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« Compassion in public health is rare - ain't that the truth | Main | Vaper-friendly conference restricts and even prohibits vaping to appease "non-vaping delegates" »

The healthiest option

I sense that few if any readers of this blog are interested in the Food and Drug Administration's decision to seize control of the regulation of e-cigarettes in the United States.

I don't blame you. According to Carl Phillips however it's "the most chatter-inducing event in the history of THR".

Carl, a US-based expert on tobacco harm reduction, has chosen not to add to the hullabaloo. "Been there, wrote that," he says, adding:

Anyone who is shocked by what was released last week was not paying attention. I have seen literally nothing in the deluge of writings since the regulation was released that I and CASAA (and others, of course) did not already point out.

Carl's post (Ecig deeming regulation - nothing new to see here) reminded me of something I wrote in January 2015, a few months after attending the Global Tobacco Network Forum (GTNF) in West Virginia.

The biggest coup was to get Mitch Zeller, director of the US Food and Drug Administration's Center for Tobacco Products (CTP). Reduced harm products presented the CTP with a challenge, he said. They may be less of a risk to the user but their availability might prevent consumers from choosing the healthiest option, complete cessation [my emphasis].

And that, in a nutshell, is what we're up against. Even the more liberal and open-minded public health officials view complete cessation as the long-term goal. Zeller didn't say it but "No safe level of nicotine" is sure to be the mantra for many years to come. Good news for the likes of ASH but bad news for the rest of us (including the taxpayer).

I suspect this explains why so many "pro-vaping" public health groups have kept silent on the FDA's deeming regulation.

The truth, as everyone but the most myopic advocates of THR must surely now acknowledge, is that the goal of 'public health' is not smoking cessation, it's nicotine cessation.

The moving target will always be the "healthiest option" so it doesn't matter if e-cigarettes are 95 per cent less harmful than combustibles, the "healthiest option" will always be "complete cessation".

Vapers seem to hope that if they ally themselves with "pro-vaping" public health campaigners e-cigarettes will be excluded from the worst regulatory excesses. Good luck with that.

The problem is, as soon as you accept punitive regulations for one consumer product you are conceding that, in the name of health, similar regulation is acceptable for other products.

The argument that regulations should reflect relative risk is good in theory but it doesn't apply here because the most powerful 'public health' bodies only see two categories - risk and no risk.

It doesn't matter that e-cigarettes are 'safer' than combustible tobacco. They are not the "healthiest option" and must be regulated accordingly.

One or two governments (including the UK) may prefer light touch regulation on THR products but ultimately they are powerless against the might of unelected 'public health' officials in Brussels (EC), Washington (FDA) and Geneva (WHO).

Btw, the response to the announcement of the FDA deeming regulation also reminded me of the response to MPs voting in favour of a comprehensive smoking ban.

Forest had been campaigning against a public smoking ban for three years. The day after the vote we were overwhelmed with calls and emails from smokers complaining bitterly about the legislation. Nothing like that had happened before.

To paraphrase Carl Phillips, it was the most chatter-inducing event in the history of smokers' rights (in the UK at least), beaten only by a similar outpouring of noise on July 1, 2007, when the legislation was formally introduced.

What we are seeing now is history repeating itself. Vapers are up in arms but why has the FDA announcement come as a surprise? As Carl Phillips says, he and others have been writing about this for years.

Meanwhile the idea that 'public health' is anything other than an enemy of choice and personal freedom is a joke yet some THR advocates cling to the hope that some form of alliance is the best way forward.

If the FDA announcement hasn't put that thought to bed I don't know what will.

PS. A lot of FDA chatter has focused on the impact the deeming regulation will have on the tobacco companies. A good example is this article in the Washington Post, Why the FDA's new e-cigarette regulations are a gift to Big Tobacco.

Returning to that January 2015 post, I also noted that another speaker at GTNF 2014 was Susan Cameron, CEO of Reynolds American, the second largest tobacco company in the United States:

Some vapers should look away now because in her speech Cameron called for the strict regulation of open-system vapour products. In her view, they present a "unique risk" because they are "open to tampering".

It's comments like these that have upset a lot of vapers. Personally I'm against strict regulation but credit to her for going public with her position in such a no-nonsense fashion and not hiding behind Chatham House rules.

Indeed. You may not like it but no-one can say Cameron wasn't being entirely open and honest about her company's position.

How the pro-vaping chatterati failed to notice all this is a bit of a mystery. It's been staring them in the face for years.

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Reader Comments (6)

Quite. (and thanks for the shout-outs)

The vaping chaterati suffers from the problems that every practiced anarchy movement does: Leadership vacuum (as in nature abhors...). Ok, they don't want to take any cues from me. I get it. But that needlessly comes at the expense of not paying attention to my analysis. There is no culture of ideas (in the technical sense, of building on what has come before), and so you get a burst of de novo chatter from people not familiar with what has come before every time something happens. There is a culture in the standard sense that carries some ideas with it, but the memes survive without an intellectual filter. That is, more like mysticism ideas than scholarly ones. (I realize this is a rather dense bit of social science to cover in one paragraph. Apologies.)

But anarchy never works, and so the leadership vacuum gets filled by people who are good at being leaders (as leaders of anti-tobacco operations have proven to be). They bring with them their memes and goals, which are often quite different from what the mob would have wanted, if they had stopped to think -- but they had no mechanism that allowed stopping to think.

To make this a little more concrete, consider that "95% less" meme that vaping advocates have been tricked into repeating, such that it became instant conventional wisdom (showing up in the "but advocates say..." bit in every pop press story). I am not sure whether it was a calculated trick, a subconscious tactic, or totally accidental on the part of tobacco controllers. But it was fucking brilliant of them, whichever it was. Getting even the defenders of vaping to claim that it is 5% as bad as smoking is the perfect way to ensure it is merely "better than smoking" but still not good enough. Game and match.

