Dear Public Health: This is why we’re angry

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Dear Public Health: This is why we’re angry

A few days ago I was talking to someone who works in public health. This person is genuinely well-meaning, and seemed upset at the amount of hostility they’re seeing from vapers. Why, they wondered, are we all so angry at them? Don’t we realise that public health activists are trying to help us?

Their hurt and disappointment were so obvious and real that I’d have needed a heart of stone not to laugh. Almost since the first electronic cigarettes appeared on the market, vaping has been under sustained assault from the public health sector. So far their efforts have resulted in a swathe of sin taxes and vaping bans across the USA; the FDA and European Union have imposed draconian regulations that threaten to wipe out the majority of products, choke innovation and make what survives far more expensive; the media is filled with scaremongering stories based on the flimsiest of science; and vapers themselves have been belittled, slandered and insulted. How did they expect us to feel?

Unfortunately, this person seemed to be completely blind to how their own behaviour looks from a vaper’s point of view – and going by the aggrieved complaints from many of their colleagues, they’re far from alone. Just to set the record straight I thought I’d set out why the public health profession is so unpopular with vapers. Settle down in your comfiest chair; this could take a while.

Vapers think public health are paternalistic

It would not be exaggerating to say that a paternalistic attitude dominates the public health sector. The focus is on making people behave the way public health think we should behave, often through coercive means such as legislation or punitive taxes – “supporting people to make healthier choices,” in the doublespeak of the profession.

This attitude suggests that many in public health don’t really understand what makes people tick. Most of us enjoy the feeling of achievement when we do something for ourselves, whether it’s as trivial as baking a loaf or as life-changing as giving up smoking. We like to feel capable and in control; outside the narrow field of identity politics, thinking of yourself as a helpless victim has little appeal.

Vaping gives smokers control. Most smokers know that they should quit, even if they don’t particularly want to, and e-cigarettes give them a way to do so without having to struggle through it or go to a stop smoking service as a supplicant, begging for help to do something they can’t do on their own.

Talk to a vaper who has fully switched, and listen to what they say. More importantly, listen to how they say it. They’ll be positive and upbeat. They will tell you that switching wasn’t difficult; often they’ll say that they suddenly realised it had been days since they smoked a cigarette. What shines through is that they’re rightfully proud of their achievement. They decided to do something, and they went ahead and did it. On their own. Without help.

And now public health want to take that away. Tobacco controllers are elbowing their way into the vaping scene, issuing proclamations on how e-cigarettes should be used and how people should be using them. Britain’s Royal Society for Public Health issued a press release showcasing this last Friday when they complained that, by not screening their customers and refusing to sell to non-smokers, vape shops were ignoring a code of conduct that 95% of them haven’t even signed up to. Of course this causes resentment.

Vapers think public health are dishonest

Vapers perceive public health as either careless with the truth or actively dishonest. A common complaint is that the vapour products industry is deliberately conflated with the tobacco industry as a scaremongering tactic. The reality is that the vast majority of products on the market are made by small and medium independent businesses. Nevertheless, vapers are subjected to campaigns like this:

The likes and retweets this tweet gained can be disregarded; they came almost exclusively from public health, politicians and assorted activists. It’s more illuminating to look at the replies. There were 34 of these, and only one was positive. The other 33 ranged from constructive criticism to open hostility.

It’s easy – and lazy – to lump vaping in with the tobacco industry, and the FDA’s decree that vapour products are tobacco products gives doing so a veneer of legitimacy. It’s also intellectually dishonest, though, because the products don’t contain any tobacco – and vapers know this. Among vapers, attitudes to the tobacco industry vary immensely; some share public health’s antipathy to it, while others do not. What all vapers have in common is that they resent being labelled as industry shills.

Unfortunately, this has become something of a default argument for many in public health. If you advocate for vaping online – even if you’re purely a consumer – it won’t be long before someone rudely accuses you of taking tobacco industry money:

These insults draw an overwhelmingly negative, and often angry, response from vapers.

I know almost all the prominent UK-based vaping advocates. I’ve met them, drunk beer with them, stumbled around Warsaw at three in the morning looking for a kebab with them. We are just ordinary people who advocate for vaping because we believe in its potential as a harm reduction method. We are definitely not industry shills or paid Astroturf, and it’s infuriating to be smeared with that accusation simply because someone would rather discredit us than listen to what we have to say.

Many vapers also suspect that public health researchers are carrying out fraudulent research. In many cases simple incompetence is a more likely explanation, but some experiments do seem to be set up to obtain the “right” answer. James Pankow of Portland State University first infuriated vapers when his research on formaldehyde, published in the NEJM and described by one vaper as “ass hattery”, turned out to have been fatally flawed. In a subsequent study he went on to “find” benzene in e-cigarette vapour, which may not be surprising as he had added huge amounts of benzoic acid to the liquid he used. This attracted critical blog posts and more hostile comments.

Vapers think public health are arrogant and pushy

Public health didn’t invent e-cigarettes. They didn’t persuade millions of smokers all over the world to cut down or quit by switching to a much less harmful alternative. But now they’re trying to crash the party and take over. They want to tell us where we can vape and what flavours we should be allowed. They’re demanding that electronic cigarettes are turned into a medicalised quit aid, and complaining that people actually enjoy using them. To a vaper this looks an awful lot like sour grapes.

A common complaint is that public health refuse to listen. Many activists insist on telling vapers how they think e-cigarettes work and how they should be used, instead of asking how they really work and how they’re actually used. Australian sociologist Simon Chapman is frequently guilty of this, and his articles and blogs tend to attract large amounts of adverse comments from vapers. A regular gripe – one that’s also frequently directed against Glantz – is that Chapman is prone to deleting comments he can’t answer.

