# Bloomberg’s Millions Funded an Effective Campaign Against Vaping. Could It Do More Harm Than Good?



## fbb1964 (24/3/21)

Updated this thread with the full debate articles for whomever interested. This is now a *very* long thread with a lot of actual vaping advocacy information presented.

This first post is the original news article as it appeared, the second post is the news article response from the Bloomberg crowd and the third post is the anti counter news article response back to the Bloomberg crowd basically telling them they have have no idea what their talking about with actual facts presented and to stop lying to all of us. Priceless!

https://web.archive.org/web/2021032...gainst-vaping-could-it-do-more-harm-than-good

*Bloomberg’s Millions Funded an Effective Campaign Against Vaping. Could It Do More Harm Than Good?*
*Public-health experts say that e-cigarettes play an important role in getting people to stop smoking.*
STEVEN SENNE, AP
The widespread use of e-cigarettes by teenagers declined after a campaign led by Michael Bloomberg and Tobacco-Free Campaign Kids.
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By Marc Gunther
MARCH 23, 2021


In September 2019, Michael Bloomberg, the billionaire philanthropist, and Matthew Myers, president of the nonprofit Campaign for Tobacco-Free Kids, unveiled a $160 million, three-year campaign to end what they described as an epidemic of e-cigarette use among kids.

In a _New York Times_ op-ed, Bloomberg and Myers attacked Big Tobacco for putting young people in serious danger by hooking them on addictive e-cigarettes, which are sold in kid-friendly flavors like cotton candy and gummy bear.

Backed by a coalition of influential nonprofits, including the anti-tobacco Truth Initiative, American Cancer Society, American Heart Association, and American Lung Association, they called for a national ban on flavored e-cigarettes.

Bloomberg lamented: “All the progress that we’ve made in reducing teen smoking is being turned around.”

Their timing was propitious. A year earlier, the FDA and the U.S. Surgeon General declared youth e-cigarette use an epidemic. Fears were mounting about unexplained deaths linked to vaping. A few cities, including San Francisco, had banned flavored e-cigarettes. Michigan had just become the first state to do so.

*What Philanthropy Is Accomplishing*
This is part of a _Chronicle_ series taking a deep dive into the results of big philanthropic efforts to discover what has worked, what has failed, and what donors can learn.
In the months that followed, five more states — California, Massachusetts, New Jersey, New York, and Rhode Island — banned flavored e-cigarettes. So did several big cities, including Chicago and Philadelphia. Congress raised the federal minimum age of sale for all tobacco products from 18 to 21. Anti-vaping messages dominated the national conversation.

All of this had an impact: The use of e-cigarettes by middle-school and high-school students declined sharply from 2019 to 2020, reversing previous trends, according to the latest data from the Centers for Disease Control and Prevention.

“I think it’s fair to say that Bloomberg’s funding has produced measurable, significant results,” says Myers, a founder of Tobacco-Free Kids and a longtime leader in the fight to curb tobacco use.

Seen in that light, the work of Bloomberg Philanthropies and Tobacco-Free Kids looks to be an uncomplicated story of philanthropic success.

It is anything but.

Bloomberg Philanthropies used its money and influence to curb vaping, to be sure. But others who have worked for decades to reduce deaths from smoking say the ongoing campaign against e-cigarettes is misguided, built on unsound science and likely to do more harm than good.

*Less Dangerous*


Kenneth Warner cares about tobacco control as much as anyone. A founding board member of the Truth Initiative — the nonprofit public-health organization committed to ending tobacco use — Warner has also been the president of the Society for Research on Nicotine and Tobacco, the senior scientific editor of the 25th-anniversary Surgeon General’s report on smoking and health, and the dean of the University of Michigan’s School of Public Health.






UNIVERSITY OF MICHIGAN
Kenneth Warner, a University of Michigan scholar, says harm from tobacco is far greater than from vaping: “Michael Bloomberg had sone great things for public health, but he is way off base on this.”
Years ago, Warner and a colleague, David Mendez, built a computer model that tracks the U.S. adult population’s smoking status and smoking-related deaths. When they ran data about vaping through the model, they found that under all but the very worst-case assumptions, the benefits of e-cigarettes, which can help smokers quit, exceed their costs in terms of lives saved. Warner says the campaigns against e-cigarettes are a mistake.

“Michael Bloomberg has done great things for public health,” he says. “But he is way off base on this.” Other respected elders of the tobacco-control movement share that view.

The critics’ argument goes like this: While e-cigarettes and combustible tobacco both contain nicotine, an addictive chemical stimulant derived from tobacco, e-cigarettes are much less dangerous than smoking. Vaping appeals to smokers who want to quit but need a nicotine fix. Like kids, adult vapers prefer flavors. So while no one wants teenagers to vape, removing flavored e-cigarettes from the market deprives adult smokers of a popular safer alternative.

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Worse, the critics say, by exaggerating the dangers of e-cigarettes, Bloomberg, Myers, and their allies have inadvertently given people a reason to smoke. Public opinion polls show that Americans overestimate the risks of vaping.

In “Evidence, Alarm and the Debate Over E-Cigarettes,” an essay in the journal _Science,_ five public-health experts write that it’s a mistake to restrict access to vaping products while leaving deadly cigarettes on the market. The authors include Cheryl Healton, the former chief executive of the Truth Initiative, who is dean of the New York University school of public health, as well as the deans of the schools of public health at Ohio State and Emory universities.

They conclude: “Careful analysis of all the data in context indicates that the net benefits of vaped nicotine products outweigh the feared harm to youth.”

*Greater Impact on the Poor*


The e-cigarette debate is about social justice as well as public health. Much of the outcry about vaping has come from well-educated, well-to-do, and well-connected parents who want to protect their kids. By contrast, the smokers who might benefit from switching to e-cigarettes, data shows, tend to be poor and less educated; people of color, especially Native Americans; gay or lesbian; homeless or incarcerated; and those with mental-health or other substance-abuse issues. They lack political clout.

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GRANT MAKING
For Robert Wood Johnson Foundation, Tobacco Is a Social-Justice Issue
Steven Schroeder, who as president of the Robert Wood Johnson Foundation from 1990 to 2002 led the philanthropy’s $700 million tobacco-control campaign, says much of the energy and money aimed at opposing e-cigarettes has come at the expense of curbing the use of smoked tobacco, which remains the leading cause of preventable death in the United States.

The CDC estimates that cigarette smoking is responsible for more than 480,000 deaths a year in the United States — more than the number of deaths caused by Covid-19 during the first year of the epidemic.

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“It’s discouraging that smokers have fallen off the radar,” Schroeder says.

*Different Approaches*


The e-cigarette debate has fractured governments and nonprofits around the world. Australia, Brazil, and India have banned the sale of e-cigarettes.

By contrast, the British government actively promotes vaping as an alternative to smoking while discouraging use by young people. This strategy seems to be working: Use of e-cigarettes is largely confined to current and former smokers. Of the 3.2 million current vapers, just under 2 million are ex-smokers who have completely stopped.

Scientists are deeply divided. Each side accuses the other of distorting evidence.

“We are neck-deep in intractable, internecine warfare,” says Cliff Douglas, the former vice president for tobacco control at the American Cancer Society. “Like so much of our discourse these days, the debate has become polarized.” Young researchers have voiced concern about the amplification of one-sided, divisive views.

*Harm-Reduction Debate*


The challenge for foundations and nonprofits concerned about health is to act (or choose not to act) amidst contentious debate and scientific uncertainty. For now, virtually all of the philanthropic money driving the conversation — overwhelmingly from Bloomberg but also from the corporate foundation of the drugstore chain CVS -- has come down strongly against vaping.

Ethan Nadelman, founder and former executive director of the Drug Policy Alliance, says: “There is now, essentially, no philanthropic funding to support harm reduction.”

The public-health strategy known as harm reduction is central to the e-cigarette debate. Simple in theory but controversial in practice, harm reduction aims to limit the dangers of risky behavior by offering safer, though not entirely safe, alternatives — clean needles or injection sites for intravenous drug users, contraception for teenagers who want to avoid pregnancies, and now e-cigarettes for smokers. Harm reduction can be useful when the evidence suggests, as it often does, that abstinence-only strategies like “just say no” don’t work.

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Steven Schroeder, who favors harm reduction, says: “The ideal solution for vaping would be to keep it out of the hands of kids and preserve it as a gateway for smokers who want to quit.”

Laws barring the sale of tobacco products to anyone under 21 should accomplish that. But the age limits are poorly enforced so the anti-tobacco nonprofits are determined to go beyond harm reduction to abolition — for better or worse.





