The September 2021 edition of CHEST, the respiratory journal, features a point/counterpoint debate on the value of e-cigarettes for tobacco harm reduction. I am making the case in favour (the Point) and Dr Hasmeena Kathuria (Boston University) and Dr Frank T. Leone (University of Pennsylvania) are making the case against (the Counterpoint). We each provide a shorter rebuttal to the arguments made by the other. We also recorded a 30-minute podcast to air these arguments face-to-face. Recognising the broader interest in the subject, CHEST has kindly made this content open access so far.
Whatever you think of the respective arguments, it was refreshing to find a forum willing to air them in a respectful and measured way, I am grateful to Drs Kathuria and Leone for engaging and making their case and to CHEST for providing the platform. I wish we could have much more debate like this.
For ease of access, I have added the relevant links below.
This blog gives my take on how to think about the FDA’s decisions (some taken, some forthcoming) on approving or denying thousands of “pre-market tobacco applications” (PMTAs) to allow vaping products to remain on the US market. FDA must make decisions no later than 9th September 2021, following legal action brought against the agency. FDA’s Director of the Center for Tobacco Products, Mitchel Zeller, provides the background in a February 2021 blog.
There’s a lot to be written on this, but I will settle for 16 observations and questions that will shape my take on FDA’s announcements.
Health Canada is trying to ban almost all vaping liquid flavours. This is on top of measures to limit nicotine strengths and marketing. It is the nearest they can get to a prohibition without actually having to prohibit the most promising low-risk rival to cigarettes. The likely effects are obvious: more smoking. But in a bizarre twisting of reality and evidence, Health Canada finds that making vaping less attractive relative to smoking will… um … reduce smoking. And that’s how it justifies the measure. We respond with a counter-analysis.
It’s World No Tobacco Day and we have sent our detailed letter and multiple critical expert comments to the WHO Director-General. The covering note and links to relevant documents are reproduced below. I hope it causes them to pause and reflect. My guess is that Tedros has been very badly advised here.
It is first-class public-interest journalism, with some hard messages for Bloomberg but plenty of balancing comment too.
The response. The interesting thing is that this drew a joint response from Kelly Henning of Bloomberg Philanthropies, Matthew Myers of the Campaign for Tobacco-Free Kids and Robin Koval of the Truth Initiative. See Vaping and Philanthropy: Debating Strategies That Work (web archive). There is a substrate of anger and panic in the letter that suggests that Gunther hit a raw nerve.
What is unusual about this letter is that Henning, Myers and Koval actually try to defend their positions. Normally, they don’t defend their positions, they just assert them with millions of dollars of amplification. It offers a rare opportunity to provide a critique of their stance. So I have taken their response letter, broken it down into 15 propositions, and provided a response to each. Each section starts with a quote from the letter pulled out in a quote box in bold dark-blue. The letter is analysed in its entirety. Continue reading “Holding the Bloomberg anti-vaping propaganda complex to account”
The Netherlands is proposing to ban e-cigarette flavours – what could possibly go wrong?
The government of the Netherlands, led by Paul Blokhuis, State Secretary for Health, Welfare and Sport, is in imminent danger of fooling itself into becoming an unwitting ally of the cigarette trade. By taking measures to make vaping less attractive (notably by proposing a ban on all non-tobacco flavours for e-cigarettes), it threatens to degrade the appeal of a low-risk rival to cigarettes, provide regulatory protection to the cigarette trade, prolong smoking, obstruct quitting, and add to the burden of disease and death. All this in the name of protecting youth, while managing to harm both adults and adolescents. Quite a feat for any politician.
The problem is hubris – believing that the world responds to regulation in the way the regulator thinks it should. Experience suggests foreseeable perverse consequences will be the result of the ill-conceived prohibitions of much safer alternatives to smoking, including flavoured e-cigarettes.
It really isn’t difficult to understand why and how this would happen – I can only assume the State Secretary received very poor advice, which would not be unusual in this field. Nevertheless, twenty-four international experts have set out the arguments and evidence in detail in a submission to the Dutch government, hoping to spare Mr Blokhuis later embarrassment and, even more importantly, to avoid yet more death and disease from smoking in the Netherlands. It should also be a wake-up call to like-minded politicians and naive policymakers in the United States, European Union, and the World Health Organisation who continue to fail to grasp the impact of low-risk products in the real world.
The case is set out in 30-page submission to a Dutch government consultation on the measure. The relevant documents are:
I have made a short submission to the consultation on the European Commission SCHEER Committee preliminary opinion on e-cigarettes. You can respond to the consultation on this very poor scientific assessment here, where you can find all relevant documentation. The closing date is just before midnight CET, Monday 26 October 2020. All contributions are helpful, but keep it polite, objective and on the subject – the science of e-cigarettes – and most importantly, in your own words.
In my view, the problems with the report are too serious and fundamental to justify a line-by-line and paper-by-paper incremental review. I set out the fundamental problems on my 30 September blog: European Commission SCHEER scientific opinion on e-cigarettes – a guide for policymakers. So rather than pretend that this dreadful report can be easily fixed with a few more references and some different takes on the evidence, I have reiterated the main themes of that blog in the “Summary” box of the consultation submission form and provided the blog as a link and upload. I’ve no idea whether they will give this the slightest attention, but they should, because I’ll back when they’ve done the final report.
I remember back when I was Director of Action on Smoking and Health in the UK (1997-2003), we used to glance across hemispheres and admire what they were doing on tobacco in Australia. Australia’s anti-smoking coalition was engaged in a feisty battle for genuine public health, defending the little guy from predatory tobacco companies. At that time, it was the David of the story taking on the giant.
What a pitiful spectacle they make now. Now they are the predatory giants, harassing and bullying the little guy.
Thousands of ordinary Australians want a better and longer life by switching from smoking to vaping but an unaccountable cadre of public health activists, apparently with unshakable convictions untempered by evidence, humility or empathy, believes the government should use its powers to obstruct them. On what basis? And how have they managed to get the Minister for Health to go along with their weird and dogmatic opposition to pro-health innovation and progress that is working well elsewhere?
In June, Australia’s Minister for Health, the Hon. Greg Hunt MP announced new measures to make access to vaping products even more difficult in Australia: Prescription Nicotine Based Vaping. This is an astonishingly poor act of policymaking and this blog takes a hard look at his proposals.
I am pleased there is to be a Senate inquiry into Tobacco Harm Reduction – this blog is my initial take on how Australian policymakers, consumers and businesses should navigate these issues – it’s quite long so please dip in.
The preliminary scientific opinion is open for consultation responses until 26 October 2020. The consultation system is here: Public consultation on electronic cigarettes and looks designed to deter responses to the extent possible. ETHRA, European Tobacco Harm Reduction Advocates, provides guidance on responding here. However, that is not the only way to respond to it, though responding directly is important. Another way is to approach the people who are intended to make sense of and use the opinion – policymakers in EU member states and European Commission, politicians in the EU legislature, and stakeholders in the political policymaking process. This post is for them.
In this post, I discuss why the SCHEER preliminary opinion offers no useful analysis or relevant insights to policymakers. It is not that the committee has not reviewed a lot of literature: it has. It stems from a more fundamental problem: a failure to frame the scientific knowledge in a way that will assist policymakers in considering what, if anything, to do next. Though policymakers should be the primary audience, the report also provides little of value to other communities of interest – smokers, vapers, parents, public health or medical practitioners, or businesses.