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Really, the WHO and other governmental health authorities should be throwing _billions_ of dollars at making vaping effective and safe. The RoI is absolutely in

Really, the WHO and other governmental health authorities should be throwing _billions_ of dollars at making vaping effective and safe. The RoI is absolutely insane - even if 10k people switch to a well researched alternative to tobacco and avoid serious health implications (probably costing $1million per person at a minimum in the US healthcare system), that's $10bn saved. You multiply that by around a billion worldwide smokers and the public health benefits are absolutely crazy. Probably on the order of tens of trillions of dollars, maybe even a quadrillion dollars over the next century.

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bsder 7y ago
> The RoI is absolutely insane - even if 10k people switch to a well researched alternative to tobacco and avoid serious health implications The problem is that vaping is converting non-smokers into vapers. That's a really BAD ROI. Estimates are now as high as 25% of high schoolers vape and has snagged more women than cigarettes would have. That's undone 20+ years of anti-smoking efforts. So, yeah, public health officials are really pissed off. Yes, vaping is a good replacement for smoking. It's not a good replacement for not smoking, however.
- quotemstr 7y ago
  Tobacco isn't harmful because it contains nicotine. There's evidence that nicotine is good for you: it improves concentration [1] and reduces BMI [2]. Vaping gives people nicotine without the harmful substances in burning tobacco. Why should we bucket vaping with smoking? Hell, given the state of public health generally, maybe we should be encouraging people to vape. [1] https://www.webmd.com/smoking-cessation/news/20021023/harnessing-nicotines-power https://www.webmd.com/smoking-cessation/news/20021023/harnes... [2] https://www.sciencemag.org/news/2011/06/why-smokers-are-skinny https://www.sciencemag.org/news/2011/06/why-smokers-are-skin...
  - washadjeffmad 7y ago
    It looks like people are disagreeing with you without providing any rebuttal. Classy. I agree that the "nicbacco" mindset is fallacious and not well-reasoned, but also that while vaping is significantly better than smoking, it's not better than not vaping. For adults who want to derive the benefits historically gained through tobacco use without incurring the full extent of the damages, certain types of vaping aren't a poor method.
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CriticalCathed 7y ago
They seem to be focused on stopping it 100% instead of practicing harm reduction. I don't think it makes any sense at all except from a bureaucratic, elementary school, Zero Tolerance kind of perspective. Is there are another reason why it seems institutions are so resistant to this? They seem more concerned with raising the age to buy these products to 21 worldwide. https://www.nytimes.com/2019/12/19/health/cigarette-sales-age-21.html https://www.nytimes.com/2019/12/19/health/cigarette-sales-ag...
- throw_away 7y ago
  The tobacco Master Settlement Agreement with the states has a provision whereby they lose money if cessation programs are 'too' successful: https://www.reuters.com/article/us-tobacco-bonds-ecigs-insight/e-cigarettes-could-stub-out-tobacco-bonds-sooner-than-thought-idUSKBN0EZ0CZ20140624 https://www.reuters.com/article/us-tobacco-bonds-ecigs-insig... & then also, I suspect the incumbent tobacco industry lobbying effort is already deeply entrenched and dwarfs anything that might be fielded by the e-cig industry.
- mkl 7y ago
  I think there is an ethical consideration about addictive substances like tobacco. It's not okay for companies to use physical addiction to force further sales of their product, and many/most teenagers aren't able or willing to think through the ramifications of starting a long term addictive habit.
  - big_chungus 7y ago
    Do you believe alcohol sales are un-ethical? Alcohol can be extremely addictive, and in spite of the rampant use among youth, I don't hear public outcry against brewers. I'm not saying it's apples-to-apples, but I believe the fact that those crying out want alcohol more than a vape may play a role in the selection of Boogeyman of the Day.
    - mkl 7y ago
      I see what you're saying, and while I personally don't consume much alcohol, I'm not convinced its sale is unethical. I think there's a difference that makes tobacco addiction more problematic: The large majority of smokers are addicted, but only a small proportion of alcohol drinkers are.
ianai 7y ago
Ah, you’re assuming those 10k people are worth 1 million in cancer treatments. Their realized cost is probably going to be a lot less...
dmurray 7y ago
Smokers don't use $1m more per person in healthcare costs than non-smokers. That doesn't pass the smell test. For comparison, total US healthcare spending is approx $3t/year, or $10k/person-year, or $750k/person-lifetime. I don't know what the real number is. There are plenty of studies showing it's negative, mostly funded by tobacco companies. That might not quite be true, but it's not far off: a non-smoker who lives to 90 has similar levels of health issues in his last 5 years as a smoker who dies at 65. Reducing smoking would be a huge public good, but the benefit mostly accrues to the smoker, not to the state. We don't need to pretend it's otherwise for these campaigns to make sense.
