In this article Dworkin compares the parallel histories of medicine and public health. His main point is that the origins of public health were science-based, for example trying to isolate the causes of cholera and determining that it was a water-borne disease and so you install or improve the sewerage and the quality of the water. Meanwhile, at the same time, doctors were still using leeches and practicing a type of medicine that wasn’t far short of witchcraft.

Now the situation is almost reversed; yes, public health still has an important role to play in combatting infectious diseases which has a basis in science, but now assumes through a lack of humility that it can now pontificate on pretty much every aspect of human activity. Dworkin writes, “Along with its traditional menu of concerns, including sanitation and immunization, the public health field now voices opinions on such issues as gun control, mental health, drug abuse, domestic violence, social justice, gender equality, sustainability, wealth redistribution, children’s day care, and foreign policy”.

And because public health is all about what goes on at a population not individual level, this lends itself to dramatic declarations of hope and aspiration over reality, making public health largely ideological; “An ideology is a big set of ideas, a sweeping philosophy relevant on a large scale and for a long period of time. It thrives by ignoring details; it is so simple in its explanations that a single slogan can sum it up. Individual cases with particular details detract from the smoothness of an ideological system. Because public health experts do not manage individual cases, reality is less likely to quash their ideological enthusiasm”.

Dworkin makes many other telling points about the arrogance of public health, but its influence can be especially baleful and ironically totally counter-productive to the avowed ‘health of the public’ in the debate about smoking vs vaping. It is a known fact that smoking causes cancer and a number of respiratory diseases – this is science. Period. But there is a group of self-righteous, opinionated public health activists with influence in medical and political circles trying to persuade anybody who will listen that (usually bogus or over-hyped) potential associations between vaping and ill-health carry the same weight as direct and unequivocal causations with a sound clinical evidence base.

But it goes much further than overweening arrogance; activity is taken to extremes through underhand and spiteful activities to smear individuals and wreck careers playing to the sleazy McCarthyite world of international tobacco control. These are the actions of those who know they cannot win the argument on grounds of science and clinical evidence so revert to the politics of the gutter.

Just caught up with this:

“Controversy is brewing in San Francisco this week as it was revealed that the Society for Research on Nicotine and Tobacco (SRNT) accepted money from an e-cigarette company to sponsor its annual meeting which is being held this week…..Stanley Glanton,(??) a professor at CFSU, told The Rest of the Story that: "This is a clear-cut conflict of interest. You can't have a conference sponsored by a company that makes products which are being discussed at scientific sessions. How can we have an objective conversation about electronic cigarettes and the epidemic of youth vaping when GreenSmokeKloud signs are all over the place and conference attendees know that this company is a major sponsor of the conference?"

“An objective conversation about e-cigarettes” from “Stanley Glanton” (sic). I almost choked on my cornflakes. But hang on, it turned out that this journal got it wrong. GSK actually stands for GlaxoSmithKline, makers of NRT. So all those who objected to SRNT taking money from Big E-Cig retracted their statements because of course there is no conflict of interest in Big Pharma with a stake in NRT and other smoking cessation medicines sponsoring a tobacco conference. Is there?

Here an interesting quote from a WHO tobacco report published back in 2008 before e-cigarettes became widely available. The report majors on smokeless tobacco, but the read across to recent safer nicotine products is pretty self-evident not least because now it is more than just theory.

“It is theoretically possible to reduce the risk for harm to tobacco users who are unable or unwilling to quit, by changing the product, its characteristics or the mode of intake by which they satisfy their need for nicotine, because most of the harm is due to contents other than nicotine. The reduction of harm due to use of tobacco can be viewed from a broad public health perspective, in which the risks for disease and premature mortality are reduced by reducing exposure to toxicants and pathogens. For instance, malaria can be controlled by reducing the numbers of malaria spirochaete-carrying mosquitoes, respiratory disease can be controlled by reducing air pollution, and HIV/AIDS can be controlled by preventing unprotected sex and needle-sharing by intravenous injection drug users”.

So we all know that vaping leads to smoking yes? It must be true because the Federal Drug Administration, the Center for Disease Control and a whole gaggle of medical agencies and anti-smoking charities tell us this is so. This assertion carries with it the logic of authority - right?

So how come a huge study of 12,000 American youngsters published by the National Cancer Institute failed to find any evidence of a gateway effect? The investigators were unable to report a single youth out of the 12,000 in the sample who was a cigarette naive, regular vaper at the start of the study who progressed to become a regular smoker at follow-up.

Still I suppose if you are on a moral crusade, you are not going to let the evidence get in the way of a good slogan.

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