by Carl V Phillips
The previous post, which pointed out that the American Cancer Society (and, as noted in a comment and the update, the American Lung Association and American Heart Association) is leading the fight against banning sales of e-cigarettes to minors, has probably generated more attention than any previous entry in this blog. After spending time writing long analyses of scientific points, it is a bit disappointing that what was basically a transcript of testimony by an ACS representative — with some analysis — got far more attention. (Oh, that reminds me, I forgot to h/t Julie Woessner for creating that transcript from the recording of the hearing.)
I am kidding about being disappointed (mostly), because I do understand the interest. People who are supportive of THR — in particular, people’s whose health has been saved by e-cigarettes — naturally wonder about those who are trying to prevent people from using e-cigarettes: what they are doing, and why? I realize that it must seem like quite the mystery to most readers. In the previous post I hinted at the motives behind ACS’s testimony, which I will examine in more detail today.
The first thing to realize is that ACS’s effort to block regulations banning the sales of e-cigarettes to minors is a calculated strategy. ACS is an almost-billion-dollar corporation, and like any such corporation, it is run by shrewd decision-makers who do not take actions like this by accident (big corporations do a lot of dumb things, but they do not do them by accident). They are not some random activists writing crazy rants or trying to do silly things like ban smoking in movies. Ms. Susan Roberts, who delivered the testimony in the previous post, may have known the real motives or she may have actually believed what she was saying — she might just be a useful idiot who actually thinks that banning sales to minors in Rhode Island would somehow derail the FDA’s research and regulations. Either way, you can be sure that those who make decisions at ACS are not so naive.
Once we are confident that a decision was made deliberately by a sensible decision-maker, then it becomes possible to learn from it. I have no inside information about their motives, but I have devoted a great deal of attention, both formal study and informal time-wasting (you will recall my presumably annoying foray into some details of chess a few days ago), to the question of what you can infer from the observed actions of rational actors.
Rhode Island was not the first time ACS has tried to block a ban on sales of e-cigarettes to minors, so this was not some local employee going rogue. It is obvious that no one with the skills necessary to be a decision-maker at ACS would believe the vague rationalizations presented in that testimony. Moreover, if those garbled transparently inaccurate rationalizations were the best they could come up with, it suggests that their real reasons are sufficiently unpalatable that they do not want to even come close to admitting them.
[UPDATE: We just happened to hear, a few days later, a leading ANTZ legal authority confirming that ACS’s stated claim — that a state law could interfere with FDA regulation — was wrong. So this is not only obvious to anyone who understands regulation, but the message is being actively disseminated in ANTZ discussion. This makes it even more implausible that ACS did not know that their rationalization was fiction.]
It is also implausible that ACS wants to ensure minors’ access to e-cigarettes because they believe that kids should be able to employ THR. There is some merit to that position, though no one (literally no one, to my knowledge) actively supports it. But we know, despite the fact that e-cigarettes reduce smoking and so reduce smokers’ cancer risk (and improve their lung and heart health), ACS and their allies (who claim to be anti-smoking, pro-lung health, pro-heart health, etc.) discourage THR in all forms, including the use of e-cigarettes. The reasons for this goal are a complicated story in themselves, which I have addressed at some length previously.
They presumably even more vehemently oppose the use of e-cigarettes and smokeless tobacco when they are used for reasons other than THR by long-term smokers. It is not plausible, as vaguely claimed in the testimony, that they are waiting for further study in case they might change their mind and embrace THR for kids. Given their active opposition to THR for adults, despite overwhelming evidence of its merits, it is impossible to imagine any study result that would cause that change of heart about THR for kids. Thus it is impossible to believe that they anticipate such a possibility and so do not want to act. Besides, if they eventually changed their minds and thought that minors should have access to THR, they know that they could probably get the sales bans reversed.
This really leaves only one apparent explanation that we can think of for the policy of trying to stop states from banning e-cigarette sales to minors: The American Cancer Society and their allies prefer that more children use e-cigarettes because that would look bad for e-cigarettes.
It is fairly clear that their political faction is trying to bring about a ban or similar crippling restrictions on adult access to e-cigarettes. But they and other ANTZ cannot have failed to notice that their goals are not shared by normal people (the vast majority who believe that public policies should support freedom, happiness, health, etc.). When state or local proposals to restrict adult access to e-cigarettes are considered, we are able to mobilize people — most of whom have quit smoking by using e-cigarettes — to explain why this is a bad idea. Almost every single time when the decision-makers are legislators or other representatives of the people, they hear this, understand its merits, and do not implement the restrictions.
Despite this general opposition to ACS et al.’s goal, they have a chance to achieve it if they can claim that banning or severely restricting availability is needed to protect the chiiiiiildren from this scourge. But right now few minors are using e-cigarettes, and for most of them it is a passing lark. If there are minor bans, then furthermore it can be pointed out that (a) there are existing laws that could be enforced to further reduce underage use and (b) those who are using are already violating the law so further regulations are unlikely to change much. Under those circumstances it is pretty hard to justify severe restrictions on the freedom, happiness, and health of adults to ostensibly protect them.
