For some people, hydroxychloroquine cannot possibly prevent or treat COIVD-19 infection because it would vindicate President Trump’s support for it. What is a straightforward medical question to some is deeply political to others.
A similar phenomenon is seen with smoking. Some people view tobacco companies — Big Tobacco, as they like to call them — as so fundamentally evil that anything they support must be passionately opposed.
This is the key reason for Australia’s draconian prohibitions on tobacco advertising, huge taxes on tobacco, its trenchant belief in plain packaging and its opposition to vaping. Those responsible for Australia’s anti-smoking policies, largely officials in the Commonwealth and state Health departments plus a raft of public health busybodies intent on saving us from ourselves, know that the tobacco companies are opposed to them. That means they must be good.
The remarkable thing is that tobacco companies support the objective of reducing rates of smoking. None of them disagrees that smoking is harmful and one of them, Philip Morris, has even committed to a “smoke-free future”. It’s just that they cannot see why those who choose to smoke should be treated so shabbily.
It’s no help though; whatever they say or do is seen as evidence of Machiavellian intent. As a consequence, Australia perseveres with policies that have either ceased to reduce the rate of smoking or, in most cases, never made any difference to it.
This is clear from the recently released 2019 National Drug Strategy Household Survey, a survey of more than 22,000 Australians conducted every three years by the Australian Institute of Health and Welfare (AIHW). This survey has become a key indicator of the performance of government health policies, including tobacco control.
What it shows is that rate of smoking is now barely declining. Moreover, it did not decline at all as a result of the introduction of plain packaging. Until 2012 the percentage of daily smokers aged 14+ had been in long-term, steady decline at a rate of 0.46% annually for 20+ years. After 2012, the year in which plain packaging was introduced (along with other measures, including tax increases), this annual rate of decline slowed by almost half to 0.26% between 2013 to 2019.
What’s more, the proportion of smokers planning to quit has not changed; three in 10 smokers have no interest in giving up smoking, the same percentage (30%) as in 2010.
This means many more Australians are smoking than would be the case if the rate had continued to decline at the pre-2012 rate. Even if those who do not intend to quit could not be convinced, many others would kick the habit if they could, whether to improve their health prospects or to simply save money.
The fact that they are not quitting means some are undoubtedly dying from smoking related issues, a direct consequence of anti-smoking policies that are not working.
One of the worst failed policies is the opposition to vaping. Despite convincing evidence that vaping is successfully reducing smoking rates in other countries, and being far safer than tobacco smoking (at least 95 per cent less harmful according to Public Health England), the Australian government recently announced a ban on the importation of e-cigarette fluid containing nicotine. Should the ban take effect in January 2021, as currently scheduled, the estimated 450,000 vapers who currently import nicotine vaping juice for personal use in e-cigarettes will either be turned into criminals (by buying on the black market) or revert to smoking. This flies in the face of obvious demand for e-cigarettes – the AIHW survey showed that between 2016 and 2019, the proportion of people who had ever used e-cigarettes rose from 8.8% to 11.3% (data on this was not collected prior to 2016).
Aside from being a public health failure, and so limiting consumer and commercial freedom without justification, plain packaging is also contributing to serious unintended consequences. Since its introduction in 2012, the country’s illegal trade in tobacco has become a major problem. The latest data from KPMG (May 2020) found that overall consumption of illicit tobacco (which includes unbranded loose tobacco along with contraband and counterfeit product) has increased by 80% since plain packaging was introduced (from 11.5% in 2012 to 20.7% in 2019).
This increase is consistent with data reported by the Department of Home Affairs in November last year and is supported by the AIHW survey which showed that the proportion of smokers smoking illicit unbranded loose tobacco had increased by 37% since plain packaging was introduced (from 10.5% in 2010 to 14.4% in 2019).
Also contributing to the illicit tobacco market is the tax imposed on tobacco, raising $17.5 billion a year and making legal Australian cigarettes the most expensive in the world. Avoiding this tax is an enormous incentive for both smokers and organised crime. Despite the government now spending many millions of dollars to intercept illegal tobacco imports, nobody believes it will be any more successful than its efforts to block the importation of drugs.
Most other anti-smoking measures are similarly ineffectual. State restrictions on point of sale retailing, for example, merely increase costs to retailers while frustrating smokers seeking to buy cigarettes. Quite pointless.
The World Trade Organisation appellate body recently ruled that plain packaging in Australia is a legal trade measure, a decision that delighted anti-smoking advocates. However, that does not mean it is effective or right, or that any other government would be wise to copy it.
What this latest AIHW data shows (again) is that plain packaging remains a flawed idea. Other governments considering the measure should think twice and conduct their own research on its effectiveness before following Australia’s example.
Perhaps it is too optimistic to expect those who hate the tobacco companies so much that they will allow Australians to continue to die from smoking-related illnesses to change their mind, just as it will be difficult for those who hate Trump to accept hydroxychloroquine even if it is ultimately shown to be effective.
But it really should be the final nail in the coffin for plain packaging and an opportunity for Australia to consider alternatives that have real potential to reduce health risks. Unlike the evidence in support of plain packaging, the evidence that vaping can reduce smoking is both increasing and convincing.
David Leyonhjelm is a former senator for the Liberal Democrats.
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