John Tierney joins Aaron M. Renn to discuss the federal government’s efforts to limit electronic cigarettes (vaping), and the corruption of the public health profession more generally.
In the late nineteenth and early twentieth centuries, public health officials combatted epidemics of cholera and dysentery through improvements in water and sewage systems. In its modern form, however, this once-noble profession acts largely as an advocate for progressive causes, with trivial priorities including taxes on soda, calorie counts for restaurants, and free condoms.
In recent years, public health officials in America have even turned against vaping—the most effective antismoking product ever created. “The public-health establishment has become a menace to public health,” Tierney writes in City Journal.
John Tierney is a contributing editor to City Journal. He spent more than two decades as a reporter and columnist with the New York Times.
Aaron Renn: Hello, this is Aaron Renn, contributing editor at City Journal, and I am joined today by my fellow contributing editor, John Tierney, to talk about his article, “The Corruption of Public Health,” which appears in the Summer edition of City Journal. So, John, thanks for joining me.
John Tierney: Thanks, Aaron.
Aaron Renn: I think one of the reasons they picked me to do this is because I wrote an article last year called “Libertarians of Convenience.” And one of the things that I noticed in the article was that so many of these progressive activists are fighting as hard as they can to legalize pot. At the same time, they are trying to crack down on vaping, and I couldn’t quite understand why anybody would hate vaping, and this article really explains that. Why do they hate vaping so much? Or, maybe, who hates vaping and why?
John Tierney: It is progressive public health activists – that was a great piece, by the way, you did.
Aaron Renn: Thank you.
John Tierney: And you’re right, there is this bizarre libertarianism, you know, on the Left. I mean, it’s pseudo libertarianism in that it is fine to vape marijuana. You know, that would be alright, but the war on vaping is just the strangest thing. And it comes out of this sort of prohibitionist streak of the Left. The progressives have had this since the original progressives of the 1920s. They were among the leaders to ban alcohol and, you know, it’s the old joke about the Left that everything that is not mandatory is forbidden, basically. And, so, after the dangers of smoking became evident, the public health establishment spoke out forcefully against them in 1964, but at that point the public health establishment was really still – considered itself doing public things, but they would do public education. They would do, you know, their tradition was doing public projects to stop infectious diseases from spreading and doing vaccines. That kind of – things that are genuine public missions, they are public goods that the government should provide. But the profession has become dominated by leftist progressives, and their real goal has become more just expanding the government power over us and expanding that any behavior that strikes them as objectionable therefore the government should get involved in regulating that. And they became so fixated on, against tobacco, that whereas the original, you know, war on tobacco had been simply to warn people about the dangers of smoking, the goal went from being a smoke-free society to a tobacco-free society. So they became against nicotine in any form whatsoever, and they spoke out against smokeless tobacco, and basically hid the fact that smokeless tobacco eliminates 99% of the harm of cigarettes. And when vaping came along, even though vaping seems to be even safer and it has been estimated that it eliminates at least 95% of the dangers of cigarettes, it’s probably more than that, that’s probably a conservative estimate, the fact that it was nicotine and that it looked like smoking, you know, they are kind of like fundamentalist Baptist who objected to dancing because it looks like sex. And, therefore, the fact it looked like smoking and involved nicotine, therefore it must be bad.
Aaron Renn: Right. So, vaping, my understanding is there’s actually no tobacco at all in vaping. Is that true?
John Tierney: No. There’s nicotine in it.
Aaron Renn: Right.
John Tierney: And some nicotine is derived from tobacco, and that’s why some people call it a tobacco product, but the thing is the nicotine is not what is bad about cigarettes. You know, nicotine, it’s really not dangerous in itself. It’s sort of like caffeine. It actually has a lot of benefits. It’s, you know, I mean that’s why people will endure those deadly toxins in cigarette smoke because nicotine is such a useful drug. It improves people’s mood, it helps them concentrate, it helps memory, it speeds up reaction time, it helps people control their weight. That’s why, you know, I mean nicotine is kind of like coffee in that it provides a lot of benefits to people. And British health authorities have been far more sane about this. They have said that you know the nicotine itself is not especially hazardous and if we could find a way to provide it to people safely without all the, I mean cigarettes have thousands of toxins in them. And if there were some way to do that, we should encourage it. But in the United States, instead, it has been no, we have to stop this. We have to ban vaping in public spaces even though, you know, it’s water vapor, essentially. It doesn’t smell, it doesn’t bother other people, but we’re banning it. And there have been all these attempts to regulate it. The Obama administration passed rules that basically would have outlawed most vaping devices next year. And there has just been this kind of crazy crusade that – and people try to call it a war on tobacco, but, you know, it’s so different from cigarettes.