SCOTT OLSON, GETTY IMAGES
Michael Bloomberg says Big Tobacco is trying to get young people hooked by selling e-cigarettes in flavors like cotton candy and gummy bear.


*Fun, Freedom, and Sex Appeal*


While people have been smoking or chewing tobacco for centuries, e-cigarettes are new. Most use a battery to heat a liquid that contains nicotine and flavors, creating a vapor that users inhale. They were brought to market in the early 2000s by a Chinese pharmacist whose father, a heavy smoker, died of lung cancer.

Vaping exploded in popularity in the United States with the 2015 launch of Juul, a company that bombarded young people with commercials associating its sleek pods with fun, freedom, and sex appeal. Juul, which loads up its pods with nicotine and delivers it rapidly to the bloodstream, became the market leader. Altria, the leading U.S. cigarette maker, bought 35 percent of Juul for $12.8 billion in 2018. To Myers of Tobacco-Free Kids, that was “a truly alarming development.”

By all accounts, Matt Myers is the most important voice in the tobacco-control movement. Tobacco-Free Kids, which is based in Washington, D.C., has about 140 staff members and a budget of $34 million, according to its most recent tax return. But it is Myers’s long history as an anti-tobacco crusader that gives him an outsize influence. A lawyer, Myers advised state attorneys general who sued tobacco companies during the 1990s, leading to the largest civil-litigation agreement in history, which transformed the anti-smoking movement.

Funds from the tobacco settlement endowed the Truth Initiative (formerly the American Legacy Foundation), which is also based in Washington. It is known for its award-winning anti-smoking commercials that over the years helped persuade millions of teenagers to avoid smoking. The Truth Initiative spends about $100 million a year on marketing, advocacy, and research.

Michael Bloomberg, meantime, has been the tobacco-control movement’s most generous financial supporter, both as an individual and through his foundation. Bloomberg Philanthropies has committed nearly $1 billion to combating tobacco use worldwide, most of it focused on poor and middle-income countries. Bloomberg is also the largest individual donor to Johns Hopkins University, his alma mater, which named its school of public health after him, and as New York’s mayor, he was the leading advocate for a law banning smoking in restaurants and bars.





STEVE FORREST, PANOS PICTURES, REDUX
Michael Bloomberg’s philanthropy provided $160 million to end e-cigarette smoking. The billionaire has been active in tobacco-control efforts, including joining Tedros Adhanom Ghebreyesus, head of the World Health Organization, at the 17th World Conference on Tobacco or Health.
The anti-smoking work funded by Bloomberg Philanthropies and the Robert Wood Johnson Foundation counts as a landmark philanthropic accomplishment. Cigarette smoking among U.S. adults fell to a low of 13.7 percent in 2018, down by more than two-thirds from its peak of 42 percent in 1964, which was the year the U.S. Surgeon General first warned of the health consequences of smoking. Globally, nearly two-thirds of the world’s population is protected by at least one comprehensive tobacco control policy, like cigarette taxes or package warnings, up from 15 percent when Bloomberg’s work began in 2007.

While smoking hit record lows, though, Myers, Bloomberg, and their allies worried about the growing popularity of e-cigarettes. In 2018, the FDA and the surgeon general declared youth e-cigarette use an epidemic.

“We had this dramatic increase in tobacco use among kids in the U.S. Really a huge public health crisis,” says Kelly Henning, a physician and epidemiologist who leads public health work at Bloomberg Philanthropies. “That was an alarm bell.”

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Anti-smoking charities that had cautiously recommended e-cigarettes as an alternative to smoking for people who can’t quit reversed themselves. The lung and heart associations and the cancer society all get grants from Bloomberg Philanthropies, either directly or through Tobacco-Free Kids.

The American Cancer Society, for example, used to advise visitors to its website that “switching to the exclusive use of e-cigarettes is preferable to continuing to smoke combustible products.” Now it says: “E-cigarettes should not be used to quit smoking.” The growth of vaping, coupled with the FDA’s failure to regulate e-cigarettes, caused the change, according to Laura Makaroff, a senior vice president at the Cancer Society.

The Truth Initiative, too, once embraced harm reduction. Its former board chairman, Tom Miller, Iowa’s long-serving attorney general, still argues that e-cigarettes are a “means to saving millions of lives.” Cheryl Healton, its former CEO, and David Abrams, formerly executive director of the Schroeder National Institute of Tobacco Research and Policy Studies, which is housed at the Truth Initiative, are harm-reduction advocates. So is Steven Schroeder, for whom the institute is named.

Why did the Truth Initiative decide to take a harder line? “As with everything we do, our work is led by the science,” says Robin Koval, CEO of the Truth Initiative. “We have an epidemic of young people vaping. We know from an emerging body of science that these products are far from harmless.”

*Conflicting Claims*


But just how harmful are they? Debates over the health effects of e-cigarettes are contentious. The _Chronicle_ reviewed numerous studies and interviewed 30 scientists and activists to try to sort through conflicting claims. Remarkably, some scientists analyze the very same data and reach radically different conclusions.

Consider nicotine. “The big unanswered question is, is nicotine doing some harm to the [adolescent] brain,” says. Neal Benowitz, a professor of medicine at the University of California at San Francisco who is one of the world’s leading experts on the drug. “The concern is legitimate. Right now, we don’t know the answer.”

Other scientists, extrapolating from rodent studies, are more worried. “There’s no question that nicotine has negative effects on the developing brain,” says Rose Marie Robertson, a physician and the chief science officer of the American Heart Association. The State of California, in its guidance, is unequivocal, saying: “Simply put, nicotine is brain poison for youth.”

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Bloomberg, during an appearance on _CBS News_ to discuss vaping, warned: “Just think if your kid was doing this and winds up with an IQ 10 or 15 points lower than he or she would have had for the rest of her life.”

This is, to be kind, a stretch. No reputable scientist believes that e-cigarettes cause a long-term drop in IQ. If nicotine caused sharp declines in intelligence, millions of smokers would have felt the impact.

“That is a good illustration of the danger of Bloomberg and his money,” says Clive Bates, the former director of the British nonprofit Action on Smoking and Health and a strong harm-reduction advocate. David Abrams, the former Truth Initiative scientist who is now a professor at NYU, says: “It’s never justified to distort or misinform the public, even in the service of trying to scare kids.”

FDA-approved nicotine-replacement therapies, after all, deliver nicotine in the form of gum, patches, sprays, or lozenges to smokers who want to quit. (In Britain, but not the United States, nicotine-replacement therapy is prescribed to pregnant women and children as young as 12.) It’s not the nicotine but the 7,000 or so other chemicals in cigarette smoke that cause disease and death, most experts say. Michael Russell, a British scientist and a pioneer of smoking-cessation treatments, famously said: “People smoke for nicotine, but they die from the tar.”





BRIAN SNYDER, REUTERS, NEWSCOM
In Massachusetts and elsewhere, the debate over e-cigarettes and their impact on young people, are flaring in state legislatures.
E-cigarettes, however, have not been approved by the FDA for tobacco cessation.

Stanton Glantz, formerly the Truth Initiative Distinguished Professor of Tobacco Control at the University of California at San Francisco, says the negative impact of e-cigarettes goes way beyond nicotine. “For heart and lung disease, they’re about as bad as a cigarette. They might be worse for lung disease,” he says. A hero to anti-smoking activists, Glantz is one of the nation’s best known tobacco researchers.

Harm-reduction advocates don’t trust Glantz. Among other things, his 2019 federally funded study alleging that vaping doubles the rate of heart attacks had to be retracted when it turned out that some of the heart attacks took place before people started using e-cigarettes. The peer-reviewed study was published in the _Journal of the American Heart Association._

Many scientists share at least some of Glantz’s concerns. Laura Crotty Alexander, a physician and associate professor at the University of California at San Diego, had hoped that e-cigarettes could help her patients at a local VA hospital quit smoking. But as a mother of two, she’s grown concerned about young people and nicotine. “I’ve been surprised by the data that has come out showing that e-cigarettes are harmful,” she says. She supports a ban on flavored e-cigarettes, as does Jonathan Samet, a physician, epidemiologist and dean of the Colorado School of Public Health and longtime tobacco researcher. “We should be doing more science to address the uncertainties,” he says.

*Rebellion and Experimentation*


The anti-vaping forces and government agencies also worry that e-cigarette use today will lead to cigarette smoking in the future — that vaping functions as a gateway to smoking. Many studies show that young people who vape are more likely than their peers to go on to smoke and use illicit drugs.

