Rates have fallen, and cigarettes have moved out of the center of social life.

But tobacco control did not simply reduce smoking. It reorganized where smoking remains, concentrating it among those for whom quitting was never merely an individual choice.

Over the past several decades, few stories have been told with as much consensus as those of tobacco control. It runs through reports, treaties, and scientific papers as one of those rare victories public health likes to display without lowering its eyes: a widespread problem, deeply embedded in social life, gradually pushed to the margins until it seemed, at least on the surface, to be under control.

One need only look at the curves.

They slope downward with an almost pedagogical docility, as if they recorded not only what happened, but the proper way to read it: this is what works, this is the path, this is the proper way to govern risk.

In that sense, the curves do more than measure. They instruct. They organize perception. They indicate where the problem is assumed to lie, and, just as importantly, where it no longer appears to be.

In institutional presentations, those curves appear clean and noiseless.
Clear, steady lines, almost a little too persuasive.
But lines conceal things too.

Their clarity depends, in part, on what they leave outside the frame: who continued smoking after the cigarette had already been expelled from the center, under what conditions smoking persisted, and who came to bear, in body and in life, the residual weight of what came to be called success.

This narrative did not arise on its own. It took shape through experiments carried out in the United States—especially in California, a pioneer from the late 1980s onward in programs that combined tax increases, media campaigns, and, above all, a deliberate effort to dislodge the cigarette from the center of social life and push it toward its farthest edges.

Before long, what had once occupied the hands of movie stars and the tables of cafés was driven out of pubs, restaurants, offices, and airports, until often all that remained was the sidewalk.

More than a regional case, this process established a repertoire of strategies that would, over time, become a model. Governments and international organizations adapted and disseminated them until they were consolidated, in negotiating rooms and technical documents alike, as the very language of what it means to control tobacco. In the early 2000s, through successive rounds of meetings, delegations from dozens of countries began negotiating the terms of that consensus. It would take institutional form in the Framework Convention on Tobacco Control.

From a sufficient distance, this trajectory cannot be explained by any single measure, but by a rare convergence: robust, well-funded science; persistent policymaking; supportive media; and a measurable shift in collective behavior.

A success difficult to dispute. Especially when told this way.

But this story was not only about taxes, campaigns, and effective regulation. It also relied on something less visible and more far-reaching: the transformation of smoking’s social role. Denormalization did not simply reduce the acceptability of cigarettes. It recoded smoking as an increasingly awkward, discreditable, and publicly inconvenient practice. Smoking ceased to be only a risk; it became a sign of conduct to be displaced, corrected, and kept at a distance.

It is precisely here that the narrative of success becomes most persuasive—and most misleading. The decline in prevalence supplies its clearest marker; the reduction in morbidity and mortality, its public-health justification; regulatory consolidation, its institutional face; denormalization, its normative culmination.

And yet the narrative does not quite hold.

At a certain point, the very success recorded by the indicators begins to expose their limits. Aggregate decline does not dissolve the inequalities that structure tobacco use. In many settings, those inequalities persist; in others, they sharpen. As smoking recedes from the center of social life, it becomes increasingly concentrated among those with fewer material, social, and psychological conditions for leaving it behind.

The question, then, is no longer merely whether the interventions worked. It is what kind of success they produced, where smoking was made to remain, and who came to bear, more intensely and more visibly, the material and moral weight of what, in the aggregate, came to be called progress.

What the Averages Conceal

From Aggregate Decline to Social Concentration

Aggregate decline no longer suffices as evidence of effectiveness—much less of justice. The question can no longer remain sheltered within the technical language that once seemed able to contain it. It is no longer simply a matter of how many people smoke less, but of where smoking remains, who was better positioned to respond to policy, and who stayed more exposed both to tobacco-related harm and to the burden of the measures designed to combat it.

This shift changes the object itself. What once appeared as a collective trajectory now reveals a more uneven pattern: the social concentration of a practice that is increasingly abandoned by those with greater stability, support, and the room to comply. Tobacco control did not simply reduce smoking across a uniform population. It reorganized where smoking would remain, concentrating it along existing lines of inequality.

As Lapalme observes, the point is not to deny the overall effectiveness of tobacco control, but to recognize that it has long coexisted with persistent inequality from within. Smoking does not disappear. It is redistributed—and tends to settle precisely where the material and symbolic conditions for giving it up are scarcest.

A closer look at the map makes this visible. The global decline is uneven: in some regions, it barely moves; in others, it advances slowly; in still others, it shows signs of exhaustion. The Western Pacific region, for example, has seen the slowest decline—around 8 percent between 2010 and 2024—driven by high prevalence in countries such as China and Indonesia. In Europe, progress has been similarly sluggish, with rates among women more than double the global average. In several countries—including Indonesia, Egypt, Congo, and Jordan—prevalence has scarcely shifted over the past decade.

But these numbers do more than describe variation. They trace a pattern. Smoking is not distributed at random. It follows the fault lines of the societies in which it takes hold. Where inequality runs deeper, smoking becomes denser, more persistent, and harder to dislodge.

This gradient is now one of the most consistent findings in the epidemiology of smoking—and one of the least comfortable. The lower the income and the level of education, the higher the prevalence, and the more difficult cessation becomes. In countries with relatively low overall prevalence, the pattern remains: smoking becomes progressively more common the further one descends the social scale.

But inequality is not limited to who smokes. It appears even more starkly in who manages to quit.

Low-income smokers show significantly lower abstinence rates—often roughly half those seen in more advantaged groups. Lower adherence to treatment, cohabitation with other smokers, greater dependence, and weaker support networks help explain the gap. But the problem begins earlier: in precarious material conditions, unstable routines, persistent stress, and the scarcity of time and energy that make giving up tobacco harder to initiate and harder still to sustain.

Even so, to explain is not the same as to understand. These factors do not operate in isolation. They accumulate, overlap, and reinforce one another until quitting smoking ceases to be merely difficult and becomes, for many, improbable.

