111 Posts

www.lvlc.us – I wrote a piece for Spectator Health about the Scottish court ruling that sided with the government in the minimum pricing case.

Those of us who voted Leave in June understood that there is a trade-off between sovereignty and trade. The SNP are an overtly paternalistic party with authoritarian tendencies, but they have been resoundingly elected by the Scottish people. If they want to drain the pockets of the poor by putting a deadweight cost on alcohol, there is a case for respecting their sovereignty. On the other hand, they are party to a trade deal in the form of the common market which, until today, seemed to forbid such actions. 

For those of us who like free markets and oppose minimum pricing, the EU’s ban on such restrictive practices was one of the things we were going to miss after Brexit. After today, it is one less thing to worry about.

Do read the rest.
I suspect that this will now got to the Supreme Court. The judge’s rationale was far from compelling and, to my mind, did not fully engage with the objections raised by the European Court of Justice. We shall see, but I don’t think the lawyers are going to lose out from this saga. 

www.lvlc.us – Here is the second part of a two-part series in which Brent Stafford interviews me about the vaping controversy. Brent did a fantastic job of covering all of the key issues in the debate, and I tried to explain the scientific reasoning behind my position on the major points of contention.


The executive editor of a West Kentucky newspaper known for its conservative editorials is taking a stand against cigarette taxes, but not in the way you might expect.

In a Sunday column, Steve Wilson of The Paducah Sun lambasted the state’s low cigarette tax of 60 cents per pack.

“The average tax in all states is now $ 1.65 a pack. The tax in neighboring Illinois is $ 1.98. New York has the nation’s highest at $ 4.35,” Wilson writes. “With a tax so much less, Kentucky is not doing right by its citizens in terms of revenue, public health and health-care costs.”

Noting that Kentucky has the second-highest smoking rate in the country, 26.5 percent, Wilson suggests that a higher cigarette tax would generate greater revenue for the state and would spark a decline in smoking.

“If people have to pay more for cigarettes, they are less likely to buy them. That’s especially true for younger smokers who have lower incomes and are less addicted. And when people smoke less, the benefits to their health and the state’s health care costs are huge,” he says.

Wilson cites research indicating that health-care costs directly related to smoking in Kentucky are nearly $ 2 billion a year. He says the state’s annual Medicaid costs related to smoking are almost $ 600 million and paid by taxpayers.

The state set up a Blue Ribbon Commission on Tax Reform in 2012. It spent nearly a year evaluating Kentucky’s tax policies and recommended a 40-cent raise, to $ 1 a pack, which would have brought the state an extra $ 120 million a year, but the General Assembly didn’t bite. Wilson advocates passing that 40-cent increase now and committing a portion of the revenue to smoking-cessation programs.

“Given the staunch anti-tax attitude of the legislature and governor, an increase of any amount is a long shot in the next session,” he writes. “It’s so much easier for the lawmakers to do nothing and proudly say they stand firm against all tax increases. What they don’t say is that such a low tax helps maintain a high rate of smoking, the nation’s highest rate of smoking illness and ever-increasing medical bills pushed on the backs of taxpayers.”


That’s right, Paduda’s Pre-election pundit ponderings is now present for your perusal and learning pleasure.

www.lvlc.us – I’m pleased to report the launch of a new e-cigarette consumer group, the International Network of Nicotine Consumer Organisations. They’ve published a press release today…

Among INNCO’s priorities is to demand an end to the prohibition, disproportionate regulation, and punitive taxation of safer nicotine products like e-cigarettes and snus. The network seeks a dialogue with the World Health Organisation (WHO) over its opposition to e-cigarettes and other safer ways to use nicotine – an issue which INNCO believes is fuelling a rising tide of resentment towards the UN health agency.

INNCO is concerned that the WHO has shown a generally negative response to e-cigarettes since their introduction. Despite the increasing wealth of scientific evidence which supports their unique potential for harm reduction, the WHO tends to ignore the positives and selectively focus on unsubstantiated fears.