In fact, a refusal to engage with vapers is characteristic of public health – and it’s making people angry. Public health’s interest in vaping is almost exclusively focused on imposing new restrictions and taxes, or on co-opting electronic cigarettes to suit their own goals. The people most affected by this are vapers themselves – but we almost never appear on public health’s list of “stakeholders”. Any vaper who doesn’t show them the deference they feel entitled to is generally ignored or, on social media, blocked. It is incredibly annoying when someone starts trying to rearrange your life, but doesn’t even have the courtesy to talk to you about it.

Vapers think public health are self-serving

Many vapers believe that public health are more concerned with their own prestige and careers than with actually helping smokers. A 2014 report from UCSF, partly authored by Stanton Glantz, began its executive summary as follows:

“California’s position as a leader in tobacco control is under threat”

Vapers don’t care about California’s position as a leader in tobacco control. They just want to be able to buy the products that have replaced cigarettes in their lives, and they get annoyed when their well-being is given a lower priority than the ego of Californian anti-tobacco activists. The UCSF report was strongly attacked by Not Blowing Smoke, a consumer advocacy group based in the East Bay, which – like many vapers – links California’s extreme hostility to e-cigarettes with the state’s vulnerability to falling Master Settlement Agreement funding. Not Blowing Smoke has been referred to as astroturf. It is no such thing; it’s run by Stefan Didak, a former smoker and current vaper, who established it with his own money and runs it in his spare time.

E-cigarette advocates are not being paid for what they do. People who work in public health are being paid, and many vapers think that they’re more concerned about preserving their jobs and funding than about actually eliminating smoking. This may be unfair, but it isn’t an unreasonable conclusion given the ferocious hostility to vaping shown by many in the sector. Fair or not, many people believe it.

Vapers think public health despise us

Some prominent figures in public health seem to revel in being loathed by the public. For example, at the recent World Congress on Public Health, Professor Martin McKee – an outspoken anti-vaper – apparently said “Enemy of the people is a label we should aspire to as heroes of public health”.

Predictably, the reaction to this – largely from vapers – was furious; comments ranged from “petulant tyranny” through “useless, greedy sociopaths” to an image of a firing squad.

It’s easy to write McKee off as an ignorant loudmouth, but where was the condemnation from his professional colleagues? Simple: There wasn’t any. This gives vapers the impression that McKee’s opinion is acceptable or even mainstream in public health – and if public health activists aspire to be our enemies, why shouldn’t we hate them? The failure of the majority in public health to condemn the behaviour of the extremists is tarring the whole profession with the same brush.

In one notorious incident in September 2014 the president of the UK’s Faculty of Public Health, John Ashton, launched a drunken rant on Twitter in which he hurled obscenities at vapers. Although Ashton later claimed he had been provoked, his timeline appeared to show that he had been seeking out vapers to abuse. This caused a huge amount of anger, expressed on social media, in forums, through blogs and in numerous complaints to FPH. However, FPH took no action for almost two weeks; then, after a perfunctory “inquiry”, Ashton was allowed to continue as president.

Throughout Ashton’s brief and voluntary leave of absence – he wasn’t even suspended – and the inquiry, numerous public health activists rallied round him. Media coverage was shaped by comments from his colleagues and put the blame on vapers despite the timestamp of tweets clearly showing that Ashton had initiated the incident. His deliberate abuse of members of the public was brushed aside or openly defended.  Ashton’s erratic and obnoxious behaviour – in one bizarre interview he was told he sounded like a bloke in a bar – and the staunch support he received from across the public health sector, generated enormous hostility from vapers.

On another occasion Lorien Jollye, who at the time was a waitress in a Cornish café, submitted a letter to The Lancet calling for a more inclusive debate on vaping. Instead she got an arrogant and dismissive reply from Stanton Glantz, Martin McKee, Simon Chapman and Mike Daube. This was seen as a crude attempt to shout down an unpaid consumer advocate, and provoked more blogs.

Vapers have, increasingly, had enough

Some figures in public health have been detested by vapers for years. Stanton Glantz is particularly unpopular; most vapers see him as an unqualified zealot with a poor grasp of science, and any research he does is usually dismissed (generally with good reason) as junk.

Glantz is so unpopular among vapers that a parody Twitter account has been created to mock him.

Martin McKee and Simon Chapman are almost as unpopular as Glantz, with Matthew Myers of the Campaign for Tobacco Free Kids, Tom Frieden at the CDC and Mitch Zeller of the FDA not far behind. There are many more in the vapers’ pantheon of hate figures, all of whom have richly earned their places.

However, the animosity held by vapers towards public health is becoming less tightly focused and is spreading to take in the whole field of public health activism. Even organisations that were previously seen as somewhat supportive of vaping are now attracting more hostility. Where vapers used to discuss in the hope of reaching a compromise, they increasingly feel that public health works on a ratchet principle – they will push for restrictions, then when these are achieved the goalposts are shifted and a new set of demands is issued. Vapers are coming to believe that any accommodation they reach with public health will simply be a step on the road to full prohibition.

The anger caused by public health’s approach to e-cigarettes is spilling over. Many vapers are now openly hostile to any public health campaign aimed at regulating people’s lifestyles – the global push for sugar taxes, for example. With millions of vapers around the world, and their numbers growing daily, further embedding the “them and us” attitude that’s emerging will reduce public health’s legitimacy in the eyes of the public – and they will only have themselves to blame.