This accumulation is most visible in low- and middle-income countries, where roughly 80 percent of the world’s 1.3 billion smokers live. There, the distance between what works in clinical trials and what is possible in ordinary life becomes stark. Treatments such as nicotine replacement therapy or varenicline may cost between $100 and $500 a year—amounts beyond the reach of much of the population. In some settings, that cost can approach 20 percent of a smoker’s monthly income, while cigarettes remain relatively cheap. Public coverage is limited, and access to behavioral support remains uneven.

In that setting, what the indicators record as behavioral persistence begins to reveal itself as something else: the cumulative effect of social conditions that make quitting smoking not merely painful, but structurally improbable.

Taken together, these patterns point to something more unsettling than the narrative of success usually allows. Population-wide policies have been effective, but not neutral. They did not merely reduce smoking; they reorganized where it would remain, on whom its burdens would concentrate, and under what conditions that persistence would be lived.

The averages record fewer smokers, lower exposure, and greater social disapproval of cigarettes. The distribution tells another story: one of progressive concentration among those for whom quitting is more costly, more constrained, and less compatible with the conditions of everyday life.

What the curves show clearly, the margins quietly undo.

The Remaining Smoker

Class, Suffering, and Social Concentration

More often than not, someone lights a cigarette before even noticing that a decision has been made. The gesture emerges in an interval: between one task and the next, between one shift and the one to follow, between a worry that has just ended and another already beginning. It is a pleasure. But not only pleasure. Nor merely dependence. It is, above all, a way of organizing time—opening a pause where no pause has been given.

The global decline in prevalence has altered the epidemiological landscape—and with it, the figure of the smoker who remains. Persistent smoking is no longer diffusely distributed across the social body. It thickens. And it thickens, above all, where economic insecurity, political neglect, and accumulated suffering are already dense. The remaining smoker is not simply someone who failed to respond to public-health messaging. More often, he or she occupies the point where behavioral language encounters the limits of its own explanatory power.

Here, Hilary Graham remains indispensable. Persistent smoking is not merely a risky behavior, nor a simple residue left behind by successful policy. It is a situated social practice—interwoven with class, income, gender, and place—and deeply inscribed in suffering, constraint, and inequality accumulated over the course of a life.

That perspective unsettles one of the most comforting assumptions in tobacco control: that continued smoking is primarily a matter of ignorance, irrationality, or insufficient motivation. Quitting does not take place in a vacuum. It depends on predictability, support, access to care, and some degree of control over one’s own life—conditions that are unevenly distributed, and often scarce precisely where smoking remains most prevalent.

In contexts of economic insecurity, housing instability, and mental distress, the cigarette takes on functions that exceed chemical dependence. It operates as emotional regulation, as a fragile interval within exhausting routines, as a way of sustaining the body and the day when other forms of support are scarce. It can become an anchor in the day: something inscribed in breaks at work, in transit, in the intervals between domestic tasks—in those minimal moments when the act of lighting a cigarette offers structure, marks off a boundary, and opens a brief space to breathe. What appears, from the outside, as persistence may also be a form of maintenance: a way of holding together what would otherwise come apart.

Qualitative studies reflect this with unusual clarity. Many smokers describe the habit less as addiction than as a form of everyday support: relief from anxiety, time of one’s own amid overload, a resource for regulating emotions that might otherwise spill over. In these accounts, there emerges something like a precarious economy of care—the cigarette as a tool for enduring the unendurable.

Research conducted in Brazil points in the same direction. Smoking appears as a palliative for sadness, discouragement, and isolation. In routines marked by precarity, that function intensifies. The cigarette ceases to be merely a habit and becomes instead a mediator between the subject and an everyday life that offers few alternatives for pause, relief, or self-regulation.

This dimension becomes clearer still when one considers the broader landscape of suffering. Persistent smoking is strongly associated with mental distress and traumatic experience. People with histories of abuse, depression, or anxiety smoke more—and find it harder to quit. What appears, in epidemiological terms, as behavioral persistence begins to shift in meaning. It is not simply dependence, but the overlap between dependence, suffering, and structural inequality. Under these conditions, cessation is not merely difficult. It becomes, in many cases, scarcely viable.

This reveals a persistent mismatch. The field of tobacco control recognizes these inequalities, but struggles to reorganize its responses accordingly. Equity appears in the discourse; in policy, far less so. Instead, many strategies continue to treat smokers as a homogeneous public. National campaigns, standardized protocols, universal approaches—tools that scarcely register how radically the conditions for cessation vary across income, place, and mental health.

As smoking declines, another transformation takes shape. The smoker’s social position becomes more sharply defined—and more heavily marked. Denormalization does not simply reduce the acceptability of cigarettes. It also produces identities. The smoker ceases to be merely someone exposed to risk and becomes increasingly legible as someone who has failed—morally, socially, and individually.

That shift is not abstract. It materializes in everyday life: in the glance that condemns, the body that withdraws, the subtle experience of being out of place. In domestic space, it appears as silence, interruption, or reproach. In health services, it can take the form of judgment—and, at times, of retreat.

For those already living under conditions of disadvantage, that experience intensifies. Smoking becomes not only a stigmatized practice, but a marker of social failure—one that may be internalized as shame, guilt, and diminished self-worth.

What emerges from this convergence is one of the most difficult tensions in contemporary public health. Policies designed to confront a widespread behavior now act upon a population that is smaller, more concentrated, and more vulnerable. In that setting, smoking can no longer be read simply as a matter of individual risk. It condenses something larger: inequality, suffering, and the uneven distribution of the conditions required to abandon it.

At that point, the question changes. If persistent smoking is not merely a behavior but a situated practice—anchored in constraint and unequal access to support—then the problem can no longer be framed solely in terms of why individuals continue to smoke. It must also be asked how public-health interventions act upon this uneven terrain, and what happens when policies designed for a widespread habit come to bear upon a socially concentrated one.

