, weakens his argument.

    1. ‘I don’t see evidence of a campaign to demonise e-cigs’

      I read an article on a US site today quoting a professor of medicine (Dr.Hurt from the MAYO clinic) again iterating that 60mg of nicotine is fatal for an adult, this is not the case at all, it is far higher. Dubious amateur experiments from 1856(!) form the basis of this falsehood. How can we read that and not think its deliberate obfuscation? We know absolutely Pharma has lobbied hard against ecigs and it difficult to believe this hasn’t seeped into deliberate misinformation.

      Anyway, having an ‘Anti’ come on this site is progress, thank you

    2. Hello Stan
      I am not a fanatic in anyway at all. I know many people who have given up smoking using the types of e-cigarettes / liquid that are to be banned by the EU (at least 30 people). All tried quitting with NRT many times and found it easy with good e-cigs. They are not in fact one product (some are very good and some are not). The liquid I use is made to a medicinal purity and has less chemicals in it that most NRT products. Also all bottles have all the correct labelling and are child proof. This liquid will probably be licensed as a medicine. I believe in some regulation, re. purity and quality of products and poisons labelling etc. However, limiting nicotine to levels that will not satisfy the heavy smoker (the very ones who need to urgently quit) and the most useful devises is not the way to go about it.

      I am scientifically qualified and have a fast knowledge of the development of ECs and efficacy and safety research.
      I must say the media has been negatively bias in the UK as I have read all the articles. The ones that have not been the exception.

      N.B. I know 2 people who have died from smoking including my Father who was a Senior Vice President at JP Morgans. He had a horrendous death from lung cancer that spread to his liver, spin and brain and after nursing him for 18 months he suffocated in front of my eyes, going blue and then black veins forming all over his body. I am an anti-smoker. It would be good to concentrate on the cigarettes – I would like to see them banned. The product I use contains no carcinogens and the vapour and liquid has been thoroughly analysed for impurities. If my Father had found e-cigarettes he probably would be alive today.

    3. Stan
      well, the research in question is already leading to a ban on e-cig use in public places in Wales because of the ‘gateway effect’. That took a long time! It is exactly as I said we are not fanatics on this blog – it is only the opponents that seem to get there way re. policy development and in my view bad policy development that will cost lives. This is why the blog is needed and pro-ecig people are passionate – as their views and the research evidence tends to be ignored, importantly leading to policy that is restrictive.

  29. I think that the cat, as it were, is so far out of the bag that the Tobacco Control myopics are doomed to failure. You could outlaw E-cigs, E-Fluid and Nicotine tomorrow and it won’t stop any Vaper from enjoying the product far, far into the future.

    This is, in essence, the power of organized individuals to determine their fate regardless of the short-sighted (and in some cases well-meaning) dictates of Public Health and over-reaching Government.

    The networks to subvert and destroy any official attempts to stop E-cigs are already being put in place. Good luck with your Bans!

    1. localpeasant

      Sadly its the excessive regulations that will send users to the far more dangerous illicit market in the future

  30. Stan some points on your reply:

    Do you agree with my critique? If you weren’t arguing against the points I was making, what were you doing? (And why the invective?). The letter is about sloppy or purposefully misleading scholarship – and you don’t seem to dispute it. If you were widening the debate, I’d be happy to do that, but you need to be a bit more systematic than grabbing some poison report and being scandalised by effective advertising. In the post you responded to, I was trying to test the various claims made in the paper and media and show how a media storm was created out of nothing, and used politically – and not for the first time. I fail to see how this is verbiage.

    Citing people funded by the tobacco industry. I didn’t have to rely on Rodu or Phillips, I chose to. I linked to them because they made good rigorous points. The errors in the Glantz-Dutra paper are so elementary I think could have analysed them all on my own. To be pedantic, the linking to these sources doesn’t weaken the case itself, it changes the perception of the case by those who think like you do. Carl Phillips is especially interesting on what a gateway would actually mean, and specifically how unimportant initiation and sequencing is – eg. here. I haven’t seen any of the public health establishment discuss this concept analytically, and there is certainly no useful conceptual framework established in the Glantz-Dutra paper.

    Rodu’s fair representation of NYTS data. Brad Rodu and I both spotted the flaw in the chart in the Fairchild A et al (2013) NEJM article: The Renormalization of Smoking? E-Cigarettes and the Tobacco “Endgame”. This chart was incorrectly formulated, but done properly would be a useful visualisation of the CDC NYTS data, which has been heavily abused by the CDC, FDA and public health establishment into a scare story, when it is nothing of the sort. However, the author and the editors appear to have decided it was less embarrassing to stick with the wrong version than change it. Anyhow, I think it is a useful and illuminating chart and I want to use it, so we made a correct version, as displayed above in the letter… and I am certainly not going to deny Brad Rodu the credit because you disapprove of his funding. The questions you should really ask are: why did none of the scholars and professionals (with funding you approve of) do anything about this? Why doesn’t the NEJM publish a correction when there is no ambiguity that the original was wrong? What are the subtle and usually undisclosed conflicts built in to the funding you do approve of – and how has this affected the discourse on harm reduction?

    Poisons and risk. The listing of most common poisons incidents isn’t mine – it’s from the MN poisons centre annual report. I was trying to make the point, evidently without success, that we live in world of routine poisons hazards and have pretty good ways to manage the risks that arise without closing down or demonising the industries involved. If there was no benefit to e-cigs, you’d have a point – but a ~99% reduction in risk compared to smoking is a big benefit and you shouldn’t deny smokers that option for the simple reason they want it. Just manage the risks. I don’t really know what happened in Israel – it’s certainly very sad. But I suspect a childproof container would have made a difference – but no-one can cannot guarantee anything to be truly risk free or insusceptible to human error.

    On the ‘good and amusing theory’ comment – I recognise that irony doesn’t travel well over the Atlantic but your indignation sounds a little overdone to be honest. I responded to the comment because I wanted to make two serious points: the lives at stake in the tobacco epidemic and standards of quality control and challenge in other disciplines that would not tolerate this sort of work. I think there is just too much poor science and propaganda coming of public health activist academia – there are not many other disciplines where you see it to the same extent.

    The disparagement of vapers. I can’t really respond to the rest of your thinking about Ptolemaic universe etc… it isn’t an accurate characterisation of what I think, or frankly what the ‘vaping community’ thinks as far as I understand it (…it isn’t homogenous by the way, there is no Big Vape). There are certainly people who are passionate about what vaping has done for them, who hope that others will follow, and worry about reckless regulation of the type you favour. You could try listening to them rather than dismissing them as ‘e-crusaders’. If you think this:

    Taking a stick of anything, a cigarette or a vapestick, is a pathetic, juvenile act, and in the former case, one w/truly profound, deleterious consequences.

    …I’m not surprised you struggle with this issue and the people involved. Can you see how you appear to seethe with contempt for the people who are supposed to be beneficiaries to the work done in public health? This sort of statement betrays a disturbing and intolerant world view. Is it really about health? Or is it a judgemental attitude to bodily purity, authority and control? Stan, I don’t know what drives you, but you could reflect on this question in the context of harm reduction [see Alderman, Dollar, Kozlowski (2010) for a fascinating segmentation of the moral psychology of the protagonists in debates on harm reduction.

    Appropriate regulation. You argue there is a medical role for e-cigs, but not an ‘open market free for all’. I don’t know of anyone seriously involved who doesn’t want some sort of regulation. But many in tobacco control simply do not understand the negative unintended consequences of imposing high regulatory barriers to entry to e-cigs (or don’t care). Why wouldn’t you allow e-cigs to compete with cigarettes to radically change the market for recreational nicotine from dirty to clean nicotine? What a bizarre idea – that only the most toxic products should be in the open market.

    Big picture and whose vision for the ‘endgame’. I think it is the supporters of low-risk nicotine products who have the big picture. If you want infantile Ptolemaic ideas, take a look at the official ‘Tobacco Endgame’. Many of these unworldy authoritarian fantasies haven’t yet had the criticism they deserve, but most are utterly unworkable or plain silly. But if you did actually want to reduce smoking by 30% by 2025 (I assume you do), I think e-cigs would be very much in your arsenal – and you would want the advertising to be highly effective to increase the penetration into the cigarette market as far as possible. If we approach the issue more purposefully, it is possible to get seriously good public health results without coercion, taxation, prohibition, or pissing people off on an epic scale. It’s happened with snus, and, given the right regulation, true and fair information, and end to black propaganda from the public health establishment, it could happen with e-cigarettes on a grander scale.

  31. Stan Shatenstein


    You’ve missed the spirit and the point entirely. In the first place, I wasn’t so much agreeing w/you as simply allowing that you had a fair case to make from your perspective. I thought I made some fair points in broadening the discussion. We can agree to disagree. But you’re just plain snotty w/the bit about irony not crossing the Atlantic. I was criticising you, not holding you in contempt. You were indulging someone’s lunatic ramblings and you had neither the fair-mindedness, in that instance (I am not judging your character as a whole, just responding to what you wrote), to call him out on his ignoble comments, nor the decency (again, in this instance) to admit to me you were wrong.

    You are more deeply wrong, profoundly wrong, in your take on my reaction to smokers. If you can claim I “appear to seethe with contempt” for smokers, you are utterly clueless. (And “bodily purity, authority and control”? Pathetic psychoanalysis, but thanks for the free consult.) I am making the ‘spittoon point’. We don’t see spittoons in bars and pubs (saloons!) anymore because it’s a grotesque habit that has lost public favour. The act of smoking is pathetic and juvenile, and cigarettes rightly called pacifiers. That is not a judgment of smokers, whatever you may think. It is pointing that they began the habit of smoking when there were elements of it that had the appearance of cool and social acceptability and, as we well know, by the time most regret starting, they are addicted and find it incredibly difficult to quit. I am categorically not mocking smokers. I am criticising the celebration of e-cigarettes as they do interfere w/the denormalisation of the act of smoking.

    And yet, all that said, I’ve admitted, freely, all along, that they may well have a certain utility. I am not bound by any dogma. But the fact that cigarettes are tragically, egregiously under-regulated, does not mean that e-cigarettes should get a nearly free pass. This sounds like the child’s ‘not fair, he hit me first’. It IS utterly unfair that cigarettes are treated as they are on the marketplace, so could we avoid making the same mistakes w/e-cigs? Yes, less harmful, but not necessarily safe and, more than anything, for the impact they may have on continued smoking.

    It may be hard for me to stick to my word and resist further response, but given your grotesque read (it’s the word that came to mind spontaneously, I hesitate to use it, but given your view of what you think I’m saying about smokers and what I know of my personal feelings, it actually does fit) of what I wrote, and the day’s obligations, this will be my last word here.



    1. Stan Shatenstein: “To Carl Phillips: I reject your characterisation of my comments as ad hominem. You surely know the body of literature indicating that tobacco-industry funding influences and taints results. I’m not analysing any specific work of yours in any particular detail. I am maintaining, to Clive, that reliance on works of authors who acknowledge tobacco industry funding, as you do, weakens his argument.” and “Phillips and Rodu are not credible and I maintain it weakens your case if you need rely on them.”

      You seem pretty sure of yourself there. So let’s put it to the test: Identify one single analysis in my extensive corpus of work that is wrong. Bonus points if you can find anything remotely as wrong as the antecedent for this conversation: Glantz writing papers whose conclusions are **not at all** supported by the results he presents. (Hint: It is not possible to do the latter. It is possible to do the former, but I believe that I have later corrected – and acknowledged – every mistake of substance I am aware of.)

      That too tough for you? Yeah, I suppose – it would require understanding my analyses. So how about this: Identify a single instance of tobacco industry funded or conducted research being corrupt in the last generation. Or are your ad hominem attacks based on the behavior of people who retired or died years ago? Do you respond to Germans whose views you do not like by invoking Nazis too?

      So, I am asking for just one example of either.

      I’ll wait.

      Oh, and even if you find it, your game was still ad hominem attack. You really hurt your credibility, such as it is, when you cannot even distinguish between “I believe my ad hominem attack is justified” (which is what you seem to be claiming) and “I deny that I am making an ad hominem attack” (which is what you said, despite the patent evidence to the contrary).

      On my previous point about you apparently not even reading what you write yourself:
      “You are more deeply wrong, profoundly wrong, in your take on my reaction to smokers. If you can claim I “appear to seethe with contempt” for smokers, you are utterly clueless. …. I am making the ‘spittoon point’. We don’t see spittoons in bars and pubs (saloons!) anymore because it’s a grotesque habit that has lost public favour. The act of smoking is pathetic and juvenile, and cigarettes rightly called pacifiers. That is not a judgment of smokers, whatever you may think.”

      If that is compassion, the mind boggles at how you speak of those that you *do* feel contempt for.

    2. A Semantic point. Smoking/Nicotine use IS an adult act, a recreation firstly of choice, then of addiction in some cases. Society through age restriction on products recognizes it as an adult pastime. To call it Juvenile is quite frankly wrong. I could go as far as to say that to claim nicotine as juvenile is senile, but I won’t. (but I did).

