Tobacco control’s violations of human subjects ethics, and other implications of the RSPH “sting” of ecig vendors

by Carl V Phillips

So apparently there is a UK organization known as the Royal Society of Public Health which presumably had some importance back when the East India Company was not just a retail brand. And apparently they did some secret shopper research of vape stores for purposes of generating publicity for themselves (like a retail brand would). The main payload was the breathless observation that half the shops did not interrogate the customer about their smoking status before selling e-cigarette products to them, and that most of the rest did not refuse to sell upon learning the faux-customer was playing the role of a nonsmoker. The RSPH then portrayed this as a violation of a largely-nonexistent “code of conduct” and managed to get this non-story all over the press in the UK.

I write that so dismissively — about the organization and the research — for a reason. This was much ado about nothing (as Paul Barnes entitled his post about it, which you can read for more of the basic details; see also Clive Bates’s post in which he dismisses it as a “cheap publicity stunt”). But despite this just being a blast of silly throwaway junk — what we observers of the public health industry simply call “Friday” — blogs and Twitter just lit up about it.

Part of the heightened reaction, as compared to all the other bullshit press releases, can be explained by the strange British obsession with anything containing the word “Royal”. Partially it is because the core failure — the notion that legal retailers of a consumer good should be policing their adult customers to see if they were “the right kind of people” — is something everyone can spot the flaws in; it is not some arcane matter of sample selection bias or confounding. So, for example, we can observe that no retailer ever checks to make sure an adult customer is a smoker before selling her cigarettes. This also makes it particularly easy and fun to satirize. (Incidentally, if a retailer in the USA discriminated in the way RSPH demands, refusing to sell to a potential customer because of his nonsmoker status, there is a good chance it could be successfully sued.)

But I also think the widespread reaction to this silliness, even among those who recognized it was just a publicity stunt, reflects a gut-level feeling that there is something more nefarious here than the surface level reaction implies. Since I try to point out the forest that is hidden among the trees (or should I use the royal “amongst” today), I will point out three deeper issues here. As I often do, I am trying to make a case that just responding to attacks like this at the level of their specific merits, even when the response is that they have no merits at all, is a fail. It is a terrible strategy to treat research like this as if it were fundamentally legitimate but merely flawed, as if it exists in isolation, and as if it were the work of decent ethical people who merely erred. That remains true no matter how effectively you eviscerate it on the surface.

The first forest-level observation was covered very nicely by Dick Puddlecote, so I will mostly direct you to his post, which is summed up in its title, “Today’s Lesson In Who Not To Trust“. It seems that RSPH is among those tobacco controllers who the dominant faction of UK e-cigarette advocates thought were their friends. The tale that DP offers about that is akin to my cautionary tale of tobacco control coming to own the vaping mindspace.

There might be a rare instance where common cause can be found with an entity whose raison d’etre is to destroy exactly what you are fighting for, but it takes strategic genius to recognize it and tactical acumen to play it right. In the real world, any appeasement or compromise with tobacco control is just a gift to them. For example, that “code of conduct” bit refers to a clause in the voluntary rules for members of one vape industry association. That document does indeed say that member retailers should only sell to smokers or former smokers, and by implication that they should demand personal information from their adult customers in order to make that decision. You can read more details about that in any of the above-linked posts — e.g., that only a tiny minority of the study subjects, if that, were even members of this organization.

The big-picture issue is that this rule is purely an attempt to appease tobacco controllers; there is obviously no legitimate reason to deny one’s low-risk product to the rare nonsmoker adults who want to try it, and no competitive advantage to be gained by agreeing to do so (this is the type of “rule” that can sometimes be to help cement a cartel, but it was not going to have any such effect in this case). And look where appeasement gets you: The “public health” types use the “compromise” — which they offered nothing in exchange for — as a bludgeon to demonstrate the legitimacy of their absurd demand, and as a launching point for demanding even more. In this case they implied that every retailer agrees to abide by this stupid rule, and then further stretched it into demanding that e-cigarettes be sold only as proper smoking cessation therapy. Well done, guys.