But if children can legally buy e-cigarettes (and just a few merchants are willing to sell to them, even though most have a policy of refusing to do so even where it is legal) the number of underage users will increase and the arguments about just enforcing existing laws will not apply. So it would be a reasonable plan to try to maximize the use of e-cigarettes by children in anticipation of using that prevalence as a tool in the ultimate fight for prohibition or semi-prohibition.
It might sound over-the-top to suggest that ACS et al. would sacrifice the children in pursuit of their real goals, but I have not thought of or heard any other explanation for the behavior that has been observed. Besides, the real brains behind the ACS policy must know that a little dabbling with e-cigarettes does not pose any serious threat to the kids (especially when compared to the illegal products that can easily get and dabble instead). So even though ACS’s useful idiots do not realize this, the leadership know that any harm from children’s use is quite minor.
This tactic is not particularly unusual; indeed, it is quite common and proven effective. When you want to solve a problem (to them, the existence of THR products is a problem), but do not have the support to make it happen, it is often effective to intentionally make the problem worse in order to gain more support. Can’t get the world to care about the oppression of your people? March in the streets or sit down at lunch counters until you are arrested or battered or shot, and the world will eventually decide that something needs to be done. Can’t get the complacent peasants to fight back against the occupying force or government that you believe is oppressing them? Provoke those in power into acts of greater oppression and violence against the people to motivate the resistance. The world has forgotten that you have been imprisoned without charges at Guantanamo for your entire adult life? Go on a hunger strike. Compared to those uses of this tactic, causing more kids to use e-cigarettes is pretty benign.
Those dramatic examples obviously involve greater sacrifice, but notice that in such cases those suffering the sacrifice are also (at least in the eyes of the actors) the ones who are already seriously suffering. So causing more kids to use e-cigarettes is comparatively harmless, but would be a rather more cold and calculated application of this tactic.
Could I be wrong about my inferences here? Of course. But no alternative explanation for ACS’s actions is apparent. And my analysis does pretty closely match the stated position (pdf) of ACS et al. on indoor smoking bans, of refusing to support “step in the right direction” regulations when they cannot get everything they want. Of course, the official statement dresses it up nicer (and merely calls for not supporting, rather than actively torpedoing), but the unstated motive is the same: If you let the world move more toward the state where normal people think that things are basically fine, then you cannot get them to support radical policies as the “only” alternative to the status quo. This is basically the same as the assessment I reached before someone pointed out that document to me: Intentionally make things worse (compared to a world where generally-supported regulations have been implemented) to try to manipulate the people into supporting much more radical steps than they would otherwise support.
If ACS (or their allies who have worked to prevent minor sales bans) offer CASAA an alternative explanation for their actions, one that does not include intentionally getting more kids to use e-cigarettes, I will let you know. They had a chance in the Rhode Island testimony to give a plausible explanation for their position, but they chose to talk around it and make non-credible claims about their motives. Their allies from Rhode Island have engaged in a Facebook conversation with us, but have said nothing of substance yet. This blog has a standing offer to let anyone who is indicted here write a guest post to reply, so they could take advantage of that. I know that the previous post was sent to them, and I am confident this one will be too (hint hint!), so if there is no such reply it will not be because they have a defensible alternative explanation but merely did not realize they needed to explain it.
The random ANTZ in academia and exclusively anti-tobacco and anti-THR organizations can easily get away with socially destructive behavior because they have engineered a situation where they only have each other to answer to. ACS has a lot of support from other constituents and the general public. I wonder how those supporters would react if they knew about this?
[UPDATE: another post about this here]
Tobacco harm reduction, anti-THR lies, and related topics 
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Carl, your analysis is strange and unusual.
And I happen to agree with it 100%. There was a study that you or another blogger wrote about a couple of months back where the main body of data seemed to be ignored in favor of stressing the point that a seemingly large percentage (62% or some such) of 12 year olds who had tried e-cigarettes were ::gasp:: NONSMOKERS!
The point was clearly one of positioning e-cigs as a major “gateway drug” to smoking.
HOWEVER… when one considers the fact that only about five percent of the 12 year olds would be self-identifying as smokers to begin with, the picture becomes a bit different.
Let’s say we looked at SIX year olds instead of twelve year olds. If we searched around diligently until we found a hundred of them in the entire country who’d “experimented with” e-cigs, we’d probably find that only two out of that hundred (if that many!) were self-identified smokers. Thus we’d be able to make the terrifying claim that NINETY-EIGHT PERCENT of six-year-old e-cig “smokers” were nonsmokers in general and were being “introduced” to smoking by e-cigs. 98%!!!! Now how would THAT be for an “emergency” statistic indicating that “Something HAS to be DONE!” ?
The study had collected a fair amount of actually interesting and valid data if I’m recalling it correctly. But they chose to emphasize this ONE off-the-wall statistic of 62% of 12 year olds as though it actually had real meaning. And the ONLY sort of motivation behind that kind of thing would be exactly the sort that you point out in this blog entry.