The Truth Initiative says: “Young people who had ever used e-cigarettes had seven times higher odds of becoming smokers one year later compared with those who had never vaped.”

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The trouble is, studies that find an association between vaping and smoking reveal something about kids who vape — they’re more prone to experimentation or rebellion than their peers — but they do not establish a causal relationship between vaping and smoking. “If teens try one thing, they’re going to try other things,” says NYU’s David Abrams.

Population studies that track large numbers of young people cast doubt on the gateway theory. Smoking by high-school and middle-school students fell during the 2010s, the decade when more kids began to vape.

In a paper called “How to Think — Not Feel — About Tobacco Harm Reduction,” Kenneth Warner looked at a government-funded survey of smoking: “The year of the largest increase in e-cigarette use, 2013–14, saw the largest one-year percentage decline in high school seniors’ cigarette smoking prevalence (16.6%)” in the survey’s 40+ year history.”

*Focus on Children*


The two sides can’t even agree about whether the use of e-cigarettes by kids should be called an epidemic. A 2020 survey found that about one in five high-school students reported vaping in the previous month, but only about one in 15 frequently used e-cigarettes, the CDC says. Is that an epidemic?

Nuance was cast aside when Tobacco-Free Kids and its allies took their campaign to states and localities. They made Big Tobacco the enemy — that was easy after Altria bought a stake in Juul, which had aggressively marketed to teens — and they adapted a playbook developed during battles over tobacco taxes and laws prohibiting smoking in public places.

“Starting at the local level is always the best practice when it comes to tobacco-control policies,” says Cathy Calloway, director of state and local campaigns at the Cancer Action Network, the advocacy arm of the American Cancer Society. With a presence in every congressional district, the Cancer Society can “mobilize our grassroots volunteers and encourage them to contact their elected officials,” she says.

The anti-vaping campaign focused on kids. There are good scientific reasons to do so, explains John Pierce, a professor of public health at the University of California at San Diego who supports the work of Bloomberg and the nonprofits.

“It’s so hard to get people to quit,” Pierce says. It’s easier to get people not to start,” says Pierce.

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Politically, too, focusing on kids was smart. “There’s a fear of harming kids, and especially those who are seen as pure,” says Lynn Kozlowski, a professor of community health at the University at Buffalo and a harm-reduction advocate.

“You can’t understate the significance of the youth-use problem,” says Myers. “The level of harm that we have seen to kids far outweighs any benefit to adult smokers that has been actually studied and documented.”





JOHN TLUMACKI, THE BOSTON GLOBE, GETTY IMAGES
Maura Healey, the Massachusetts attorney general, was joined by anti-vaping activists when she announced a lawsuit against e-cigarette makers. The state’s legislature was among the first in the nation to ban the sale of all flavored tobacco products.


*‘Dubious Public Health’*


In San Francisco, the political action committee formed to support bans on e-cigarettes in two citywide referenda was called San Francisco Kids vs. Big Tobacco.

Here again, Bloomberg flexed his financial muscles: He contributed $9.4 million of his own money to the San Francisco anti-vaping campaigns in 2018 and 2019, accounting for 84 percent of the money they raised. (The American Heart Association gave another $612,000.) The tobacco companies, led by Juul, spent far more, but they were soundly defeated twice at the polls.

The result? You can buy Marlboros or marijuana but not e-cigarettes in the city. That may be good politics, but it is “dubious public health,” says Steven Schroeder.

In Massachusetts, Tobacco-Free Kids gave about $300,000 to a Boston charity called Health Resources in Action that made grants to community organizations that serve Black, Latino, and LGBT people to push for a ban on all flavored tobacco products. Among other things, they distributed a 15-minute film called Black Lives/Black Lungs about the toll that tobacco takes on African Americans and built a website called Fight All Flavors, with the help of Tobacco-Free Kids.

“What started locally in Boston accelerated quickly,” Kathleen McCabe, a managing director at Health Resources in Action, which fought for local and state laws. “I don’t think any of us anticipated how quickly the law was going to pass,” she said. Last June, Massachusetts became the first state to end the sale of all flavored tobacco products.

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What happened next should not have come as a surprise. Sales of tobacco products fell sharply in Massachusetts — by about 24 percent, judging by tobacco tax receipts — while tobacco sales grew in all five neighboring states. It’s too soon to know for sure, but “early signs indicate that the ban will not decrease tobacco consumption in the state,” says Ulrik Boesen, a senior policy analyst at the Tax Foundation.

In Minnesota, which was one of the first states to impose a steep tax on vaping, the consequences create additional cause for concern. A study by the National Bureau of Economic Research found that declines in smoking leveled off after imposition of the tax. The authors wrote: “The e-cigarette tax increased adult smoking and reduced smoking cessation in Minnesota.”

Harm-reduction advocates say they are starting to see similar trends across the United States. In an article headlined “Smoking’s Long Decline Is Over,” the _Wall Street Journal_ reported that cigarette sales, which had been declining slowly but consistently, were flat in 2020. It’s impossible to know precisely what halted the decline — Covid-19 surely played a role — but some e-cigarette users probably returned to combustible cigarettes “because of increased e-cigarette taxes, bans on flavored vaping products, and confusion about the health effects of vaping,” the _Journal_ reported.

Most people believe, erroneously, that vaping is as dangerous or more dangerous than smoking, surveys show.

David Sweanor, a lawyer based in Ottawa, Canada, who has worked globally for nearly 40 years at reducing tobacco’s health toll, including by suing cigarette companies, has been warning that the concerted efforts to demonize vaping have created a moral panic.

“The inevitable result,” Sweanor says, “is that it is more likely that smokers will stick with deadly combustibles, more vapers will revert to smoking, smoking will decline more slowly than it otherwise would, and the lucrative cigarette trade will have again been protected from a disruptive threat.”

He calls the anti-vaping nonprofits Big Tobacco’s Little Helpers.

Correction: This article has been updated to fix the attribution of a quote. The State of California, not Tobacco-Free Kids, said “Simply put, nicotine is brain poison for youth.”

We welcome your thoughts and questions about this article. Please email the editors or submit a letter for publication.
FOUNDATION GIVING



Marc Gunther
Marc Gunther is a veteran journalist, speaker, and writer who reported on business and sustainability for many years. Since 2015, he has been writing about foundations, nonprofits and global development on his blog, Nonprofit Chronicles.

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## fbb1964 (5/4/21)

https://www.philanthropy.com/article/vaping-and-philanthropy-debating-strategies-that-work

*Vaping and Philanthropy: Debating Strategies That Work*
MARCH 29, 2021


To the Editor:

Regarding Bloomberg’s Millions Funded an Effective Campaign Against Vaping. Could It Do More Harm Than Good? (_Chronicle,_ March 23), there is still much we don’t know about e-cigarettes. But here is what we do know.

We know that 3.6 million kids currently use e-cigarettes, a threshold that in 2018 led the U.S. surgeon general to declare youth e-cigarette use an epidemic. Of these kids, 1.3 million use e-cigarettes frequently or every day, a strong sign of nicotine addiction.


We know that e-cigarette companies have infused their products with thousands of kid-friendly flavors, which are chosen by an overwhelming majority of kids who use e-cigarettes.

We know that tobacco companies have spent billions of dollars to create, distribute, and advertise e-cigarette products in a “patently youth-oriented” manner.

We know that e-cigarettes can deliver as much nicotine or more as a whole pack of cigarettes and that nicotine can have detrimental impacts on kids’ brain development and health.

All of this led our organizations to mount major campaigns to reverse the youth e-cigarette epidemic, including Bloomberg Philanthropies’ Protect Kids: Fight Flavored E-Cigarettes initiative launched in 2019 and Truth Initiative’s National Youth-Vaping-Prevention Truth® campaign, which includes This Is Quitting, a free text-message program currently helping hundreds of thousands of young vapers quit. Thanks to these and other efforts, youth e-cigarette use has started to decline, although it remains at epidemic levels, with nearly one in five high-school students vaping.

Bloomberg Philanthropies’ e-cigarette initiative is a complement to and not a substitute for Bloomberg’s ongoing $1 billion commitment to reduce traditional tobacco use, the Bloomberg Initiative to Reduce Tobacco Use, which has saved more than 35 million lives around the world over the past decade by investing in and advocating for proven policies to prevent tobacco use.



Tobacco companies have fought us tooth and nail every step of the way, and we are disappointed to see so many similarly baseless assertions receive safe haven in Mr. Gunther’s article.