As I have repeatedly pointed out, if you want to preserve the right to use e-cigarettes or any other tobacco products (or for that matter to eat snack food, etc.), the “public health” menace must be resisted everywhere, all the time. Their strategy — and it works brilliantly — is to impose any limitation they can whenever they can, and take any concession offered, and then lock in that progress as the new battlefront and never slow their push forward. They portray the most extreme policies found anywhere as the minimum standard that everyone else is remiss for not meeting. They can be confident their progress will ratchet because there are basically immune from counterattacks: Consumers are fully focused on fighting the next holding action (even as they are losing ground somewhere else) and have limited resources in any case. Industry adjusts to the new regime, optimizing their practices to profit under the rules, and so has little interest in changing the status quo, even in a direction that could benefit them in the long run. Even efforts like FOREST’s strongly-supported campaign to roll back the ban on smoking rooms in pubs make little headway; most of the businesses that lost a lot as a result of the ban are already gone, and those that survived have already adjusted.

Moving on, the second deep issue afoot here is the patently unethical nature of this research. Tobacco control research is so replete with unethical behavior — misrepresenting study results, torturing the data, etc. — that it is easy to stop noticing just how truly evil it really is. As in, “You say the POTUS broadcast four more blatant lies today? *shrug* What else is new?” But in this case, it is a violation of human subjects research ethics, where there actually are binding codes of conduct in terms of national laws and international treaties.

The political behavior of “public health” is so unethical that it is easy to overlook what might seem like a minor technicality. But we should not let this pass. RSPH makes clear that they considered this as formal systematic research, not just a quick little “Channel 4 On Your Side” hidden camera investigation of a local news story. It was conducted on human subjects without their consent and with an element of deception. These observations alone are enough to demand that it be subject to serious outside ethical review, which it pretty clearly was not. That review would need to conclude that the knowledge being generated justified these dubious actions, which it clearly does not. But most importantly, the research was conducted with the intent to harm the subjects who were being studied. It is not like this “violating a code of conduct” attack was an afterthought, let alone the general goal of using the results to demand rules that harm the subjects. Even without the intent, the near-inevitability of resulting harm to the subjects makes this per se unethical research, a blatant violation of all accepted rules of human subjects research. The intent makes it worse still.

Perhaps some observers were distracted by the fact that this looks like a legitimate secret shopper sting operations where underage shoppers try to buy tobacco products. But whatever you might think of those operations, they are primarily police actions (even if statistics are later reported), designed to catch and punish people who are violating the law. They intend to harm the people being investigated because that is what police do. But social science researchers are not allowed to do that, even if what they are researching is a crime or similar bad act (which in this case it is obviously not).

To put this in perspective, consider a scale of human subjects violations:

  1. No problems at all.
  2. Mere technical violation of the rules with no risk of harm to subjects (e.g., a voluntary survey of non-sensitive information from fully-informed anonymous adults, conducted without ethics review)
  3. Accidentally and harmlessly collecting more information than you claim to be collecting (e.g., discovering you have inadvertently collected identifying information in the study in 2. and then deleting it.
  4. Secretly entering a special space where people think they are free of prying eyes and observing them as part of a project that is ultimately intended to harm them, even if the research itself is not harmful (e.g., spying on services at a mosque or the FDA-funded vape convention research conducted by Virginia Commonwealth that I documented here)
  5. Giving subjects misleading and harmful health advice and never briefing them that it was false, plus promising them compensation and then refusing to provide it, admonishing the subjects for even asking for it (the disturbing combination of ethical violations committed by the NIH- and FDA-funded researchers and Glantz satellites, Popova and Ling, that I documented here and here, and in this guest post by Brian Carter)
  6. Tuskegee (i.e., intentionally harming subjects as part of the research, secretly and without their consent)
  7. Mengele (i.e., carrying out obviously harmful research on involuntary captive subjects)