- trianglem 7y ago
  >$750,000 per person You’re making GP’s point. If you filter for just tobacco users from the general population it could very well be above a million per tobacco user.
  - Retric 7y ago
    Sanity check. From 1990 to 2000 ~1/4 of US adult population smoked. Suggesting that smoking adds 750,000 * ~50,000,000 people / (75 years lifespan) ~500 Billion per year to US heath care costs is wildly off base. It turns out smokers do cost more while alive, but die sooner which mostly erases the difference in medical costs. There are estimates for lost productivity amounting to 150 Billion per year in the US, but again these ignore the fact Nicotine is a stimulant.
    - trianglem 7y ago
      Not all of them die early. Plus there are a variety of high priced treatments that they use along the way.
      - cm2012 7y ago
        And some have almost no healthy issues. But the average is overall cheaper costs, which is what we're discussing.
forrestthewoods 7y ago
I have very bad news for you. Smokers (and the obese) are cheaper in health care costs than non-smokers. Why? To be blunt, because smokers die early. Keeping someone alive into their 90s is more expensive than someone who dies of smoking derived illness in their 70s or younger. This is similarly true for the obese. https://www.nejm.org/doi/full/10.1056/NEJM199710093371506 https://www.nejm.org/doi/full/10.1056/NEJM199710093371506
- martinald 7y ago
  Yes, of course. Smokers and many other bad habits are great for the public purse - especially with less state pension payouts. But this isn't an argument we accept in public health. If it was, we wouldn't provide any healthcare that prolonged life after someone was after working age. Regardless there are still an awful lot of really dibilating conditions that massively affect productivity caused be tobacco related illnesses that isn't just death or cancer care.
  - forrestthewoods 7y ago
    I was replying to a comment proclaiming the financial savings. It isn’t a savings. It’s a cost. It may well be a cost worth paying. I’m not arguing policy. OP’s math made incorrect assumptions. Just letting them know.
- chiefalchemist 7y ago
  Yes and no. The use less. But they also are able to contribute less. That said, yes a whole lotta money is spent on the last 0 to 6 months (or so) of life. From what I understand, this is a USA only problem.
  - forrestthewoods 7y ago
    > From what I understand, this is a USA only problem. The study I linked was based on the Netherlands. I suspect the cost difference will be true for most countries. Unless you just let people die earlier. But that’s a whole other discussion. I don’t know if anyone has done any studies on productivity differences. That would be interesting.
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dragonwriter 7y ago
> The RoI is absolutely insane In purely financial terms, it's negative; premature deaths from tobacco (even with the health care costs of tobacco-related disease) actually significantly reduce health and net social welfare costs. The benefit is in years and quality of life (mostly in the after-working-career years), not financial returns.
- stoops 7y ago
  This doesn't account for the extra value those folks will create.
  - dragonwriter 7y ago
    Yes, it does, but most of the years lost are when people are drawing social security or similar public pensions, not economically productive; there have been numerous studies on this, and while many have raised moral arguments against acting the way tobacco companies propose (as they have actively lobbied based on them in many places in the world) based on them, there has been no serious disputes of the facts of net financial savings.
moksly 7y ago
According to our national health institute vaping doesn’t actually help people quit smoking, and this is an area we take rather serious in Denmark because we genuinely want people to smoking all together. There is no evidence to show that it’s safer either. It may be, but we’ll need to wait a few decades to see what the long term effects on the population actually are. So it would be rather silly for the WHO to invest billions in moving people from one ”tobacco” industry to another at this point. Even if we assume it’s safe, I’m not sure your suggestion is really sound. There is no evidence suggesting that smokers are actually that expensive to a society. Yes, they tax the healthcare system making up as much as 70-80% of the total expenses in some countries, but they also live shorter. There isn’t actual science on this, because it’s highly immoral, but the biggest expense of a lot of western countries isn’t healthcare, it’s elderly care, and that’s an area that benefits greatly if you die in your seventies after a relatively short period of lung cancer as smokers are prone to do.
- pas 7y ago
  Does it help with second hand smoking? It certainly helps with the smell, the basic side products of burning, and so on, no? Sure that might not mean much in terms of total impact on QALYs. (Because it might lead to prolonged exposure of lower dosages, ultimately resulting in the same grave health impact.)