      As regulation goes Age Restriction is all that is necessary, if properly set out and adhered to.

      further more on the marketing, it shouldn’t matter if a company uses mickey mouse on the back of road runner, saying “hey try smoking kids, it’s cool”.

      Because even though they might want them (…there is no little evidence of this thus far) no self respecting retailer will sell the product to anyone underage, beside the fact that to do so is illegal.

      If you see someone underage smoking, someone along the chain from manufacturer to end consumer has broken the law.

  32. Stan – as I say, I don’t know what you think about this or what drives you – and I wouldn’t presume to know. I’m talking about how that comment appears – and I’m sorry if you don’t like it. The bodily purity stuff is not mine it’s from the interesting Alderman, Dollar, Kozlowski paper – which I think is a credible attempt to unpick the hostility generated by the harm reduction debate.

    Have a productive day.


  33. Stan and Clive – let me first say that it is refreshing to see a debate opened up like this. Let me move on to offer Stan the opportunity to debate this live, on web TV, one Thursday night in the near future, in the company of Clive, myself, my estimable colleague Sav, and a fair few viewers, who will also have the chance to chime in.

    What do you think??

  34. localpeasant

    At times like this I could do with a FAG, thats a Tobacco cigarette Stan= consequencies of bad policy making ;-)

  35. Pingback: The Clive Bates Throw-Down: Go Read The Commen...

  36. It’s not up to regulators to decide whether or not an individual switches from tobacco smoke to vape. The health psychotics seem to forget about this and seem not to realize the sole factor that determines their success in they ‘quest’ is if they can convince the smoking population with their make believe fairy tail science. And looking at the statistics on different usage they seem not be doing a very convincing job. Honest and truthful information is freely available for everyone on the internet; so lying trough your teeth is no longer an option like it was in the 80’s.

  37. Stan – I think your ‘spittoon point’ is extremely revealing. It is indicative of sensibilities towards a practice that you consider ‘grotesque’, ‘pathetic’, and ‘juvenile’. Would you be so bold as to make this charge of native American peoples who have used tobacco for millennia? Clearly it is a ‘civilised code’ – behavioural standards – that drive your opposition to e-cigarettes. Surely any scientist worth his or her salt should be extremely cautions of allowing heteronomous (i.e. extra-scientific) evaluations undergird their analyses? Moreover, the idea that we can conflate ‘vaping’ and ‘smoking’ through the common pathway of their involving a ‘stick’ which is sucked upon ‘like a pacifier’ suggests you have effectively found e-cigarettes guilty by association with their combustible counterparts (and at that, guilty until proven innocent).

    Your response perfectly fits a more general pattern in which e-cigarettes are being opposed more on the grounds of the ‘social dangers’ they present than on the basis of any substantial long-term clinical research. Again, this follows the much longer history of ‘smoking’: what are at first moral arguments subsequently become transposed into medical ones. As for your being unaware of any ‘campaign to demonise e-cigarettes’, it would surely be difficult not to have noticed recent newspaper headlines that include such misinformation as ‘E-cigarettes can cause more harm than smoking’ http://www.dailymail.co.uk/health/article-2268702/E-cigarettes-cause-harm-smoking-experts-say.html (albeit that in this case, the piece was redacted after the misinformational damage was done). Whether or not these constitute a ‘campaign’ – with all the conspiratorial connotations that term implies – is an empirical question. A ‘campaign’ suggests rational planning and orchestration by an individual or group who would need to have considerable influence over the popular media; perhaps that would lead us too much towards a conspiracy? But at the very least, such articles would appear to constitute evidence of segments of the popular media more than ready to generate a ‘panic’ about e-cigs.

  38. TheInvisibleHand

    Enlightening exchange. Should show people what Tobacco Control actually thinks about the people they claim to want to help..

  39. Stan Shatenstein

    I’m keeping my word w/respect to Clive, and I thank him for his final comments, but I will respond now to two new interlocutors:

    To John Hughes (the same I know slightly, from Vt?):

    First, have you been following the mystery and tragedy of the lost Malaysian airplane? Have you seen the accuracy and thoughtfulness of media coverage? I think everyone would answer yes to the first question, no to the second, the point being that I’m not here to defend the news media! And I’m not here to attack smokers, vapers, or anyone else. I used the word ‘grotesque’ to describe the use of spittoons, and I stand by that. I used pathetic and juvenile in respect to the habit of repeatedly moving hand to mouth to ingest drugs and, though it may seem harsh, I’ll stand by the use of both words. In your sensitivity to native Americans, would you have taken the same logical tack if their practice had been the injection of heroin?

    The point is autre temps, autres moeurs. You can defend just about any practice, and I am not a prohibitionist at all, but I do think smoking is pathetic in the true, deep sense of the word pathos. People engaging in a behaviour for which some claim pleasure (while most acknowledge they are simply stuck w/a horrible addiction), but which is ultimately just the satisfying of an addiction – an addiction for which we both know they will pay a terrible price. And in a great many cases, one which will lead them to inflict great harm on others. I don’t think cultural nostalgia for the peace pipe really serves the discussion well. Include tobacco in a sacred ceremony if that’s your cultural tradition, but don’t dress it up as something noble, or make a veiled charge of cultural imperialism against me.

    To Mark Hillman:

    You quoted a phrase I used accurately, but that does not mean you can commandeer it to summarise the “Public Health” (why the capitals and scare quotes?) argument against e-cigs. I outlined some of my concerns, and I only speak for myself, not a community (and if you’re following the larger debate, you must surely know there is division in whatever you would consider the public health and tobacco control communities over e-cigs. Just as there may be no vape community monolith, the same applies to the other communities as well), but I categorically reject that your summation has anything to do w/my broader views.

    As I said, I’m not a prohibitionist, nor do I wish to deny anyone some of life’s pleasures. There are people who experience a thrill jumping out of perfectly good airplanes. I’d never do it myself, but most do it w/o killing themselves so, make sure the safety standards for parachutes and airplanes are, pardon the expression, up to snuff (let me know if my sense of humour crossed the Atlantic, Clive), and knock yourselves out. Ok, not literally, but have fun. But it is not my iconoclastic judgment that smoking isn’t one of life’s pleasures. There is, if nothing more, a cost-benefit equation more eloquent than anything I can say. Hey, there might be a thrill for some in Russian roulette, no doubt some would defend it on libertarian grounds, but we get into a reductio ad absurdum about ‘pleasure’ and Russian roulette and smoking (which undeniably is a slow form of the former, w/far worse odds of survival, esp. considering most would only try Russian roulette once, but smokers are often in for the long, yet paradoxically, too short haul), and I think you’re on the wrong side of the argument. Regulating is not nannying. You may think it semantics, but you want regulations to keep you safe and to ensure products you buy work as advertised, everyone does. It’s just a facile charge and I suspect you know it. It’s fair to debate degrees of regulation, but not the principle.

    Nicotine is an insecticide. It is a problem, period. But it is not a problem of the magnitude of what are collectively known as the tars of cigarettes, no trouble for us to agree there. I’m not going to get into a battle of citations here, but I maintain a massive library of scientific literature on smoking and health issues and your claim that “more and more credible science” is, presumably, backing up the innocuous nature of nicotine is not supported by my groaning e-bookshelves. There absolutely are studies that argue to your point, but many against, and there are established deleterious effects. Yes, of course, better to get anything via a non-smoked route, but caution required.

    1. Stan, I could, were I so inclined, be affronted that you saw fit to reply to two other posters but failed to acknowledge my serious and genuine offer of a platform to debate this live on web TV. (Note that that sentence is meant to be light hearted, and in no way an admonishment.) So, how about it? We’re not “Scare quotes bat droppings crazy people”, but, we like to think, a serious TV show dedicated to discussing the issues surrounding ecigs. I may not be David Dimbleby, but I’m halfway there. All it takes is Skype and a webcam, and you’re as good as in the studio. I can guarantee a warm welcome and a lively discussion. Yes? No? If not, why not?

      1. Dave (and Clive and John and Mark) is the Stan posting comments here the real Stan that we know and – ah – love!?

        Seems like an educated troll to me. I wonder, because THIS Stan’s views seem to lack maturity or wisdom. Even the vaguest concept of the mouth being a pleasure zone in animals, however it is used, is absent in this Stan. “The act of smoking is pathetic and juvenile, and cigarettes rightly called pacifiers.” can only be the words of a troll.

        We only follow western History i.e. that tobacco came from America, but populations in Africa and many other countries were smoking long before America was discovered! There must be something really pleasurable about it – more profound than pathetic and juvenile. I can’t believe the real Stan, with all his power could reveal himself to be so superficial. He’s playing with you.

        There are other aspects of this Stan’s ideas that seem odd to me, if you think carefully about what he writes. Two small examples that struck me to prove my point were “In your sensitivity to native Americans, would you have taken the same logical tack if their practice had been the injection of heroin?” Whaaaa?

        and “Nicotine is an insecticide. It is a problem, period.” has not been thought through properly has it, seeing it is an essential in our food? Lots of little straw men everywhere, is what I think. Too too many to actually get one’s head around.

        It would be wonderful to see the real Stan interviewed by you Dave, on TV, but I suspect THIS Stan, might disappear in a poof of – can I say it? – smoke!

    2. Stan wrote:

      “I used pathetic and juvenile in respect to the habit of repeatedly moving hand to mouth to ingest drugs and, though it may seem harsh, I’ll stand by the use of both words. In your sensitivity to native Americans, would you have taken the same logical tack if their practice had been the injection of heroin?”

      I enjoy it. Who the bleep are you to tell me I shouldn’t be able to enjoy it (or should have my access to a habit I enjoy restricted)?

      That is the fundamental question. If you can come up with some compelling, empirical evidence to suggest that harms posed by e-cigs dramatically outweigh the benefits, then sure, we’d all have to listen — but you haven’t even come close to meeting that rather high burden.

      All you’ve managed here is a bunch of baseless emotional appeals. “Oh, one child was poisoned, and don’t you dare dismiss that as unimportant you savages!” No one dismisses even a single child’s death, but if one child’s death (the details of which in this case, by the way, are quite vague) were sufficient to indict an entire industry, then we’d all have no freedom at all.

      The poison-call-center statistics, likewise, are hilariously insignificant in the grand scheme. You’re grasping at straws. And you do this for a living? Ha, pathetic indeed.

      Maybe if you weren’t drawing a paycheck for manufacturing justifications for gratuitous restrictions on a disproportionately poor segment of the populace, I could take you more seriously. For many people, their ability to vape is one of the few pleasures available in their daily life, but pleasure doesn’t matter does it? Only longevity.

      Well, longevity and your paychecks.

  40. Adam Williams

    Re’ the little girl. My understanding is that it occurred in a country where e-cigarettes are banned. So the nicotine was brought in on the black market, probably in a form that would be non compliant in the UK (CHIP safe, labelling, and strength etc)
    My view is that over regulation / banning e-cigs would increase the odds of this happening elsewhere and disinformation from Glantz etc could ultimately leave some smokers killing themselves through such ignorance.
    I see no one has mentioned the fatalities attributed to some NRT’s either, Chanpix Zyban et-all. Is this acceptable “collateral damage” Stan?

  41. I think Clive and Stan are closer to each other than they are apart on this. It’s seems to be emphasis that separates them.
    I’m making a lot of assumptions here so correct me if I’m wrong; but from a public health perspective both Clive and Stan would agree that if all smokers switched to ecigs then we would have a positive health outcome. Both would agree that smoking is the problem right now, nicotine use may prove to be a problem later though it could never present the harm that smoking has.
    The difference is Clive doesn’t see a problem with hand to mouth ingestion of a drug as a recreational activity if it doesn’t involve a harm to the user. Stan see it as pathetic and unnecessary. I assume again that this attitude extends to the hand to mouth ingestion of caffeine (another insecticide) and alcohol.
    Both would accept that they have no place as public health advocates dictating to people on their personal choices once it doesn’t incur a health cost, the only thing to be settled is how to regulate the use of ecigs to achieve the best possible outcome. That’s the discussion we should be having , not what might happen if we do or don’t restrict them.
    The point of Clive’s challenging of the other Stan’s ‘research’ was that it wasn’t honest, truthful or helpful, it distorted the facts and causes harm in itself by doing so.
    If a proper regulation that maximises the benefits and reduces the possible harm is to come about we need honest factual research, not propaganda that misdirects the regulation.
    Adopting an attitude of “we disapprove of this behaviour and wish it to go away because we don’t like it” is not helping, it only shows that public health has lost it’s focus; health and become a temperance campaign.

  42. thanks for the response Stan.

    I put “Public Health” in scare quotes deliberately. There are a lot of campaigners who are fighting for the good of the public health, there are also a lot of what I call “Public Health” advocates who appear to me to be campaigning about things simply for the sake of campaigning, and whose motives are selfish or puritanical. The quote I used illustrates that. I put anyone like Glantz who purposefully misrepresent science to further their own agenda into the scare quotes category. Let us do the science and follow where it leads, and let us do so honestly. I cannot saying which category I think you are in as I’ve not read enough to hold an opinion on that.