For instance, the article strongly implies that removing flavored e-cigarettes from the marketplace will prevent adult cigarette smokers from quitting. That is simply not true. The FDA has approved a variety of smoking-cessation products — some with nicotine, others without — including patches, gums, nasal sprays, inhalers, lozenges, and pills.

It takes Mr. Gunther more than 2,500 words to mention that the FDA has not approved a single e-cigarette as a smoking-cessation device, and he ignores completely the fact that no e-cigarette company has even tried to prove to the FDA that its products are effective at helping smokers quit.

In fact, every major U.S. public-health authority that has comprehensively reviewed the scientific evidence has reached the same conclusion: To date, there is limited and inadequate evidence to conclude that e-cigarettes are effective for smoking cessation.

For decades, tobacco companies were permitted to run rampant, ruthlessly addicting millions, before governments finally asserted their authority to prioritize the health of children and families over tobacco companies’ profits. E-cigarette companies are counting on the “wait and see” approach repeating itself. Not on our watch.

Kelly Henning
Public Health Program Lead, Bloomberg Philanthropies

Matthew L. Myers
President, Campaign for Tobacco-Free Kids

Robin Koval
CEO, Truth Initiative


To the Editor:

Mark Gunther’s article on Bloomberg’s funding of efforts to prevent youth e-cigarette use did a good job presenting the current conflicts in the public-health community about e-cigarettes and how best to regulate them.

But it did not suggest any ways those conflicts might be resolved or, perhaps, made less important. Given the common, overriding goal of reducing tobacco-nicotine deaths and harms as quickly as possible, there are many new tobacco-control policies that all sides of the e-cigarette conflict should be able to agree on and actively support.

Most importantly, new, much stronger antismoking measures — such as minimizing nicotine levels in all cigarettes and similarly smoked tobacco products or banning all added flavors in smoked tobacco products, including menthol in cigarettes — could more quickly and sharply reduce smoking initiation and increase smoking cessation than any other politically viable policy options.

Such antismoking measures would not increase any restrictions or requirements on e-cigarettes. But they would dramatically reduce the risk that any youth who initiated e-cigarette use would ever move on to smoking, one of the major concerns about youth e-cigarette use. Moreover, if cigarettes and similarly smoked tobacco products could no longer feed smokers’ nicotine addictions (with or without a flavor ban), it would be much easier for e-cigarettes to compete against them.

Although conflicts would still arise in regard to whether new bans on flavored smoked tobacco products should also ban all or some e-cigarette flavors, all those concerned with reducing overall tobacco-related harms should at least agree that the top priority should be to get rid of all added flavors in _smoked_ tobacco products.

Indeed, if smoked tobacco products no longer had added flavors, e-cigarettes would not need flavors as much to compete successfully against them — although it is quite possible that having menthol e-cigarettes available after a ban of menthol cigarettes would prompt more menthol smokers to switch to using menthol e-cigarettes instead of simply switching to nonmenthol cigarettes.

Similarly, anyone who wants to see a decline in tobacco-use deaths and harms should support raising the prices of smoked tobacco products through effective minimum-price laws, increased taxes, and other means. Again, conflicts could arise regarding whether the price-increase measures should also apply to e-cigarettes. But all should at least agree on raising _smoked_ tobacco prices; and perhaps even those arguing for stronger restrictions on e-cigarettes could at a minimum agree that government tax and price measures should not make e-cigarettes more expensive than smoked tobacco products.


Another possible consensus antismoking strategy might not raise any significant conflicts, even if it were extended to e-cigarettes (or to all tobacco products). That is requiring that all tobacco products be sold only in adult-only sales outlets.

This regulation would dramatically reduce youth access while also helping shrink overall use. But that would not make finding and buying e-cigarettes any more difficult for adults than finding and buying smoked tobacco products. To promote switching from smoking to vaping (without any downside risks), even those opposing an e-cigarette harm-reduction approach should also be able to agree that all sales outlets that sell smoked tobacco products should be required to offer e-cigarettes, as well (but not vice versa).

Another point missing from the article, and rarely mentioned by either side of this e-cigarette debate, is that the availability of e-cigarettes makes implementing much stronger new antismoking measures much easier. To start, the availability of e-cigs directly addresses the argument that it would be unfair to addicted smokers to make their cigarettes and cigars less readily available or non-addiction feeding because they would be left with nowhere to go. By switching to e-cigarettes, those that do not quit all tobacco-nicotine use in response to the antismoking measures could still continue inhaling nicotine into their lungs to feed their addiction. That continuing smoker access to e-cigarettes also eliminates the already somewhat silly claim that desperate smokers would swamp our health care system if they could no longer smoke to feed their nicotine addictions.

Legally available e-cigarettes also sharply reduce the likelihood that any large black-market trade in illicit cigarettes would emerge in response to strong new antismoking measures (a favorite, already suspect, industry argument).

Faced with more expensive smoked tobacco products, no menthol cigarettes, or cigarettes and other smoked tobacco products that no longer feed their nicotine addiction, smokers who do not want to quit inhaling nicotine or cannot stop would still have the convenient and legal option of switching to e-cigarettes. Even where states or localities raise taxes on cigarettes and other smoked tobacco products, if smokers can legally evade the higher prices by switching to readily available, less-expensive e-cigarettes, fewer will take the time and trouble to go to any nearby lower-tax jurisdictions to get less-expensive smokes.

At the same time, the continued marketing of e-cigarettes, and the fact that some smokers will switch to e-cigarettes in response to new antismoking measures, further diminishes already specious cigarette-company arguments that sharply reducing smoking will reduce employment or cause other economic harms. Because of such switching, modest taxes on e-cigarettes also provide governments with a way to offset some of the tobacco tax-revenue reductions caused by sudden, sharp smoking declines (although the cost savings and harm reduction from the smoking reductions will already be much larger than any revenue losses).

Allowing the marketing of nicotine-delivering e-cigarettes also gives the tobacco industry a way to survive and remain profitable even after truly strong new antismoking measures are put into place.

That should dampen tobacco-industry opposition to such antismoking measures, especially now that the big tobacco companies have already publicly stated that they believe all smokers should quit or switch. Those public statements by the big cigarette companies also make it easier for policy makers to support new antismoking measures, even if they have protected the industry in the past. It is also possible that e-cigarette companies that do not also profit from smoked tobacco product sales will finally endorse and lobby for strong new antismoking measures (which will push many smokers to use their e-cigarettes, instead) if the new antismoking policies do not apply to e-cigarettes or do not apply as strictly.


So the public-health community and health-minded policy makers do not need to resolve the existing conflicts regarding e-cigarettes. It does not matter whether e-cigarette use harms are trivial compared with those from smoking or only some fraction less.

Nor does it matter whether the marketing of e-cigarettes, by itself, causes significant reductions in adult or youth smoking and secures significant public-health gains despite increasing nicotine addiction among otherwise nonusers.

What does matter is that the availability of e-cigarettes sharply increases the political viability of strong new antismoking measures that can reduce the overall harmful effects of tobacco use much more quickly than any other strategy.

Regardless of the contrasting views about e-cigarettes and how to regulate them, the public-health community should, first, come together and, with a single, strong voice, actively support powerful new antismoking measures as the appropriate top priority for the FDA and other tobacco-control policy makers at all levels of government. And private foundations and other funders should explore ways to try to help make that happen.

Eric N. Lindblom
Senior Scholar

O’Neill Institute for National & Global Health Law
Georgetown University Law Center

_Lindblom was director of the Office of Policy at FDA’s Center for Tobacco Products from 2011 to 2014._

_We welcome your thoughts and questions about this article. Please email the editors or submit a letter for publication._

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## fbb1964 (5/4/21)

https://www.clivebates.com/holding-the-bloomberg-anti-vaping-propaganda-complex-to-account/#S13

April 1st, 2021
Holding the Bloomberg anti-vaping propaganda complex to account



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

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

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

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

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


No sign of debate about strategies that work
Dismissing credible and well-informed critics
Misunderstanding adolescent vaping
Misrepresenting the role of flavours in vaping
Baseless claims about the vaping industry
Alarmist but empty claims about nicotine
Banning flavoured e-cigarettes – a campaign that is likely to do more harm than good
Claiming credit for reductions in vaping achieved by misleading claims about lung injuries
Tobacco control as inflexible dogma locked in the past
Smears and innuendo
Displaying basic misunderstandings about tobacco harm reduction
Missing the point about vaping regulation
In denial about evidence for smoking cessation but prohibitionist anyway
Anti-industry war-cry to deflect attention from their own weaknesses
The question of accountability
Other relevant material

Bloomberg’s Millions Funded an Effective Campaign Against Vaping. Could It Do More Harm Than Good?  [access](_Chronicle,_ March 23), there is still much we don’t know about e-cigarettes. But here is what we do know.