I include the examples in 2 and 3 as a confession that I have done that. No one is perfect (though there is a serious campaign afoot to eliminate the pointless rules that make the harmless social science research in 2 a technical violation). I left gaps because I am not one of those silly people who thinks it is possible to completely order complicated multi-factored lists; this is meant to be rough. In the 3,4,5 range is lots of somewhat ugly but sometimes ethically-defensible research that involves some harm to subjects who grant informed consent (e.g., medical RCTs give half the patients a therapy that we believe is inferior), or some deception (e.g., most psych lab research) or involuntariness (e.g., use of data collected for other purposes). By the time you get to 6, you are definitely in the realm of researchers who think “petty rules do not apply to great minds like me!” or at least the similar “my work is so important to the world I will not let procedural rules get in my way.” By 7 or 8 you have layered onto that a belief that you are sufficiently superior that you get to unilaterally decide what is right and wrong to do to people. At 9 and 10 you have reached the point where harming the subjects matters not at all to the researcher, and indeed is probably considered a feature rather than a bug — the backwater black people in 9 and Jews in 10 were “those people”, after all.

In the present case, the those people are e-cigarette merchants or vapers, who are similarly despised by tobacco controllers who do research on them. The RSPH research is in the 9 range, maybe a bit below Tuskegee but not much. Obviously I am not suggesting the consequences of what RSPH or Popova-Ling did to their subjects are of similar magnitude to letting them die of syphilis. This is not a consequentialist scale, but rather is about rules of conduct that govern whether any nontrival harm to subjects, deception, involuntariness, bad intent, etc. are allowed. There is a consequentialist overlay, as I suggested about the 3,4,5 range: Sometimes the potential benefits of the research justify some dubiousness regarding these considerations, as with a potentially informative medical experiment. However, basically nothing in the 8,9,10 range could ever pass that test, short of research to defend against an extinction-level threat. But the thing is that, like Tuskegee, the RSPH research, along with the Virginia and Popova-Ling studies, had zero potential to produce any useful scientific information. Thus no imposition on subjects could be justified, even down in the 2 or 3 range. At least Mengele’s work actually produced scientific knowledge (which created a whole other set of ethical questions: because the work itself was so evil, should scientists have just pretended they did not have the fruit of the poison tree?).

I cannot overstate this: The RSPH and similar research is horrifying, in terms of its disregard for the rules of human subjects ethics. This, in turn, says something about the commentators who ignore that. I am not talking about the average consumer who makes valid criticisms of the specific junk claims. But everyone who fancies himself a researcher, professor, or expert on research should scream about this. The fact that they — including a lot of supposed friends of vaping — do not is an equally horrifying commentary on the ethics of public health more generally. People in that field exhibit none of the sense of care-demanding responsibility a researcher or teacher should feel toward his subjects or students, and none of the humility required to be a genuine scientist. It seems that they are blind to just how outlandish this flouting of ethics is because they are personally not so far removed from the behavior of RSPH or Glantz et co.

This brings us to the third big-picture issue, which I will discuss only briefly because I am in the process of writing something more comprehensive about it: The RSPH attack research is a perfect example of the tendency toward fascism in public health. There were quite a few amusing tweets about RSPH’s demand to restrict e-cigarettes to smokers, along the lines of suggesting that grocers should demand to know that someone already drinks sugary soda before allowing them to buy diet soda. One that I did not see was the suggestion that workers be allowed to take the weekend off, or take a vacation, only if they can demonstrate that they are too tired or burned out to just keep working. Resting up for next week is, after all, the reason we have weekends, right? This analogy gets to the fascist essence of the mindset of tobacco control and more generally “public health”: Force should be used to prevent people from engaging in consumption that merely makes them happy; consumption should be limited to those for whom it improves their productivity (including bettering their health).

This mindset — that everyone owes all their possible time and energy to The State / The People / the proper worship of God / Her Royal(!) Highness’s Feudal Lords — is the essence of fascism/communism, or even out-and-out feudalism. It is also the only possible justification for denying people an e-cigarette or a soda, or for that matter cigarettes or an in-control heroin habit. Oh, they try to gin up claims that these cost other people money, but those are so obviously wrong that they cannot actually believe them. No, the only possible cost to society is analogous to people taking Saturday off — i.e., not using all their available energy to produce for The State et al. This is about not letting the serfs damage the tools, which happen to be their own bodies. Anyone with the slightest inclination toward individual freedom believes people have sovereignty over their own bodies. The “public health” special interest group, along with religious extremists and latter-day feudalists, do not.