    I am not against regulation of e-cigs and other smokefree alternatives at all. There needs to be good regulations that adequately protect the public. I take the view that we should hold off on imposing overbearing regulation until such time as a negative health issue is shown. All of the science I’ve read to date says (to over simplify) ‘the danger from smoking is in the smoke’ – read a more complete synopsis by Dr. Murray Laugesen here It is easier to impose regulation than it is to repeal bad legislation, so I favour regulation being as light touch as possible.

    Nicotine is not an insecticide. It’s a chemical produced by plants from the genus Nightshade, of which potatoes and tomatoes are also members. While it can be argued that nicotine evolved as an antiherbivore chemical, it is by no means proven. In any case exactly the same charge could be levelled at caffeine on the basis of similar arguments and that is classified GRAS.

    While nicotine was used as an insecticide and is indeed highly toxic, as I am sure you are well aware toxicity is a function of dose. Given how ubiquitous potatoes and tomatoes are in our diet everyone in the western world tests positive for nicotine. Certainly at the tiny doses present in widely consumed food nicotine is completely harmless.

    At the doses contained in a e-cig or a snus portion nicotine is harmless to the best of my knowledge, when used as directed. If you can show evidence to the contrary then by all means.

  43. Regarding the last paragraph. Yes, nicotine is an insecticide and is toxic but it is a relativism argument that is important here again. Nicotine causes no know smoking related diseases that have been proven of itself:the toxic cocktail of cigarette smoke cause all the diseases period. I don’t think vapours want something as safe as a apple or orange anyway? What about the benefits of nicotine these are never even considered as there is and ingrained negative premise of dangerousness. See link on benefits:


  44. A closed narrow minded thought process, is unwilling to be open to change and thinks it knows what’s best for others no matter what evidence is put before it.

    Some people have “groaning e-bookshelves” because the books realise they are being read but not understood.

    And we don’t all require regulation and controlling influences of our lives as some people think we do. Though we may appear too some, to be pathetic and juvenile, we are actually adults who can make decisions for ourselves without controlling minds telling us what’s best for us!

    No matter how verbose they are.

    Besides it has nothing to do with what’s best for us, its all about money and control, not health! This precautionary argument is just a smoke screen(how fitting).

  45. Nicotine may be an insecticide, but this is no different to the “antifreeze” propaganda (salt’s an antifreeze, it doesn’t make it poisonous). Lavender and citrus oils are insecticides, this quality is irrelevant to the argument.
    Nicotine is considered to be no greater risk to the individual than caffeine, and
    I would confidently propose that it’s a much safer drug to society as a whole than alcohol (which has been actively normalised amongst children in the last 40 years).
    Then we get to the “renormalisation” argument, that seems to be the only one the anti-vaping community feels it can use. Smoking hasn’t been denormalised by smoking bans. Smoking rates have not significantly reduced as a result of smoking bans, and vaping could more logically be argued to be normalising smoking cessation.
    It’s interesting to note that none of the anti-ecig brigaide are opposing nicotine inhalators, which require the same hand-to-mouth action and contain all the same ingredients as an ecig, but with the addition of a range of other, more disturbing, chemicals. NICE now agrees that nicotine replacement can be used long term to replace smoking with a reduced harm alternative. Personally, I’d rather have the more pleasant recreational alternative where I can control the ingredients and experience than have the unnecessary chemicals contained in NRT

  46. it amazes me, how polarised this subject has become. I feel let down by the experts who claim to have my best interests at heart. The wholesale delivery of my eventual death to the hands of those who profit per word written on my tombstone, Here lie Shaz, once a smoker, always a smoker, tobacco free or not, she deserved to die for Stan was right as the dead are always wrong.

  47. Stan Shatenstein

    David Dorn: Sorry to hurt your feelings, but put yourself in my shoes. I’m a humourless troll who may or may not be real and who lacks maturity and wisdom and doesn’t even know about oral pleasures. Hell, I wouldn’t want me on your show! But seriously, will consider. But more seriously, it’s time-consuming to sort out the wheat from the chaff here, as you may have noticed.

    Adam Williams: I don’t work for Big Pharma. Your point about risks of Chantix etc is perfectly fair but all the more reason to not have more products on the market making claims that are not validated. That is NOT a call for e-cig prohibition, only for meaningful regulation.

    I would ask all of you what you think of the tobacco industry. If you run or ran a business, would you knowingly continue to market a product that kills consumers in industrial numbers? Well, that’s who’s taking over the e-cig market. Now, that’s not a reason that e-cigs shouldn’t exist, but it’s a gross distortion to think that people like myself who call for muscular regulation and, yes, medicalisation of e-cigs, are going to prevent all the little mom-and-pop shop entrepreneurs from delivering you the best product. Big Tobacco is taking over, and they won’t mind if some of you quit, as long as they can sell either or both products, knowing that e-cig advetising is just the ticket to ensure increased dual use.

    Shaz: Assuming I’m the Stan referred to here, you could not be more wrong. I want you to live as long and as healthy a life as you can. I don’t have to know you to wish that. It’s called being human and decent. But my concerns about e-cig are not allayed, even though you feel they’ve saved your life. I’ve made it clear. I have no doubt that you, as an individual, are running far less risk if you only vape and NEVER smoke, but public health policy can’t be determined by what’s good for any one individual or even a small number of individuals.

    Tom Gleeson: In the land of the blind, the one-eyed are kings. It’s a JOKE. Computer-generated by a troll who will disappear in several megabytes. By which I mean to say, I find much of what you write eminently reasonable, but it goes off the rails at the end. Combining things from a couple of posts, sure, a coffee cup goes hand to mouth, but that’s out of context. Part of the ‘virtue’ of e-cigs is that they give smokers the hand-mouth behaviour along w/the nicotine, but I don’t think it takes deep understanding to distinguish between fork to mouth eating and a ritual drug intake gesture.

    I’m sure there’s more, I don’t mind trying to engage w/serious people, and there are some here, even if there’s time lost reading through the nonsense, and that is what some of it is, but there’s only so much time I can devote to this. Gotta get back under the troll bridge, my shift coming up.

  48. Sorry Stan, Public Health in the UK is built on patient centred health policy, its enshrinded in the NHS Charter. There isn’t a one size fits all model, to use the excuse that policy is for the majority is not why I joined the NHS. I work dam hard to ensure people are treated individually and on a case to case basis. Listen to hearts of the people here on this blog. We are not loons. We are people who care.

  49. I have no desire to wade into what is certainly shaping up as a lively debate (!), but CANNOT endure having read all this without pointing out a vitally important (IMO) issue which appears to have gone unnoticed thus far:

    Stan Shatenstein mentioned the ‘precautionary principle’, but what about the ‘proportionality principle’?? Both are enshrined in the Treaty on the Functioning of the European Union (so sorry if not relevant to the US, but I imagine – in fact, I am certain – that you have similar principles even there), so why is it so vitally important to the two Stans and their cohorts that the precautionary principle should take priority? Especially in the context of the exact opposite precautionary principle also being the case, i.e. that if too much caution is applied, people will continue to die in higher numbers than need to if we do NOT take these precautions????

    The existing regulations in the EU need very little added to them to make them entirely robust enough to ensure consumer protection while keeping these life-saving products available to the smokers who are unable and unwilling to quit, but who ARE ready, willing and able to switch to vaping instead – and I should know, having studied and codified these very regulations over the past 4 years!

    Thank you, Clive, for your continued efforts, but I can imagine you must be beginning to feel more than slightly beleaguered at the behaviour of some portions of “deliberate-scary-quotes-and-caps-Public-Health”, driven by the criminal World Harm Organisation, who really ought to know better and absolutely MUST be stopped before we are all wiped out!

    Sorry. Rant over. As you were, everyone.

  50. “I would ask all of you what you think of the tobacco industry. If you run or ran a business, would you knowingly continue to market a product that kills consumers in industrial numbers? Well, that’s who’s taking over the e-cig market.”

    I do run a business, and if it turned out that e-cigs were in fact as harmful as lit tobacco I would shut up shop tomorrow.

    “Big Tobacco is taking over, and they won’t mind if some of you quit, as long as they can sell either or both products, knowing that e-cig advetising is just the ticket to ensure increased dual use.”

    Big Tobacco is going to have a hell of a fight on it’s hands. The technology has now far moved on from look-a-like devices and so far the tobacco companies are only looking to sell 1st generation e-cigs for the most part. They’re not doing too well so far.

    Let me ask you the following. If all the tobacco companies stopped selling tobacco and started selling widgets that caused no health problems to anyone at all, how many anti-tobacco company campaigners would still campaign against them? If they evolve to sell e-cigs and smokeless tobacco with little to no health issues then where is the problem?

    As far as ‘ritual drug intake gestures’ go sit in a coffee shop and watch how people drink their coffee for half an hour, or watch a group of friends at a bar. Some gestures and idiosyncrasies are normal and acceptable.

    Lastly and most importantly, have you ever smoked? I suspect the answer is no.

    If you only take one thing away from this conversation please let it be this.

    Vaping does NOT normalise smoking. It normalises vaping. The two are worlds apart. Almost noone who prefers vaping to smoking will go back to smoking once they have switched. Once you’ve not smoked for any length of time (several weeks or more) various health benefits are noticeable, primarily your sense of taste returns and the smell of burning tobacco isn’t good.

    If vaping is unavailable then an ex-smoker will want nicotine and will be forced back to smoking, but;

    vaping is cheaper, it’s cleaner, it doesn’t make you, the house, your clothes etc smell bad, your health improves, your life expectancy improves, the risk of house fires is negligible, vaping tastes better, you can very easily tailor your strength of nicotine or flavour to mood, time of day etc

    While seeing people exhale clouds of vapour may look similar e-cig vapour, smoke is immediately identifiable because of the smell.

    That’s the only thing that’s similar, the exhaled vapour cloud. Even the hand to mouth action is different, unless you are using a look-a-like. It’s much different to smoking in many respects and time and time again we hear someone talking about ‘normalising smoking’. I think it’s difficult to explain to a never smoker just how different the two things are.

  51. I am truly amazed at the fore-going discussion. It is like discussing at at what point one person out of a thousand or so will drown as a consequence of walking about outside in the rain and inhaling water vapour. Truly amazing.

  52. Stan Shatenstein

    Mark Hillman: Sorry if I miss my count, but I think it’s wrong, wrong, wrong, wrong, wrong:

    Wrong premise: I was not doubting your integrity, nor anyone else’s here. I didn’t ask if e-cigs were as harmful as cigs, I was asking if you would do as the TI does. I worked on the assumption you wouldn’t.

    Wrong argument: The preceding point was leading to the fact that the TI is taking over – I have all the business takeovers on file, but if you don’t trust me, go to Dr. Google – and will not act w/the integrity I’m sure you would show.

    Wrong conviction: You may be the reincarnation of Don Quixote, but if you think the TI has a big fight on its hand from the vape firms, I say w/o mockery that you are flatly naïve. Money talks and everything else walks. The TI has already bought out many good-sized firms, you really can look it up, and the movement is irrevocable. As has been said in other contexts, you are playing checkers and they are playing chess.

    Wrong premise: Would I shake my fists at BAT Widgets? PMI Widgets? JTI Widgets? I doubt I’d know a widget if I tripped over one and I could not care less. But BAT, PMI, JTI etc would not be tobacco firms if they only sold widgets so it’s really a moot point, right? I haven’t seen any widget mortality tables, so I really don’t care.

    Wrong suspicion: I did smoke some, v. young, and I was lucky. I don’t feel superior to anyone who smokes. I experimented for some of the same dumb reasons other 10-12-y-o’s do and, v. fortunately for me, I apparently didn’t have the ventral striatum and nucleus accumbens structure and receptors to make me prone to addiction.

    Yes, basically 5 wrongs in your note, think I have it covered. I am far more sympathetic to the vaping community than many of you think, based on selective reading of my posts here, but I have read every single study and report I can get my hands on (yes, I’ve read Laugesen, know him well) and, fluent in French, I read Philippe Presles La cigarette électronique as well, and there is a paucity of evidence in favour of e-cigs, but the incipient dominance of the TI and current e-cig marketing practices cry out for caution.

    And for Katherine Devlin, if you think the WHO a criminal ‘Harm’ organization, I’d REALLY like to know what you think of the tobacco industry by comparison?

    The troll-bridge calls again, night shift, wonder what goodies I’ll find in the o’night mail….

    1. I keep up to date with which companies the TI is buying out, which ones they aren’t. My understanding is that they are going after the 1st generation look-a-like part and ignoring the rest of it. Lets say that I am naive and they really will buy the whole thing, if in 20 years time the bulk of what they sell is smokeless and almost noone is smoking lit tobacco, then isn’t that a good result from the point of view of public heath?

      In any event the TI is doing so well and is set to do better because overbearing regulation is handing the market to them on a silver platter. If the regulators make it so expensive, by say enforcing pharma GMP standards onto producers, so that the average SME is unable to get into the market then only the big players will be left. The market is better and the consumers have more choice if the bar to get in is within reach of a small business startup. Over regulating, being too ‘cautious’ will leave consumers with bland big business products, or completely unregulated, untaxed, black market products and nothing inbetween. Faced with that choice a lot of potential vapers will likely stay smoking.