Despite the opening claim, the letter does not give a realistic account of what we do and do not know about e-cigarettes. Henning, Myer and Koval clearly did not like Marc Gunther’s reporting on their approach, but his account is basically accurate and mostly told through the testimony of credible independent experts. Gunther appears to have gone to great lengths, excessively generous in my view, to reflect the views of the anti-vaping activist-academics in his coverage. But the criticisms made in the article rest on statements from impeccable sources like:


Ken Warner, Avedis Donabedian Distinguished University Professor Emeritus of Public Health, Dean Emeritus of Public Health, University of Michigan
Cheryl Healton, Dean of School of Global Public Health, Professor of Public Health Policy and Management, New York University. Founding President and CEO of the Legacy Foundation / Truth Initiative.
Steven Schroeder, Distinguished Professor of Health and Health Care, Department of Medicine, Director of the Smoking Cessation Leadership Center, University of California at San Franciso.
Ethan Nadelmann, Founder, Drug Policy Alliance.
David Abrams, Professor of Social and Behavioral Sciences, School of Global Public Health, New York University and founding Executive Director of the Schroeder National Institute of Tobacco Research and Policy Studies at Truth Initiative
David Sweanor, Advisory Committee Chair, University of Ottawa Centre for Health Law, Policy and Ethics, Adjunct Professor, Faculty of Law, University of Ottawa, Canada
Without pausing for breath or reflection, or even considering if these serious critics may have a point, Henning, Myers and Koval go straight on the attack. Theirs is a vast financial and corporate advocacy undertaking in which there is no room for doubt, humility or debate – even if raised politely by acknowledged experts in the field.

3.6 million kids currently use e-cigarettes, a threshold that in 2018 led the U.S. surgeon general to declare youth e-cigarette use an epidemic. Of these kids, 1.3 million use e-cigarettes frequently or every day, a strong sign of nicotine addiction.

This statement is designed to generate alarm to support the case for anti-vaping activism. However, far more nuance is needed to understand these headlines. However, the underlying position is more subtle than they are willing to explain to readers.


Firstly, the number of vaping adolescents sharply decreased between 2019 and 2020. In 2019, it was 5.38m high-school and middle-school students. In 2020, it was down to 3.57m. This reminds us that some use is transitory and that demand is prone to fads and fashion. In 2019, past-30-day e-cigarette prevalence among high school students was 27.5%, but by early 2020 its was down to 19.6%.
Secondly, and most importantly, frequent vaping is highly concentrated in young people _who have already used tobacco_. Vaping is entering the mix of their tobacco/nicotine use and may well be beneficial by diverting them into a much less risky behaviour than smoking. In 2019, 27.5% of high school students had vaped at least once in the last 30 days. This is how that breaks down, when segmented by frequency of use and prior tobacco use (see data)







Third, if these adolescents were really dependent they would be using daily and intensively. It is not necessary to make heroic leaps of faith about nicotine addiction. Researchers have examined the actual indicators of dependence in the NYTS dataset and found that signs of dependence are highly concentrated in those _already using tobacco_. See: Jarvis et al. Epidemic of youth nicotine addiction? What does the National Youth Tobacco Survey 2017-2019 reveal about high school e-cigarette use in the USA? _Qeios_, 2020.
_Conclusions: While use of e-cigarettes in US high-school students increased sharply between 2017 and 2019, frequent use and signs of e-cigarette dependence remained rare in students who had only ever used e-cigarettes and never any other tobacco product._
flavors, which are chosen by an overwhelming majority of kids who use e-cigarettes.

Empty terminology designed to mislead. This claim is simply not true unless you define _any flavour_ that appeals to anyone (other than tobacco flavour) as ‘kid-friendly’, which is the approach adopted by these groups. Flavoured vaping products are also chosen by the overwhelming majority of adults. This is partly because, for many, the point is to get away from tobacco and smoke flavours. Almost all vaping products are flavoured in some way, including tobacco flavoured products. What exactly would a ‘kid-unfriendly’ flavour be? Just something that tastes nasty? Unless they can define their terms, these assertions are meaningless. The fact is that adults find (non-tobacco) flavours attractive and many adults will choose them, even if Henning, Myers and Koval declare they are targetted at kids. Here is one study (annotated by me in red), showing adult flavour preferences, Russell et al (2018):






Sleight of hand. Back in 2017, these groups were defining ‘kid-friendly’ flavours very differently – raising concerns about flavour _descriptors_ with a plausibly childish connotation like ‘Gummy Bear’ and ‘Cotton Candy’. Then came the rise of Juul (as an adult product and among young people). Juul did not have any flavours like this. But the internal logic had to hold together:

IF kid-appealing flavours cause teenage e-cigarette use AND the use of Juul among teenagers has increased THEN Juul flavours must be kid-appealing.

That meant Juul flavours like mango, creme, cucumber were by definition kid-appealing flavours. And with this started the gigantic scope-creep that has led to pretty well any flavour other than tobacco flavour being defined as kid-appealing. I describe this sleight of hand in more detail: Kiddie-flavours are now defined as all flavours except tobacco flavour – but it wasn’t always that way.

Bring the money and they will come. This has created the basis for what amounts to an e-cigarette prohibition drive at all levels in the US and increasingly internationally. Before long Bloomberg Philanthropies had piled in to fund a multimillion-dollar campaign.

_Bloomberg Philanthropies Launches New $160 Million Program to End the Youth E-Cigarette Epidemic_

_Goals of the initiative, “Protect Kids: Fight Flavored E-Cigarettes,” include banning all flavored e-cigarettes—and stopping Juul and other e-cigarette companies from marketing their products to children. The three-year program will be led by the Campaign for Tobacco-Free Kids, which will partner with other leading organizations including parent and community groups concerned about the nation’s kids and health._

To no-one’s surprise, activist organisations quickly came to see the merit of banning flavours. To paraphrase Mrs. Merton, “_what was it about the multi-million dollar campaign to ban e-cigarette flavours that convinced you of the central importance of banning e-cigarette flavours?_”

patently youth-oriented” manner.

This claim is obviously wrong. We certainly do not know this. By far the most lucrative market for e-cigarette companies is the population of adult smokers – people who make regular use of vaping products as alternatives to smoking. They consume more and more regularly and are potential longer-term customers. Even among the e-cigarette businesses of traditional tobacco companies, the marketing effort is targeted at winning market share from the cigarette and e-cigarette consumers of rival companies and defending their own market share. Selling to under-18s is simply not worth it – both in terms of the return on promotional expenditure and in terms of the massive political and regulatory grief it would cause the companies. That does not mean all companies are beyond reproach. Nor does it mean none are simply clueless and don’t even realise what they are doing. But to claim that all e-cigarette products, marketing and innovation are “patently youth-orientated” is obviously nonsense – it’s the adult market that brings in the money and reliable customers.

The evidence presented does not support their claim. The link provided by Henning, Myers and Koval to justify their claim is to a very poor quality 2019 white paper by Jackler and colleagues. The analysis is risibly simplistic and cannot support the claim that “tobacco companies have spent billions of dollars…” _on anything, _let alone on marketing products to youth. The paper does not even analyse tobacco companies marketing spend or themes. Nor does it look at how much spend went behind which themes. All the paper does is selectively show pictures of marketing from one company, Juul, and invites the reader to be scandalised. Juul is not even a tobacco company. On 19 December 2018, a real tobacco company, Altria, took a 35% stake in Juul, but that is _after_ the period studied in the paper (June 2015 – November 2018) and coincided with a decline in Juul’s fortunes. It does not assess the advertising weight (how much the ad was shown and seen) or attempt to correlate the evolving themes of Juul advertising to the timing of the rise in Juul product sales among youth or adults. Much of the advertising Jackler et al. refer to is in Juul’s earliest campaigns in 2015-16. (the Vaporize campaign – 2015 to early 2016 uses young adult models – see below),





Juul young adult ads 2015 – “twenty-something” models

The timing is all wrong. But the Vaporize campaign runs in _2015 and early 2016_, well before Juul started its dramatic ascendancy – see data on convenience store sales below.