Aaron Renn: What does the science say about vaping as helping people to quit smoking or maybe get people on smoking? What does the evidence show there?
John Tierney: Well, the claim by, you know, by the foes of vaping has been that it is a gateway drug. That it gets, you know, will get teenagers to start smoking again. In fact, there is no evidence for that whatsoever. And, in fact, the amazing thing is that since vaping became popular around 2010, the rate of smoking among both adults and among teenagers has plummeted. It has declined much more quickly than it was before vaping came along. And at this point it is estimated that two-and-a-half million adults in America are vaping now who were former smokers. It has basically helped people quit. And it is not, and there’s no evidence that it’s causing, you know, teenagers to pick up smoking. In fact, you know, there have been some studies in towns where they restricted sales of vaping devices in these cigarettes to teenagers that they end up with a higher rate of smoking than they would have if they had left them alone.
Aaron Renn: You made a couple of interesting analogies in the piece. One of them is you compare the public health advocates who want to, who basically take a zero tobacco, nicotine approach, you know, complete radical approach to that to the abstinence only sex education…
John Tierney: Yeah.
Aaron Renn: …and then you sort of compare it to the advocacy that they have for things like needle exchange…
John Tierney: Exactly.
Aaron Renn: …for heroin use. So, it’s like they are opposed to giving someone who is a smoker a vaping tool that might get them, some of the toxic effects of that, but they support giving out clean needles to heroin addicts. I mean, how do you explain this?
John Tierney: I mean, it’s partly this sort of style, or the preference in virtue signaling. You know, the helping a downtrodden heroin addict is okay, but tobacco and nicotine are so evil. And it’s, you know, there’s still this idea we are fighting the tobacco companies if we fight nicotine, so there’s some of that and just in, sort of, virtue signaling. That they support harm reduction for heroin addicts and they support harm reduction in that same philosophy is we should give out condoms to high school students because that will reduce the harm from sex instead of trying to insist on abstinence, but when it comes to nicotine it’s, you know, it’s abstinence only. It’s also, you know, called quit or die. So, there are actually heartless about that. I mean, the other, you know, there are a couple other financial explanations. One is that when – needle exchanges and antismoking campaigns provide jobs for people, you know. There is lots of jobs in these campaigns. The Robert Wood Johnson Junior Foundation spent, I think, about 700 million dollars in this goal of a tobacco-free society. So, there are conferences, there are lots of things from that. But when people quit on their own, whey they use smokeless tobacco or when they use e-cigarettes, there’s no jobs for anyone in that. And the astonishing thing is that really vaping is, I think, the most promising antismoking device that has come along. You know, they have been trying for decades now to get people to chew nicotine gum and lozenges, and use these other things, and the success rate is terrible. It is about 7%. And people don’t really like these things that much. And vaping came along – you know, people wouldn’t even use this gum very much when they would get it free as part of their prescription plan. Vaping comes along and has no official encouragement at all. People go out, spend their own money, find their own things, and they are quitting smoking. As I said, two-and-a-half million people have quit smoking and are vaping now.
Aaron Renn: Well, you know, you hit on the financial incentive aspect of this, and it is notable, right, that the – if, in fact, it is causing people to quit smoking, then the tobacco companies would obviously be in favor of banning vaping. And then you also mention that maybe some of the drug companies who are creating some of these prescription products like nicotine patches, and gums, and things like that, also don’t like vaping very much.
John Tierney: Right. There’s what is called a Baptist and bootlegger coalition that is named after Baptists who wanted no liquor sales on Sunday and the bootleggers who profited from it silently. And, so, you had – the Baptists are these kind of zealous progressive public health people who campaign against vaping, and then the people who benefit are certainly the drug companies whose own antismoking therapies that do involve nicotine, they are hurt. And they have lobbied, you know, for more restrictions on vaping. The tobacco companies, they are kind of a funny position because obviously they, you know, these two-and-a-half million people who are vaping are no longer buying cigarettes, so they are hurt in that way. They also have realized that vaping is the future more. There’s ten million vapers now in America, and people say that is going to double in the next ten years, so they are doing their own vaping devices, their own e-cigarettes. And they benefit, though, from having these devices regulated very heavily, which the Obama administration wanted to do. They put in place this process where everything would have to go through this approval process that could cost, I mean, you know, the estimates were all over the place. Some people were saying it is going to cost you a million dollars to get something approved. And the way it was written, actually, that in these vape shops now that sell stuff, that every single product there, every single kind of e-liquid that you have would have to get a separate approval. So, this is great for the tobacco companies, because they can afford to go through this whole licensing, but all the small companies, who have really been the great innovators in vaping, they have come up with all these new devices and new liquids and things like that that make vaping a lot cheaper and a lot more pleasurable. So, the tobacco companies have been, in that sense, behind, you know, they have supported the regulations, too.