Invisible Costs

Regressivity, Stigma, and Legitimacy

If smoking has ceased to be a widespread habit, the policies devised to confront it have, to a large extent, remained the same. Taxation, spatial exclusion, denormalization campaigns, and standard cessation protocols were designed to act upon relatively diffuse populations. But the terrain has changed. Once smoking becomes socially concentrated, these instruments no longer fall upon a broad and heterogeneous public in the same way. They bear down most heavily on those with the least room to absorb their effects.

This is not only a distributive problem in the narrow sense. It is also a moral one. Tobacco control does not merely regulate products and behaviors; it distributes pressure, legitimacy, and blame. And once smoking is concentrated among socially vulnerable groups, the burden of that distribution becomes harder to ignore.

Tax increases remain one of the most effective tools for reducing average consumption. But the same measure operates differently across unequal social worlds. For those able to quit, higher prices may function as an incentive. For those whose smoking is entangled with instability, dependence, and scarcity, the effect is often less cessation than compression: other parts of the household budget contract so that smoking can continue under more punitive conditions. Some shift to cheaper alternatives, including illicit ones; others absorb the higher cost by cutting elsewhere.

The harm does not disappear. It is redistributed.

What is no longer spent on other needs—food, health care, education—comes to sustain a habit from which it is harder to escape. A policy effective in the aggregate thus reveals its regressive face.

It is here that the consensus begins to creak, even within the literature. Raising the price of cigarettes is, at once, one of the most effective tools for reducing consumption and one of the clearest demonstrations of the inequality of its effects. For those who manage to quit, it works. For those who do not—and who often live under greater material and mental vulnerability—it becomes a form of continuous penalization.

But the costs are not only material. They are symbolic as well—and for that very reason, harder to measure. Policies do not merely regulate behavior; they also distribute responsibility. Among low-income smokers, smoking often comes accompanied by guilt, shame, and social judgment. These experiences are not peripheral. They shape one’s relationship to the habit itself—and often to the health-care system as well.

At this point, denormalization ceases to be merely a public-health tool and becomes a mechanism of social classification. Making smoking socially undesirable was central to the success of tobacco control. But that success had ambivalent effects. In reducing the acceptability of cigarettes, it also helped fix around the smoker an identity marked by reproach and devaluation.

Once smoking is concentrated among vulnerable groups, this process no longer operates only as prevention. It also intensifies experiences of exclusion.

The tension deepens because many persistent smokers live under conditions that make cessation especially difficult. When the institutional response relies chiefly on restrictions and symbolic sanctions—high prices, exclusion from spaces, moral condemnation—it may increase the weight of those difficulties without offering proportionate support for confronting them. The result is a structural mismatch: equity appears as a principle, but rarely translates into policy design.

At that point, the question can no longer be framed solely in terms of effectiveness. It becomes a question of legitimacy. Interventions capable of producing broad population-level benefits may still be justified even when they impose individual costs. But that justification grows more fragile when those costs fall systematically on the very people who already live under multiple forms of disadvantage.

To take tobacco control seriously, then, is not to reject it, but to judge it more rigorously: not only by how much prevalence has declined, but by how its benefits and burdens are distributed, and by who comes to bear, more intensely, the residual weight of its success.

An Imperfect Victory

Justice, Proportionality, and the Limits of Behavioral Rule

In light of this new configuration, the standard of evaluation must change. It is no longer enough to ask whether tobacco control worked. The more difficult question is what kind of political and moral rationality its success has relied upon, and whether that rationality remains defensible once smoking is concentrated at the social margins.

Classical indicators—prevalence, consumption, mortality—remain indispensable. But taken on their own, they reveal less than they seem to. They register aggregate movement while remaining largely silent about social concentration, unequal exposure to burden, and the moral classification of those who remain. It is in that silence that the problem of justice begins.

What is at stake, then, is not only whether public-health gains were achieved, but how they were achieved—and under what assumptions about responsibility, conduct, and the location of the problem itself. A policy may save lives and still remain normatively narrow. It may reduce risk while deepening shame. It may improve averages while consolidating, in practice, a way of governing that treats as failures of conduct what are also expressions of suffering, inequality, and unmet need.

At that point, the problem ceases to be only tobacco. It becomes a test of public health itself: of whether it can recognize the limits of a framework that reads socially rooted practices primarily through the language of behavior, discipline, and correction.

This tension offers no simple resolution. The point is not to abandon tobacco control, nor to deny its gains. The difficulty lies elsewhere: in recognizing that a policy may be effective and yet remain distributively unequal and ethically incomplete.

To take that tension seriously is to confront the rationality that guided this success. By privileging abstinence, discipline, and disapproval, tobacco control has often treated as a failure of conduct what is also a demand for care—what condenses, in practice, accumulated inequality, constraint, and suffering.

From this point on, certain positions within the field become harder to sustain as merely technical. When smoking is concentrated among vulnerable groups, insisting exclusively on the eradication of behavior—without expanding the repertoire of responses—begins to appear less as prudence than as a narrowing of what counts as a legitimate form of care.

Viewed in this light, tobacco control ceases to be only a success story. It begins to expose the internal tensions of public health itself. It shows that effective policies can transform the epidemiological landscape of a problem while operating through a grammar ill-equipped to engage those who remain at its margins.

When that happens, public-health success loses the innocence of averages. Counting lives saved is no longer enough. We must also ask what forms of care were legitimized, what forms of suffering went unanswered, and which subjects came to be treated less as people to accompany than as behaviors to correct.

In the end, the curves do not lie. But they do not tell the whole story either. They show decline, improvement, and measurable gain. What they cannot show is how that success is lived, how its burdens are distributed, and how its remainder is governed.

At that point, the problem ceases to be only tobacco.

It becomes control.

Notes and Sources

The consolidation of tobacco control as a public-health paradigm, often told as a story of success, can be traced through the Californian experience revisited by Roeseler and Burns in “The Quarter That Changed the World” (Tobacco Control, 2010), as well as through the institutional literature that followed.