The astonishing rise of Juul happened well after the Juul Vaporize campaign

US teen vaping fell after the Juul Vaporize campaign. Juul’s youth-orientated (actually, young adults) 2015-16 campaign was so successful that _adolescent_ vaping actually, um, DECREASED sharply in the United States after the Vaporize campaign. It was substantially higher in 2015 than in 2016 and 2017. So that is hardly a conclusive indictment of Juul, the vaping industry or the tobacco industry.





US adolescent vaping declined after theVaporize campaign

By 2018 when the Juul product was taking the vaping world by storm and driving down smoking, Jackler’s paper shows that Juul marketing had become relatively sedate and adult-orientated.





Youth marketing?

Wholly unconvincing. So Henning, Myers and Koval are trying to spin the entirety of the e-cigarette industry as tobacco industry youth predators on the back of the marketing of one company, which briefly produced youth-orientated ads (using young adults) _before_ its product was successful with adults and while youth vaping plunged. So no, I am not convinced. It is a ridiculous assertion with no basis in fact and the authors present no evidence to support it.

nicotine or more as a whole pack of cigarettes and that nicotine can have detrimental impacts on kids’ brain development and health.

A vacuous comparison. The first part about an e-cigarette delivering as much nicotine as a cigarette packet an empty scare line, albeit one that is widely used in tobacco control propaganda. No one smokes one pack of cigarettes in one go. No one vapes a pod in one go either. A larger pod would contain more nicotine and last longer, a smaller one less and would run out sooner. _So what?_ This has no public health relevance at all. In fact, the inclusion of this line in the letter tells us that its authors have grown used to uncritical groupthink and no substantive challenge.

Competing with cigarettes. It is unclear what Henning, Myers and Koval actually think is good here. Do they want cigarettes to be the best way of delivering nicotine? Do they think that e-cigarettes should be regulated to make them less satisfactory as alternatives to smoking and to make it less probable that smokers will switch? Do they want to gift cigarettes a monopoly of effective nicotine delivery? This is what we mean by protecting the cigarette trade, promoting smoking and adding to the burden of disease and death. So what is it?

Show us the brain-damaged teenage smokers. American campaigners (including agencies like CDC and FDA) have gone all-in on the activist talking point that nicotine damages the young brain. The first problem with this argument is that it rests primarily on rodent studies with large nicotine exposures. But the fatal problem is that if there was any real effect here, it would be visible in the multiple generations of adults that grew up as _adolescent smokers_ – but no one can find it. It is simply implausible that we would not have detected some sort of lasting cognitive detriment in adults who started as adolescent smokers. The proponents of this theory have never addressed this objection.

Protect Kids: Fight Flavored E-Cigarettes initiative launched in 2019 and Truth Initiative’s National Youth-Vaping-Prevention Truth® campaign, which includes This Is Quitting, a free text-message program currently helping hundreds of thousands of young vapers quit.

This campaign is likely to do more harm than good. These are the reasons…

The wrong way to address youth risk behaviours. Firstly, they are targeting a relatively trivial youth risk behaviour compared to other things that harm young people, including smoking, opioids and other illicit drugs, teenage pregnancy and STDs, binge drinking, drunk driving or riding, fighting and carrying weapons, mental health problems, bullying, and discrimination. Often in combination with poverty and poor prospects, these make some young lives miserable. A truly humane approach to young people would not start from the lens of a relatively innocuous substance use behaviour and make that the big issue. It would start with the young person and their troubles.

Ignoring a likely diversion from smoking. Secondly, if they engaged with adolescents as ‘young people’ rather than ‘teen vapers’, they might even find that their vaping is a positive thing – a diversion from smoking or other risk behaviours. Because smoking is far more harmful than vaping only a small diversion effect would make the overall impact of teenage vaping net positive protective for youth. If there is a substantial net diversion effect, the impact of a “successful” anti-vaping campaign would be to reduce diversion from smoking and cause harm. However, there is convincing evidence that this is exactly what is happening.

Seyla & Foxon, 2021 show evidence for a diversion effect:

_“a substantial diversion effect is needed to explain observed nicotine use trends among US adolescents, and it must be larger than any possible opposing catalyst effect, if present.”_

Levy, Warner and Cummings 2019, showed that as youth vaping increased, the rate of decline in smoking accelerated:

_“There was a substantial increase in youth vaping prevalence beginning in about 2014. Time trend analyses showed that the decline in past 30-day smoking prevalence accelerated by two to four times after 2014”_

So what have Henning, Myers and Koval done to check they are not, if successful, breaking a diversion from smoking for adolescents? The answer appears to _nothing_. If they had, they wouldn’t be doing what they are doing.

Indifference to the welfare of adults. Thirdly, what about adults? Henning, Myers and Koval do not consider the impact of their campaign on the approximately 10 million adult vapers in the United States, other than just saying they can use NRT and prescription meds (see 11 below). The fact that these people are choosing to vape instead of using NRT or Varenecline would tell anyone interested in their welfare that they are making that choice for a reason. They cannot just assume that smoking cessation medications are a viable substitute for vaping. (more on this in sections 11 and 12 below).

Fourthly, they clearly have no idea what the effect of interventions to ban flavours or stigmatise vaping would do in practice. Let’s try to imagine what they hope will happen _and what might happen._

Desired outcome: young people stop vaping and smoking, become abstinent from nicotine and do not adopt any other risk behaviour, but do something virtuous instead.

Range of reality-based possible outcomes:


Relapsing back from vaping to smoking – both teenagers and adults
Not switching from smoking to vaping and continuing to smoke
Initiating smoking instead of initiating vaping
Continuing to smoke or to start smoking as an adolescent because parents or adult role models smoke instead of vaping
Using other tobacco or nicotine products – hand-rolling tobacco, smokeless tobacco, heated tobacco, or new nicotine pouches
Using tobacco-flavoured vape products instead of other flavoured products
Accessing flavoured vapes via an illicit supply chain (a black market)
Buying from foreign or out-of-state suppliers in person or via the internet and importing for personal use
Buying from foreign or out-of-state suppliers to resell to others through informal networks
Making and mixing their own flavours at home or buying or selling home-mixed flavours
Adding flavour agents for food, drink or aromatherapy to unflavoured nicotine liquids
Using flavours made for vaping but ostensibly marketed for another purpose
Switching to cannabinoid (THC or CBD) vapes
Adopting another risk behaviour that may be worse
Buying flavoured vapes from criminals who introduce young people to other illicit substances – a gateway effect from flavour _prohibition_ to fentanyl! Prove me wrong.
Some or all of these may happen in response to a vaping flavour ban and the mix might change over time as an illicit supply chain develops. How have Henning, Myers and Koval assessed the risks of doing more harm than good? Bear in mind that because of the respective risks, it only needs a small uptick in smoking to swamp any possible benefit from reduced vaping. Let’s see the working.

Dave et al 2020 examined the deterioration in risk perceptions about vaping following the EVALI scare:

_The EVALI outbreak created an information shock, which was followed by additional new information in a later CDC recommendation. We use data on consumer risk perceptions from two sets of surveys conducted before (HINTS survey data) and during the EVALI outbreak (Google Survey data). The empirical model examines changes in risk perceptions during the early crisis period when the CDC was warning consumers that they should avoid all vaping products and during a later period when the message was refined and focused on a narrower set of illegal vaping products that contain THC (the main psychoactive compound in marijuana). Econometric results suggest that the immediate impact of the first information shock was to significantly increase the fraction of respondents who perceived e-cigarettes as more harmful than smoking. As the outbreak subsided and the CDC recommendation changed to emphasize the role of THC e-cigarette products, e-cigarette risk perceptions were only partially revised downwards._

The EVALI scare may have exerted a downward effect on vaping risk perception and vaping behaviours, but this was in my view an unforgivable and deliberate operation to mislead the public. We can be pretty confident that it was _deliberate_ because those who implied it might be attributable to nicotine vaping have made little effort to reset risk perceptions or to clarify that nicotine vaping was _not involved_.

Bloomberg Initiative to Reduce Tobacco Use, which has saved more than 35 million lives around the world over the past decade by investing in and advocating for proven policies to prevent tobacco use.

Mr Bloomberg has a preferred policy package for tobacco control called MPOWER. This includes six measures that form the tortuous acronym.