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bsder 7y ago

> The RoI is absolutely insane - even if 10k people switch to a well researched alternative to tobacco and avoid serious health implications The problem is that vaping is converting non-smokers into vapers. That's a really BAD ROI. Estimates are now as high as 25% of high schoolers vape and has snagged more women than cigarettes would have. That's undone 20+ years of anti-smoking efforts. So, yeah, public health officials are really pissed off. Yes, vaping is a good replacement for smoking. It's not a good replacement for not smoking, however.

quotemstr 7y ago
Tobacco isn't harmful because it contains nicotine. There's evidence that nicotine is good for you: it improves concentration [1] and reduces BMI [2]. Vaping gives people nicotine without the harmful substances in burning tobacco. Why should we bucket vaping with smoking? Hell, given the state of public health generally, maybe we should be encouraging people to vape. [1] https://www.webmd.com/smoking-cessation/news/20021023/harnessing-nicotines-power https://www.webmd.com/smoking-cessation/news/20021023/harnes... [2] https://www.sciencemag.org/news/2011/06/why-smokers-are-skinny https://www.sciencemag.org/news/2011/06/why-smokers-are-skin...
- washadjeffmad 7y ago
  It looks like people are disagreeing with you without providing any rebuttal. Classy. I agree that the "nicbacco" mindset is fallacious and not well-reasoned, but also that while vaping is significantly better than smoking, it's not better than not vaping. For adults who want to derive the benefits historically gained through tobacco use without incurring the full extent of the damages, certain types of vaping aren't a poor method.

deleted 7y ago

[deleted]

CriticalCathed 7y ago

They seem to be focused on stopping it 100% instead of practicing harm reduction. I don't think it makes any sense at all except from a bureaucratic, elementary school, Zero Tolerance kind of perspective. Is there are another reason why it seems institutions are so resistant to this? They seem more concerned with raising the age to buy these products to 21 worldwide. https://www.nytimes.com/2019/12/19/health/cigarette-sales-age-21.html https://www.nytimes.com/2019/12/19/health/cigarette-sales-ag...

throw_away 7y ago
The tobacco Master Settlement Agreement with the states has a provision whereby they lose money if cessation programs are 'too' successful: https://www.reuters.com/article/us-tobacco-bonds-ecigs-insight/e-cigarettes-could-stub-out-tobacco-bonds-sooner-than-thought-idUSKBN0EZ0CZ20140624 https://www.reuters.com/article/us-tobacco-bonds-ecigs-insig... & then also, I suspect the incumbent tobacco industry lobbying effort is already deeply entrenched and dwarfs anything that might be fielded by the e-cig industry.
mkl 7y ago
I think there is an ethical consideration about addictive substances like tobacco. It's not okay for companies to use physical addiction to force further sales of their product, and many/most teenagers aren't able or willing to think through the ramifications of starting a long term addictive habit.
- big_chungus 7y ago
  Do you believe alcohol sales are un-ethical? Alcohol can be extremely addictive, and in spite of the rampant use among youth, I don't hear public outcry against brewers. I'm not saying it's apples-to-apples, but I believe the fact that those crying out want alcohol more than a vape may play a role in the selection of Boogeyman of the Day.
  - mkl 7y ago
    I see what you're saying, and while I personally don't consume much alcohol, I'm not convinced its sale is unethical. I think there's a difference that makes tobacco addiction more problematic: The large majority of smokers are addicted, but only a small proportion of alcohol drinkers are.

ianai 7y ago

Ah, you’re assuming those 10k people are worth 1 million in cancer treatments. Their realized cost is probably going to be a lot less...

dmurray 7y ago

Smokers don't use $1m more per person in healthcare costs than non-smokers. That doesn't pass the smell test. For comparison, total US healthcare spending is approx $3t/year, or $10k/person-year, or $750k/person-lifetime. I don't know what the real number is. There are plenty of studies showing it's negative, mostly funded by tobacco companies. That might not quite be true, but it's not far off: a non-smoker who lives to 90 has similar levels of health issues in his last 5 years as a smoker who dies at 65. Reducing smoking would be a huge public good, but the benefit mostly accrues to the smoker, not to the state. We don't need to pretend it's otherwise for these campaigns to make sense.

