Tuesday 16 February 2016

The Pope, Anti-Vaxxers, And Tobacco Control

You may not have read it because it is behind The Times paywall, but Lord Ridley has written a pretty good article about the daft stance many in 'public health' adhere to when it comes to vaping.

Running briefly through harm reduction ideas which have proved themselves incredibly successful in areas such as HIV, heroin addiction, sex education, 'designated driver' schemes for drinkers, and even allowing the homeless the occasional tipple to encourage them to stay in a shelter rather than on the street, he wonders why there still appears to be resistance to the same principle with e-cigs.
We are surrounded by policies designed not to stop us doing things, or stigmatise us, but to encourage us to do them more safely. In the case of addictions, where people find it genuinely very difficult to resist temptation, this surely makes sense. 
Which is what makes the attitude of so many public health professionals to vaping so baffling.
Well quite.
Yet instead of encouraging vaping, the government is about to implement an idiotic clause in the European tobacco products directive, which will ban stronger e-cigs, the very ones heavy smokers start with if they quit, and burden new vaping products with extra regulation, stifling innovation. Unless very much watered down, this is certain to slow or reverse the rate at which people quit smoking, while encouraging a black market - and might also energise furious vapers to vote “leave” in the referendum. 
Erm, and then some!
If public health experts can see the success of exchanging dirty for clean needles in the fight against HIV and hepatitis C, why can so few of them see the benefits of exchanging dirty tobacco smoke for clean nicotine vapour?
The answer to that question, of course, is ignorant ideology, as Ridley alludes to earlier in his piece.
So ingrained is the view that tobacco smoking - probably the most widespread and harmful of all drug addictions - must be fought with condemnation, that many medics and public policy officials cannot stand the thought that a far less harmful way of satisfying nicotine cravings has emerged from outside the public health realm, through a consumer product.
This is the "not invented here" phenomenon very well described by Clive Bates when pulling apart the desperate smears promoted by proven liar Martin McKee in November. It's a simple concept and perfectly understandable in relation to a group of people who have always revelled in their position as the nation's state-funded finger-waggers, as Bates neatly explains.
Not invented here: the products and harm reduction benefits have emerged through the free play of producers and consumers in a lightly regulated market. No one in public health has given their approval or been asked for it, no public spending is required and public health organisations have no controlling influence.
It doesn't help that most in 'public health' seem to be sixth-form level, industry-hating leftards either. Again, as Bates encapsulates.
Hostility to the private sector: culturally, the public health establishment is inclined to paternalism, and state-based or not-for-profit interventions. It instinctively distrusts the private sector and capitalism. It is ill at ease with the idea of consumers as empowered agents.
Regulars here know me well enough by now to predict that this is where I say this proves opposition to vaping is nothing to do with health. And it isn't. But there was a superb article published earlier this month that goes even deeper into this damaging anti-health position from those who should know better, and it comes from way up high.

Entitled "How to Deal with Stupid: The Denormalisation of Industry", risk and science communications specialist David Zaruk puts his finger firmly on the problem. And it won't surprise you that the problem is, once again, the WHO.
I came across the term “denormalisation of industry” in 2012, in, of all places, a publication by the WHO on e-cigarettes. The World Health Organisation was rejecting the possible benefits of e-cigarettes in reducing harm because it “could therefore undermine the denormalization of tobacco use upheld by the WHO”. Anyone unaware of the activist nature of the WHO under Margaret Chan might be alarmed that a global body would reject a beneficial technology out of spite, but this follows perfectly their anti-industry rhetoric, seen also in their anti-pharmaceutical industry position during the Ebola crisis or any IARC study on anything industry produces. On tobacco, the WHO has isolated industry, refusing to consider their research, engage with their representatives or even allow them to attend meetings (nor anyone else for that matter - DP). While they acknowledge that the tobacco companies are still legally permitted to sell products, they are excluded from any normal role within society – they are pariahs … who pay taxes.
Denormalisation, huh? Well whaddya know?

He continues ...
Research against second-hand smoke was, to say the least, quite dodgy (remember the claims that second-hand smoke was more dangerous than direct inhalation), but given the anti-tobacco bias of regulators, it was enough to act against industry. In a denormalised situation, it seems acceptable to reject an industry position without good data while legislating on shaky research. Who, after all, would stand up for the tobacco industry? Given that their scientists were not allowed to participate in the discussions, there was really no need for a fair assessment of the research.
Yep, this is what the tobacco control industry routinely does. It will exaggerate its own shonky research and pretend that is unimpeachable despite being mostly junk, but will apply impossible standards of probity to anything which opposes the 'official' position. It is rank and fetid hypocrisy which was perfectly described in "a tale of two Delphi groups", an article published in Addiction last month but posted at NSP in September (if you haven't yet read this, I recommend you do).
So what does all this tell you about tobacco control research? It tells you that when it comes to weighing the harms of different products, or assessing the impact of different policies, tobacco control researchers embrace the research that reports the findings they like and rail against the studies that report inconvenient or unwelcome findings. That is a hugely regrettable aspect of research in this area. The science of understanding human behaviour is difficult enough without the added burden of political interests around big tobacco and smoking colouring how different studies are assessed and different researchers are attacked.
And that's the whole thing in a nutshell. It's why we're seeing junk study after junk study thrown at e-cigs almost on a daily basis; why anything promoting vaping is instantly condemned as being a product of the shadowy Big Tobacco even if it has nothing to do with it; and why, yes, none of it is anything to do with health.

The 'public health' community - and most especially tobacco control - has mostly fallen in line behind pathetic policies which exclude opposition that might get in its way. It wishes to monopolise the debate and the best way to do that is to undermine those who challenge the 'approved' policy based on nothing but pre-determined junk science and ignorant, puerile, ideological stupidity.

Ironically, where tobacco harm reduction is concerned, this places those tobacco controllers who still deny the benefits of vaping in the same category as the Pope refusing to accept that condoms could help stop the spread of HIV in Africa, and ideology-driven, science-blind anti-vaxxers.

They're in good company then, and history will one day judge them in the same laughable fashion.

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