Monitor tobacco use and prevention policies
Protect people from tobacco smoke
Offer help to quit tobacco use
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion and sponsorship
Raise taxes on tobacco
MPOWER is a Bloomberg initiative. MPOWER was launched by WHO in February 2008 in conjunction with Michael Bloomberg and it has remained the central pillar of Bloomberg funded tobacco control activism (along with anti-industry campaigns). The tobacco control grants awarded by Bloomberg Philanthropies (by far the biggest funder of anti-tobacco and anti-vaping activism worldwide) come with a contractual commitment to promote MPOWER. I am not going to discuss the merits or otherwise of MPOWER here other than to say that I don’t think the evidence is strong as Mr Bloomberg thinks it is or that MPOWER measures are without harmful unintended consequences that limit its applicability.

MPOWER has not, will not, and cannot solve the problem. Whatever the merits of MPOWER, we still have 1.1 billion people smoking worldwide (WHO 2016 data). The World Bank puts global tobacco-use prevalence at 24% (World Bank 2018 data). In countries with advanced economies, smoking prevalence ranges from 1-in-7 to 1-in-3 adults, despite extensive and long-standing warnings of the risks and decades of anti-smoking campaigns. In the United States, 14% of adults smoke, that’s 34 million Americans – 2019 CDC data). In richer countries, smoking is usually concentrated in disadvantaged groups in society (by socio-economic, race/ethnicity, education, employment, mental health status etc- see CDC summary on smoking inequalities in the United States and on smoking disparities). WHO claims that “_Tobacco kills more than 8 million people each year. More than 7 million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke_“. At the time of writing (March 2021), the SARS-CoV-2 virus pandemic has killed about 2.8 million worldwide in its first full year (data).

Being clear about the endgame. The basic ‘problem’ is that nicotine is a popular drug and would be more popular if it was not so closely related to cancer etc through smoking. There is a big difference between _smoke-free,_ _tobacco-free_ and _nicotine-free_ goals. Of these, the only public health goal that matters is smoke-free – trying to achieve the others will fail and will hold back progress on the first. The smoke-free goal cannot be attained by the brute force of regulation – that will just nourish black markets. The only way to do it is with the consent of consumers – and that means having appealing nicotine products available that will substitute for smoking but with risks consistent with more normal risk-appetite in society. For more on this, see my piece: _The endgame revisited_.

The case for additional harm reduction measures is strong. So, given the number of people dying in agony and living in misery as a result of smoking-related disease, I would _expect_ advocates in this field to be looking for new ideas and opportunities to reduce the toll of cancer, cardiovascular and lung disease. I would _expect_ them to be open to innovation and new ideas. I would expect them to approach new technology by asking “how do we make this work for health?” not by reflexively trying to bock it. I would _expect_ activists in this field to be open to harm reduction strategies – i.e. approaches to reducing the health and other impacts of tobacco use (including the harmful effects of anti-tobacco policies such as regressive taxation and stigma) for people who wish to use tobacco and nicotine or find it difficult to stop. Harm reduction is widely practised in other branches of public health – illicit drugs, HIV, sexual health etc. Why not in tobacco control? In fact, it should be an ethical obligation – if policymakers want to ratchet up the pressure to quit with coercive, punitive, restrictive and stigmatising measures, then there is an ethical obligation to offer every possible option out of smoking and to make it as easy as possible to quit.

But Bloomberg-funded entities oppose harm-reduction and campaign for prohibition. What we see instead is a Bloomberg-funded worldwide movement of prohibitionists, dedicated to banning reduced-risk products, even in counties where there are high levels of smoking and cigarettes are ubiquitously available. For example, see the position paper of The International Union Against Tuberculosis and Lung Disease (“The Union”) urging bans on low- and middle-income countries (LMICs) – where 80% of the world’s smokers live: _Where bans are best: Why LMICs must prohibit e-cigarettes and heated tobacco product sales to truly tackle tobacco’_ (press release – May 2020). See also the excellent response to this dreadful position statement by the consumer organisation INNCO: Why Bans of Low-Risk Nicotine Alternatives to Smoking in Low- and Middle-Income Countries (LMICs) Will Do More Harm Than Good (March 2021).

Creeping prohibition. Bans of much safer vaping products where cigarettes are easily accessible have steadily become normalised instead of being widely seen as _obviously insane_. In 2018, WHO proudly reported that 30 countries had banned e-cigarettes [FCTC/COP/8/10] and John Hopkins Bloomberg School of Public Health also shows 30 countries with bans, including India (89m smokers); Egypt (13.7m smokers, male smoking prevalence = 44%) and Turkey (16.7m smokers, male smoking prevalence 41%). Bloomberg Philanthropies targets its grants programme at 10 LMICs (see table below) and these account for around one-half of the world’s smokers and many with very high males smoking prevalence (data from the Tobacco Atlas) and, of course, the ubiquitous availability of cigarettes.






Risk of more harm than good. The way I see this table, half a billion people, almost half the world’s smokers, are at considerable risk of Bloomberg-induced policies that will deny them access to the safer products that they can use at their own expense and on their own initiative to reduce their own personal risks. This will potentially harm and possibly kill some of them. It is quite possible that Bloomberg will do more harm than good.

Bloomberg money reaches deep inside important institutions like WHO and the World Bank. Bloomberg money funds the 2-yearly WHO Report on the Global Tobacco Epidemic (2019 version) which takes a highly positive view of MPOWER (and is based on it) and, unsurprisingly, a very hostile approach to tobacco harm reduction and reduced-risk products. The Global State of Tobacco Harm Reduction looks into the well-funded attack on tobacco harm reduction and the complex structure of grant-giving and influencing that sits behind it: see Chapter 5: Project Fear: the war against nicotine.





The Bloomberg Anti-Vaping Propaganda Complex – a visualisation

In my view, this constantly evolving infrastructure has become a vector for harm through its opposition to much safer alternatives to smoking. Despite all its hostility to the tobacco industry, this Bloomberg Anti-vaping Propaganda Complex is doing a great deal to protect the cigarette trade from technology disruption that would ultimately render cigarettes obsolete.

2 above) by attributing them to the tobacco industry. This is another reason why it is clear they are not sincere: they choose not to engage their critics but to dismiss them. The fact is that there is a deep base of support for tobacco harm reduction among academics and practitioners, including those quoted in Mr. Gunther’s article. For example, see the 72 signature to this letter to the WHO – they can hardly be called tobacco industry stooges, yet they disagree with Henning, Myers and Koval.

The tobacco and nicotine industry transition. This may be a surprise, but the tobacco companies are, to varying degrees, actually following their consumers, who have no interest in dying from cancer if there is an alternative. It is a _good thing_ if the companies are trying to get out of the _Merchants of Death_ business. The rate of transition from combustibles to non-combustibles will depend on what people think about switching and the regulatory and fiscal environment. This rate is currently much slower than it might otherwise be because campaigners like Henning, Myers and Koval are working tirelessly to impose restrictive regulation and the creating of a hostile information environment, which makes it less likely that smokers will switch from cigarettes to e-cigarettes. It is worth thinking about how tobacco companies see changing market. I have tried to put myself in the seat of a tobacco CEO and imagine what it looks like: Pariahs, Predators or Players: the tobacco industry and the end of smoking. Public health advocates should be working out what system of incentives would expedite this transition, but the tobacco companies are just too useful as the bad-guys in the story to do that.

The threat of safer products. At first sight, it seems difficult to understand why these organisations would oppose products that are, beyond any reasonable doubt, much safer than the dominant market incumbent, cigarettes. In my view, the reason is that ‘harm’ is their campaigning currency. Were it not for harms in some form, then the whole edifice of tobacco control organisations, grants and campaigns would have little reason to be. Safer products create a lifeline for smokers, they create disruption for the industries involved in the transition, _but they create an existential threat to tobacco control interests_. I’ll leave it to readers to consider the interests and incentives of the various actors involved when confronted with the prospect of much safer nicotine products.

[paste:font size="5"]smoking-cessation products — some with nicotine, others without — including patches, gums, nasal sprays, inhalers, lozenges, and pills.

Tobacco harm reduction is not the same as smoking-cessation treatment. This comment betrays a misunderstanding about how vaping works to reduce risks, and it shows that Henning, Myers and Koval have not done adequate due diligence on their policy proposals. They are missing an important distinction:


Smoking-cessation medication: used to mitigate the effects of withdrawal and craving while the user attempts to transition from smoking to abstinence.
Tobacco harm reduction: different ways of using the mildly stimulating and calming drug nicotine with much less harm and more pleasure.
In their dismissal of vaping, Henning, Myers and Koval make the rookie error of offering the former as an alternative to the latter.

