tim's experiment

Two similar stories in Tuesday’s English-language newsrags, from which I think we can infer that somebody held a press conference. Amalgamating the information provided in both stories we can produce a list of dramatis personae who were present. For the Council On Smoking and Health: Executive Director Vienna Lai Wai-yin and chairman Antonio Kwong Cho-shing. For the Hong Kong University School of Public Health: Professor Lam Tai-hing and Associate Professor Daniel Ho-Sai-yin. The ostensible purpose of the proceedings was to announce the results of a survey, commissioned by COSH and conducted by the SPH, into the public’s use and knowledge about vaporisers, or e-cigarettes. The basic principle of these gadgets is that a little wire heats water, which you inhale. The water can according to taste be given a variety of flavours, or a drop of nicotine if you happen to be addicted to the stuff. Basically you are inhaling steam, which is harmless enough as long as it is not too hot, and in my youth was a popular folk remedy for a blocked nose.

However this is not the way COSH sees it. In the view of single-issue fanatics who have been persecuting smokers for years anything with cigarette in its name must be the work of the devil. So the purpose of the survey was to put some wind into the sails of the COSH effort (incorporated in newspaper ads the next day) to persuade the government to ban the gadget outright. Actually the survey did not amount to much. In fact it amounted to so little that the Post’s reporter ignored it altogether, regaling his readers instead with the old statistic that an earlier survey had found 1.8 per cent of respondents were using the things. I shall refrain, although nobody else did, from describing the activity as “smoking” because this is flagrantly misleading: there is no smoke, and no tobacco. The resemblance to smoking is in the fevered imagination.

For the ostensible purpose of the press conference we had to turn to the Standard, which reported that the survey was conducted last year, and that 809 respondents were interviewed, of whom 74.5 per cent were “aware” of vapeing (as fans call it).  The survey also found that 4.4 per cent of the people aged 15-29 had vaped at least experimentally, compared with only 1 per cent of those aged over 30. At this point readers with highly-tuned statistical antennae will smell a rat. How many of the respondents, they will wonder, were in each age group? This is an important matter because if the size of the sample is too small then the conclusion is worthless, and it is no good having a sample of 800 if a question is only addressed to some of them. Happily this small detail was revealed. There were only 248 people in the 15-29 age group. That is not enough. To meet academic standards, which are not particularly exacting, you need what is known technically as a 95 per cent confidence level, and to reach that you need a sample size somewhere in excess of 400. So the survey result which we were being invited to share, in horror, was garbage.

Of course there was plenty of other stuff to write about. This consisted of what the lawyers call obiter dicta, which is the polite legal term for judges rabbiting on about matters on which they have heard no evidence. So Prof Lam was worried that there were harmful chemicals in e-cigarettes, which is disputable, and expressed fears that young people would get “hooked” on them. Come of it, Prof: no nicotine, no addiction. Prof Ho thought that new harmful ingredients “kept emerging”, which is nonsense, and cited two substances which have to be found to be carcinogenic at high temperatures. This is a well-known piece of research, and the temperatures required are much higher than those supplied by vapeing. If you tried to inhale steam at such temperatures you would cook your tongue. Prof Ho also recalled as a triumph that the government had banned mouth snuff in the 80s, “so that’s why today we don’t see any cases of people with cancer because they chewed…” Dear me. This has the logical structure of the lady in New York who used to go outside her house every morning and bang a gong. A neighbour asked her why she did it. “To keep the tigers away,” she said. “But there are no tigers round here,” said the neighbour. “You see. It works!” Prof Ho also, we were told “rebutted the claim” that e-cigarettes were safe, saying that there was no evidence to prove this.

The COSH gloss on all this was interesting. They thought the government should follow the WHO advice that e-cigarettes should be regulated in the same way as traditional products. By which they mean totally banned. But traditional products are not totally banned, so there seems to be a piece missing in this argument somewhere.

Both newspapers managed to get a quote from the Sec for Food and Health, Ko Wing-man, who told the Standard that the government would “carefully study” the call for legislation and told the Post that the government was “inclined to agree with it”. Mr Ko thought there was a “proven risk” that youngsters would graduate from vapeing to smoking.

Now let us make a few things clear. The hysterical opposition to vapeing has no scientific basis. Here is the comment by Marcus Munafo, professor of biological psychiatry at Bristol University, on a rather similar attempt to present the issue as a youth epidemic in the UK: “To describe electronic cigarette use as ‘a new drug use option’ and part of ‘at-risk teenagers’ substance using repertoires’ is unnecessarily alarmist, given the evidence that regular use among never smokers is negligible, the lack of evidence that electronic cigarette use acts as a gateway to tobacco use, and the likely low level of harm associated with electronic cigarette use.” The evidence from places where vapeing has been common for some time is overwhelming: the vast majority of users are people who want to stop smoking cigarettes. It is also widely known that many of them succeed. Some of those who switch to vapeing because it doesn’t require them to forgo their nicotine fix do actually find that they can gradually reduce the nicotine content to zero. The addiction, it seems, is as much to having something to fiddle with, put in your mouth and suck as it is to the actual nicotine content. Switching to vapour is the most successful way yet invented for hard-core smokers to avoid the substantial known hazards of real cigarettes. So if vapour is banned the consequences will be that large numbers of people who might have lived longer healthier lives will stick to their cancer sticks and die young. This is a curious way to improve public health.

I would also like to urge the School of Public Health at HKU to consider whether it is really appropriate and desirable for it to put out junk results in support of public agitation which it approves of. The purpose of such a school is to elucidate the scientific facts on which policy should be based, not to squirt propaganda into the public prints.

If the profs wish to continue as a political force then they need to get their heads round a few general public policy principles which are relevant here:

1. It is not acceptable to ban activities for adults because they would be dangerous for children. There are many things which would be dangerous for children, ranging from smoking, drinking and driving to getting married and signing contracts. The solution is to put minimum age limits on the activity, not to rule it out for people who are old enough to make their own decisions.

2. An activity should not be banned merely because it is dangerous for the person who chooses to do it. People in Hong Kong are free to hang-glide, Scuba dive, ride bicycles in busy roads, free-fall parachute, or join the French Foreign Legion if they wish. Restrictions on freedom are justified to prevent harm to others.

3. It is not up to people who invent or choose a new activity to prove it is safe or see it banned if they cannot do so. Those who wish to use the coercive power of the state to impose restrictions have the burden of proving that they are necessary. You cannot “rebut” the argument that something has no known hazards so far by pointing to the possibility that some will be discovered in the future. I realise that where the issue concerns chemicals and the human body this will sometimes mean that hazards are discovered the hard way. But if things are to be banned on the basis of scientific speculation we shall never make any progress. When the first railway trains appeared it was seriously predicted that if they travelled at 40 miles an hour the passengers would be unable to breathe.

4. People who want proposed prohibitions taken seriously would do well to avoid the argument that the controversial item has already been banned in Singapore.