{"id":1213,"date":"2015-11-13T05:44:51","date_gmt":"2015-11-13T05:44:51","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/tc\/?p=1213"},"modified":"2015-11-13T05:44:51","modified_gmt":"2015-11-13T05:44:51","slug":"e-cigarettes-and-children-advocates-walking-on-both-sides-of-the-street","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/tc\/2015\/11\/13\/e-cigarettes-and-children-advocates-walking-on-both-sides-of-the-street\/","title":{"rendered":"E-cigarettes and children: advocates walking on both sides of the street?"},"content":{"rendered":"<p>Post written by Prof Simon Chapman AO<\/p>\n<p>Follow Simon on Twitter: <a href=\"https:\/\/twitter.com\/SimonChapman6\">@simonchapman6<\/a><\/p>\n<p>&#8212;-<\/p>\n<p>In a 2014 <a href=\"https:\/\/nicotinepolicy.net\/documents\/letters\/MargaretChan.pdf\">open letter<\/a> to the WHO\u2019s director general Margaret Chan signed by 53 researchers, it was argued \u201cControls on [ecigarette] advertising to nonsmokers, and particularly to young people are certainly justified, but a total ban would have many negative effects, including protection of the cigarette market and implicit support for tobacco companies. It is possible to target advertising at existing smokers where the benefits are potentially huge and the risks minimal.\u201d<\/p>\n<p>Clive Bates who \u201c<a href=\"http:\/\/www.clivebates.com\/?p=2181\">had a hand<\/a>\u201d in organising the letter but curiously did not sign it, is a former director of England\u2019s Action on Smoking and Health. In that role, Bates directed and wrote one of the most excoriating critiques ever published of the tobacco industry\u2019s long standing (and still running) denials of its designs on children.<\/p>\n<p>In the October 2000 <a href=\"http:\/\/www.ash.org.uk\/files\/documents\/ASH_625.pdf\">Danger in the Playground<\/a>, Bates documented many of the most telling examples of candid industry talk about the vital role of children to the future of tobacco industry profitability. This accompanying <a href=\"http:\/\/ash.org.uk\/files\/presentations\/ASH_4.ppt\">powerpoint<\/a> presentation (also authored by Bates) rubs it in even harder. These revelations were all made in internal tobacco industry documents released through the US <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tobacco_Master_Settlement_Agreement\">Master Settlement Agreement<\/a> between US state governments the tobacco industry, millions of which are now freely available <a href=\"https:\/\/industrydocuments.library.ucsf.edu\/tobacco\/\">here<\/a>.<\/p>\n<p>The tobacco industry\u2019s business model about the importance of youth smoking was never put more succinctly than in this 1984 <a href=\"https:\/\/industrydocuments.library.ucsf.edu\/tobacco\/docs\/#id=yjkw0091\">document<\/a> from an RJ Reynolds tobacco official: \u201cIf younger adults turn away from smoking, the industry will decline, just as a population which does not give birth will eventually dwindle.\u201d (\u201cyounger adults\u201d was <a href=\"https:\/\/industrydocuments.library.ucsf.edu\/tobacco\/docs\/#id=qynj0144\">industry code<\/a> from the mid 1970s for children and young adults, to be used in all written communications)<\/p>\n<p>In a 2000 <a href=\"http:\/\/www.ash.org.uk\/media-room\/press-releases\/danger-pr-in-the-playground-new-report-reveals-tobacco-giants-sinister-strategy-on-youth-smoking\">press statement<\/a> at the time of the launch of the publication, Bates said \u201cWhen you look at what they say privately, and compare it to their public posturing, the whole idea that tobacco companies might be working against teenage smoking is revealed as sinister self-serving public relations.\u00a0 The more they try to define smoking as only for adults, the more they are saying \u2018hey kids, smoking&#8217;s for grown-ups&#8217; with a sly nod and a cynical wink.