Aaron Renn: I didn’t see this in the article, but I’m curious if whether some of the state governments especially have a financial incentive because they tax tobacco very heavily…
John Tierney: Right.
Aaron Renn: …and so you know, in a sense they are hooked on tobacco from a budgetary perspective. Are people – do you think some of the government people are worried about losing tax revenue?
John Tierney: Well, I mean they can’t say that, obviously. But they do look at it. And, so, what they are doing is people switch to vaping. They are lobbying for – Andrew Cuomo, included in his budget this year, they are trying to tax vaping and trying to impose these same high taxes on it, which is really immoral, because I mean you should want a smoker to switch to something that is safer and you shouldn’t be taxing that heavily in order to – but they are basically doing it, it’s just a way to replace some of that revenue that they have lost as smokers quit.
Aaron Renn: You mentioned the Obama administration’s regulatory agenda. Is there any indication of what the Trump administration can or will be doing on this?
John Tierney: Well, they’ve got, you know, Scott Gottlieb is now in charge of the FDA and he is, you know, far better. I mean, Tom Frieden, who is at the CDC under Obama, and I mean, the Obama people were these just leftwing activists who really put activism before science, and were a bit, just sort of nutty about vaping. I mean Tom Frieden would say it’s worse than smoking in some ways, which is just an insane thing to say. Scott Gottlieb has been much better in that he announced recently that they were going to postpone these regulations that the Obama people had put in that would have, essentially, outlawed all vaping devices next year. You would have had to go through this big process to get it done. So, I mean that’s a great step forward. It’s not really enough, though. The problem is that we are treating these as tobacco products. That’s what they are classified as. And the FDA has all this authority to regulate them and to make them more expensive, and to slow down innovation. And one of the reasons that so many people are quitting smoking and taking up vaping is that all these small companies have, you know, have come out with these innovative new products or ways to do it. I mean, it’s this great subculture, the vape shops. People go there and so that has really encouraged people to stop smoking, and if you just start regulating this and taxing it, it is really going to slow down the process.
John Tierney: That’s an old-fashioned view, really. I mean, who has time to worry about infectious diseases nowadays when you are a good progressive activist?
Aaron Renn: I mean, from a standpoint of just how we structure and think about government generally, this is kind of a window into this mission creep, if you will, of these organizations now off into all sorts of la-la land on a lot of things that seem to be outside of their core mission, and in some cases not even doing their core mission very well. You mentioned the head of the CDC almost got sidelined on Ebola because he was screwing it up so bad. What would you recommend as sort of a reform agenda to bring these organizations back to focusing on their core mission?
John Tierney: I mean, I would certainly look for ways to cut their budget, because you see, I mean, the stuff they are doing – they are running all these campaigns about individual behaviors. I mean, there is a genuine role for – there are genuine, you know, public problems, like, you know, when you’ve got an infectious disease, you know, the classic things – problems like cholera, where you want to clean the public drinking water. You want public sewage systems that work. That’s what they should be doing. But, basically, they have expanded, as you say, mission creep, they have expanded public health to mean basically anything that is on the progressive agenda. Anything that they deem a problem, whether it is obesity, whether it is domestic violence, whether it is handgun violence, and most of these things are individual behaviors. Now, the government, I think, has a role in public education, although, I mean, even there, you know, when it comes to nutrition, for instance, which they have – which that is an individual choice – and the advice they have been giving has been absolutely awful. They have probably contributed to diabetes and obesity. But I can understand a role for the government sponsoring research and for providing the public with some information, but they have just gone way beyond that, where they have taken on, you know, any individual or social problem, called it a health problem, and taken it upon themselves to try to start regulating this behavior and it has even gone beyond that. I mean, the public health profession, their main professional group, is just in charge, you know, that it favors nationalized healthcare, it favors, you know, income redistribution. I mean, these are not public health issues, but they try to define anything that – you know, income inequality is a public health issue according to them. So, I would cut their budgets and tell them work on genuine public problems instead of trying to micromanage people’s individual behavior.
Aaron Renn: Once again, the article is “The Corruption of Public Health.” It is in the Summer 2017 issue of City Journal. It is a great, albeit somewhat depressing read, I must admit. Thanks for joining me.
John Tierney: Thank you, Aaron.
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