trianglem 7y ago
>$750,000 per person You’re making GP’s point. If you filter for just tobacco users from the general population it could very well be above a million per tobacco user.
- Retric 7y ago
  Sanity check. From 1990 to 2000 ~1/4 of US adult population smoked. Suggesting that smoking adds 750,000 * ~50,000,000 people / (75 years lifespan) ~500 Billion per year to US heath care costs is wildly off base. It turns out smokers do cost more while alive, but die sooner which mostly erases the difference in medical costs. There are estimates for lost productivity amounting to 150 Billion per year in the US, but again these ignore the fact Nicotine is a stimulant.
  - trianglem 7y ago
    Not all of them die early. Plus there are a variety of high priced treatments that they use along the way.
    - cm2012 7y ago
      And some have almost no healthy issues. But the average is overall cheaper costs, which is what we're discussing.

forrestthewoods 7y ago

I have very bad news for you. Smokers (and the obese) are cheaper in health care costs than non-smokers. Why? To be blunt, because smokers die early. Keeping someone alive into their 90s is more expensive than someone who dies of smoking derived illness in their 70s or younger. This is similarly true for the obese. https://www.nejm.org/doi/full/10.1056/NEJM199710093371506 https://www.nejm.org/doi/full/10.1056/NEJM199710093371506

martinald 7y ago
Yes, of course. Smokers and many other bad habits are great for the public purse - especially with less state pension payouts. But this isn't an argument we accept in public health. If it was, we wouldn't provide any healthcare that prolonged life after someone was after working age. Regardless there are still an awful lot of really dibilating conditions that massively affect productivity caused be tobacco related illnesses that isn't just death or cancer care.
- forrestthewoods 7y ago
  I was replying to a comment proclaiming the financial savings. It isn’t a savings. It’s a cost. It may well be a cost worth paying. I’m not arguing policy. OP’s math made incorrect assumptions. Just letting them know.
chiefalchemist 7y ago
Yes and no. The use less. But they also are able to contribute less. That said, yes a whole lotta money is spent on the last 0 to 6 months (or so) of life. From what I understand, this is a USA only problem.
- forrestthewoods 7y ago
  > From what I understand, this is a USA only problem. The study I linked was based on the Netherlands. I suspect the cost difference will be true for most countries. Unless you just let people die earlier. But that’s a whole other discussion. I don’t know if anyone has done any studies on productivity differences. That would be interesting.

deleted 7y ago

[deleted]

dragonwriter 7y ago

> The RoI is absolutely insane In purely financial terms, it's negative; premature deaths from tobacco (even with the health care costs of tobacco-related disease) actually significantly reduce health and net social welfare costs. The benefit is in years and quality of life (mostly in the after-working-career years), not financial returns.

stoops 7y ago
This doesn't account for the extra value those folks will create.
- dragonwriter 7y ago
  Yes, it does, but most of the years lost are when people are drawing social security or similar public pensions, not economically productive; there have been numerous studies on this, and while many have raised moral arguments against acting the way tobacco companies propose (as they have actively lobbied based on them in many places in the world) based on them, there has been no serious disputes of the facts of net financial savings.

moksly 7y ago

According to our national health institute vaping doesn’t actually help people quit smoking, and this is an area we take rather serious in Denmark because we genuinely want people to smoking all together. There is no evidence to show that it’s safer either. It may be, but we’ll need to wait a few decades to see what the long term effects on the population actually are. So it would be rather silly for the WHO to invest billions in moving people from one ”tobacco” industry to another at this point. Even if we assume it’s safe, I’m not sure your suggestion is really sound. There is no evidence suggesting that smokers are actually that expensive to a society. Yes, they tax the healthcare system making up as much as 70-80% of the total expenses in some countries, but they also live shorter. There isn’t actual science on this, because it’s highly immoral, but the biggest expense of a lot of western countries isn’t healthcare, it’s elderly care, and that’s an area that benefits greatly if you die in your seventies after a relatively short period of lung cancer as smokers are prone to do.

pas 7y ago
Does it help with second hand smoking? It certainly helps with the smell, the basic side products of burning, and so on, no? Sure that might not mean much in terms of total impact on QALYs. (Because it might lead to prolonged exposure of lower dosages, ultimately resulting in the same grave health impact.)