To tie this back, consider again the unforced error in that “code of conduct”. Denying custom to nonsmokers is not merely the tactical error of conceding anything to tobacco controllers, such as agreeing to some restriction on advertising. It actually concedes that their worldview about people’s (lack of) rights to control their own bodies has merit.

Responding to each bit of public health junk science on its technical merits, implicitly conceding the problem is not their fundamental lack of ethics or vile view of humanity, is like criticizing U.S. military attacks only for their tactical errors, implicitly conceding that unauthorized killing of civilians we are not at war with is just fine so long as it is technically well executed.

26 responses to “Tobacco control’s violations of human subjects ethics, and other implications of the RSPH “sting” of ecig vendors

  1. David in the UK

    I read this blog when I get a chance. I’m always so impressed by the incredibly high standard of writing and intellectual application. That’s not meant to sound patronising or sycophantic – I genuinely feel that way and I believe such praise is justified. I am interested in philosophy and politics and if the same standards of analysis and reasoning were applied there as here, things would be a lot better. So, Carl, thanks for the sheer quality of what you do.

  2. Excellent article, Carl, thank you for writing it.

    When I saw that ‘research’ yesterday, all I could think is that the next step is going to be yellow stars for smokers – and probably vapers. Maybe the vapers will get a different coloured one. As a concession from public health, you know. Because if you give the prohibitionists the slightest concession, that’s what happens.

    I don’t know if I’m more unnerved about that, or about how so many people these days actually believe that the state makes better judgements about what we consume, how we spend our time, than we do. It’s all pretty scary.

  3. natepickering

    This one scores only slightly lower on the Facepalm-o-Meter than the headline that’s been making the rounds about “One in four teens” being exposed to “secondhand smoke from e-cigarettes.”

    The thing that makes it really horrible is that a lot of horrendously misguided vaping activists don’t understand why it’s horrible.

  4. As usual, a great blog.

    I, as I’m sure the rest of the world has, have seen the press release. What I can’t find is where the actual ‘research’ is published. Is there a peer reviewed publication or, at least, a full report anywhere in the public domain?

    • Carl V Phillips

      There is not any more than that release out there as far as I know. It seems like a safe bet that they will never publish a proper paper. As I noted, they presumably did not get outside ethics approval for this, and any legit journal would reject it on that basis. That would not stop them from publishing the paper themselves, of course, but I doubt they have the skills to do it. I suspect they never even had a scripted protocol or properly recorded their methods. (I just base this on my knowledge of what typically passes for research in “public health”, not any specific knowledge about the project.)

  5. Very good post, Carl – I agree with all you say. My own modest effort was to get some usable facts and arguments in play early in the day should this story start to run. It’s not so much a ‘Royal’ obsession, but concern that the BBC was running with it – which usually means most people in Britain will hear about it.

    • Carl V Phillips

      That makes sense. From far away it is difficult to see the difference between “it was available via a major press outlet if you looked for it” and “they blasted it at you if you so much as checked the day’s headlines”. I gather it was closer to the latter, which definitely motivates (and warrants) a greater response than average.

      I am still not going to give up my “Royal” hypothesis, however. :-)

      So it will be interesting to see if your network of open-letter-signing professors and slightly-rogue tobacco controllers says boo about this, re the points that I made. The smart money says they won’t since they apparently do not read much and are blind to the core problems. I will cross my fingers for Hajek — he seems to be the brains of that crowd.

      • Carl V Phillips

        re: “brains of that crowd”

        It occurs to me that I should make explicit the “present company excepted” that I intended with that. You, Clive, of course provide excellent insight. The point was — and I will make this explicit too, because I don’t want to be misinterpreted — is that most of the supposed friends of vapers in that crowd seem to avoid saying what would really be useful to say, or it is actually beyond their skills to figure it out.

  6. And I meant to say, you are right to note there was some deeper unease about this ‘research’, which hadn’t been articulated. The subterfuge and (bogus) entrapment needs justification – and there is no justification for this.