Denormalization, which was central to displacing the cigarette from accepted social norms and driving its gradual marginalization, is discussed by Bayer and Stuber in “Tobacco control, stigma, and public health” (American Journal of Public Health, 2006), and by Bell in “Legislating Abjection?” (Critical Public Health, 2011) and “Tobacco control, harm reduction and the problem of pleasure” (Drugs and Alcohol Today, 2013). See also Bell et al., “‘Every space is claimed’” (Sociology of Health & Illness, 2010), and “Smoking, stigma and tobacco ‘denormalization’” (Social Science & Medicine, 2010).

The persistence of inequality within aggregate decline, and the progressive concentration of smoking among socially disadvantaged groups, is developed by Graham in “Why social disparities matter for tobacco-control policy” (American Journal of Preventive Medicine, 2009) and “Smoking, stigma and social class” (Journal of Social Policy, 2011), and succinctly synthesized by Lapalme in “Tobacco control’s effects on social inequalities in smoking” (European Journal of Public Health, 2020).

The ethical dimensions of tobacco control, especially when its effects are distributed unequally, are examined by Voigt in “Smoking and social justice” (Public Health Ethics, 2010); by Breton and Sherlaw in “Examining tobacco control strategies and aims through a social justice lens” (Public Health Ethics, 2011); and by Thomas et al. in “Population tobacco control interventions and their effects on social inequalities in smoking” (Tobacco Control, 2008).

The social and subjective consequences of denormalization—including stigma, withdrawal, and marginalization—are explored in Ritchie, Amos, and Martin, “‘But it just has that sort of feel about it, a leper’” (Nicotine & Tobacco Research, 2010), and in Stuber, Galea, and Link, “Smoking and the emergence of a stigmatized social status” (Social Science & Medicine, 2008) and “Stigma and smoking” (Social Service Review, 2009), as well as in Bell et al., “Smoking, stigma and tobacco ‘denormalization’” (Social Science & Medicine, 2010).

Recent debates about equity, legitimacy, and the limits of the so-called tobacco “endgame”, especially once smoking has become concentrated at the social margins, include Malone, “Justice, disparities and the tobacco endgame” (Tobacco Control, 2021); Mills et al., “Recommendations to advance equity in tobacco control” (Tobacco Control, 2022); Lund and Sæbø, “Challenges in legitimizing further measures against smoking…” (Harm Reduction Journal, 2024); and Meier and Shelley, “The fourth pillar of the Framework Convention on Tobacco Control” (Public Health Reports, 2006).

The shift in emphasis, from aggregate effectiveness to the social distribution of outcomes, is formulated with particular clarity by Lapalme in “Tobacco control’s effects on social inequalities in smoking” (European Journal of Public Health, 2020).

The social determinants of smoking including life conditions, support networks, and unequal access to cessation are discussed by Garrett et al., “Addressing the social determinants of health to reduce tobacco-related disparities” (Nicotine & Tobacco Research, 2015); Paul et al., “The social context of smoking” (BMC Public Health, 2010); and Boland et al., “‘I’m not strong enough…’” (International Journal for Equity in Health, 2017).

The understanding of persistent smoking as a situated social practice shaped by class, suffering, and accumulated inequality owes much to Graham, especially “Smoking, stigma and social class” (Journal of Social Policy, 2011).

The ethical and legal implications of “endgame” strategies, especially with respect to proportionality and legitimacy, are addressed by Thomas and Gostin in “Tobacco endgame strategies” (Tobacco Control, 2013), and further developed by Voigt in “‘If you smoke, you stink’” (2013) and in “Tobacco as a matter of public health,” in The Oxford Handbook of Public Health Ethics (2019).

The persistence of inequality within policies widely regarded as successful is also examined by Malone (Tobacco Control, 2021) and Mills et al. (Tobacco Control, 2022).

For a normative framework grounded in equity, proportionality, and dignity, especially relevant when the burdens of policy become concentrated, see Voigt (Public Health Ethics, 2010); Breton and Sherlaw (Public Health Ethics, 2011); and Voigt in The Oxford Handbook of Public Health Ethics (2019).

The ethical problem posed by denormalization, particularly when it becomes entangled with stigma and exclusion, is developed by Bell (Critical Public Health, 2011; Drugs and Alcohol Today, 2013) and by Bayer and Stuber (American Journal of Public Health, 2006).

The tensions among care, exclusion, and legitimacy, particularly visible when public health success coexists with the social concentration of harm, are evident in Malone (Tobacco Control, 2021), Lund and Sæbø (Harm Reduction Journal, 2024), and Meier and Shelley (Public Health Reports, 2006).

Atem und Wandel – Breathe for Change did more than name the conference.

It established its mood. “Breath” carried an obvious literal meaning, given Barmelweid’s close association with respiratory care. But it also carried a moral one, linking cessation, clean air, prevention, and behavioral change. The English subtitle, together with the presence of the WHO and the ENSP, placed the event in a familiar register: locally anchored, internationally legible.

The image of the clinic set against greenery, and the column of seals a few pages later, completed the effect. Before anyone spoke, the event had already been framed through care, order, certification, and authority.¹

The seals mattered. Barmelweid foregrounded its international Gold recognition within the network of tobacco-free healthcare services. At the same time, the network itself described certification not only as a mark of commitment but also as a valuable signal to insurers and referring physicians. The effect was not merely symbolic. Certification did not just affirm a principle; it helped place the institution within a hierarchy of credibility.²

The conference projected public health, certainly. But it also projected standing.