      I would encourage you to consider Dave Dorns offer. A conversation in real time would help all of us to understand each other better.

      I have read as many studies as I can find on nicotine as well. If there are any that you can dig up from your bookshelves that show nicotine is harmful I’d still be very interested in reading them. The paper that’s the topic of this blog article is bad science, it gathers data and comes to a conclusion that is not based on the data. What good science is there that shows nicotine to be harmful to health at the doses used in e-cigs?

  53. How about putting your money where your mouth is and take up David Dorn’s offer to appear on his live web TV? That would be a really good goody. Plus it would prove that you’re not a “troll” posting here with the deliberate intent of provoking vapers for reasons only known to yourself.

  54. Stan – if you smoked “some, v. young”, apparently at the age of 10-12, you really have absolutely no idea about and no understanding of long term smokers.

    Also – and you might not realise this – but you come over as remarkably smug and patronising towards smokers and vapers. It’s a common trait amongst tobacco control (look at McKee, Glantz and Chapman for prime examples), and I’m sure it’s related to the lack of understanding of smokers and vapers, but it does no good whatsoever. Rather, it simply gets people annoyed and more determined and entrenched in their own position.

  55. Stan, I used the hand to mouth gesture of drinking both alcohol and Coffey specifically because both are close to the hand to mouth action of inhaling vapor. To divert this to the fork to mouth action of eating food just shows how far from understanding this you are.
    Again I’m going to repeat myself here but the important thing is finding appropriate legislation. Your medical model is flawed for a lot of reasons but mostly because it creates exactly the situation you most fear. An ecig market dominated by tobacco companies. They are the only players in the field that can afford medical certification. Like you I doubt they intend to replace their core product anytime soon. The best possible outcome for tobacco is a slow transition to vaping, time to build brands and spread the cost of transition over time.
    They are not buying ecig c business to get into the market but to control the market. Witness their lobbying efforts so far.
    To get the best possible outcome we need regulation that will encourage smokers to switch, that will not encourage new users and that allows for development of new and improved products. Both in performance and safety.
    Caution is a good thing but it must be balanced against the clear and present danger of smoking. It would be a shame if tobacco control missed an opportunity to reduce smoking prevalence by knee jerk reaction based on aesthetics.
    If this opportunity is missed then the glacial pace of smoking reduction will continue for the foreseeable future, tobacco companies will continue to profit and people will continue to die from avoidable causes. That’s what this is about Stan, peoples lives, not their personal habits or proclivities. as you are free to not smoke or vape, others are free to both smoke or vape. Unless you feel that this choice should carry a health penalty it would be wisest to remove the harm before trying to persuade them to remove the habit.

  56. Stan… just a thought, if you don’t disagree with my assessment of the Dutra-Glantz paper that is actually the subject of this blog, will you inform your extensive network of the unreliability of its conclusions and the media spin it created? Did you do anything to propagate the idea that the study had found a ‘gateway effect’? If so, do you feel any obligation to undo that? We could even jointly call for its withdrawal from JAMA Pediatrics and so launch a new era of rigour and challenge in tobacco control? Or do you think the study really does justify its main conclusions that:

    Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among US adolescents


  57. Stan – along with plenty of others in the public health industry, I suspect you are talking only about 1st generation cigalikes. Whether that’s deliberate obfuscation or genuine ignorance, I don’t know (though I have my suspicions) but the “muscular regulation and, yes, medicalisation of e-cigs” that you call for will result in the availability of only those products, and they are the ones that BT is investing in. They also don’t work particularly well, as anyone here would probably be happy to tell you, assuming you’d be happy to listen. The result: your “muscular regulation and, yes, medicalisation of e-cigs” means that the only people producing e-cigs are the BT companies, and they’re producing e-cigs that don’t really work. I wonder – do you think they might be happy with that situation?

    To explain, in case it’s genuine ignorance: any small company with a little nous and access to batteries, tanks and coils can make and sell a 2nd or 3rd generation device, which is why BT is *not* getting involved in those devices. If you have “muscular regulation and, yes, medicalisation of e-cigs” – for example, in the way the EU suggests – then you have a market that is so regulated that only the big companies can bring products to market. It’s exactly what Big Tobacco and Big Pharma want (I suspect it’s also what a lot of the more puritanical public health campaigners want, because they can then say “well, it’s just Big Tobacco trying to get more smokers. Let’s regulate, ban and restrict”).

    On the “gateway effect”, I’m afraid that’s just scaremongering, pure and simple. In terms of harm reduction, it’s simply a case of numbers: if we assume e-cigs are 99% safer, then for every smoker who switches to e-cigs, we would need (almost) one smoker to switch from not using nicotine at all, to e-cigs, and thence to smoking for harm not to be reduced. Is that plausible? Assume about 500,000 people in the UK have made the switch from smoking to e-cigs. Do you think it’s remotely plausible that about 500,000 people who had no previous use of nicotine have had a complete brain storm and not only taken up e-cigs, but then moved to smoking real cigarettes? How about even 50,000? Or 10,000? No, it’s an insane position, but it’s essentially what much of the public health industry is saying.

  58. Adam Williams

    Stan, your stance in this whole debate reeks of ‘emotion’ which appears to have little to do with science, idealism, would I think better describe your motivation.
    So yes, we have the bad guys, the tobacco industry, but the fact is they are now smelling the coffee and are increasingly seeing their profits starting to nose dive, they know that if they continue on their old path, they will eventually be all but snuffed out (Scuse the pun) and we know it. IMO so long as they don’t get to monopolise e-cigs which could be their saving grace, which I have no doubt is what they will attempt to do, I have no problem with them taking their share of the industry, proportunatly. This appears to be your main objection, your arguing that turning a poacher into a gamekeeper is a bad thing. 70 years ago some of today’s finest car manufacturers were a huge part of a war machine building panzers and bombers backed by the Nazis. Today we drive their cars in the millions, should we crush the German car industry because of what they once did? Less than 70 years from now (Possibly a lot less time) combustible tobacco may well be a dead duck, I think both side of the house would say amen to that.
    So the question is, who REALY is the loser to e-cigs? Katherine didn’t say it in as many words but I know where she is coming from. The WHO! (and you appear to be missing this) Why? Because it is the one industry backed organisation that stands to lose the most. Its paymasters, the pharmaceuticals industry, stand to lose out on its dismally performing NRT products BUT only by a fraction when compared to the losses due to the potentially huge decline in demand for their other products more associated with tobacco related diseases, eg cardiac, pulmonary, vascular etc and the employment that goes with it. We’re talking £multi billions.
    Stop smoking services (SSS) are reporting fewer recruits to their service and are blaming the take up of e-cigarettes for this, thus their justification for existence is starting to become an issue, except in leister, I think, where they are adopting EC’s as a cessation tool (Experimentaly)
    Did you know a successful quitter is regarded by the SSS (NHS) as someone who’s abstained from cigarette for a pathetic 28days? AKA cooking their books. In addition, they have also extended their patches etc to pregnant women and can recommend patches or gum to 12 year old kids WITHOUT PARENTAL CONCENT.
    Glantz is getting what he wished for and is regretting it, now finding himself desperately back footing, using emotive arguments and publically misrepresenting science. In the USA some states are putting the screws on EC’s through proposals of outright banning or tax hikes. A closer look reveals that these states receive huge government grants for being anti tobacco, so nothing to do with genuine health concerns there then!
    I think we can ALL agree that sensible regulation is the way forward but over restrictive regulation is not, out of interest have you studied ECETA’s guidelines? Everything needed is there, make it law, it wouldn’t be a problem for those that are in this for the long run.
    In the mean time, the black marketers are waiting on the side lines and rubbing their grubby hands in anticipation that vapers are pushed in their direction…….Underground!

  59. Stan Shatenstein

    Kia: I didn’t categorically refuse David Dorn’s offer but time is a big factor and I doubt I can commit to it. Also, while it is worthwhile to have an engaged discussion w/people like Clive and Tom Gleeson, I don’t have time for the Davids of the world, and this list, who find me smug and patronising yet misinterpret almost everything I write and pull ‘facts’ out of thin air.

    More messages are landing as I write, and I really have too much work to devote real time to this. I will say to Tom Gleeson I’m most in agreement w/this statement: “To get the best possible outcome we need regulation that will encourage smokers to switch, that will not encourage new users and that allows for development of new and improved products. Both in performance and safety.”

    However, you are sincerely mistaken if you think my position comes from a “knee jerk reaction based on aesthetics.” We can try to dig down on the nuances another time, perhaps, but I do sense we could have a useful discussion. But I fully admit to a lack of patience for people like David who write w/o thinking or reading the literature, apparently, and then accuse me of bad behaviour, and make assumptions about what they think I think of smokers. Well, correct to a certain extent, I hold you in contempt, David, life too short for people who aren’t fair or thoughtful.

    And Clive, w/whom I disagree but who most decidedly is thoughtful, no, I will not join you in your efforts. I only conceded, as I repeat, that you were fashioning a case that had its own merits, but the Dutra-Glantz paper, viewed in its entirety, is hardly junk science nor w/o merit. And wait for next week. I would never break an embargo, but there’s more coming out that should give this list pause.

    If I repeat myself, I apologise, but as succinctly as I can, I have sympathy for smokers and vapers and I DO see several merits in e-cigarettes. However, they are not a panacea, nor anything like one, and the tobacco industry, which can handle the challenge from any generation e-cig (and I have done my reading and I do know the difference, you arrogant twit), will have the best of both worlds. With over a billion cigarette smokers, we’re not just going to replace smoking w/vaping in some smooth transition. Let’s get that, yes, ‘muscular’ regulation (you have something against mucles) and make sure e-cigs are not used in any of the places cigarettes were once welcome (and, yes, I know many of you will object to my bringing that up, but I’m on v. solid scientific ground here) and we’ll have a more serious discussion going forward.

    PS Was about to hit send when I saw Adam Williams’ post and this is why I’ll have to try to resist the temptation to continue the dialogue. I’m being accused of a solely ’emotional’ response when I’ve done anything but. I do understand that many of you have been personally helped by e-cigs but w/o arrogance, it’s fair to say that THAT can create an emotional response. But I know that those of you, like Clive, who read the literature know that, whatever objection you may have to an individual statement in a specific paper, there is NO body of literature validating the view that e-cigs are saving 100s of 1000s of lives. This is a new technology/cessation tool, still undergoing assessment, and the jury is most decidedly still out – and undecided. But there are risks, and I’ve pointed some out. Nothing more nor less. Cheers.

    1. Wow… so how poor and misleading would something have to be before you decided it was necessary to call it out and reject its finding? This one passed that threshold for Tom Glynn of ACS and David Abrams of Legacy (hardly foaming trolls), as well as several others who have done this behind the scenes. if you disagree with my analysis, would you mind saying where, specifically? Because I’m not hearing anything yet that you dispute in what I’ve said.

      The danger is that you and other activists in tobacco control value the tactical utility of the propaganda more than you despise the deceptive unethical treatment of science, media and politics. Good luck with that – it’s the road to oblivion.


  60. I’ll keep this comment brief. I’d just like to say thanks Stan for continuing the discussion.

    I too agree wholeheartedly with Toms statement:

    “To get the best possible outcome we need regulation that will encourage smokers to switch, that will not encourage new users and that allows for development of new and improved products. Both in performance and safety.”

  61. Stan – I find you smug and patronising simply because, well, that’s how you come across to me. You may well not be smug and patronising, but a lot of us have been patronised for decades now, as smokers and vapers, and comments like “taking a stick of anything, a cigarette or a vapestick, is a pathetic, juvenile act” are hardly likely to endear you to people who do very thing that every day. Can you really not see that? And see how utterly self-defeating it might be?

    Anyway, that aside, would you care to tell me which facts I pulled out of “thin air”? The fact that somebody who smoked “some, v. young” can have no real idea of what it is to be a long term smoker? The fact that BT are only investing in 1st gen cigalikes? The fact that those devices don’t work very well? The fact that anyone with some nous can make and sell 2nd and 3rd gen devices? The fact that EU rules and medical regulations will mean that only large companies – and most likely BT – can afford to make e-cigs, leading to exactly the situation you claim to be concerned about? The fact that Big Pharma want regulation (see the Glaxo emails)? The fact that, at 99% safer, for there to be no harm reduction, you’d need roughly one person going from no nicotine use to e-cigs to cigarettes for each smoker that goes to e-cigs? Please, feel free to educate us.

  62. By the way, if the tobacco industry can handle the threat from any generation product, why have they not invested in 2nd and 3rd generation products at all? And, even if they did (and I don’t believe they will, simply because they can’t overcharge for them), why would that be an issue?

    1. Jonathan Bagley

      Perhaps the TI is confident the 2nd and 3rd generation products will effectively be banned? It’s their only hope for the long term success of their “ink jet printer ink” ecig business model. Sealed cartridges each containing 18mg of nicotine in 1ml of liquid. That’s equivalent to 6 cigarettes – not the 20 they claim. So, for an ex 20 a day smoker, at £2 a cartridge, just over £6 a day. Slightly less than £8 a day for cigarettes, but many times more than the 11.5 pence I pay for the 72mg of nicotine I use each day. They can’t compete with that, and they can’t make enough profit doing it themselves. Therefore they either hope, or know, it will be banned.