  7. Thanks so much for this excellent article, Carl; this is a very valuable lesson.

    A thought ….. Another unintended consequence of this code of conduct and especially as it’s now been spread throughout the media by RSPH, is perception of harm. It could be picked up on as the IBVTA conceding harms, by opponents who only deal in BS propaganda and junk studies, especially from the US. By stating that vaping supplies should never knowingly be sold to non-smokers, when people are never grilled when they purchase cigarettes, could give entirely the wrong and harmful message …. it could suggest to consumers and non-consumers that all that BS may be true and that vaping is as, or more, harmful than cigarettes, as some sadly, already believe.

    Why on earth would anyone voluntarily state this, when it does more harm than good, unless it is only as an ill thought out, misguided concession to public health, but unnecessary when you have a product that is pretty near harmless? Give them an inch and they’ll take a mile! It’s nobody’s business why a person wants to buy a legal product and who, running a small business, can afford to turn trade away when there’s no good reason for it? After all, those non-smokers could be potential smokers, where vaping would be a very valuable diversion.

    As I understand it, many small businesses feel the IBVTA’s fees are prohibitively expensive, so it’s likely that very few, if any, were members ignoring this code of conduct.

    • Carl V Phillips

      (note: I made the typo correction you requested)

      Yes, I agree that the concession also had that additional effect, of implying there was some genuinely legitimate reason to refuse to sell — which would be presumed by most people must be because of unacceptable health risk. I am not sure the contrast with cigarettes purchases would actually push that so far as to cause people to think that the risks were similar or even greater than smoking; anyone who could manage to fill that in and think it through would probably be immune from the false signal.

      Thinking about this more, I am thinking that the worst part of the signaling is not about the product but about the politics again. So not only does the concession give immediate and direct aid and comfort to the enemy, but it also signals the public that the enemy must be right. As in, “The company denied any wrongdoing, but agreed to change its practice and compensate past customers.” => “No wrongdoing? Ha! Yeah, right, they just gave in because everything was perfectly fine.”

      As for why, I suspect no one thought it through. No one even thought it through enough to realize they were creating something that needed to be thought through. Consider this: no one ever asked me “mind taking a look at this to see if it seems like a good idea?” Could you imagine creating such a policy without even spending the few hours and few dollars it would take to ask the half dozen top analysts in the area (who are not exactly reclusive) to review it, even if you ultimately might not take their advice.

  8. Para 1. The reason I contrasted it with cigarettes was because all the polls show that each year, thanks to all the propaganda, more and more people believe that vaping is the same as, or even more dangerous, than smoking. For people who have seen or participated in these polls, or have come to such conclusions themselves, I didn’t think it was such a leap, but that’s maybe because I’m so close to it.

    Para 2. Exactly!

    Para 3. I’m pretty sure that IBVTA now wishes they had asked for advice and after the fallout, if they’re sensible, they will be removing their concession, even though the horse has well and truly bolted, left the field and is half way down the motorway.

  9. “e-cigarettes or any other tobacco product”

    Only got this far, and will read the rest, but…

    Stop that.

    Liquid with nicotine isn’t a tobacco product.

    Liquid with no nicotine certainly isn’t.

    If vaping liquid is a nicotine product, so are potatoes, aubergines, tea and tomatoes.

    And, no, I’m not suggesting they also get included in the TPD.

    • Carl V Phillips

      As I have explained (repeatedly!!!), categories cannot be wrong unless they are absurd. You can define the category, “tobacco products”, in various ways that include e-cigarettes. Most people do. The U.S. government does that (based on it containing a bit of the tobacco plant). I do that (based mostly on its niche in society). An e-cigarette without nicotine does not fit the U.S. government definition (though FDA is trying to ignore that fact), but it does still fit mine so long as it is still being thought of as being like a cigarette (which could change). You seem to be referring to a different candidate definition of the category that does not include e-cigarettes. I can think of a few candidates (contains visible bits of tobacco; more than X% of the total object is derived from the tobacco plant), but I have no idea which you are using (and I would bet that you don’t either). If you used a Star Trek replicator to create a perfect replica of a Marlboro, building it up from atoms, the U.S. government definition would exclude it, mine would include it, and yours…?