Its organizing core was local. It centered on Klinik Barmelweid, a Swiss specialty and rehabilitation clinic with a strong focus on pulmonology and nicotine-cessation counseling, and on the FNBS, which appeared in the program through Susann Koalick, head of the clinic’s nicotine counseling service and president of the forum. Barmelweid maintained a formal cessation structure; FNBS presented itself as a nonprofit platform supporting institutions and professionals in implementing evidence-based standards for nicotine prevention.¹˜³

A second layer came from transnational legitimation. By opening with José Luis Castro, the WHO Director-General’s Special Envoy for chronic respiratory diseases, and Cornel Radu-Loghin, secretary-general of the ENSP, the meeting placed itself under two established forms of authority: the WHO’s norm-setting role and the European tobacco-control advocacy represented by the ENSP. The conference presented itself not simply as training, but as part of a wider field organized around nicotine control. ¹˜⁸

A third layer came through practical translation. The program spanned oncology, dentistry, child and adolescent psychiatry, cardiology, addiction medicine, occupational health management, work psychology, and digital communication. In that arrangement, nicotine appeared not as a narrow clinical issue but as a cross-cutting problem touching cancer, mental health, youth, workplace culture, and public communication. The session on Rauchfrei-Kultur, featuring hospital managers and human-resources personnel, was especially revealing. The focus shifted from the individual smoker to institutional governance and the production of smoke-free and nicotine-free environments.¹

That shift matters. The conference did not simply ask how to reduce smoking. It also asked who would define the legitimate terms of prevention, which institutions would be recognized as exemplary, and how those standards would circulate.

The most visible interest was preventive and sanitary. The program framed nicotine as a matter of reducing tobacco and nicotine use, protecting young people, integrating cessation into cancer care, cardiology, mental health, and dentistry, and responding to the spread of newer products such as snus, pouches, and electronic cigarettes. But a second interest was also visible: the consolidation of a field. By convening the WHO, the ENSP, hospitals, clinicians, psychologists, prevention specialists, and communication professionals, the organizers were doing more than assembling a conference. They were assembling a network of authority.¹˜⁸

Two sessions made that especially clear: Nikotinindustrie und Sprache and Chancen digitaler Reichweite für Nikotinprävention. The struggle here was not only clinical or regulatory. It was also semantic. The program treated nicotine not simply as a substance to be governed, but as a narrative terrain to be occupied: the language of prevention had to compete with the language of innovation, lifestyle, and harm reduction. In that sense, the event did not merely communicate a position. It also worked to stabilize the vocabulary through which the problem would be understood.¹

The omissions helped define its character. On the publicly listed event page, no industry representatives, vape consumers, harm-reduction associations, or openly dissenting voices were visible. That fact alone does not invalidate the meeting. But it does clarify what kind of meeting it was. This was not a forum designed to test disagreement at its outer edge. It was a forum of alignment.¹

The same logic becomes clearer once one looks beyond the program and into the infrastructure behind it.

The network ran on both money and legitimacy. Revenue came from membership dues, certification fees, training revenue, project-related contributions, and the host clinic’s economic base. Legitimacy came through certification, international recognition, and alignment with cantonal programs and healthcare mandates. Together, those elements produced a more durable kind of standing within the health system: greater authority to speak in the name of prevention, greater value as a reference point, and greater credibility with insurers, referring physicians, and institutional partners.²˜³˜⁵

The clearest starting point is an official record. The 2nd Nikotintagung Klinik Barmelweid received 9,000 Swiss francs from the Swiss Tobacco Prevention Fund between April 2007 and May 2008. The project was framed not as a commercial activity, nor simply as an academic exercise, but as information and awareness-raising and as part of a broader effort in networking and creating favorable conditions for prevention. In the final report, the organizers described the conference as a platform for exchange, a means of expanding knowledge in research and practice, and a way of supporting the implementation of smoke-free measures in hospitals and healthcare institutions. From the beginning, then, the tagung appears less as isolated professional training than as an instrument for organizing a field.⁴

By 2026, that structure no longer looked experimental. The 11th Nikotintagung again placed Barmelweid at the center, with Koalick in a key role, explicit support from the FNBS, and a schedule populated almost entirely by actors from public health, prevention, hospital management, and preventive communication. Registration was set at CHF 300. What appeared in 2008 as a publicly supported effort to build exchange among specialists had, by 2026, become recurring infrastructure: a site where common language, professional visibility, and institutional alignment could be reproduced.¹˜⁴

Its financial base was mixed. The Swiss Tobacco Prevention Fund states that it receives 2.6 rappen per pack of cigarettes sold and disposes of roughly 12 million Swiss francs per year to finance tobacco- and nicotine-prevention measures. Part of this world, in other words, rests on a stable public revenue stream anchored in the very consumption it seeks to reduce.⁴

The statutes of the former FTGS, later renamed FNBS, make the association’s revenue structure explicit: membership fees, certification income, project-related contributions, contributions from the Confederation, cantons, and municipalities, donations, service revenue from activities such as training, and investment income. This was not a body sustained by a single grant. It was built to operate as a platform: part association, part service provider, part intermediary for public and institutional money. Even the membership forms point in that direction. Individual membership costs CHF 80 per year; collective membership requires a CHF 250 entry fee and CHF 450 in annual dues. These are not large sums. But they show that affiliation was not only symbolic. It also generated structure.³

The material center of this arrangement was Klinik Barmelweid itself. In 2024, the clinic reported CHF 80.1 million in total revenue, almost all of it from services and deliveries, including CHF 70.6 million from medical and nursing services. It also held positions on the hospital lists of Aargau, Basel-Landschaft, Basel-Stadt, and Solothurn. That mattered because its place in the system did not rest on reputation alone. It rested on cantonal mandates, payer recognition, and formal insertion into the Swiss healthcare infrastructure.⁵

Certification is where these strands converge most clearly.