The WHO seventh Conference of the Parties (CoP7) to the Framework Convention on Tobacco Control (FCTC), will take place in Delhi, India next month and INNCO believes it is likely that the organisation will seek to entrench their prohibitionist stance yet further. The CoP7 agenda contains several proposals which, if enacted, would make it even harder for current users or smokers wishing to switch to access e-cigarettes, or use them in public places.

INNCO finds the WHO’s refusal to engage with the most important stakeholders concerning. It is consumers who actually use reduced-risk nicotine products, and therefore ignoring them throughout the decision-making process contradicts the UN and WHO advice to engage with affected communities.

At previous meetings, the press was dismissed from the proceedings after the opening statements were completed. INNCO worries the WHO has normalized secrecy, with the conference amounting to little more than a biennial lesson on how to avoid transparency.

This is very true. The WHO is one of the biggest obstacles to an evidence-based (let alone liberty-based) approach to nicotine consumption anywhere in the world. Their conference in Delhi will be a secretive farce, as usual. They have shown no signs of interacting with anybody outside of their prohibitionist clique. 

On 2nd October, INNCO wrote to Margaret Chan, Chairman of The World Health Organisation, enclosing its response to the WHO FCTC CoP7 report ‘Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS)’ and formally requested a meeting to discuss our concerns over increasing disproportionate global regulation. INNCO has yet to receive a response. 

They’ll be waiting a very long time, but I wish them luck.

Read the whole press release here.

www.lvlc.us – Earlier this week, eight national anti-tobacco groups, headlined by the Campaign for Tobacco-Free Kids, filed a lawsuit against the FDA in an attempt to force the agency to re-issue a requirement for graphic warning labels on cigarette packs.

As the lawsuit explains, here are the key facts:

1. “The Tobacco Control Act became law on June 22, 2009. Section 201 required the FDA to  promulgate its final rule [regarding graphic warning labels] “not later than 24 months after the enactment” of the Act: June 22, 2011.”

2. “On June 22, 2011, exactly two years after the Tobacco Control Act was enacted, the FDA promulgated a final rule designating nine graphic warning labels depicting the negative health consequences of cigarette smoking as required by Section 201 and set September 22, 2012 as the time by which such warning labels would be required.”

3. “On September 2, 2011, a group of tobacco product manufacturers and sellers filed an action in the United States District Court for the District of Columbia alleging that the 2011 Rule was unconstitutional as applied because the specific required content, placement and type style of the mandated warning labels infringed their rights of free speech under the First Amendment.”

4. “On February 29, 2012, the United States District Court for the District of Columbia found that the specific warning labels required by the 2011 Rule were unconstitutional and enjoined the  enforcement of the rule. On August 24, 2012, the Court of Appeals for the District of Columbia Circuit affirmed the judgment of the District Court and vacated the 2011 Rule. The Court of Appeals remanded the rule to the FDA and vacated the District Court’s permanent injunction.”

5. “On March 15, 2013, Attorney General Eric Holder, in a letter to Congress, stated that, given the FDA’s plan to undertake research to support a new rule mandating graphic warning labels consistent with the Tobacco Control Act, the Solicitor General had determined not to seek Supreme Court review of the Court of Appeals’ ruling.”

The lawsuit’s complaint is that although “more than four years have now passed since the Court of Appeals vacated the 2011 Rule, the FDA has not even be gun rulemaking proceedings to promulgate a new graphic warnings rule as required by Section 201. No proposed rule even appears on the FDA’s Unified Regulatory Agenda for action during 2016.”

The Rest of the Story

This is a very weak lawsuit. At this point, whether or not the FDA re-issues a rule regarding graphic warning labels is entirely up to the agency’s discretion. The agency has already complied with the statute, which merely requires it to issue a graphic warning rule by June 22, 2011. The FDA did issue that rule, on June 22, 2011, as required. The rule was deemed unconstitutional by the D.C. District and Circuit courts and was vacated. Since the FDA issued the rule as required by the statute, it has fulfilled its obligation under the law and is not required to issue a subsequent rule. There is nothing in the statute indicating that if the initial rule is found to be unconstitutional, the agency must keep issuing additional rules until one finally passes Constitutional muster.