      Anyway, the point is that the only choice in sight that is clearly wrong is to declare any of these definitions to be wrong.

      • But it *is* absurd.

        Carl, “Something that isn’t actually made from tobacco, but happens to contain something that is also in tobacco, is a tobacco product” seems to be part, if not the entirety, of your definition.

        Apparently – I’ve just learnt – along with “even if it doesn’t have anything from a tobacco plant, it still actually is a tobacco product.”

        Which is why aubergines actually *do* fit your apparent definition of a tobacco product. And, by extension, you want them included in the TPD?

        As I said, absurd. And stop it.

        • Carl V Phillips

          First, you need to be more careful in your writing. It would represent a level of familiarity beyond our brief social media exchanges to even phrase what you just said as advice, and is rather outlandish to phrase it as a demand.

          Second, you need to be a lot more careful in your reading. Literally every claim in your reply is already shown to be wrong in my short response that you are replying to.

          If after you have reviewed my previous writings on the topic you really think that you have something to say about this that I have not already considered, you can circle back and tell me what it is. (oh, and: Third, you need to recognize that it is very rare that someone can come up with a major point that an expert who thinks a lot about the topic has never considered. You can often save yourself some embarrassment by habitually using phrases like “How do you respond when someone observes…” or “I am sure you have already thought of this, but…” in such situations, to avoid suggesting you think the idea is novel.)

  10. Roberto Sussman

    Very well argued exposition of the vast massive rest of this iceberg, which involves ethical and political issues that go far beyond a trashy thuggish “sting” to vaping vendors (the tip of the iceberg).

    Could this tip of the iceberg be a sort of “trial balloon” that would precede (along the “salami theory” modus operandi of public health) a sequence of gradually intrusive regulations whose goal is to officially and legally restrict e-cig usage to smoking cessation medicines, to be purchased on prescription by “registered nicotine addicts” ? After all, this goal is explicitly stated by the RSPH and has been voiced by a lot of public health bureaucrats. This desired transformation of e-cgs from recreational consumer products to medicines is in line with regulators (FDA, TPDA) trying to destroy the vaping industry, all of which begs the question (that you raise eloquently) of how long will vaping merchants and/or promoters remain in bed with those trying to destroy them.

    To transform e-cigs tobacco into smoking cessation medicine only sold to “addicts” the tobacco controllers need to convince the government of the necessity to create official registries of smokers or ex-smokers (ie to make the present informal IBVTA “code of conduct” officially legal and binding). They know that this is very intrusive, and thus under current conditions it would raise a lot of legal issues and could provoke a strong political reaction (like the reaction that would have occurred in 1985 to proposing intrusive outdoor smoking bans), so they try to do it by the gradual salami theory and we are seeing the first trial balloon of the sequence.

    Another reason for controllers to release now this trial balloon preceding a salami theory is to prevent what would be the worse nightmare scenario for them, namely: millions of non-smokers and never-smokers starting to vape without ever having smoked tobacco AND without migrating to tobacco smoking. This potential scenario is not impossible and would not compromise *REAL* public health because vaping is a very low risk habit (most never smokers would vape without nicotine as surveys show). However, it has important political and financial implications, as massive vaping would create a multi-billion’s worth market that could be filled by the present vaping and tobacco industries. Obviously, the controllers know this is potentially very disruptive for them, not only to their ideology, but (more importantly) to their “gravy train” and to the vested interests of their pharmaceutic allies and sponsors. No wonder this crowd regards this as an important existential issue that cannot be hampered by the ethical issues you raise.

    • Carl V Phillips

      I would say that calling it a trial balloon gives them much too much credit for being organized and strategy. Rather, I would suggest that pushing everywhere on their battlefront all the time, without any real strategy other than that, the resulting tactics replicate the effect of sending up trial balloons (lots of them). That is, they are constantly floating everything they can think of, and — as I noted in the post — grabbing on to anything that sticks.