      1. That’s pretty much it. Put it this way – I’m a photographer, and as such, I know a lot of other photographers. We all use remote release cables, which are essentially a battery, a cable and a switch with a very simple mechanism. Canon (and Nikon, I expect) charge somewhere around £40+ for this simple device, but non-Canon versions – and there are lots of them around – can be had for £10-£15. Because it’s very, very simple, and it’s almost a throwaway device (I’ve lost 3 or 4 and been through more). Nobody I know uses a Canon version, and anecdotally, the only people who would buy them are hobbyists who perhaps don’t know better. A 2nd gen e-cig is no more complex than a remote release cable, so Big Tobacco will always be undercut by a factory in China, in the same way that Canon is always undercut (quite probably by that same factory). Now, perhaps 20 years ago that wound’t have happened, but now we have this Internet thing….

  63. My final post on this, because I don’t believe Stan is genuinely interested in serious discussion:

    “Let’s get that, yes, ‘muscular’ regulation (you have something against mucles) and make sure e-cigs are not used in any of the places cigarettes were once welcome (and, yes, I know many of you will object to my bringing that up, but I’m on v. solid scientific ground here) and we’ll have a more serious discussion going forward.”

    Or, in short, do as I say, then we’ll talk.

    By the way, Stan, I smoked heavily from 17 to 48. I stopped by using e-cigs (2nd gen, as it happens, because 1st gen are pretty useless) after trying everything else. It may – and only may – have extended my life by several years, and I and my family are quite chuffed about that, despite me being an “arrogant twit”. That’s why I’m emotionally invested, and I’m not alone in that, but nobody is claiming they’re a panacea – that’s simply a strawman.

  64. Stan Shatenstein

    Not nice of me to call you an arrogant twit, but you continue to misread me and I get exasperated at some point. You don’t think I’ve made any effort to communicate some points of value? And I was wrong to use the word arrogant, why? I hope your family has you until 110 in perfect health. If you think I’m insincere you are the king of arrogant twits – and I STILL want you to survive to 110. Cluelessly, but in good health. I have a policy dispute w/most of you. I don’t wish you ill. Clueless, sincerely.

    1. I know I said last post, but:

      “taking a stick of anything, a cigarette or a vapestick, is a pathetic, juvenile act”, “arrogant twit”, “the king of arrogant twits”, “Cluelessly”, “you are flatly naïve”, “utterly off the rails”, “your response had me embarrassed for you”, “If you can claim I “appear to seethe with contempt” for smokers, you are utterly clueless”.

      But not patronising.

  65. Stan Shatenstein: “To Carl Phillips: I reject your characterisation of my comments as ad hominem. You surely know the body of literature indicating that tobacco-industry funding influences and taints results. I’m not analysing any specific work of yours in any particular detail. I am maintaining, to Clive, that reliance on works of authors who acknowledge tobacco industry funding, as you do, weakens his argument.” and “Phillips and Rodu are not credible and I maintain it weakens your case if you need rely on them.”

    You seem pretty sure of yourself there. So let’s put it to the test: Identify one single analysis in my extensive corpus of work that is wrong. Bonus points if you can find anything remotely as wrong as the antecedent for this conversation: Glantz writing papers whose conclusions are **not at all** supported by the results he presents. (Hint: It is not possible to do the latter. It is possible to do the former, but I believe that I have later corrected – and acknowledged – every mistake of substance I am aware of.)

    That too tough for you? Yeah, I suppose – it would require understanding my analyses. So how about this: Identify a single instance of tobacco industry funded or conducted research being corrupt in the last generation.

    Just one example of either.

    I’ll wait.

    Oh, and even if you find it, your game was still ad hominem attack. You really hurt your credibility, such as it is, when you cannot even distinguish between “I believe my ad hominem attack is justified” (which is what you seem to be claiming) and “I deny that I am making an ad hominem attack” (which is what you said, despite the patent evidence to the contrary).

    On my previous point about you apparently not even reading what you write yourself:
    “You are more deeply wrong, profoundly wrong, in your take on my reaction to smokers. If you can claim I “appear to seethe with contempt” for smokers, you are utterly clueless. …. I am making the ‘spittoon point’. We don’t see spittoons in bars and pubs (saloons!) anymore because it’s a grotesque habit that has lost public favour. The act of smoking is pathetic and juvenile, and cigarettes rightly called pacifiers. That is not a judgment of smokers, whatever you may think.”

    If that is compassion, the mind boggles at how you speak of those that you *do* feel contempt for.

  66. Stan Shatenstein

    Too late. I got the version of your comments w/the Nazi invocation. Presumably you thought better of it? Thoughtful…

    There are many definitions of ad hominem, and I am familiar w/them. I still maintain it wasn’t that type of criticism but, rather, a fair reflection of the literature indicating that tobacco industry funding taints research and that reliance on support from said research didn’t help Clive’s case. Clive maintains his case is solid w/o reliance on you or anyone else and you maintain, in a presumably ad hominem fashion, that I lack the intellectual bona fides to assess your work and come to any conclusions about it. Duly note. Thank you.

    Compassion means wanting smokers to stop so that they have reasonable hopes of a normal life span. When you see a cluster of smokers huddled outside a building in all kinds of weather, if you don’t think the behaviour at least a tad pathetic, well, who am I to judge your honesty? Smokers are not juvenile because they smoke, but due to an addiction initiated almost certainly in childhood or adolescence, they evince a juvenile appearance, needing to suck on a tube of tobacco that provides no sustenance. Judge me for the observation, I don’t care. Compassion means wanting people not to suffer. Smokers suffer for their smoking. I have compassion for the vapers on this list who are hard on me for my comments, as long as they give me a fair reading, as some have. They don’t want to suffer and die young, and I could not be more supportive. But I can and do differ on the best policies on e-cigarette marketing and promise. That’s a lot, but that’s all.

    I have as much doubt as the next person, well, unless it’s you, as you seem to have no doubt about the unassailable nature of your work. Moving on…

    1. I can’t help but note that you didn’t actually attempt to address his argument about the quality (or otherwise) of his work…..

      1. Apparently that is beyond the wit of Stan.


        Can you cite a study that shows nicotine to be harmful?

        What terrible societal consequences to e-cigs do you see?

        The science I’ve read basically boils down to this:

        Nicotine and the excipients in e-liquid are all well understood and long since been proved not harmful (at the typical doses used)
        Flavours and colours added to e-liquid might prove to have long term health issues, we cannot know what these might be for another 10-20 years or which flavours might prove harmful and which not as the data on this has not been collected.
        Similarly the act of heating e-liquid to the point of vapourisation might also introduce some hitherto unseen health issues in the long term. (breakdown of chemicals in e-liquid or transfer of materials used in the atomiser, metals from the coil for example)
        All that said in the short to medium term (1-5 years) e-cigs seem to be entirely harmless, as there is not yet any observed health problems in people who have been vaping for at least that amount of time. (that’s not to say there aren’t any, but any that there are are so small they get lost in the statistical noise)

        To date whenever an obvious health issue has been discovered the vaping industry stops using the offending ingredient very quickly (see Diacetyl) and many e-liquid producers have their liquids regularly tested for quality and checked for things like Di-ethylene glycol.

        Vaping is a young, so far responsible, innovative, fast growing industry and none of the vaping products currently on the market were developed by the tobacco industry. (or at least vanishing few, and those only very recently)

    2. “Too late. I got the version of your comments w/the Nazi invocation. Presumably you thought better of it? Thoughtful…”
      There was only one version. I do not even see how I could alter my text on this page if I wanted to. But you are right that what I wrote included an observation about how the anti-industry ad hominem is based on the behavior of some people who are long since retired or dead, and I compared that to attacking a German critic by saying “you people are all Nazis”. That does not seem to appear, and I have no idea what happened to it (but in searching for it, I notice that Adam Williams made a similar point, with better detail). Apparently the version I wrote appeared and then a sentence or two was removed, but it was not by me. In any case, I suspect that you saw “Nazi” and thought I was going Godwin on you because you did not understand my point. I obviously was not.

      You said that my work was faulty because of some characteristic of the author. That is pretty much a perfect definition of ad hominem. (I invited you to find fault with the work. You seem to be aware of no such fault. I forget to thank you, in accord with my new policy of thanking those who make ad hominem attacks on me, and thus implicitly endorse the quality of my work by pointing out they do not like it but cannot touch it.) Clive drew upon my work because I offered insights that he judged to be useful, and he gave due credit. He could have just plagiarized them — would that have been better?

      “Compassion means wanting smokers to stop so that they have reasonable hopes of a normal life span. When you see a cluster of smokers huddled outside a building in all kinds of weather, if you don’t think the behaviour at least a tad pathetic” Um, no. Compassion means caring about *people* not about their longevity. It is pretty clear that you don’t even understand the difference. “Pathetic” is a nice word choice there. It technically means that it inspires pathos, but when people like you use it, it means “detestable”.

      “Compassion means wanting people not to suffer.” And so you support punishing and demonizing smokers, you insult them, and you speak up in support of disinformation designed to dissuade them from finding a dignified and pleasant low-risk alternative. Is it really beyond your abilities to see how this causes suffering?

      “Smokers are not juvenile because they smoke, but due to an addiction initiated almost certainly in childhood or adolescence” I realize that tobacco control does not realize it is not 1975 anymore, but are you aware that most American who start smoking in this century do so in adulthood? I assume not.

      “I have as much doubt as the next person, well, unless it’s you, as you seem to have no doubt about the unassailable nature of your work.” So you are saying that you write things that you believe to be wrong? That would explain a lot. I have been working on THR for most of this century. People like you have attacked efforts by me and others to help tobacco users without punishing them at every turn. And yet I am genuinely unaware of a single instances where one of the attacks actually pointed out genuine flaws in my work. I am not sure what better testament to accuracy one could ever find: A billion dollar industry (tobacco control) is attacking me, but has never once landed a blow. Care to take a shot at it? I didn’t think so.

      1. Oh, and I should point out , Mr. Shatenstein, that just as accusations about people lying come most easily to those of you who constantly lie, the accusation of intentionally memory-holing something is more a reflection of your ethics than my action. Honest scientists (you might know some from some field outside of tobacco control) post retractions or corrections, rather than trying to memory hole content they have changed their mind about or discovered were out-and-out wrong. This contrasts with your friend Glantz, as evidenced by this amusing bit of desperate coverup on his part: http://antithrlies.com/2013/09/09/newz-ecig-clinical-study-an-i-told-you-so/

        It is just sad that he goes to so much trouble to correct one inconsequential errors but it does not even slow down his willingness to spout off about things he does not know.

      2. Actually it was removed be me, the editor. But only because it looked like exactly the same post had been posted twice and so I thought I was cleaning up a mistaken post – careless me. Now restored. Can’t see what the fuss is about.

    3. In this forum Stan Shatenstein has stated that my work is “not credible” because it was funded by (unrestricted) grants from tobacco manufacturers to my universities. I join Carl Phillips in taking comfort that Mr. Shatenstein and other critics have not documented a single instance in which my work was inaccurate or otherwise faulted.

      Tobacco industry funding is Mr. Shatenstein’s benchmark for credibility, so I am delighted that my work from 1994 to 1999, which solely supported by university department funds, is credible. This includes:

      1. Tilashalski K, Rodu B, Mayfield C. Assessing the nicotine content of smokeless tobacco products. Journal of the American Dental Association 125: 590-594, 1994.

      2. Rodu B. An alternative approach to smoking control. American Journal of the Medical Sciences 308: 32-34, 1994.

      3. Rodu B, Cole P. Tobacco-related mortality. Nature 370: 184, 1994.

      4. Tilashalski K, Lozano K, Rodu B. Modified tobacco use as a risk reduction strategy. Journal Psychoactive Drugs 27: 173-175, 1995.

      5. Vigneswaran N, Tilashalski K, Rodu B, Cole P. Tobacco use and cancer: a reappraisal. Oral Surgery, Oral Medicine, Oral Pathology 80: 178-182, 1995.

      6. Rodu B. Smokeless tobacco for smoking cessation: a practical harm reduction strategy. Ohio Dental Journal 70: 6, 1996.

      7. Rodu B, Cole P. The rewards of smoking cessation. Epidemiology 7:111-112, 1996.

      8. Cole P, Rodu B. Declining cancer mortality in the United States. Cancer 78: 2045-2048, 1996.

      9. Tilashalski K, Rodu B, Cole P. A pilot study of smokeless tobacco in smoking cessation. American Journal of Medicine 104: 456-458, 1998.

      10. Rodu B, Cole P. Nicotine maintenance for inveterate smokers. Technology 6: 17-21, 1999.

      11. Rodu B. For Smokers Only: How Smokeless Tobacco Can Save Your Life. Sulzburger and Graham Publishing, LTD., New York, 1995. Reprinted by Sumner Books, Los Angeles, 1998.