– MJM
“…..minors’ access to e-cigarettes…..kids should be able to employ THR. There is some merit to that position, though no one (literally no one, to my knowledge) actively supports it.”
Yes, that is a powderkeg just now. Only the brutally honest and totally fearless could support it: if a youngster is going to start smoking or consuming nicotine anyway, then is it better they start smoking or vaping? There are many reasons why the answer is of course: “Let them start vaping”.
It may be that the day someone can state that in public, without recrimination, then THR is truly accepted.
(p.s. I never said it, you just imagined it.)
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The reason why ACS (and other health groups) opposed the bills in RI is because I and others informed them that the bills were being sponsored by RJ Reynolds (as I knew that would convince them to oppose the bills).
So I don’t understand why Carl is trashing ACS since it (and other groups) joined forces with CASAA in opposing the legislation.
Bill Godshall
Well, you could call it trashing. Or you could call it giving them credit for clever tactics. But I am inclined to call it pointing out to people what is really going on, and identifying the lies. Not everything is about winning whatever political skirmish happens to be occurring this week.
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Every health group I know of is against selling e-cigs to children and would support legislation that addressed ONLY that specific issue. However, the RJR-written legislation was a Trojan horse that claimed to be about protecting kids while conveniently excluding e-cigs from the statutory definition of tobacco products, thereby introducing a myriad of potential legal ramifications at the federal, state, and local level. Understandably, there is no trust. RJR’s reputation for protecting kids is far less than stellar.
Look again at what I wrote (including the recent post based on Mike Siegel’s followup on this). I am not sure how you reconcile the words and deeds of the three mentioned “health” organizations with your claim.
The RJR-written legislation was indeed unfriendly for consumers, interfering with merchants other than the tobacco-selling convenience store distribution chain that RJR has, and presumably plans to use, but others do not. However, even when CASAA arranged to strip out the offending bits and distill it down to basically just a minor sales ban, ACS still opposed it, and specifically said they opposed the minor sales ban. ACS have also actively opposed minor sales bans that had no industry involvement for years. It seems like a pretty desperate clutching at straws to try to make excuses for their explicit statements based on some unidentified and unexplained “Trojan horse” that was generally not present in the legislation they opposed.
As for the “reputation” side of that, would you (or whoever you are quoting from, if you are just repeating and not offering your own opinion) argue that, say, RJR should not be allowed to build a fence around one of their manufacturing plants to keep kids from getting in and getting hurt? It is the same logic: nothing they do, no matter how obviously a beneficial good idea, could possibly help protect kids because they have a bad reputation.
I did try to identify and explain the Trojan horse concern. The definitions proposed in the “youth access” legislation written and promoted by RJR in several states would have exempted e-cigs from the statutory definition of tobacco products. For or against that particular language, it is substantial and has far-reaching ramifications. Yes, I certainly agree RJR should be able to build a protective fence around their corporate property. However, I oppose efforts by those recently-convicted racketeers to write legislation.
Ok, sorry for missing that. I am not sure which cases that was still in there after most of the bill was changed. Not all of them in any case — some just defined the products as best the writers could and forbade sales to minors — so it does nothing to clear ACS from the indictment.
On your point, yes, lumping e-cigarettes in with other tobacco products for all regulatory purposes has substantial ramifications. So far, basically no one who thinks it through seems to think that is a good idea. Why de facto prohibit e-cigarette specialty shops and give advantages to merchants who sell cigarettes? How can existing tax laws on “other tobacco products” port simply to something whose units of measure are radically different, even setting aside the general stupidity of imposing a tax that discourages harm reduction? Those are the two main ramifications — other than the sales ban to minors — of a state declaring that e-cigarettes are part of all their OTP laws. There seems to be no advantage of that to anyone other than the merchants of other tobacco products (and, of course, those whose business model is threatened by harm reduction itself, like ACS).
I should have said “no one who thinks it through and is motivated by the public interest, good governance, or public health thinks it is a good idea”
R.J. Reynolds tried to deliver a very full Trojan horse to Oklahoma… http://newsok.com/tobacco-bill-a-sign-that-oklahoma-lawmakers-had-reached-their-limit/article/3835585
The Oklahoma bill, as readers of the CASAA blogs know, was rather more complicated than the RI or AZ or various other minor ban bills that ACS opposed. CASAA worked with the sponsor to remove the (arguably hidden) anti-competitive bits when it was resurrected as an amendment to another bill after we successfully worked to get it defeated when it was first voted on (see, I told you it was complicated). The final bill did lock in (as much as anything can be locked in by a legislature) a lower excise tax on low-risk products compared to cigarettes — which is and even better idea than just a minor ban (though note that there is no excise tax on e-cigarettes right now, so it was not entirely clear we should support that; again, I told you it was complicated). But exactly how is that a Trojan horse? It was right there for everyone to see. Also, it was an additional benefit of the bill, not some hidden negative or carve out for RJR.
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