The key argument of the plaintiffs, which include the Campaign for Tobacco-Free Kids, American Cancer Society, American Heart Association, American Lung Association, and the American Academy of Pediatrics, is that the FDA has failed to comply with Section 201. I don’t find that argument compelling because the agency has in fact complied with Section 201 by issuing a rule on graphic warning labels, as required, by June 22, 2011. The FDA is not in violation of Section 201.

While the plaintiffs have every right to use advocacy strategies to urge the FDA to re-issue a graphic warning label requirement that does not conflict with the First Amendment rights of the cigarette companies, their attempt to use the law to force the agency to re-issue a graphic warning label rule is unsupported by the facts of the case.

While not directly relevant to the legal issues in the case, the plaintiffs repeatedly claim that the scientific evidence shows that graphic warning labels are effective in getting smokers to quit. However, I do not believe that is the case. The evidence supporting the use of graphic warning labels to promote smoking cessation is weak. Moreover, there is substantial evidence that graphic warning labels are ineffective. A body of psychology and neurophysiology research suggests that graphic warning labels on cigarette packages will have very little effect in deterring smoking among existing smokers.

The Circuit Court recognized as much: “FDA has not provided a shred of evidence – much less the ‘substantial evidence’ required by the APA – showing that the graphic warnings will ‘directly advance’ its interest in reducing the number of Americans who smoke. FDA makes much of the ‘international consensus’ surrounding the effectiveness of large graphic warnings, but offers no evidence showing that such warnings have directly caused a material decrease in smoking rates in any of the countries that now require them. … FDA’s Regulatory Impact Analysis (RIA) essentially concedes the agency lacks any evidence showing that the graphic warnings are likely to reduce smoking rates. … The Rule thus cannot pass muster under Central Hudson.”

Thus, the lawsuit’s claim that the failure of the FDA to issue a new graphic warning label rule is hindering the anti-tobacco groups’ ability to carry out their mission is unsupported.

The rest of the story is that what is really hindering the ability of these groups to carry out their mission is their continued refusal to promote smoking cessation if that cessation involves anything that resembles smoking, even if no tobacco is involved. Of course, I am talking about their continued attack on electronic cigarettes and vaping, despite the evidence that vaping has helped millions of smokers to quit or substantially cut down on the amount they smoke.

The obsession of the anti-tobacco groups with graphic warning labels coupled with their vigorous protection of cigarette consumption by discouraging smokers to switch to vaping suggests that something else is going on beyond a simple desire to promote smoking cessation. It appears that the desire is to promote smoking cessation only in the way that these groups prefer. Whether the advocated strategy is actually the most effective or most helpful to smokers is not important. What is important, apparently, is not that smokers quit, but that they quit in the “right way.”

Quitting using e-cigarettes is not the “right way” because it involves an activity that resembles the act of smoking (even though the product is tobacco-free). Quitting by being bombarded with graphic warnings is the “right way” because smokers are being punished and chided for what is viewed as an immoral or stupid decision to smoke (even though the approach has been shown not to be very effective).

These groups also continue to urge smokers to use other ineffective methods, such as nicotine replacement therapy, because they view these as a “right way” to quit. For the 90% of smokers who fail to quit using nicotine replacement therapy, and for whom e-cigarettes might be the only viable option, these groups still discourage vaping because it is just not the “right way” to quit.


Commonwealth Fund graphic:
People who visited marketplaces, but didn’t enroll

About 2.5 million Americans are overpaying for health insurance because they don’t use the government exchanges or marketplaces that provide tax credits to reduce premiums, says a study by the Department of Health and Human Services. Kentuckians will use the federal exchange to enroll, starting Nov. 1.

HHS estimates that of the 6.9 million people who have health insurance in the off-exchange individual market, “1.9 million either have incomes that would qualify them for Medicaid or place them in the Medicaid coverage gap, or are ineligible to purchase marketplace coverage due to immigration status, while the remainder could enroll in marketplace-qualified health plans.”

