Tuesday 16 May 2017

E-cigarattes; cultural bias; pluralistic society; and warped incentives

Permit me a little bit of a rant here, but it is actually a very important case study in public policy gone awry, and how vested interests can capture the debate and result in the spread of false and misleading information, and result in policy choices occurring that are utterly irrational. Bear with me, as I believe the read will be worth it if you can persevere to the end, as smoking remains one of the most misunderstood phenomenon among intelligent members of modern day society.

In the interests of full disclosure, I am a former smoker of regular and e-cigarettes, but have quit - mostly for health and tolerance/dependency reasons, but partly because e-cigarettes are getting harder to legally come by, which is eliminating my freedom to enjoy nicotine in a relatively harmless way. My outrage is predominately a matter of principle, but there is a modicum of self-interest at play here. I have researched these issues extensively and objectively, however. 

By way of quick reference, the following link is a good summary of many of the proven health benefits of nicotine that most non-smokers are probably not aware exist. Most of the listed benefits here certainly ones I can attest to having subjectively enjoyed in the past. The anti-smoking PR lobby has been so successful and one-sided that most people are not aware of these benefits. Nicotine is reason smokers smoke, but it is not what kills them - it's the tar/chemicals in conventional cigarettes that do that. E-cigarettes have no tar and very few added chemicals.


In recent times I have become increasingly dismayed - if not outraged - by the 'war on e-cigarettes' that is being waged across many parts of the world. E-cigarettes have already been completely banned in certain countries, such as Australia and Singapore, for instance. It is about time people stood up to this insanity, and began to fight for the putatively free society in which we supposedly live. Delving into the causes of the opposition to e-cigarettes also reveals a lot of very cynical things about human nature, and the true motives of many so-called 'do gooders'.

Imagine if, for the first time, cigarettes were invented today, and there were two types. One had mountains of research indicating that they were harmful to health, reducing life expectancy by 5-10yrs for lifetime users; and the other where evidence of harm was limited and purely speculative, and based on current evidence, quite probably trivial (likely on par with the use of a similar but more socially acceptable stimulant, caffeine). There was no guarantee future research would not indicate that the latter were harmful, but no harm was yet demonstrated.

Which cigarette should you ban, and which should you keep legal? A five-year-old would be able to tell you the correct answer. The fact that we are keeping the former legal and banning the latter is pure insanity. Apparently, smokers are only allowed to smoke cigarettes that are proven to kill them. Smoking ones that, at worst, might be injurious to health, and if so, likely to a much lesser extent than conventional cigarettes, is an absolute no-no. This is pure madness.

There are a few retorts. One is that 'well, you shouldn't be smoking in the first place'. It's a bit like banning diet coke, depriving people that enjoy drinking coke of a sugar-free alternative, because it is possible but not proven artificial sweeteners are harmful to health. If coke drinkers were to respond by saying 'but I enjoy drinking a coke from time to time, but would prefer not to be forced to drink the sugary variety, which subjects me to proven risks of diabetes and obesity', the response would be 'tough - you shouldn't be drinking coke at all, as both variants - sugared and unsugared - are not good for you; just quit and stop moaning'.

I have a very principled objection to this approach, which I elaborate on further below in the 'why do people smoke' section. This line of reasoning ignores the pleasure people get from drinking a coke, or engaging in other indulgences, and focuses only on the costs. And it assumes we should promote optimal health over any and all pleasures/indulgences in life. If people want to prioritize health over all else in their own lives, then fine - by all means do that. However, people that do not want to do that should not be forced to do that - particularly if we aspire to live in a free and pluralistic society. Such restrictions are no less than creeping totalitarianism. Accurate and science-based evidence on the health risks of products should be available, and non-users should be protected from exposure, but beyond that we should seek to preserve freedom of choice.

The other objection to e-cigarettes is that they may be a 'gateway' drug, making smoking socially acceptable again, and increasing smoking rates. The problem with this approach is that it assumes ipso facto that smoking and nicotine consumption are bad thing - even if no harm is proven - but that puritan approach makes no sense. Should we not celebrate a newfound ability to enjoy the pleasures of nicotine and smoking in a harm-free way, rather than demonize it? To understand this line of reasoning, we need to understand why it is that people smoke (see further below).