FNBS offered three certification levels for healthcare institutions—Bronze, Silver, and Gold—with formal pricing, staged requirements, and periodic recertification. More important than the fees was what the standards covered: leadership, communication, training, identification and support for cessation, tobacco-free environments, workplace health, public engagement, and evaluation. Certification, in this sense, did not merely attest compliance. It organized a model of institutional conduct.⁶

The signets extended that logic into the visual environment. FNBS marketed registered “Smoke Free” and “Smoking Area” signage, linking prevention to signage, space, and institutional design. Prevention, here, was not only advice or counseling. It also took material form as an organizational product.⁶

The strategic value of certification was stated most clearly by the network itself. In an interview on the Barmelweid blog, Susann Koalick described certification as a valuable signal to insurers and referring physicians and as something that strengthened the institution’s standing in other quality-certification processes. Barmelweid likewise emphasized that it had been the first Swiss clinic to receive this international Gold recognition in 2020 and the first to be successfully recertified in 2024. Certification did not, on its own, create the right to bill the mandatory insurance system that still depended on hospital lists and cantonal mandates. But it improved its relative position within the healthcare field. It made the institution more legible, more reputable, and more useful within the circuits of referral, reimbursement, and accreditation.²˜⁵˜⁷

At that point, certification ceased to be a detail and became an instrument.

What emerges from these documents is not a conspiracy, and does not need one. The interest is visible enough without it. Public-health language, public funding, certification, clinical infrastructure, and professional events were not operating separately. They were reinforcing one another. The result was a network able not only to advocate prevention but also to define standards, circulate recognition, organize training, convene aligned actors, and strengthen its own centrality within the field.

What remains unknown matters too. Within the public material reviewed here, there is still no audited breakdown of FNBS revenue by category, no precise weighting of each income stream, no full financing breakdown for the Nikotintagungen, and no complete public map of cantonal contracts and projects linked to the network. Those limits should be stated plainly. But they do not erase the pattern already visible in the available record.

That pattern is straightforward. Public money helped build the network. The network helped produce standards. Standards helped produce certification. Certification helped produce a position.

And position, in this case, had effects. It shaped access to recognition, referrals, institutional trust, and public partnership. It helped define what counted as exemplary practice. It generated recurring services around assessment, recertification, training, and materials. It made the network a more plausible partner for policy implementation and more influential in setting the tone of the debate.⁴˜⁵˜⁶˜⁷

The Swiss Barmelweid/FNBS network did not operate in isolation. It operated within a broader field in which the WHO, the ENSP, and philanthropic actors contributed to the financing, coordination, and dissemination of tobacco-control norms, campaigns, and institutional agendas. But the core mechanism is already visible at a closer range. In Barmelweid, prevention appeared not only as a medical or ethical imperative. It also appeared as a way of building position inside the health system, and of turning that position into further influence.⁸

In that sense, the question is not only what prevention opposes. It is also what prevention organizes, what it rewards, and what kinds of authority it helps reproduce.

Notes / Sources

1. Event framing, listed speakers, target audience, registration, and publicly visible omissions on the official page for the 11th Nikotintagung (2026):

https://fnbs.ch/events/11-nikotintagung-atem-und-wandel-breathe-for-change/

2. Barmelweid and network communications on certification value, international Gold recognition, recertification, and certification as a signal to insurers and referring physicians:

https://blog.barmelweid.ch/die-barmelweid-ist-eine-echte-vorreiterin/

https://www.barmelweid.ch/news/artikel/die-barmelweid-erhaelt-erneut-gold-in-der-tabakentwoehnung-international

3. FTGS/FNBS institutional continuity, statutes, revenue structure, governance, and membership categories/fees:

https://fnbs.ch/wp-content/uploads/2023/09/FTGS-Vereinsstatuten-2023.pdf

https://fnbs.ch/wp-content/uploads/2023/09/Einzelmitgliedschaft_Antrag.pdf

https://fnbs.ch/wp-content/uploads/2023/09/Kollektivmitgliedschaft_Antrag_d.pdf

https://fnbs.ch/ftgs-heisst-jetzt-fnbs-praevention-weitergedacht/

4. Swiss Tobacco Prevention Fund support for the 2nd Nikotintagung Klinik Barmelweid, including project record, final report, and TPF funding logic:

https://tpf-livingdocs.bagapps.ch/livingdocs.php?cq=2004%3B2025%3B0%3B%3B%3B%3B%3B0%3B&id=94&lang=de

https://tpf-livingdocs.bagapps.ch/data/pdf/94-0.pdf?v=1566208714

https://www.tpf.admin.ch/de/der-tabakpraeventionsfonds

5. Klinik Barmelweid institutional and financial profile, hospital-list status, cantonal mandates, insurance recognition, and patient admission pathway:

https://www.barmelweid.ch/fileadmin/user_upload/Dokumente/GB2024/Jahresrechnung_Klinik_Barmelweid_AG_2024.pdf

https://www.barmelweid.ch/ueber-uns/portraet/leistungsauftraege

https://www.barmelweid.ch/barmelweid/ihr-klinikaufenthalt/anmeldung

6. FNBS certification model, standards, pricing, recertification, and signets/signage materials:

https://fnbs.ch/zertifizieren/

https://fnbs.ch/produkt-kategorie/signete/

7. Certification as institutional signal and relative advantage within referral, reimbursement, and accreditation circuits:

https://blog.barmelweid.ch/die-barmelweid-ist-eine-echte-vorreiterin/

https://www.barmelweid.ch/news/artikel/die-barmelweid-erhaelt-erneut-gold-in-der-tabakentwoehnung-international

https://www.barmelweid.ch/ueber-uns/portraet/leistungsauftraege

8. Wider international coordination and financing ecosystem involving WHO, ENSP, EU-supported ENSP activity, Vital Strategies, and Bloomberg-linked tobacco-control programs:

https://www.who.int/teams/health-promotion/tobacco-control/implementing/capacity-building

https://ensp.network/wp-content/uploads/2017/05/ENSP-20-Years-LOWRES-ilovepdf-compressed.pdf

https://www.parlament.gv.at/dokument/XXVII/EU/38925/imfname_11019376.pdf

https://cordis.europa.eu/project/id/681109

https://ensp.network/wp-content/uploads/2022/02/ENSP-Annual-Report-2019_final.pdf

https://www.vitalstrategies.org/resources/tobacco-control-initiatives/

https://fctc.who.int/docs/librariesprovider12/technical-documents/global-progress-report-who-fctc-2023.pdf?download=true&sfvrsn=bd10da90_16

https://www.who.int/teams/health-promotion/tobacco-control/implementing/capacity-building

https://www.tobaccocontrolgrants.org/s/01-Tobacco-Industry-Interference-Grants-Call-for-Proposals-R5-Jan-final-2026-47fj.pdf

https://www.bloomberg.org/public-health/reducing-tobacco-use/bloomberg-initiative-to-reduce-tobacco-use

That may have been why it passed through the room without friction: the absence of conflict did not signal agreement so much as delimitation—a quiet recognition of what could be said, what need not be defended, and what had already been settled in advance.