      Also, the more realistic pathway toward mostly enforcing that registry idea is just to make something prescription-only. Yes some medics with libertarian values will just hand out prescriptions to anyone who can pay for a consult (as with medical marijuana) but most people will be shut out. Watch Australia, though — if anyone goes for tattooing a star on the arms of smokers, it is they.

  11. Roberto Sussman

    Yes, a ‘prescription only’ approach would overcome (at least in the short run early stage of the salami process) the need to create smokers registries, but it is may still be problematic today because legally e-cigs are not medicines. In a lot of countries (for example Mexico and I would say all of Latin America) prescriptions are handed in a very lax manner. Save for medication with known potentially dangerous side effects or controversial usage (marijuana), every other medication that requires prescription in the USA can be bought in any Mexican pharmacy without prescription. A lot of Americans cross the border to buy less controversial medication without prescription. Demanding a prescription only sale of e-cigs would be the first step of the salami theory, which would still leave (as you say) a lot of enforcement holes, the next salami theory step would be to raise the goal posts by placing e-cigs at the level of marijuana or hard tranquilizers.

    I agree that controllers may be acting in a haphazard trial and error tactical form, but given the threat they (and the pharmaceutics) feel from possible massive usage of e-cigs by non-smokers and never smoker, perhaps this time they are acting strategically. Perhaps Australia is (for them) the “trial country” to pursue this strategy.

    • Carl V Phillips

      Yeah, I am still not buying this as strategic targeting. I still think their strategy is nothing more sophisticated than “push for more, everywhere and all the time”. These are generally not very bright people; some are clever and many have social tactics skills, but there is not much sign of real intelligence. There is no evolutionary pressure for them to become strategic or to weed out those who are not: They have unlimited resources, they face no counterattacks, and most of all they never have to demonstrate any accomplishments. In other words, we are talking about an entire group of people who are like Donald Trump, only more so, and no one would mistake his policies for being strategic.

      • Roberto Sussman

        You know them much better than I do, as you have been engaging them for years, so I take your word on their lack of strategic thinking (which is not necessarily intelligent thinking). However, an academic-political cabal that lacks evolutionary pressure to become strategic risks becoming sclerotic (regardless of their money and political clout). The analogy with the old Soviet Union (keeping proportions) suggests that such systems may implode from internal contradictions and external factors. Nobody thought the USSR would implode in the 1980’s, but it did. Just wondering.

        • Carl V Phillips

          Keep a good thought.
          Yes, it is certainly not beyond plausible that they would start to melt down with little warning. But a governmental system is ultimately answerable to a huge number of people who can turn on it, even if they are extremely oppressed. TC is answerable to no one who really cares (“mobilize the US congress against them!” — yeah, right).

        • Roberto Sussman

          Yes, I agree: even a dictatorship like the former USSR was somehow (even if indirectly) answerable to millions of its subjects, whereas an omnipotent health bureaucracy (like TC) is not answerable to the public. I agree, mobilizing millions of citizens to force congress against TC will not happen. However, TC may implode from its main weakness: its dependence on government (and partly pharmaceutic) funding to survive. Notice that the USSR did not implode because some external donor stopped funding it. Even the Castro regime in Cuba did not collapse when the USSR stopped funding it, but TC might implode, perhaps gradually, once its funders decrease or stop funding it.

          TC is currently facing a lot of external stress and internal contradictions (which are hushed by a wall of secrecy) that did not exist 10-15 years ago at the peak of its power. Perhaps their lack of strategic thinking is concurrent with the exhaustion of its prohibitionist paradigm (based on the “tobacco wars” of the 1980’s plus the ETS scare). Add to this their failure of steep up the decrease of smoking prevalence and the challenge from THR (as weak and contradictory as it may be). Further: public health funding seems to be shifting emphasis on obesity and sugar. All these are signals that the TC imploding process may have already began.

      • Carl, Roberto
        re :There is no evolutionary pressure for them to become strategic or to weed out those who are not: They have unlimited resources, they face no counterattacks, and most of all they never have to demonstrate any accomplishments.
        There are an awful lot of people these days who spend virtually all of their days doing conferences and doing strategic plans.

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