Furthermore, why would e-cigarettes be a 'gateway' drug to an inferior product? Real cigarettes smell bad; taste awful; and have many side-effects that are terrible for your health; many smokers would love to do away with them for a healthier alternative. This will be even more the case for smokers that start directly with e-cigarettes - why would they ever switch to an inferior product? If e-cigarettes are allowed to flourish and are exempted from the heavy taxation imposed on regular cigarettes, it is very likely that conventional cigarettes will slowly fall into disuse over the years, and in the process, millions of premature deaths from conventional smoking will be avoided.

Why do people smoke anyway?

A negative PR campaign against nicotine and smoking has now been underway since the 1960s, and has been waged so effectively that few non-smokers recognize that there are any benefits or upsides to nicotine use whatsoever - only addiction, withdrawal, and adverse health effects. Consequently, non-smokers now believe that people who smoke are unfathomably stupid - after all, if this view is true, why would anyone do it, given the health risks, when there is no upside?

The answer is that there is upside - you just don't understand it if you've never smoked - as nicotine has very real effects on the brain and is not merely an illusion. The best way I can help a non-smoker to empathize is to draw an analogy with drinking alcohol. Someone who had never used alcohol might well argue the following: 'you would have to be utterly stupid to drink alcohol. It tastes and smells bad; it costs a fortune; its a poison that's bad for you and your liver; it reduces life expectancy; its fattening; it interferes with your sleep; in high quantities it makes you ill/dizzy and gives you a hangover; it causes social problems like drunk driving; violence; etc. Ergo, people that drink alcohol are fools, and we should completely ban the use of alcohol, or tax & restrict its use to extreme degree, to protect these fools from themselves, and for society's benefit'.

The problem with this line of reasoning is that it ignores all the benefits & pleasures people derive from drinking, and focuses only on the costs. What is implicitly happening with this line of reasoning is that the prohibitionists are forcing their value system onto others - namely that maximizing health and life expectancy should take priority over everything else, including having fun and engaging in pleasurable indulgences. But who is to say that that value system is correct? Should people not be free to enjoy life's indulgences, even if they are not good for their health in the long run, if they are informed of the risks and choose to do so? Charlie Munger made a recent point to this effect regarding the demonization of Coca-Cola as well Berkshire's 2016 AGM.

The unpopular but hard truth is that, like all drugs, the nicotine high entails many benefits to users. That's why people smoke, and that's why it's so hard to quit. It is comparable to caffeine - also an addictive drug - in its stimulant effect, speeding up one's metabolism, but it also has other powerful cognitive effects, including increasing dopamine flow to the brain (which makes you feel good); and increasing cognitive function in a lot of complex ways. Numerous studies have demonstrated that this is not a placebo effect - the cognitive benefits are real not imagined - and why should they not be? What other drug do you know of that does not have real effects?

It is surprising (if you do not understand nicotine's effects) how many extremely high-performing & creative people historically have been/are smokers. Diego Maradona was a two-pack a day smoker. Ronaldo smokes. Einstein puffed incessantly on his pipe. Daniel Kahneman - author of 'Thinking Fast and Slow' - is a heavy smoker. Christopher Hitchens - one of the finest journalists and orators of our age, was a heavy smoker. Obama smoked and had difficulties quitting. Shane Warne smoked. Many musicians and artists smoke. I could go on.

These are not unintelligent people. And they all chose to smoke. It's not that they are dumb. It's that the benefits they received from nicotine were powerful, and after they quit, their performance suffered. That's what truly makes it hard to quit. The withdrawal symptoms can be easily suffered through. It's getting used to operating with less mental energy and cognitive function on a permanent basis that is most difficult. Indeed, I wouldn't be surprised if the clamp down on smoking in the work place has been one contributor to anomalously-low productivity growth in recent decades (Denmark reportedly suffered a large and unexplained decline in productivity the year after they implemented a wholesale workplace smoking ban).

Why does the anti-smoking lobby oppose e-cigarettes?

The anti-smoking lobby will claim that they oppose e-cigarettes because of the potential long term harm they can do, and the fact that the safety of the products is not yet proven.

The truth, unfortunately, is a lot less flattering. The real reason is that the individuals staffing these organizations have spent their lifetimes battling smoking as public enemy number one, and by admitting that a non-harmful nicotine delivery mechanism has arrived, they will be both (1) rendering themselves useless in the world; and (2) putting themselves out of a job. Anyone who knows anything about human psychology and the functioning of bureaucracies will realize they have powerful incentives to oppose e-cigarettes and claim the existence of phantom harm. The government also has an incentive to listen as excise tax revenues on cigarettes are an important source of income (this is more important than saving lives it would seem).

