Last year the federal health department, on behalf of the Intergovernmental Committee on Drugs – senior bureaucrats advising federal, state and territory ministers on drug issues – commissioned a policy review on the regulation, sale and marketing of e-cigarettes with or without nicotine, and the practice of “vaping”.
The department determined the tender brief, called for tenders and recommended (that is, chose), the successful tenderer. It happened to be a consortium of the School of Public Health of the University of Sydney and the New South Wales Cancer Council.
For nearly a year after the tender was finalised, with no fanfare, the review went underground. Lately, word’s gone quietly went round expert circles confirming consultations are happening.
An email to some academics and clinicians advised:
The Prevention Research Collaboration at the University of Sydney has secured Australian government commissions to look into policy options to “minimise the risk associated with marketing and use of electronic nicotine and non-nicotine delivery systems”. They are running a closed consultation with “relevant organisations and technical experts in ENDS (electronic nicotine delivery systems), tobacco control or public health.” A background paper has been written.
Note those words. Closed consultation. Minimise the risks of electronic nicotine and non-nicotine delivery systems. Relevant organisations and technical experts. The unmistakable message is that vaping is in the dock, and the presumption is that e-cigs with or without nicotine are as risky, or as risky, to health as tobacco products.
It’s also very clear that this is a review by experts, involving only experts, especially those unlikely to rock the restrictionist, prohibitionist boat.
The background paper itself is a closely-held secret, and the review team warned recipients it is not for wider disclosure. Its title, however, says it all:
Discussion paper: Options to minimise the risks associated with the marketing and use of electronic nicotine delivery systems [ENDS] in Australia.
The discussion paper
A well-placed source, who has received the paper, says “it is very much focused on the risks of marketing and use of e-cigs, not on the risks of NOT using them”. And, looking at the make-up of the project team, that’s no surprise: more on that later.
Fortunately, a related questionnaire for consultees has fallen off the back of a truck. It confirms the discussion paper is canvassing views on the following policy options:
- Maintain the status quo.
- Increase awareness and enforcement of, and compliance with, existing regulations (which in Queensland and NSW have been toughened since the review was foreshadowed and South Australia looks likely to follow suit soon).
- Regulate ENDS as medicines.
- Regulate ENDS as tobacco products.
- Regulate ENDS as consumer products.
- Develop a (new) ENDS regulatory framework; and, leaving the best to last:
- Adopt measures to ban ENDS.
Sources who have seen the paper say the options actually are presented relatively objectively, with pros and cons being set out. If so, it’s surprising it hasn’t been made public for that reason alone.
However, sources also say the paper cherry-picks the evidence and commentary to skew the discussion down the “e-cigs aren’t as bad as smoking but still highly risky, they aren’t effective quitting aids, they are unproven for passive exposure, and are a gateway to smoking for a new generation” path. For instance, last year’s Public Health England landmark evidence analysis, concluding that vaping is at least 95 per cent safer than smoking, is conspicuous by its absence: not surprising given review team member Simon Chapman’s trenchant criticism of it.
Indications are the discussion paper is well-disposed to significantly heavier regulation, if not outright banning. To have them as consumer products, available as a readily-accessible and much lower-risk alternative to tobacco cigarettes, is frowned upon by public health prevailing opinion.
Interestingly, sources also say the treatment of nicotine as a regulated and prohibited substance also is overlooked. Currently, poisons scheduling generally prohibits nicotine except in, absurdly, “tobacco prepared and packed for smoking”. It needs to be changed to accommodate nicotine-containing vaping devices and make them widely available in Australia.
Ignoring basic regulations that effectively lock out nicotine-containing but much lower risk e-cigs, and locks in deadly cigarettes, indicates a policy dog’s breakfast behind those closed review doors.
The review team
The consultation interactions have also revealed the full composition of the University of Sydney-Cancer Council review team.
Unsurprisingly it mostly comprises public health academics believing in prohibiting and banning and “social marketing”, not kindly disposed to giving new alternatives to tobacco the benefit of the doubt while evidence continues to accumulate.
Simon Chapman needs no introduction. The goateed guru of tobacco control, media public health go-to person and spare-time Twitter troll is no friend of harm reduction, being stridently protective of his patch. He has picked fights with, and ridiculed, pro-vaping research, researchers and advocates from the Lancet and British Medical Journal to social media.
Project lead Becky Freeman is his protégée and self-described “established authority on the potential of the internet to circumvent tobacco advertising laws”. Blyth O’Hara is an expert on physical activity, nutrition and obesity, who has tweeted enthusiastically in favour of a sugar tax on the poor.
Scott Walsberger “leads a passionate (NSW Cancer Council) team to reduce the burden of tobacco on the people of NSW”. Bill Bellew boasts of his “Leadership…in capacity building for evidence-informed policy around the spectrum of public health issues…through tobacco control and other population health strategies”. Adrian Bauman is a “world-leading” obesity expert with strong World Health Organisation connections.
And James Kite is NSW president of the Australian Health Promotion Association which, in its submission to the Leyonhjelm Nanny State inquiry, said: “Based on current evidence, it appears as though E-cigarettes are harmful (though not as harmful as tobacco cigarettes), are attractive to younger people, and have more of a ‘gateway’ effect (introducing young people to tobacco smoking) than a quitting effect.” His views seem pretty decided.