The framing did not begin with the speech. It was already embedded in the program. Throughout the day, the themes aligned with minimal deviation: nicotine prevention, smoke-free culture, the industry's language, the impact of new products on children and adolescents, and digital strategies designed to contain their spread.

This kind of organization is hardly unusual in contemporary public-health gatherings, where the convergence of research, advocacy, and policymaking tends to narrow the space for explicit dissent. The language of prevention helps organize action, but it also prefigures the terms of debate.

What emerged was not a confrontation between competing interpretations so much as the reiteration of a shared vocabulary from multiple angles. In that arrangement, the conference functioned less as a site of reflection than as a mechanism of stabilization: before asking how risks, uses, and contexts might be distinguished, it had already determined which distinctions would count as relevant.

Its coherence is derived from that.
And so did its limit.

In this context, Castro’s position ceases to be incidental and becomes part of the arrangement itself. He speaks not from a distance, but from within a role that blends formulation, mobilization, and the defense of agendas. As a WHO Special Envoy, his task is to amplify messages, build alliances, and sustain institutional priorities.

This does not diminish the weight of what he says. But it does change how the speech must be heard. It operates not as an arbitration between competing hypotheses, but as a situated intervention within a broader effort to organize perceptions, align interpretations, and stabilize frameworks in public debate.

To his credit, Castro does not conceal this shift. He says so plainly: policy alone is not enough, because it is often “downstream from culture.” The issue, then, is not that the speech disguises its priorities, but that it relocates the center of gravity of the debate—from differentiating risks to defining the cultural and narrative terms through which those risks will be understood.

At that point, the problem no longer appears solely as one of evidence or scientific uncertainty, but as one of perception: how nicotine is seen, interpreted, and absorbed into the social imagination. Castro marks this shift explicitly when he frames prevention not only as a matter of regulation but also as a matter of understanding “how products are positioned, how language is used, and how perceptions of risk are shaped.”

He goes further. If policy is often “downstream from culture,” then what matters is “the story we are telling in the culture.” In his formulation, the concern is that “the narrative around nicotine is being shaped elsewhere,” in the language of innovation, choice, and harm reduction —and that, if left unchecked, it may “take hold before we have had a chance to define our own.”

With that move, the dispute extends beyond what is known to include which languages are granted legitimacy to describe the problem. The question is no longer only what counts as evidence, but who defines the narrative terrain on which that evidence will be interpreted.

That shift alters the nature of the problem. What once appeared as a question of differentiating risk now operates at the level of authority: who defines categories, who names phenomena, who establishes equivalences.

As that axis shifts, conceptual precision no longer occupies the center of the scene. Distinct products begin to circulate under a shared designation, sharing language before they share properties.

“New nicotine and tobacco products” becomes less a description than a container. Within it coexist the regulated e-cigarette used by an adult trying to quit smoking, the illegal device designed to maximize youth appeal, occasional experimentation, regular use, initiation, substitution, and relapse.

This cognitive economy is not trivial. In conditions of high complexity, broad categories facilitate communication, decision-making, and coordinated action. But they also reduce the capacity to distinguish among risks of different kinds, scales, and consequences.

The differences do not disappear. But they begin to matter less. What remains intact is the continuity of the category—and the cognitive economy it makes possible.

That cognitive economy was on display throughout the day. But once one returns to the empirical level—to the available data on youth use—the picture becomes less uniform than the language suggests.

Youth use of electronic nicotine devices, for instance, is unevenly distributed and does not follow a single trajectory. In many cases, it takes the form of episodic experimentation, often entangled with other risk behaviors and specific social settings. Part of that variability can be traced to factors that precede contact with the product itself, patterns of risk, family context, mental health, peer networks, and that resist reduction to any simple logic of exposure or access.

More persistent use tends to cluster among groups already predisposed to nicotine use or other forms of risk, which complicates linear explanations based solely on product characteristics, marketing, or availability. At the same time, in several countries, youth use appears to have peaked before declining or stabilizing, often alongside steeper declines in combustible cigarette use.

None of this erases the problem. But it does make it harder to treat it as a single phenomenon, with a single cause and a uniform solution.

Once those distinctions become secondary, policy design tends to follow the same logic. Interventions begin to operate as though they were addressing a homogeneous phenomenon, even when patterns of use, motivation, and risk differ sharply. Measures guided by simplified causal models focused on product, access, or marketing may leave the underlying drivers of demand largely untouched.

In some contexts described in the recent literature, this not only reduces policy effectiveness but also opens the door to less intuitive outcomes: users migrate across products, parallel markets expand, and potentially less harmful alternatives lose ground to more established forms of consumption.

Where alternatives are regulated without differentiation, demand does not simply disappear. It reorganizes itself, often toward more entrenched and, in some cases, more harmful patterns.

The problem, then, is no longer only risk itself, but the way risk is distributed and, at times, redistributed by the very responses designed to address it. That is what becomes harder to see once a single vocabulary settles too quickly over heterogeneous realities.

In public health, there is an inevitable tension between the need to simplify and the obligation to distinguish. Simplification helps organize action; it makes communication, mobilization, and scale possible. But every simplification carries a cost: it erases differences that, in some contexts, are precisely what matter most.

Simplification is inevitable. But not every simplification is innocent.