      Reprints of these publications are available from the author.

      Brad Rodu

  67. Kurtis Sunday

    “I used pathetic and juvenile in respect to the habit of repeatedly moving hand to mouth to ingest drugs and, though it may seem harsh, I’ll stand by the use of both words.” – Quote from above.

    Are we talking about coffee here? Or tea? Or wine? Or marijuana?

    Maybe we should inject?

    Sorry, I have to go now ….. somebody somewhere is enjoying themselves … I need to investigate and since it’ll probably look pathetic and juvenile, PUT A STOP TO IT!

    Moving hand to mouth …. repeatedly …..

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  69. Elaine Keller


    I take issue with your statement, “I’m saying clearly that there is a possible medicinal role for e-cigs but not an open market free-for-all.” The open market is the very thing that has made e-cigarettes work for so many smokers who had almost given up all hope of ever being able to quit.

    I speak from experience, as I was a smoker for 45 years. Over the years I tried many times to stop smoking. The methods I tried included every single form of NRT, but every time I stopped using nicotine (as directed) cognitive and emotional impairments drove me back to smoking.

    I was told these problems are temporary, but I once suffered through 6 miserable months of nicotine abstinence back in the 90s; and although medication worked for the severe depression, my doctors told me there was nothing they could give me to cure my cognitive disabilities. I couldn’t afford to miss deadlines and make mistakes indefinitely and my job was in jeopardy. At that point, I made a conscious decision to resume smoking. Even if I could have afforded to lose the paycheck, I hated feeling so incompetent and stupid!

    I began researching smoking in general and nicotine in particular. When I learned that nicotine was being considered as a treatment for depression, anxiety, attention deficits, mild cognitive impairment, and even as a preventive for Alzheimer’s and Parkinson’s, I finally figured out that the only way I ever would be able to stop smoking would be if I could find a less hazardous delivery method for an adequate dose of nicotine to keep my brain working normally.

    I tried using nicotine gum and lozenges as a replacement for smoking, but dyspepsia kept me from using more than 4 or 5 pieces per day. I developed an allergy to the adhesive in the patch. The nicotine inhaler requires a prescription, is too expensive, and is difficult to use. I used the excruciatingly painful nasal spray just once.

    In 2008, I began using an e-cigarette occasionally, but it didn’t work well enough to keep the urge to smoke at bay. The highest nicotine concentration available at that time was 18 mg/ml (1.8%). Nevertheless, in March of 2009, I and stopped smoking altogether by using the e-cigarette daily, augmented by nicotine gum. But I still struggled with some memory and concentration problems until I began using a refill liquid at a 2.4% concentration (24 mg/ml). On the 27th, I will celebrate five years of being smoke-free.

    Bullen, et al. compared using e-cigarettes with using a nicotine patch. The success rates were not statistically different. But then again, all subjects were treated for a limited period of time; and when treatment stopped, relapse began setting in. Unfortunately, that trial reflects the real world use of NRTs. They are a temporary solution to what is, for many people, a permanent problem.

    That trial did not, however, reflect how e-cigarettes are being used in the real world by successful former smokers. We decrease nicotine intake if there are signs of nicotine toxicity (e.g., headache and nausea) and increase nicotine intake if we start feeling “brain fog” or strong urges to smoke. The “open market free for all” allows the consumer to control the nicotine intake to meet his or her needs and to determine when, if ever, to decrease nicotine strength or stop vaping. Tight controls on nicotine strength and instructions to discontinue use after a set “treatment period” will make e-cigarettes just as ineffective as NRTs.

    If you keep doing what you have always done (insisting on nicotine abstinence), you’ll keep getting what you’ve always gotten (relapse rates of over 90%.) That’s just unacceptable.

    Too many lives are at stake. Two many smokers will have heart attacks and strokes and/or develop lung disease and cancers because they kept smoking (or quitting and relapsing) while waiting for proof of 100% safety. E-cigarettes don’t need to be proven 100% safe. They only need to be less hazardous than smoking.


    1. Completely agree! The ‘just say,no’ coming out of so many health authorities is also very perplexing , ‘harm minimisation’ is the preferred option for any addiction/medical issue for very good and well known reasons. Prohibitions do not work , often make minor problems into big problems and encourage breakdowns of respect for the law. From what I can see the typical e-cig user is over 50 , well educated and not in any normal sense criminally inclined, all that thees proposed restrictions will do is turn a lot of ordinary middle aged citizens into illegal personal use importers of their preferred strength/method of ‘NRT’.

      And all of this looks even stranger in the light of New Zealand’s recent decision to legalise the supply of designer drugs http://blogs.reuters.com/great-debate/2013/10/08/new-zealands-bold-experiment-with-regulating-recreational-drugs/

      In NZ you can buy synthetic ‘cannabis’ but you cannot buy e-liquid, figure that one?

  70. Including ecigs in smoking bans which you claim is on solid scientific grounds is anything but on solid scientific grounds within the bounds of the legislation that enables smoking bans.Or any scientific grounds for that matter.
    This is one of the things about ecigs, they require us to rethink the whole approach to tobacco control both as a social phenomena and a health campaign.
    We can take the view that all they are is another nicotine delivery method, albeit a safer one and regulate as smoking while hoping that they become the delivery method of choice for current smokers. I call this the wish and a prayer approach. It is all stick and no carrot. We might agree that at this stage the health risk of smoking and benefits of quitting is of little concern to current smokers, they seem immune to the well established dangers.
    If we are to sucede in encouraging switching we need to incentive the alternative over the traditional tobacco cigarette.
    I see no need to impose public use bans as smoking is so anathema in society that this will take care of itself as bushiness decide based on the demands of their customers whether to allow or disallow vaping. It might mean that we have a selection of venues that allow vaping and a selection that don’t. This is a win win for everyone as vapers can choose to patronise vape friendly venues or forgo vaping for the attractions offered elsewhere. People who dislike being in the presence of vaping will also have a choice.
    Claiming that their’s a health concern with second-hand vapor is just doing a disservice to the effort to reduce smoking. And it’s a lie but we are used to lies from some sections of tobacco control.
    Taxes, while attractive to governments would also be a bad idea as it would remove the financial incentive as would the cost of the product if a robust medical regime was imposed.
    Advertising is the big concern as this is the thing that’s hardest to target. However it is imperative that vaping be seen as better than smoking and in our world this is best done by the madmen. Unfortunately no one else has as good a grasp of how to win friends and influence people.
    But first the decision needs to be made and made now before the opportunity has passed to make ecigs one of the tools in tobacco controls toolbox. Or rather that ecigs become a second front for reducing smoking prevalence. One that requires only slight regulation and encouragement to become the delivery method for nicotine of choice. Tobacco control has no investment to make and no work to do other than keep hammering home the message that smoking kills and let people decide whether they want to switch or not.(encouraged by the attraction of cool sexy ecigs ;0 ) Discouraging switching is a dead end both in the hope of stemming the spread of nicotine addiction and reducing smoking. Big tobacco have survived everything tobacco control has thrown at them so far, what makes you think that plain packs and raising the minimum age or extending smoking bans to nicotine use will make any more differenced than the 15 to 20% prevalence that education achieved?
    This is a fast track to reducing smoking, while it may encourage nicotine use we must not loose sight of the target, smoking reduction. If that comes at the cost of renormalizing nicotine use so be it. We are not panicking about caffeine use and we are becoming relaxed about THC use even to the extent of legalizing its smoking. Who is sending mixed messages here the health community who say smoking tobacco is bad but now smoking mary jane isn’t?
    Looking forward to the solid scientific evidence that will back up the Glantz study and the solid scientific evidence that supports public use bans. I suspect it social science not, you know, real science but whatever. It’ll do if it’s all we have.

  71. I am sat here reading all of this, and I have to restate my invitation to a live debate on web TV at http://www.vapourtrails.tv – and our audience has already given its support for this to happen. Stan, you simply have to *make* time for this debate – it is not enough to sting and run, hide behind a keyboard or dissemble. You absolutely must agree. How about it? If not, why not – and remember lack of time is not a good reason if you’re passionate about and convinced of your argument. Would you refuse Paxman?

    1. Dave, I think Stan will have to decline, as he doesn’t actually have anything to debate – just a list of well used rhetoric from the 90’s

  72. Mr Shatenstein, long term chemical dependence is not the same as addiction. The neuroadaptations that occur in the brain following repeated use of some chemicals is normal and an example of the brain operating exactly as it should.

    I have not seen any evidence that electronic cigarettes users form addictive involvements with them. This contrasts starkly with cigarette smokers, where many users keep smoking despite bio-psycho-social harm.

    Are you able to point me towards cases of people who keep using electronic cigarettes despite adverse consequences?

  73. From a blogger on another debate

    Science does not advance by consensus. In the early days, the Royal Society understood this. That’s why for two centuries, its house journal Philosophical Transactions, contained the following advertisement:

    … it is an established rule of the Society, to which they will always
    adhere, never to give their opinion, as a Body, upon any subject,
    either of Nature or Art, that comes before them.

    This wasn’t a cop-out. This wasn’t fence-sitting. This was the world’s pre-eminent scientific institution laying out – and abiding by – one of the most important rules of science: that the science isn’t “settled”; that a useful scientific theory holds the key to its own destruction – that is, it is falsifiable, and thus capable of being overturned by a more plausible theory, as was, say Becher’s theory of phlogiston.

  74. I thought vaping denormalised smoking? It doesn’t make your home, car, breath or anyone’s clothes stink. It doesn’t leave yellow stains on your hands, mouth, teeth or any other surfaces. It’s a small fraction of the cost and doesn’t affect your ability to exercise. Oh.. and it doesn’t kill you or harm anyone else’s health.

    It does the opposite of normalise smoking or provide a gateway – it makes choosing to smoke tobacco less normal than it has ever been. We should be focusing on rewarding the choice to vape, rather than on limiting availability of effective products.

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  76. This is a great blog, although, it has become apparent to me that those who exhibit the phenomenon of ‘confirmation bias’ (i.e. only cherry picking or even making up evidence that supports their assumptions), don’t seem to know enough about e-cigs to argue their anti e-cig rhetoric! I know this because of factual inaccuracies or omissions many opponents provide.

    Examples, include constantly stating ‘they are likely to be better for you than cigarettes’. That is such an understatement it is lubricous as they are approximately 1% of the risk to smoking, many contain none of the chemicals that cause smoking related diseases. They are without doubt far less risky, however, the question is how much? It is possible they could be almost if not harmless. There have been many studies on toxicity showing that they are no even a fraction as toxic as cigarettes. Also, there has now been a systematic review ‘proving’ they are far, far safer:


    Hundreds of studies like the above are completely ignored as are many studies including 2 RCTs showing they are effective in getting people to quit. It is completely bizarre.

    Statements on this blog from opponents have included that we cannot form a health policy around the fact that they have been good for a few individuals for quitting. For a start there are approximately 10 million users world wide now and I personally know 30 people including myself who have quitted using them. 3 of these people smoked 60 cigarette per day and have not smoked now for over 3 years. None of these people are dual users either. They all use products that would be banned by the EU Directive.

    People also get confused as to the difference between what is in the liquid and the contents of the vapour as well as absorption. A number of studies, albeit the nicotine have found no toxins whatever in the vapour rendering some products possibly completely harmless. A user will not absorb anything like the amount of nicotine that is actually in the liquid. In some cases less than 30% (range 30% -80%)! This means that the 20mg/1ml EU liquid limit for some products would only deliver approximately 7mg /1ml which is far too little nicotine to satisfy even a light smoker.

    Lastly, I have even heard some opponents stating that some are writing lunatic ramblings, when they are just stating some facts! It is very poor and truly pathetic!

  77. Growing evidence of positive effects nicotine
    See my other post which no one ever
    Mentions due to negative premise assumptions
    from pro and con! Also PG and VG is is
    Inhospitable to virus’s and bacteria!

    1. localpeasant

      These are points I considered when I checked out vaping for myself some 15 months ago. The end thought was, with the anti bacterial and anti mycrobial etc benefits of Nicotine/PG/VG, would a vaper by better off health wise than a NON SMOKER ?

      1. To local peasant:

        Benefits include improving the effects of neurodegenerative disorders, being less likely to develop ulcerative colitis and being thinner! On average smokers are nearly one stone, 6 kgs or 12 pounds lighter than non smokers. When smokers quit they generally put on 6 kg and never lose this weight. In addition, ECs contain VG and / PG as a vaporisation base which is in hospitable to viruses and bacterial – PG being used in lung transplants and enhances cell regeneration, etc apparently!