Amother problem is that only 46 percent of uninsured adults (as of spring 2015) were aware that the Patient Protection and Affordable Care Act offers financial assistance, according to a 2015 study by The Commonwealth Fund, report the fund’s Sophie Beutel, Sara R. Collins and Munira Z. Gunja. Researchers also found that in 2014 more than half of people who visited the marketplace but did not enroll said they weren’t able to find an affordable plan, even though “most of these people had incomes that made them eligible for premium subsidies.”

www.lvlc.us – Tariq Ahmad, the (unelected) aviation minister, has decided to take a look at the availability of alcohol in airports. ITV News says there will be a ‘crackdown’. Being a Muslim, Ahmad is – I assume – a teetotaller who believes that it is wrong to drink alcohol. That doesn’t sound very promising, but he says “I don’t think we want to kill merriment altogether” so that’s alright then. He only wants to kill it a bit.

On Twitter last week, I expressed the view that per capita alcohol-related disturbances are probably lower in airports than they are in most other public spaces, despite the 24 hour availability.

This was no more than an educated guess. Airports are areas of high security where people can’t get away with too much silliness. Even drunks respond to incentives.

At the Guardian today, Sally Adams-Merry of Bath University provides some rough and ready numbers to provide illumination.

A figure doing the rounds in the media states that 442 individuals have been arrested on suspicion of being drunk on a plane or airport between March 2014 and March 2016. This figure was obtained by the Press Association through Freedom of Information requests to the Police . Whilst this sounds high, it needs to be considered in the context of the number of passengers traveling through airports each year and the number of arrests on flights that are not alcohol-related. Unfortunately, obtaining a figure for non-alcohol related arrest proved difficult. However, in terms of all travellers, the UK Aviation Industry reports that more than 251 million individuals passed though UK airports in 2015. If we take this as a typical year, then the 442 passengers arrested on suspicion of being drunk represents approximately 0.00018% of all air travellers.

Alas, she doesn’t give us the figures for the general public, but 0.00018% certainly doesn’t sound like an epidemic and Sally speaks up for the 99.99982% of us who don’t get our collars felt in airports for being pissed up.

An airport-wide ban could see moderate drinkers penalised for the behaviour of a handful of individuals.

Indeed it could. In fact it definitely would. And the same is true of tax hikes, minimum pricing and other ‘public health’ policies directed at the whole population, but when this is pointed out to the ‘public health’ racket, we are told that it is an “industry argument”. See, for example, this article from Sally’s colleagues at Bath University…

The focus on a small number of alcohol misusers provides the AI [alcohol industry] with a frame that has the potential to invalidate the current focus of health policy; the AI argues that population-level approaches, such as taxation or restrictions on advertising, penalizes moderate drinkers because of a ‘few people’ who consume alcohol in an irresponsible way and that these approaches do not tackle alcohol misuse effectively. This supports AI claims that ‘existing regulation is satisfactory’

Does the Guardian realise it is being used as a vehicle for evil industry arguments or does the threat to a nice glass of Sancerre before jetting off to Goa make them valid on this occasion?


As a couple of people of Twitter have pointed out, the maths in the Guardian is wrong (shocking, I know). The 442 arrests were over two years so the annual percentage of arrests is 0.000088%. 

www.lvlc.us – Every two years, the WHO holds a ‘Conference of the Parties’ to wibble on about the Framework Convention on Tobacco Control. The next one is coming up in a month or two. The last one was held at the height of the Ebola epidemic which killed 11,000 people and the WHO was rightly criticised for its inept response. Tackling contagious diseases isn’t high on the WHO’s list of priorities these days, and why should it be when there are people in the world drinking fizzy drinks and using e-cigarettes?

On 13 October 2015, while Ebola raged in Africa, a spokesman delivered a short speech on Margaret Chan’s behalf. He began with an apology…

The Director-General sends you her best wishes for a productive session. She is fully occupied with coordinating the international response to what is unquestionably the most severe acute public health emergency in modern times.

Few would have known that she was actually attending a tobacco control meeting in Moscow from which all observers were banned.

I reported this at the time. Since then the text of her speech on October 13th has been published and it makes for interesting reason. It puts the lie to the claim that she was ‘fully occupied’ doing anything other than sucking up to Vladamir Putin and attacking e-cigarettes.