In addition, we now have such a powerful cultural bias against smoking that we can't bring ourselves to believe that it is possible - let alone desirable - that we have an ability to smoke that does not cause harm. Smoking and nicotine has been the enemy for so long that it is impossible for many people to make the mental transition to viewing e-cigarettes as a good thing - a source of pleasure, much like a strong coffee in the morning, or a good glass of red wine in the evening - that we need not oppose.

Cultural biases are interesting. Western culture loves caffeine and alcohol, but nicotine is a no go. Go to Arabian countries, however, and smoking shisha (which has nicotine) is highly accepted, but alcohol is not. You can smoke a shisha on a Dubai beach but you cannot order a beer. Our cultural bias against nicotine is very real, but the fact that it is merely a bias is invisible to most people.

Unfortunately, anti-smoking activists that are opposing e-cigarettes are now threatening to do far more harm that good for public health. To the extent they successfully restrict e-cigarettes and force smokers to smoke the far more harmful analog cigarettes, they may in fact contribute to millions of premature, avoidable deaths. Indeed, in a lot of respects these organizations/activists are now as bad as the tobacco companies in the 1950-60s. They are spreading false information for their own selfish benefit that is causing millions of people to die premature deaths. It is utterly reprehensible behavior and it should be exposed for what it is.

Anti-tobacco activists that are opposing e-cigarettes are showing their true colours: they don't (and so presumably never did) care about public health. They instead care about their own career and job prospects; ego aggrandizement; and taking the moral high-ground, and don't give a damn about public health. In the past, this cynical approach was fine - they probably did end up saving lives anyway. However, their cynical behavior now increasingly threatens millions of lives and they need to be stopped. These people have become more dangerous than the cigarettes themselves.

What we should do:

First and foremost, we should not ban e-cigarettes, and it is even arguable we should go further and actively encourage smokers to transition - perhaps via MoH funded advertising (although I won't go that far at this stage). In addition, additional polices should be the following.

*We should always and everywhere restrict sales of nicotine-based products to minors. Nicotine is a powerful and addictive drug and should only be sold to adults capable of making an informed choice.

*We should provide unbiased and scientific evidence on the health effects/dangers etc of smoking and vaping to the public, that is free of agenda or moralizing. Unfortunately, the information coming out of anti-smoking lobbies these days is no longer science-based and is every bit as agenda-laden and biased as the information coming from the smoking lobby in the 1950-60s. This must stop, and a fair and balanced dialogue on smoking/vaping needs to emerge.

Beyond that, we should recognize that individuals, in a free society in which we aspire to live, ought to be able - on an informed basis and without prejudice to non-smokers - to choose to smoke and to do so without being subject to unreasonable taxation, social condemnation, harassment (i.e. unreasonable restrictions on where and when they can smoke/vape), banning, or any other moralistic, totalitarian and prohibitionist approaches to nicotine regulation.

*We should, however, ban both smoking and vaping in enclosed public spaces to avoid forcing non-smokers to be involuntarily subjected to harmful smoke or (in the case of vaping) haze. This includes the indoor areas of bars/restaurants, malls, movie theaters, airports, etc.

*We should make a limited number of exceptions to the above policy by permitting specialist cigar/smoking/vaping bars to operate.

*Restrictions should in no instances be placed on smokers ability to smoke in indoor areas in their own private property (houses, cars, etc), unless infants & young children are also present. There should be no restrictions on outdoor smoking on private property.

*We should restrict smoking of traditional cigarettes in certain outdoor public areas where it is liable to result in litter (cigarette butts and ash) and foul odors for passers by. However, we should not go overboard and should provide areas for people to smoke if they choose. In addition, we should not ban vaping in these areas, including in public parks and beaches, as there is no foul oder, no harmful smoke, and no litter (no cigarette butts or ash).

*As a courtesy, we should provide smoking rooms or segregated areas to smokers in places where smoking is prohibited - particularly in places where easy outdoor access is unavailable, such as airports.

*We should tax tobacco only to the extent it can be shown that it is harmful and imposes a burden on the public health system (and note that by dying 5-10yrs earlier, smokers impose significantly less burden on the public pension system to counter their burden on the healthcare system). Beyond that, hitting smokers with moralistic sin taxes is unethical and paternalistic and has no place in a putatively free society.

*We should enthusiastically embrace the advent of e-cigarettes as a way for people to enjoy the pleasures of smoking and the benefits of nicotine in a way that does not cause harm, in much the same way we might embrace the technological advent of healthy potato chips/junk food etc.

I doubt anyone has made it this far, but if you have, feel free to leave a comment.