In reality, I would bet on snus (and maybe also ecigs) being a net health benefit rather than cost. I suspect those in tobacco control realize this is a possibility and so nothing could make them happier than getting everyone to stipulate that it is bad, and at a nontrivial fraction of how bad smoking is. Trick the proponents into focusing on the health comparison, and then sucker them into making a claim that is not really all that great, and the case for banning becomes a quibble about magnitudes -- that is, a purely tribal fight where either side can claim they are right. They win that every time.

Ok, I'll stop. I really should write a blog about this. Oh, wait, I have. I wonder if anyone paid attention.

Tuesday, May 10, 2016 at 14:15 | Unregistered CommenterCarl V Phillips

I disagree with you completely on your statement that the public health goal is nicotine cessation Simon, there is far too much money in their patches and gums for that to be the case.

A more accurate description would be "selective nicotine cessation."

They hate e-cigs with a passion because it is something that they didn't come up with, and the fact that people are shunning free patches and gums etc. to actually purchase vaping equipment they hate it even more.

Tuesday, May 10, 2016 at 15:39 | Unregistered CommenterTony

As if we needed more evidence that tobacco control is driven by ideology. As we gave all noted before, tobacco control is not about health it is about social control. The real question os how do you counter a global movement with mass and elite political support.

The fact that the support is based upon lies, manipulated data, and propaganda makes it complicated because their message is essentially the only one heard and reported by the media. The propaganda prevailed and the tobacco controllers dominate. Soon they expand to prohibition of alcohol and regulating other aspects of life.

The end result is tyranny. The question remains: how do you counter totalitarian control?

Tuesday, May 10, 2016 at 17:10 | Unregistered CommenterVinny Gracchus

What is a THR product?
I thought THR was a strategy. A particular product could be part of this though why it would be called a 'THR product' I'm not sure. The use of High/Low risk products are just part of the strategy and not exclusive to it.

It now seems a THR product could be a nicotine alternative e,g e-cig, a non-smoked alternative e,g Snus or both depending on who is speaking. Certainly tobacco control do not see Snus as an alternative despite being low risk. Is Heat not Burn a THR product?

What is a THR advocate?
I thought this meant someone who advocates THR as a strategy yet it seems to be being used, by tobacco control and others, as an advocate of nicotine containing alternatives to smoking.

Some vaping supporters and tobacco control seem to see a THR advocate as someone who agrees that a THR product is an intermediate product on the way to quitting.

Tobacco control (as predicted) pretended to be allies before pushing their own ideas. Now they seem to be setting the agenda. Referring to an e-cig as a 'THR product' is part this. Of course since tobacco control are involved 'THR products' can only to be used under strict regulation.

A tobacco control THR advocate could easily drop a 'THR product' i.e e-cigs, without affecting what they are really advocating (hint quit).

THR seems to be far wider than just high/low risk products. It includes, among many other things, motivation, psychology, social interactions and economics. To narrow this down to 'THR products' and hence 'THR advocates' for 'THR Products' does the whole area of THR a disservice.

Tobacco control are fine with this narrowing of the term THR as it absolves them of the consequences of their own harmful actions while allowing them to maintain an unmerited benevolence.

In addition redefining terms helps tobacco control sow confusion and maintain control of the debate.

No wonder Vaping/Smoking/THR advocates are talking past each other.

This reflects my understanding of THR, and attempts to navigate the confusion, which is always open to new thoughts on the subject.

Tuesday, May 10, 2016 at 19:15 | Unregistered Commenterwest2

In reply to "west2":

Very good questions and observations. I am probably as good a candidate as an authority on the terminology, since I played a major role in establishing it and have seriously analyzed what it really means. As I noted at length here -- -- real harm reduction thinking is not just about technical adjustments to a consumption pattern that reduce the risks. That is clearly part of it, when possible, and so products that offer such reduction in risk are reasonably called THR products. All of them, even the ones that do not reduce the risk as much as switching to snus.

But also inherent in the concept of harm reduction is empowerment and freedom to make choices, as well as reducing caused harm (such as by taxes or criminalization). Thus the phrase "tobacco control THR advocate" is pretty close to an oxymoron. It is difficult to imagine someone being properly called a tobacco controller if they were not trying to control -- punish smokers with taxes, force changes to other products, etc. Control and harm reduction are anathema. People pushing for the adoption of alternative products as a "cure" for smoking, while actively taking steps to deny people the choice to smoke or to punish them for it, are not supporting harm reduction.

Tuesday, May 10, 2016 at 23:09 | Unregistered CommenterCarl V Phillips

The announcement wasn't that much of a surprise really, at least for those of use that read Carl's blog, but the sheer 'fuckwitted cuntery' (thanks Sarah) that lay behind it, and still continues to outpour from the FDA is disappointing to say the least.

The one hope is that the egregious of the legislation, e.g. 0mg juice requiring labelling as 'This is a tobacco product', to say nothing of the rules surrounding batteries, atomisers, wicking material etc. means that a legal challenge is slightly more likely to succeed, at least in part. This could be tied up in legal battles for years.

The worrying thing is that some vendors, at least, seem to think that the whole thing is about the ban on selling to minors (in some states that'll be under 21 year-olds!). Where have they been all this time - don't they pay attention to anything?

The most disappointing announcement for me was from Derek Yach, who appears to be supporting the FDA's action - I thought he understood the battle better than that.

FDATobacco needs to be buried for this - by law suits, queries, even fake applications. Tie them up in red tape and strangle the bastards.

Wednesday, May 11, 2016 at 1:23 | Unregistered CommenterRobert Heyes

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