Unintended consequences

Counterfactual

www.clivebates.com@clive_bates

Unintended consequences: Ban flavours

Indoor vaping ban

Control advertising?

Impose burdens, costs and restrictions

Diminishing and negative returns to regulation

Net health

Net harm

Val

ue

to

so

cie

ty

Regulatory costs, burdens and restrictions

Builds confidence

Destroys viable firms and products

Compromises design & consumer appeal

Sweet Spot

Morgan Stanley on FDA deeming regulations

The greater barriers to entry (slower approval process, higher costs, higher product standards), will ultimately take a toll onthe number of available products and rationalize the category.

This could result in the larger tobacco companies dominating the category in the future, given the burden it would place on smaller manufacturers.

Bureaucratic regulators

Predatory companies

Public health’s “useful idiots”

The Unholy Trinity

Changing perceptions – for the worse

Birth defects

Lipoid pneumonia

Third hand nicotine exposure

Ultrafine particles

Blindness

Anti-freeze

PoisoningGateway

Winning hearts and minds?

85%

65%

0%

20%

40%

60%

80%

100%

2010 2013

Believe e-cigs safer than cigarettes?

US adult smokers

Tan ASL, Bigman CA. E-cigarette awareness and perceived harmfulness: prevalence and associations with smoking-cessation outcomes. Am J Prev Med 2014; 47: 141–9.

Perceived e-cig risk in young British smokers

Trends in electronic cigarette use in young people in Great Britain over 2013-2014 Arnott, Britton, Cheeseman, Dockrell, Eastwood, Jarvis, & McNeill ASH, CR-UK, PHE 2014

Science: five orientating propositions

• Relative risk: at least 95% less harmful than smoking, probably lower, may be negligible risk.

• Bystanders: no material health risk, possible nuisance

• Adolescents: use rising with adults, vast majority of users are smokers, may be displacing smoking

• Smoking cessation: combines appeal and effectiveness and improving over time – limited studies show at least as good as pharma nicotine already.

• Promoting smoking: no sign of gateway effects or renormalising smoking.