An open-minded, unbiased expert panel with no pre-formed opinions this is not. It is obsessed with tobacco control, not nicotine. The honourable exception is Nicholas Buckley, a pharmacology professor who presumably can advise the group that nicotine separated from deadly tobacco smoke is a totally different safety proposition from nicotine wrapped up with the deadly cocktail of gases and chemicals in that smoke.
The health department chose its team well if its agenda is to suppress e-cigarettes and vaping.
There are no experts in tobacco control and harm reduction who take a benign view of vaping and e-cigs comparable to public health authorities and anti-smoking in the United Kingdom.
Moderate voices like the Victorian Cancer Council’s Ron Borland, and the University of Queensland’s Coral Gartner and Wayne Hall may be included in the closed consultations, but they have no say over the questions being asked, or the review’s final report and recommendations.
It is good that at least the reviewers are not shutting out all uncongenial opinions, but there’s no obligation on them to take these on board. Nor is it likely that those experts who have clashed in the past with, particularly, Simon Chapman, will receive more than lip service to their views.
What’s even more striking is the insistence on secrecy. It’s clear that even the discussion paper isn’t intended for the light of public scrutiny, let alone comment. This is a conversation by experts, for experts. Lay people aren’t getting a look-in, no matter what acquired insights and expertise they have.
Disgracefully, vapers as consumers are being ignored, presumably because they are scientifically-ignorant and biased in the eyes of the review team and their public service project managers. But a policy review of vaping without vapers is like the Yes, Minister hospital without patients. Users of vaping devices are highly-placed to give knowledgable opinions of vaping’s effects on their health, their nicotine consumption, and vaping’s impact on their ability to give up tobacco smoking. They deserve to be heard.
Manufacturers, wholesalers, retailers and distributors of vaping hardware and consumables have also been ignored. Perhaps the taint of Big Tobacco hangs over them all? But as for that, why should it matter? Surely if Big Tobacco finds a new and profitable market that reduces their incentive to sell their deadly products, isn’t that a good thing with a definite social benefit?
Overall, the lack of transparency is not only unwise politically, but leaves the final outcomes subject to being labelled as intellectually and scientifically – and politically – biased and dishonest.
What on earth is the federal government doing?
Despite the “client” being the Intergovernmental Committee on Drugs, this project is the brainchild of the federal Department of Health. Its specifications were set by the Department of Health. It answers to the Department of Health. Its invoices are sent to the Department of Health.
The outcomes surely will be whatever the Department of Health wants them to be: isn’t that what it’s all about?
It seems that both responsible senior federal ministers, Health minister Sussan Ley and Rural Health minister Fiona Nash, have washed their hands of this process, which now conveniently has dragged on to the point that nothing will surface until the upcoming federal election is done and dusted.
Senator Nash in particular, as the directly responsible minister for population health and tobacco control, has shown no inclination to rock the tobacco control boat: indeed, the few public statements she has made on the subject show that she is in thrall to the public health zeitgeist as any of her Labor predecessors.
The public service, and the public health establishment, run this particular policy show.
What should the federal government do?
The answer is simple. Ms Ley or Senator Nash should intervene urgently to ensure the policy review is impartial and objective, and scientifically defensible. They should satisfy themselves the review team has not pre-determined the outcome and, if they believe that’s the case, they should cancel the review and start over with a more balanced expert team. Or forget about it altogether, and sort regulatory issues without it.
At the very least, the review must allow public comment and participation. The discussion paper must be released for public comment, and vapers and other interested parties must be allowed to have their say.
Ministers should also ensure expert opinions consulted are truly diverse. They should also ensure divergent voices, and mounting scientific evidence positive for vaping (including for passive exposure), aren’t silenced or ignored because they don’t fit the preferred picture.
That includes openly drawing on international expertise, especially in the UK and Europe, including views not agreeing with the project team’s. The pro-vaping trend in Britain, a healthcare system in many ways like our own – and with a similar culture – is particularly relevant, but has been attacked by outspoken Australian public health figures including Simon Chapman. His very presence in the review team raises doubts about its impartiality, and that the department agreed to his involvement betrays its own biases.
Bureaucrats and the reviewers want to ignore inconvenient evidence and opinions on vaping because it doesn’t fit their world view and ideology. Only ministers can make them take a broader perspective.
Before the government goes into caretaker mode, which looks likely to be the second week of May, ministers therefore should act like ministers and not ciphers of their bureaucracy, put their department back in its box to ensure a timely policy review outcome that will be respected because of its transparency, quality and objectivity.
As things stand, all three of these factors are unforgivably absent from this government-sanctioned review process. The fix is in, and that’s an insult to good academic as well as policy practice.
That this is happening under a Coalition government, supposed to uphold informed personal behavioural choices and responsibility instead of suppression and prohibition, is both perplexing and disappointing. Sadly, that’s been par for the course with this government in so many ways.
But it’s not too late.
Terry Barnes is a policy consultant and Australian lifestyle economics fellow of the UK Institute of Economic Affairs