Smoking cessation options remain available. There is no doubt that some people wish to give up smoking and nicotine completely – for them, the smoking cessation medications are available and are not in any way diminished by the tobacco harm reduction options. It is also the case that vaping products can function as smoking cessation aids and there good data from randomised controlled trials to suggest that they work well and probably better than the alternatives. The reason they work well is that that they replace _more_ of the smoking experience than smoking cessation medications, for example, nicotine exposure, throat sensation, flavour, hand-to-mouth movement, behavioural ritual – and all at much lower risk. There is therefore less to lose by switching.

Swapping one pleasure for another. But a significant proportion of vapers have little interest in complete abstinence or, if they do, it may be driven by baseless safety fears, given what we know of risk perceptions. The point is that the _appeal_ of the product (including its flavours, branding, nicotine effect, and cost-saving) is what makes vaping an attractive rival ‘value proposition’ to smoking, _but at much lower risk_. This is why it is an important option for the population at risk, adult smokers. The population at greatest risk is the people who like using nicotine, may like smoking and don’t want to quit or find it difficult to quit smoking. These are not the people who volunteer for smoking cessation trials on which the approvals of smoking cessation medications are based. The diagram shows elements of the rival proposition using the ‘7 Ps’ of the marketing mix. In tobacco control, activists try to degrade the smoking value proposition. But what is the effect if they degrade the vaping value proposition – through taxes, bans, packaging mandates, nicotine limits etc? That would make the transition from smoking to vaping harder – and that’s exactly what Henning, Myers and Koval are doing – protecting the cigarette trade, probably without realising.






A feature of the second mechanism, tobacco harm reduction, is that it works in a way that Henning, Myers and Koval are unlikely _ever_ to embrace – the interplay of pleasure-seeking consumers with profit-seeking innovators in a lightly-regulated market, where regulation is focussed on competition and consumer protection. If that sounds scandalous, remember that is how the markets for alcohol and caffeine work, and I can think of many tobacco control activists who enjoy the mild intoxication of a glass of wine with their dinner or a beer after work.

[paste:font size="5"]Eurobarometer 506.





A tobacco product that reduces smoking and tobacco-related harm without being a medicine? No one, not even Henning, Myers and Koval, would think of the smokeless tobacco product snus as a “smoking-cessation product” that should be taken to a regulator and approved as a smoking-cessation medication. Yet, here we are with a tobacco product responsible for an anomalously low rate of smoking. Thanks to the peerless work of Lars Ramström, we also know this translates directly to health gains in the Swedish population – see: Tobacco-related mortality Sweden & EU charts – the difference between men and women arises because snus use among women is lower.





Extensive use of snus in Sweden translates to reduce smoking and tobacco-related disease

Henning, Myers and Koval are leaders in this field and they control the funds and policy positions of hundreds of activists in the United States and worldwide. Frankly, I find it disturbing that they do not understand this public health model. It’s troubling to me that they cannot see that this basic idea also applies to vaping. Through vaping, heated tobacco products, smokeless tobacco and nicotine pouches we might be able to generalise the spectacular harm reduction proof-of-concept from Sweden to most countries. Though they may look like (and can perform like) a kind of pimped-up NRT, e-cigarettes fit into a similar psychological enclave as snus, not as NRT. I hope that is now clear.

Vaping companies are properly following FDA’s regulatory pathway. Henning, Myers and Koval imply that the vaping companies are somehow rogue operators. However, they know, or should know, that the vaping companies are following the FDA’s process for approving vaping products under the Tobacco Control Act – the ultra-burdensome Pe-Market Tobacco Application (PMTA) process under Section 910 of the Act. After a federal court determined that vaping products were not smoking cessation medications in 2010, FDA deemed vaping products to be ‘tobacco products’ for the purposes of the Act in 2016. It did not finalise its guidance on the requirements for this process until early 2020. Companies were required to submit their applications by 9 September 2020 and now FDA is considering thousands of application. To gain approval, applicants have to show their products are “appropriate for the protection of public health”. The companies are doing what the law and their regulator requires.

Sabotaging the Tobacco Control Act – and I don’t mean Big Tobacco. It appears that groups like Campaign for Tobacco-Free Kids are now nervous that FDA might actually authorise some of these products and find that they are “appropriate for the protection of public health”. That was never the idea: the point was to use massive paperwork burdens to throttle these companies access to market. But now it has fired up its supporters in Congress to urge the FDA to dump all this careful analysis and weighing of benefits and detriments to public health, and get straight to the point and implement bans. Alex Norcia in Filter has the story: Why Are Congress Members Demanding That the FDA Halt Its Evaluation of Flavored Vapes?  The groups behind this letter are the ones going rogue, not the tobacco and vape companies.

every major U.S. public-health authority that has comprehensively reviewed the scientific evidence has reached the same conclusion: To date, there is limited and inadequate evidence to conclude that e-cigarettes are effective for smoking cessation.

This is so feeble. Firstly, many in the US public health establishment are also caught up in the absurd anti-vaping moral panic created and amplified by Bloomberg-funded entities – so there is group-think at work.

Secondly, the absence of evidence is not evidence of no effect – it arises because the companies do not do expensive trials for no reason. They are following a different track – the PMTA as described above and the data in those applications remain confidential.

Third, they are not making therapeutic claims and therefore are not doing trials to support therapeutics claims.

Fourth, the evidence that supports the conventional smoking cessation treatments is only narrowly applicable and much weaker than Henning, Myers and Koval seem to realise.

Fifth, there is actually good evidence that vaping is effective for smoking cessation. The UK smoking cessation expert, Professor Robert West summarises the evidence in his presentation: Should health professionals recommend health professionals to switch to e-cigarettes? which includes the following slide:





An expert assessment of the evidence for the effectiveness of e-cigarettes

There is good evidence on smoking cessation if you are open to it. What is disturbing is that Henning, Myers and Koval are prepared to treat a statement about ‘limited and inadequate’ evidence as if it means there is _sufficient reliable evidence that the products are ineffective_. On that basis, they try to justify punitive measures such as flavour bans. The evidence is already compelling if you are open to it. For example, the authoritative Cochrane Review concluded in its report on e-cigarettes of October 2020:

_The results showed that more people quit smoking if they used electronic cigarettes containing nicotine than if they used another form of nicotine replacement. _

_Evidence from four studies (2312 people) showed that more people who used nicotine-containing electronic cigarettes quit smoking than those who received only behavioural support or no support._

These are conservative statements because e-cigarettes do not function as smoking cessation products in the same way as NRT as discussed above. But the problem with Henning, Myers and Koval is not only that they are ignoring the actual evidence that _does_ exist from trials and the other sources mentioned by Professor West, but that they are acting as if they have strong evidence of no helpful effect. That is irresponsible, in my view.

Bloomberg Philanthropies, Campaign for Tobacco-Free Kids and Truth Initiative). But _seriously_ what kind of oversight do these boards impose? What level of constructive challenge? Are they bringing fresh thinking and different perspective to the board? Or are they just compliant cheerleaders, hand-picked for their facility with a rubber stamp?

Accountability is at the heart of the problem here: these groups can spend millions of dollars harming ordinary citizens and there are no consequences for anyone involved – so far. The board members of these organisations should read Mr Gunther’s article carefully and start asking some questions. Mr Bloomberg likes to say “_In God we trust. Everyone else, bring data_“. Well, I’ll happily bring data if he brings an open mind.

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## DavyH (5/4/21)

Thanks @fbb1964, you’ve been finding some excellent articles.

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## fbb1964 (9/4/21)

Interesting one noticed today... One question to ask when a "new scientific report" is published is who will benefit from the report? Especially financially. 

Produced by The Corbett Report, The *Crisis of Science* examines the factors that produce compromised *science*, and the risks they pose to all of us. There are several reasons why a *scientific* study might contain misleading data, including simple human error, prevailing bias, a flawed premise, and overt fraud.

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## fbb1964 (9/4/21)

But even more interesting is this. The popular tool deployed by social media sjw's snowflakes "cancel culture" are the "fact checking" sites they run to as defence. Let's have a look at "fact checking" shall we? Strange that the govt health officials and NGOs health professionals, the main stream media ie.. CNN, Bloomberg, MSNBC, CBC, ABC etc.. never gets "fact checked" much but taken as gospel. And not just with vaping!

https://www.corbettreport.com/episode-381-who-will-fact-check-the-fact-checkers/

https://www.forbes.com/sites/kalevl...t-checking-the-fact-checkers/?sh=631c7f83227f

https://www.ft.com/content/69e43380-dd6d-4240-b5e1-47fc1f2f0bdc

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