\u201d<\/p>\n<p>Today, Bates runs his own consultancy business and is a leading advocate of ecigarettes. Of 220 tweets he posted between Oct 1 and Nov 1, 80% were about ecigarettes. On a recent <a href=\"http:\/\/www.clivebates.com\/?p=3379\">blog<\/a> he wrote that when it comes to ecigarettes \u201cThere is little evidence of marketing to children, only assertions that certain ads or brands are designed to appeal to children but with no empirical evidence, and apparently minimal understanding of modern advertising.\u201d<\/p>\n<p>On reading this, I was struck by how far Bates appears to have moved in the 15 years since he wrote Danger in the Playground and so tweeted a juxtaposition of the two quotes above, asking \u201cwhich Clive Bates to believe?\u201d<\/p>\n<p>Bates <a href=\"https:\/\/twitter.com\/Clive_Bates\/status\/660745861069201408\">replied<\/a> challenging this apparent inconsistency, arguing that his 2000 statement referred to tobacco companies while his 2015 statement referred to ecigarette companies. He argued that currently, the vaping market is worth 100 times less than the cigarette market and that \u201cnearly all vape customers come from the ranks of existing smokers\u201d, which he said explains why adult smokers are the target market for ecigs.<\/p>\n<p>The same analysis can of course be applied to the current contribution of young smokers to the total cigarette market. For example, an early <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14705295\">Australian<\/a> analysis showed that while in one year the value of the underage market to manufacturers was $AUD18.7million, if 50% of young smokers continued to smoke, they would contribute $AUD112 billion at current prices to the industry across their lifetime.<\/p>\n<p>Bates knows perfectly that tobacco companies understand the importance of smoking uptake by children to their future, but seems to believe that such a thought has never crossed the minds of ecig manufacturers.<\/p>\n<p>In an extraordinary statement, he wrote that \u201cthere are good reasons why the e-cigarette companies, even tobacco owned ones, would not target adolescents \u2026 demand, reputational, legal and regulatory risk etc \u2026 it would be bad business.\u201d<\/p>\n<figure id=\"attachment_1214\" aria-describedby=\"caption-attachment-1214\" style=\"width: 560px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/stg-blogs.bmj.com\/tc\/files\/2015\/11\/flavour.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1214 \" src=\"https:\/\/stg-blogs.bmj.com\/tc\/files\/2015\/11\/flavour-300x199.jpg\" alt=\"flavour\" width=\"560\" height=\"372\" srcset=\"https:\/\/stg-blogs.bmj.com\/tc\/files\/2015\/11\/flavour-300x199.jpg 300w, https:\/\/stg-blogs.bmj.com\/tc\/files\/2015\/11\/flavour-1024x681.jpg 1024w\" sizes=\"auto, (max-width: 560px) 100vw, 560px\" \/><\/a><figcaption id=\"caption-attachment-1214\" class=\"wp-caption-text\">E-cigarettes contain many child-friendly flavors. <a href=\"https:\/\/flic.kr\/p\/9GL5bS\">Flickr\/keoni101<\/a><\/figcaption><\/figure>\n<p>This language only needs to be contrasted with the many counterfactual examples he supplied in his own 2000 <a href=\"http:\/\/www.ash.org.uk\/files\/documents\/ASH_625.pdf\">publication<\/a>. Yes, there are many good reasons why designs on kids need to be publicly denied. As one 1973 tobacco <a href=\"https:\/\/industrydocuments.library.ucsf.edu\/tobacco\/docs\/#id=fzjx0111\">document<\/a> describing a supposed anti-youth smoking initiative put it \u201cThis is one of the proposals that we shall initiate to show that we as an industry are doing something about discouraging young people to smoke. This of course is a phony way of showing sincerity as we all well know.\u201d<\/p>\n<p>In much the same way as the tobacco industry has long done, many of those promoting vaping are today trying to walk on both sides of the street on youth vaping. They know the reputational risk of openly saying that they are unconcerned about youth uptake. Whenever data show negligible uptake by youth, this is rapidly megaphoned as self-evidently a good thing. But when data show significant use, they try to spin this as being an entirely positive development where it happens: all children who are now vaping would have been smoking instead, these clairvoyants assure us.