First, allow me to thank the Government of the Russian Federation for hosting this sixth session of the COP. I have to say, personally, I have witnessed the commitment of this government, led by President Putin himself and of course you, sister Veronika, for overcoming very tough challenges to push through a very comprehensive law to control tobacco.

The law came into full force on the 1st of June this year. I want to thank you for your leadership. Many people told me years ago this will never happen in the Russian Federation. Thank you for proving them wrong.

Speculation is a very interesting hobby for many people. Some people speculated that I would not attend this meeting because I am so busy with so many other outbreaks of communicable diseases.

No. No. No. I will not cancel my attendance at this meeting because it is too important.

I think we can put down that claim that she was “fully occupied” dealing with Ebola as a bare-faced lie, can we not?

I wonder how more lies will be told when they meet again in India in a few weeks. As journalists are banned from attending, we’ll just have to wait for the transcripts to come out. 

www.lvlc.us – Despite the abundance of scientific evidence, including clinical studies, which demonstrate that vaping is much safer than smoking, the American Lung Association – as recently as last week – told the public that smoking may be no more hazardous than vaping.

A UPI article quoted the American Lung Association’s senior scientific advisor as stating: “We have no idea what the long-term effects are because they [e-cigarettes] haven’t been around long enough, but there’s no reason to consider e-cigarettes safe. Whether they’re going to cause less disease than tobacco cigarettes, we’ll eventually get that answer but it’s going to take years.”

The Rest of the Story

Unfortunately, in my view, the American Lung Association has completely lost any semblance of scientific credibility. They are telling the public that smoking may be no more hazardous than vaping, which is inconsistent with the scientific evidence, which definitively demonstrates that vaping is much safer than smoking. While one might argue about the exact magnitude of the decreased risk, there is no legitimate scientific argument that vaping is not drastically safer than smoking.

Even the fiercest vaping opponents – like Stan Glantz – agree that smoking is much more hazardous than vaping.

The evidence that vaping is dramatically safer than smoking continues to build. Recently, a study out of the Roswell Park Cancer Institute demonstrated substantial reductions in carcinogens and toxicants in vapers who had switched from cigarettes:

“Researchers measured levels of seven nicotine metabolites and 17 biomarkers of exposure to carcinogens and toxicants present in cigarette smoke. Their analysis revealed that while the nicotine metabolites remained unchanged among the majority of study participants – suggesting that e-cigarettes deliver nicotine effectively – the levels of the 17 toxicants and carcinogens measured dropped significantly after just one week of switching to e-cigarettes. For 12 of these 17 chemicals, the decline in was similar to the decline seen among tobacco users who quit smoking. “Toxins and carcinogens we measured in the body almost disappeared – the body cleared the 17 different chemicals we were looking for,” Goniewicz said. “They are safer, less toxic. It’s the first time we have very strong evidence that we will be able now to give (smokers) that the answer is, yes , this you should consider a transition, a substitute for your tobacco cigarette that will save your life.””

You have to go back at least 16 years – and to the old playbook of the tobacco industry – to find another example of an organization lying so blatantly to the public about the severe hazards of smoking and undermining decades of education by public health officials. It is just far too ironic that the organization reverting to this tactic is a health group that is supposed to be fighting smoking in order to reduce lung disease.

It is highly irresponsible for the American Lung Association to be undermining the public’s appreciation of the severe hazards of smoking in such a blatant and destructive way. This not only does a disservice to the American Lung Association’s donors and contributors, but it also threatens the credibility of the ALA and other public health groups and undermines the stated mission of the ALA which is supposed to be to fight against, not for, lung disease.

The ALA should be jumping for joy to see a feasible alternative to smoking that is popular among smokers and which is successfully helping millions of smokers to quit smoking completely or to cut down substantially on the amount they smoke. They should be encouraging all smokers to quit, even those who want to try to quit using e-cigarettes. By demonizing these products, they are actually promoting smoking by deterring many smokers from trying to quit and by getting many former smokers who quit by vaping to think about going back to smoking, since if there is no clear health benefit, then why not just go back to smoking?

Anyone who cares about the integrity and reputation of the American Lung Association should be protesting this fallacious statement and urging the ALA to get back into the business of telling the truth.