  78. Stan Shatenstein

    I trust that most of you will have seen this by now, and I expect you have ready answers for all the caveats and concerns but, for the record:

    Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes

    And, just off embargo, a small study but, yet again, one more piece of the puzzle showing that while many individuals, including some of you on this list, have been able to quit w/the aid of e-cigarettes, they are not a panacea:

    A Longitudinal Analysis of Electronic Cigarette Use and Smoking Cessation

    Related JAMA Int Med Editor’s Note:

    If Only Electronic Cigarettes Were Effective Smoking Cessation Devices

    Related coverage:

    Do e-cigarettes help people quit smoking? New study raises doubts
    Electronic cigarettes may not help people stop smoking –study

    There really isn’t enough time in the day to answer everything that’s been thrown at me, but I’ll try to comment on a few of the points raised:

    Mark Hillman: Notwithstanding your snark about my witlessness, I have already stated and reiterate that the renormalisation of smoking behaviour is a serious concern. If you can look at the Stanford side-by-side gallery of conventional and e-cig ads and not see any dangers, well, I really am not attacking your wit(s), but I don’t think you’re looking very closely:


    I refuse to answer your question on the harmfulness of nicotine. I assume you’re not joking. I understand that many vapers think it entirely innocuous. It is not and the body of literature establishing this is large. I encourage you to go to PubMed and start reading using a variety of search terms. Or start on Wikipedia (go ahead, attack if you will, flawed source, but a convenient starting point if you don’t want to do the real homework)


    None of which is to say that I’m nicotine-phobic (and I acknowledge there are some people who are). I will reiterate, again (sic!), I am not categorically opposed to e-cigarettes, nor do I think nicotine the most dangerous element in the act of smoking. I have a number of concerns, already articulated, but I welcome healthy debate.

    Carl V Phillips: You are still wrong, on more than one count. You deem my criticism ad hominem because I said your “work was faulty because of some characteristic of the author.” I said no such thing. Receiving funding from the tobacco industry is something you have done. It is not a fundamental characteristic of whom you are. I told Clive that reliance on your work and that of Brad Rodu didn’t help his cause because of the established lower credibility of work done on behalf of the TI. And even at that, I do not cast direct aspersions on your work. If 10 scientists are funded by the TI, a few of them may be utterly uninfluenced by their funders, but some will be. That’s why not only do I not have any time, interest or inclination to go back through your collected works (and sorry, but quite a vain conceit to think I would want to), having read much of what you published as it appeared, it’s utterly irrelevant. It’s only as being part of a body of TI-funded work that it actually is tainted by association. And are you implying, or actually stating, that the TI used to seek influence w/its money but now only spends out of the goodness of its heart? Bridge, Brooklyn, etc….

    Your parsing of compassion is tedious and tendentious. My meaning was clear, your distortions notwithstanding. Now, here, my contempt is ad hominem. You show true colours in your attempt to educate me on compassion. No thank you. I stand by pathos. Detestable is your construct and your problem.

    And worse, you fail Logic 101. I admit to this healthy human quality called doubt, especially as I know scientific concepts are falsifiable and though I do think there is a solid body of literature on which I base my views, we’re not dealing w/the speed of light or some mathematical constant but, rather, balance-of-evidence judgments. Doubt is normal and healthy. In your eyes, that equals “saying that you write things that you believe to be wrong”. No, I don’t believe the tobacco industry paid you to say that. It’s your contemptible problem, you own it.

    And to your PS, I didn’t accuse you of lying, but you sure came close to doing so for me. See above for why I made the point I did to Clive initially. And, as a scientist, you know about the several types of bias that can creep into a paper, no matter the integrity of the researchers. You’ve introduced the concept of lying here and more’s the pity.

    Brad Rodu: You haven’t earned the opprobrium Carl Phillips has in this forum, but again, notwithstanding all the merits of your extensive body of work, I stand by the initial point made to Clive.

    Elaine Keller: Sincere thanks for your posting, and my congratulations for your successful quitting using e-cigarettes. I have made the point already. I have absolutely no doubt that you found something in e-cigarettes that allowed you to quit successfully after multiple failed prior attempts using other methods. I know this to be true of others on this forum. As I’ve said, I don’t mind having my views criticised at all, as long as the criticism is fair and based on an honest reading of what I write. Nowhere have I called for a ban on e-cigarettes. However, I think that arguing they are safe, w/little or no evidence, or that there cannot be larger societal harms even as some individuals benefit, is mistaken. I know all about the attacks on Bullen and the legitimate concerns about limitations of the study. The French book by Presles is virtually anchored to that critique. But the entire body of literature is scanty and unconvincing in all respects. The study I link to today is also small and insufficiently powered for most scientific tastes and will not settle any discussion for now. But it is part of a body of literature showing the limitations of e-cigs that, taken w/the TI marketing issues and SHS restrictions concerns I’ve raised, simply underlines the need for caution and regulation. I will correct you on one point. Nowhere do I call for nicotine abstinence. That has nothing to do w/my caution on e-cigarettes. Nicotine poisoning is a legitimate concern, especially w/current product formatting, but that is not the same as calling for abstinence.

    Tom Gleeson: Yes, it is solidly scientific to argue that SHS bans reduce smoking consumption and heart disease, at the very least. Weakening those bans because of the entry of e-cigs will lead to further loopholes in laws and more smoking and more SHS exposure. That is logic, not wild speculation. There is also a solid body of literature on the psychological aspects and impact of marketing, which is why I link above to the Stanford ad collection. That is observation, not speculation. Advertising triggers responses even among people who claim not to notice ads. The confusion/overlap between e-cig and historical conventional cigarette ads is certain to have an impact. To deny that is to be anti-science, and you may wish to argue but w/confidence, not arrogance, I think I’m on solid ground in making the claim.

    You also make claims about lies. I think I’ve said enough. Any of you can disagree w/anything I’ve written, fair game. I’m not of a litigious mind, but any claim I’m lying is actually libellous. I was willing to come back on to craft this post and answer some criticisms, but w/o a withdrawal of claims to lying and a caution from Clive to that effect to those who post here, I’ll really find it easy to resist the temptation to post again. Unseemly and false claims.

    1. Stan – just repeating reports from the UCSF garbage generator adds to the case that you are not interested in truth but in the propaganda value of this work. That study has been roundly condemned (see Rogue research group opens the slurry gusher again) including a blunt dismissal by ACS. You’ve already shown you are unwilling to criticise things that are objectively and unambiguously wrong as long as they they further your case – you can find nothing wrong with my arguments on this study but won’t accept them or criticise the authors.

      Apologies for the delayed publication of your comment – it got stuck in the spam filter.

      1. Stan Shatenstein

        Criticise the study all you like, Clive, but you do know it’s not the same one you were initially critiquing, right? I acknowledged it’s small, but it is longitudinal. I’ve seen Siegel’s blog, and you and others can attack it, as fairly as you think you can, but the vaping is safe/100 times safer case, whatever the claims, are made on even thinner scientific grounds. Is it really your view I’m not interested in the truth, Clive? Who’s the ideologue? And it wouldn’t be a bad idea if some of the scolding you reserve for me were directed at the less elegant posters here. Cheers.

        1. Stop being so unscientific. Studies like this suffer from the criticisms levelled at them by Siegel and others to the point they are worthless. Unless you have a counter-critique, would you mind also accepting they are worthless too? That Grana study really is utterly worthless except as propaganda. They do not establish ‘safety’ or otherwise relative to cigarettes, which is an entirely separate question that is nothing to do with crude studies of change nicotine use status like this.

      2. I do of course know it is a different study in a different journal by different authors, but from the same group, using the same model of over-claim, hype and spin. I’ve written a different blog post about it and cited ACS’s blunt dismissal of the new study, which is different to its blunt dismissal of the one discussed in this post. You, meanwhile, grasp at these artefacts of junk science and call them in support of your world view. Why?

        I am not going to comment on what you describe as “less elegant posters here”, other than you. Firstly, I don’t think there is much surprising in the response given the infuriating attitude you display to them and to the facts involved. More importantly, I reserve my criticisms for people who are professionally engaged in the field, and who I think should be committed to sound science and an evidence based approach, combined with subtle risk politics – not making and selling propaganda.

        Having said that, I don’t like abusive posts and will remove any that truly are, but I’m not going to moderate everything or stop people communicating just how you make them feel. Frankly, you should be ashamed of that aloof attitude – I recommend reading this guest post: Nothing about me, without me.

    2. “Weakening those bans because of the entry of e-cigs will lead to further loopholes in laws and more smoking”

      Firstly, e-cigs are not covered by smoking bans, except in a very few jurisdictions, so the idea that bans are being “weakened” is wrong.

      “That is logic, not wild speculation”

      No, it’s wild speculation. Your implication is that e-cigs cause smoking, and that, to me, is the crux of the matter, because it’s about the only real argument TC has against e-cigs. But let’s look at it with numbers – for e-cigs to cause “more smoking”, more people would have to go from using no nicotine, to e-cigs, to smoking, than go from smoking to e-cigs. That’s not just speculation, it’s a ridiculous position to take. Let’s assume that a very conservative 200,000 people in the UK have gone completely from smoking to e-cigs (which, incidentally, may result in around 100,000 fewer early deaths). Have you any evidence that 200,000 people have gone from no nicotine use to e-cigs to smoking? 20,000? 2,000? Even 200?

    3. SS, you have now transitioned to being downright funny in your attacks on me. I will spell it out for anyone who may have missed the humor:

      >You deem my criticism ad hominem because I said your “work was faulty because of some characteristic of the author.” I said no such thing. Receiving funding from the tobacco industry is something you have done. It is not a fundamental characteristic of whom you are.

      Really? You cannot see what you just wrote? You suggested that my analysis is wrong because of something else I did. You try to defend that based on your attack not being about, say, the color of my skin. Yes, I suppose that would be worse still, but you are still engaged in a textbook example of ad hominem. You are claiming that my scientific contribution is wrong by attacking me personally rather than anything in that contribution. I still think you might want to look up “ad hominem”.

      > If 10 scientists are funded by the TI, a few of them may be utterly uninfluenced by their funders, but some will be.

      And yet you cannot even name one industry-supported scientist who has done work that is faulty. And I am not even talking “as faulty as is average for tobacco control” — I mean just one scientific failure. You are so sure that this problem exists based on….? On what?

      >That’s why not only do I not have any time, interest or inclination to go back through your collected works (and sorry, but quite a vain conceit to think I would want to), having read much of what you published as it appeared, it’s utterly irrelevant.

      If you have actually read my work, then presumably you would recall if there were flaws in it. So you are saying that you did read it and you cannot recall a single point that you are inclined to use as an example here. Why, thank you very much!

      Incidentally, what other people do when they want to criticize someone is take a few minutes and go back through what the target wrote in order to give their criticism some substance. It is a useful strategy you might consider for the future.

      >Now, here, my contempt is ad hominem. You show true colours in your attempt to educate me on compassion. No thank you. I stand by pathos. Detestable is your construct and your problem.

      You *really* need to look up the meaning of that term. This particular attack is not ad hominem. What you wrote here is not the logical fallacy or rhetorical dishonesty that is ad hominem. You are actually responding the the substance of my analysis, not attacking some characteristic of me to try to call into question the substance (the fact that your attack on the substance is merely a content-free protest is beside the point).

      >And to your PS, I didn’t accuse you of lying, but you sure came close to doing so for me.

      In my blog (as you presumably know, since you read my work when it comes out), I define lying to include a second sense of the term: claiming expertise that you do not actually have — i.e.., by making definitive pronouncements that are false, even though you do not know enough to really know they are false. Since you consider yourself schooled in logic, you will understand why that is a necessary analytic expediency in the world of non-mind-readers. Perhaps when you make ludicrous claims and espouse reliance on Glantz and other writings that Clive, I, and others have thoroughly debunked (as explained in the OP), you are not lying in the sense of trying to get people to believe something you know to be false. But in that case you are definitely lying in the second sense of the term, because anyone who is genuinely expert enough to offer such pronouncements knows that the content you are touting is pure junk.

    4. “Weakening those bans because of the entry of e-cigs will lead to further loopholes in laws and more smoking and more SHS exposure. That is logic, not wild speculation.”
      Stan, I’m a little puzzled by your ‘logic’ (I’m afraid the scare quotes are needed as your usage does not appear to fit within any definition of logic of which I am aware).
      My issues are:
      a)How does using a product that generates no smoke provide a loophole in a smoking ban?
      b)How does the use of non smoked products, typically by current or ex smokers as an alternative nicotine source, increase the amount of smoking?
      c)How do either of things increase exposure to second hand hand smoke?

      Perhaps there is some underlying string of argument to your proposition that I am unaware of which would resolve these issues?
      Otherwise, I fear that “wild speculation” is a far better description than logic.

  79. The use of the ‘risk’ of child poisoning is very selective. In fact in New Zealand: “The National Poisons Centre has recorded a steady increase in the number of calls it receives about the exposure of children to NRT, from five in 2004 to 27 in 2009 and 49 last year.” ALL of these cases involved ingesting pharmaceutical nicotine- Patches and gums.

    Obviously they also should be regulated out of existance.

    1. There are a number of brands of ECs that use exactly the same nicotine as used in NRT now – pharmacopeia nicotine.

      1. Yes.

        Given that nicotine in various forms has been very common in many homes for decades and decades, the very low reporting rate of serious, let alone fatal, poisonings of children, says it all. Domestic poisoning of children by things like cleaning products and solvents is far more common.

        The anti ecig case is one of the most anti-scientific or ‘colored’: filtering data selection to fit a preexisting hypothesis, that I have ever seen.