<\/p>\n<p>In the USA today data from the US National Youth Tobacco Survey show that while cigarette smoking continues to fall in US teenagers, e-cigarette use has been <a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6438a1.htm?s_cid=mm6438a1_w\">dramatically increasing<\/a> since 2011 and is now way ahead of cigarette smoking: there are now some <a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6438a1.htm?s_cid=mm6438a1_w\">50% more<\/a> middle and high school kids vaping than are smoking, with an estimated 340,000 vaping on more than 20 days each month. Advertising like <a href=\"http:\/\/tobacco.stanford.edu\/tobacco_main\/main_ecigs.php\">this<\/a>, and 3 year old birthday party favourite flavours like <a href=\"http:\/\/tobacco.stanford.edu\/tobacco_main\/images_ecigs.php?token2=fm_ecigs_st365.php&amp;token1=fm_ecigs_img17588.php&amp;theme_file=fm_ecigs_mt037.php&amp;theme_name=Teen%20Flavor&amp;subtheme_name=Candy%20&amp;%20Sweets\">these<\/a> which Bates thinks should be allowed, are plainly intended to beguile teenagers.<\/p>\n<p>A recent <a href=\"http:\/\/www.thelancet.com\/pdfs\/journals\/lanpsy\/PIIS2215-0366(15)00152-2.pdf\">systematic review<\/a> in the Lancet of nicotine and psychosis concluded that \u201cDaily tobacco use is associated with increased risk of psychosis and an earlier age at onset of psychotic illness. The possibility of a causal link between tobacco use and psychosis merits further examination.\u201d It set out important arguments about why the \u201cself-medication\u201d hypothesis about nicotine (promoted by the <a href=\"http:\/\/schizophreniabulletin.oxfordjournals.org\/content\/34\/3\/555.long\">tobacco industry<\/a>) deserves reassessment against one where nicotine might be causative in psychosis. Such serious considerations demand that <a href=\"http:\/\/www.bbc.com\/news\/magazine-23196369\">trite dismissals<\/a> of nicotine as being as benign as \u201clike drinking coffee or something\u201d be condemned.<\/p>\n<p>Clive Bates and others who signed his letter might like to comment on how \u201cit is possible to target [ecigarette] advertising at existing smokers\u201d; how many of <a href=\"http:\/\/tobacco.stanford.edu\/tobacco_main\/main_ecigs.php\">these<\/a> allegedly \u201cadult targeted\u201d ads would never attract the interest of non-smoking teens; and where parents can buy one of the miraculous magic filters that let such advertising through to smokers but somehow render it invisible or uninteresting to young non-smokers.<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Post written by Prof Simon Chapman AO Follow Simon on Twitter: @simonchapman6 &#8212;- In a 2014 open letter to the WHO\u2019s director general Margaret Chan signed by 53 researchers, it was argued \u201cControls on [ecigarette] advertising to nonsmokers, and particularly to young people are certainly justified, but a total ban would have many negative effects, [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/tc\/2015\/11\/13\/e-cigarettes-and-children-advocates-walking-on-both-sides-of-the-street\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2149,1715,567],"tags":[],"class_list":["post-1213","post","type-post","status-publish","format-standard","hentry","category-e-cigarettes","category-marketingadvertising","category-who"],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/tc\/wp-json\/wp\/v2\/posts\/1213","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/tc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/tc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/tc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/tc\/wp-json\/wp\/v2\/comments?post=1213"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/tc\/wp-json\/wp\/v2\/posts\/1213\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/tc\/wp-json\/wp\/v2\/media?parent=1213"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/tc\/wp-json\/wp\/v2\/categories?post=1213"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/tc\/wp-json\/wp\/v2\/tags?post=1213"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}