  80. I think everyone here is being far too polite to the Stan Shatenstein. In my opinion he’s just typical of the meddling self righteous **icks who for some reason seem to believe that they know best how other people should live their lives. There I wrote:

    “Every self righteous **ick knows that smokers are dirty, evil and selfish people who should jolly well be made to suffer, one way or another. Vaping is letting them off the hook scot-free! It’s not fair! There should be a law against it!”

    That seems like a pretty fair description of the Stan Shatenstein to me.

  81. Stan Shatenstein

    I wrote a long post that I can see on the page, but it’s marked “awaiting moderation” for over 24hrs, not sure if it’s due to the length, the inclusion of links, or both. I’m just sending this short note to see if it posts w/o needing the moderator and to let you know I have tried to respond to several of you.

    Whatever Adrian Hey wants to communicate w/the use of the definite article before my name, his asterisks speak clearly for the value of his opinions and I won’t need to engage w/him further. I do welcome comments from the serious people on this list, and I hope you get to read my long post soon, whatever you think of it.


    1. “his asterisks speak clearly for the value of his opinions and I won’t need to engage w/him further.”

      Oh no! You meanie! Fortunately for me, I am not so inhibited. You made your true motivations and your contempt for smokers, vapers and researchers funded by tobacco companies perfectly clear in your earlier posts. There’s no point in trying to reclaim the moral high ground now. We all know what you are, thought I guess most are still too polite to say it. The truth is that you despise us and would welcome any opportunity you may get to mess up our lives or influence law makers to do the same. Your supposed concern for our or anyone elses health is merely camouflage for your own self righteous and spiteful control freakery.

  82. Stan:

    “Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes”

    not a new form of drug (same form as existing NRT) not a powerful stimulant (both a stimulant and a relaxant, and powerful is a subjective term anyway) not powerful neurotoxins (author is conflating pure nicotine and e-liquid, e-liquid is typically less than 2% nicotine) are not regulated by the authorities (not as much as they should be but they are regulated nonetheless) not mixed on factory floors(mine are mixed in a lab, most companies are the same. Though as the dilutents are anti-microbial and bacteriostatic e-liquid is not a good medium for bacteria. Poor mixing conditions would become more prevalent in a black market) toxicologists warn […] significant risk (which toxicologists?, where?, very sloppy writing which gives more weight to baseless assertions)

    Re Accidental poisonings: (we need some perspective here. For example, in the same period how many similar incidents were caused by tobacco cigarettes, how many by window cleaner. and if this is true:

    a 2-year-old girl in Oklahoma City drank a small bottle of a parent’s nicotine liquid, started vomiting and was rushed to an emergency room. That case and age group is considered typical.

    then this
    A teaspoon of even highly diluted e-liquid can kill a small child.

    cannot be true.

    You’re a journalist Stan, surely you can recognise how sensationalist this article is. It would not be out of place in the Daily Mail (for non UK readers that is NOT a compliment) It is not a factually correct article, it overstates the dangers of e-liquid, it isn’t even internally, logically consistent.

    For a longer, better shredding of this piece see.


    The other study linked has been demolished already too. By the ACS no less!

    So Stanford have compared e-cig ads and cigarette ads and they are similar?! I’m not sure I see your point. Adverts are designed to sell products to their target audience (adult smokers in the case of e-cigs)

    Stan you are claiming nicotine is harmful, please can you cite one single study that supports this. The ones I read tell me smoking is harmful, not nicotine. I have limited time too, if you could point me to some relevant ones I would appreciate it.

    ‘Harmful’ is a function, like toxicity, of dose. We all consume (at least those of us that eat potatoes and tomatoes) nicotine. At that small dose it is demonstrably harmless. At the doses consumed by an e-cig user, a snus user or an NRT user where are the studies that show nicotine is harmful?

  83. A few thoughts on the state of this debate with Stan Shatenstein.

    My critique untouched. Stan hasn’t landed a single blow on the post I actually wrote – a harsh critique of the paper and media spin by Glantz and Dutra, even though he came on to inform me it was ‘not your finest hour’.

    Supporting things that are wrong. Though Stan hasn’t faulted the critique I made, he still seems to accept the survey findings and gateway stuff was okay and will not join me in criticising poor science and spin, and in putting right the resulting misconceptions, which he no doubt prodigiously assisted in spreading. I don’t understand the ethics of this position. He’s had plenty of time to consider the issues. He says “the Dutra-Glantz paper, viewed in its entirety, is hardly junk science nor w/o merit”. No that’s not really true is it? It was used to make a decisive false claim in its conclusion, and then hyped and spun to the press. If there were other useful things in there, they were irrelevant packaging for the main payload.

    Tobacco funded work. Stan rounds on people who are funded by the tobacco industry, and says, that: “Phillips and Rodu are not credible and I maintain it weakens your case if you need rely on them”. Yet he can’t fault a word that either of them have said (…about anything, not just this). I don’t need to rely on either of them to make the case, but both of them make the case better. His argument is inherently ad hominem as he has nothing to say about their work only their contractual relations, and he is only discussing the perceptions- which tobacco control people work hard on reinforcing -not substance.

    Lying, manipulating and misleading. Stan should recall that the tobacco industry became pariahs through years of lying, manipulating and misleading. The important words in that sentence are ‘lying’, ‘manipulating’ and ‘misleading’. And it looks to me that this is what the tobacco control high command is now doing, albeit with varying degrees of subtlety. Can you imagine the reaction if tobacco companies produced work like that Dutra-Glantz paper to make their case? I’ll say it again, I’d rather have good quality science and analysis from tobacco funded sources than deceptions and spin funded by the public health establishment. I’m not clear what Stan prefers – apparently the latter.

    Ducking an interview. Stan was offered an opportunity by David Dorn to debate the issues on VTTV – and it is true many vapers would like to see more tobacco control people debate these issues other than amongst themselves in their own insular conferences and echo-chamber networks. To his credit, he has engaged with critics on this blog. He has declined I think, citing ‘too much time’… but what price some real debate (and accountability)? There is still time to agree to appear – its just a Skype call.

    Upsetting people by being crass. Stan hasn’t worked out yet why his vitriol about e-crusaders, juvenile vaping etc upsets and angers people -I’m not going to go into the ‘he said, she said’ breakdown of who deserves to be offended. He gets a restrained and relatively polite reaction given what he says – mostly responses calmly argue their case. Where it gets more heated, I think it is because, like me, he knows nothing of vaping through direct experience – but through his choice of favoured evidence shows he doesn’t want to know. Yet for many involved, this has been a transformative experience. I recommend a bit more humility.

    Filling the public square with garbage. The problem with Stan, and hundreds like him, is that they close down the space for measured discussion about these products and the place of nicotine in society. Those who support harm reduction are always in a defensive posture fighting off the latest gateway spin from UCSF, the latest misunderstanding of poisoning data in the New York Times, scares over micrograms of impurities, trying to explain why advertising is good if it sells a product much less dangerous etc etc. There is a thoughtful debate to be had: mostly about rebalancing the obsession with minor and implausible risks with the casual disregard for huge opportunities. Very few want no regulation, but it needs to be more subtle than this discussion allows, and grounded in an honest assessment of science and insightful politics of risk.

    Waving or drowning? Stan is a drowning man in this debate – nothing he has said makes much sense or adds to understanding or insight, it just comes from the dour hymn book of tobacco control prohibitionism (now dressed up as ‘muscular regulation’ much as creationism brushes up nicely as ‘intelligent design’). Thankfully, reality is starting to catch up and will soon overtake that faction of public health. The emperor has no clothes and it is time we stopped saluting as he rides past.

    1. “Though Stan hasn’t faulted the critique I made, he still seems to accept the survey findings and gateway stuff was okay and will not join me in criticising poor science and spin, and in putting right the resulting misconceptions, which he no doubt prodigiously assisted in spreading.”

      Exactly. This has got a bit lost amongst the noise, but it’s the important point – Stan claims that there’s something wrong with your critique (mainly by attack Phillips and Rodu for TI links), but nowhere does he actually engage with it (again, except by attacking Phillips and Rodu, but interestingly, not their research or conclusions about Glantz’s “study”; and by insinuating that he knows the science better than others).

      But getting back to the point, the gateway effect. Assuming that e-cigs are at least 99% safer than smoking (and even if they’re only 90% safer, something even the more hysterical are reluctant to claim), then the only potentially reasonable point that the anti vaping people can make is that of the “gateway effect”. To do that, all they need to do is show that as many or more people have gone from no nicotine use, to vaping, to smoking, than have gone from smoking to vaping. If they could do that, it would be the killer argument. Obviously, they can’t do that, because it simply isn’t true, and is an utterly ridiculous proposition. That’s why Glantz relies on press releases to lazy journalists drawing unsupportable conclusions from his studies. Either Stan S genuinely can’t see that, in which case I’d be surprised if he could ever be educated, or – as you say – he prefers “deceptions and spin funded by the public health establishment”.

      Having said that, I expect there’ll be more from the like of the two Stans, McKee, Nathanson and others along the lines of “ignore the several hundred thousand who have gone from smoking to vaping, because here’s one or two people we’ve found who went from no nicotine use to e-cigs to smoking”. And UCSF and the BMA will power up the garbage generator, and the media will open their mouths and swallow it whole.

      What I don’t understand is why. Why do these people deliberately distort research? Why do they conjure up imaginary “gateway effects”? Why do they appear to want people to quit or die? What drives them? It depresses me, because through their dogmatic approach, they are wilfully and (I think) knowingly destroying what may be one of the greatest contributions to public health in decades.

      1. The gateway effect is really more a campaigning tactic than it is real threat.

        See this: We need to talk about the children – the gateway effect examined.

        It is very hard to conceive of it ever happening at scale, but impossible to disprove in advance. But there are people who will look hard and believe they’ve found it when they haven’t. And in a few cases it might actually be real. But you always come back to a rights-based view -on what basis do you restrict access to the safer product (e-cigs) just because you worry that someone might do something with it that you do not like (smoking – something they are able to do without the safer product).

        My filtration approach to this is to refuse to accept anything on the gateway effect from anyone unless they are first willing to acknowledge the unambiguous evidence of an ‘exit’ gateway and huge health benefit from snus in Sweden and Norway. That, for me, is a credibility test that earns the right to opine about population effects with e-cigarettes.

      2. “The gateway effect is really more a campaigning tactic than it is real threat.”

        There’s little doubt about that, but I suspect even the slightest evidence that it’s happening to any degree, no matter how tiny, will be played up and hyped to the skies. If the anti vaping campaigners can find even one person who has followed the path from no nicotine to vaping to smoking, there *will* be press stories along the lines of “John Smith had never touched a cigarette in his life, until one day he was sold an electronic cigarette by unscrupulous market traders. Now, he smokes 10 real cigarettes before breakfast, and doctors say that hundreds of Johns may exist across the country….”. The hundreds of thousands going the other way and the huge harm reduction resulting from that will be ignored.

  84. Self-important authoritarian dilettante labels an entire class of adult people as pathetic juveniles, campaigns for a baseless abridgement of their individual liberty, then acts shocked when he receives a less-than-friendly response.

    News at 11.

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  86. Alan Fletcher

    I see no real point in arguing with Stan Stanton Schatenstein Glantz at all. Tobacco control controls tobacco. With no tobacco to control they loose their job and hence livelihood and status. Ecigs are the first real alternative and threat to tobacco and millions now realise this. Tobacco control has thus lost millions of customers (or is it victims?) through ecigs. Fighting ecigs tooth and nail is, I would think, a natural and obvious reaction of tobacco control. They don’t give a monkey’s about human health.

  87. Stan I never meant to accuse you of lieing, I apologise.
    My point was that claiming that their is a harm from second hand vapor is nonsense. Wherever you got that idea from is the source of the lie. Your mistake is believing it.
    So not smoking will weaken smoking bans because it looks like smoking and therefore people who don’t smoke or exclusivity smoke will be tempted to smoke or smoke more? Hmmmmm Odd view of the world. Again ignoring the cost benefit of promoting vaping over smoking.
    I don’t doubt for one miniut the impact of advertising, sell the sizzel not the sausage is the old expression. And its the important bit that anti ecig people miss when discussing advertising. The fact that cigarette adds from years ago have a lot in common with ecig adds of today is not accidental, it’s because the adds are selling a lifestyle association. Adds are not product descriptions. Their designed to persuade. Even NRT has used the imagery of cigarette adds and for good reason, it works. Unfortunately the NRT wasn’t designed well enough to fit into the astethic of this style of add and it just looked stupid. I’m not in favour of blanket advertising but their is a need to inform smokers of the option of vaping and equally important to persuade them to switch. This is the dilemma facing public health, balancing the benefit of promoting vaping to smokers with the possibility that non smokers might also take up vaping. As to whether advertising would end up promoting a product that it doesn’t advertise, well that hasn’t happened with any other advertisement I know off.

  88. In fact Stan Shatenstein as I read back your posts I completely withdraw the word lie and lieing. It’s more accurate to term it dissemination or mainstreaming.

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