In Barmelweid, that balance seemed to tilt in a particular direction—not through any obvious error, but through the force of a consensus that arrived already structured, with its categories prepared, its urgencies defined, and its limits barely visible.

The risk lies not only in what is said about nicotine, but in what can no longer be recognized once language stabilizes too soon.

What is lost in such cases is not only nuance, but the capacity to adjust responses to realities that do not fit within a single category.

If Before the Numbers examines how consensus was made to sound natural in Barmelweid, what follows turns to the structure that helped make it so.

Its decline is real. But this shift was not merely epidemiological. It was also a change in the moral code. Smoking ceased to be a banal habit and came to signify a lack of self-command, a source of discomfort, a failure of self-discipline.

The mistake begins when this retreat is read as a uniform victory, as though the problem had diminished equally for everyone. It has not. What happened was something else: smoking ceased to be diffuse and became concentrated. And when harm becomes concentrated, its political character changes.

According to a study by Sarah Jackson, Sharon Cox, Jamie Brown, and Vera Buss, published in Nicotine & Tobacco Research and based on data from 2022 to 2024 for England, Scotland, and Wales, average consumption among smokers reaches 10.4 cigarettes per day —the equivalent of 28.6 billion cigarettes a year.

But the most important finding is not the sheer volume. It lies in the social pattern of consumption. Cigarettes are no longer distributed in a relatively even way across social strata. They are concentrated —and concentrated, above all, among the poor.

In the C2DE social grades, smoking prevalence stands at 18.8 percent, as against 10 percent among higher-income groups. Daily consumption is also higher: 11 cigarettes, compared with 9.4. On an annual basis, the gap becomes sharper still: 755 cigarettes per capita among the most vulnerable, versus 343 among the wealthiest segments.

These figures do more than measure consumption. They show how harm is distributed. In practice, that means smoking is no longer a habit spread across the social fabric; it has taken root in specific territories—neighborhoods, routines, and bodies in which quitting is not merely a decision, but a more remote possibility.

In this landscape, smoking can no longer be read simply as addiction, habit, or individual choice. It begins to function as a marker of class. Not because the cigarette has changed in nature or acquired some new sociological essence, but because its persistence tracks the line of inequality. When the better protected are able to exit first, and the most vulnerable are left behind, what emerges is not merely the persistence of a behavior, but the social concentration of harm—and, at the limit, a form of social triage.

This shift in the pattern demands a shift in language and in approach as well. Public debate about tobacco still speaks as though it were addressing an undifferentiated population: “the smoker,” “the user,” “the consumer.” They are convenient terms.

They erase low income, territory, interrupted schooling, precarious or exhausting work, psychic suffering, gender, ethnicity, the presence—or absence—of a support network, irregular access to treatment. In short, they erase the concrete intersections where vulnerability takes shape.

Those who continue to smoke are no longer a statistical abstraction. They are, increasingly, the point at which different forms of disadvantage converge. And policies that pretend not to see this end up treating as universal subjects people who have never lived under universal conditions.

Abstraction serves moral rhetoric well because individual blame is always easier to manage than structural inequality. It serves public policy badly.

For a long time, those who contest, occupy, and direct the state have learned to govern less through open prohibition than through the inducement to self-management. Health came to be demanded not only as a right, but also as a moral duty: proof of responsibility, a credential of active citizenship.

Within this regime, the good subject is one who calculates risks, corrects habits, manages the body, and lives up to what is expected of it. Whoever fails no longer appears as someone constrained by material limits, but as someone morally wanting: someone who has failed to govern himself.

It is here that the rhetoric of individual responsibility meets its limit. It can produce severe campaigns, effective slogans, and the appearance of moral firmness. But it does not explain why smoking recedes faster among the better protected and persists where life is more precarious. It does not explain why certain groups smoke more—and smoke more heavily. Nor does it explain why, when the habit loses social legitimacy, it does not disappear: it concentrates where protection is weakest.

Smoking does not vanish. It is pushed to the margins.

This displacement reveals something else: the consolidation of a way of seeing that Kirsten Bell and Hilary Graham help identify as a discursive hegemony. Certain public-health ideas no longer circulate merely as arguments; they circulate as common sense. The image of the smoker as someone who persists in error despite all the available information has become so intuitive that it scarcely needs defending anymore.

That is where the debate grows impoverished: when a worldview presents itself as a neutral description of reality. At that point, policy ceases to ask who still smokes, and under what conditions, and instead returns to the moral demand for individual self-correction.

But smoking does not distribute itself through the air. It concentrates where other forms of vulnerability have already piled up: in regions marked by deindustrialization, precarious work, overburdened public services, deteriorating housing, recurrent mental distress, and a narrower social horizon.

In these settings, the cigarette ceases to be merely a public-health risk. It begins to function as a symptom of social compression. It is not, of course, the only response to suffering—but it is one of the most visible. Smoke no longer appears simply as a private deviation; it becomes a record of collective wear and tear.

There is, then, an unavoidable political consequence. If the cigarette has become a marker of class, universal and morally abstract policies are no longer enough. Not because the state should downplay the harms of tobacco. Quite the reverse: to confront them seriously, it must recognize where they have become concentrated.

Measures designed for “the population” tend to fail when the problem has already taken hold in a specific segment—above all, a social segment historically pushed into invisibility. In such a case, universalism risks becoming, at best, a form of blindness posing as neutrality.

That is the point that ought to reorganize the debate. The problem of tobacco today lies not only in the product, though it begins there. It lies in the way harm is socially distributed.

When that harm is concentrated among the most vulnerable, public policy must abandon the fiction that warning, punishing, and taxing are enough to elicit equal responses from unequal lives. People do not respond in the same way because they do not live under the same conditions.

To treat the unequal as though they were equal may produce a tidy discourse. It produces, however, an unjust practice.

None of this absolves the tobacco industry or minimizes the toll of cigarettes on public health. Quite the opposite: it compels us to shift the question and expose the limits of a mindset that still dominates tobacco control—the mindset that reduces the problem to individual failure, insists on correcting behavior, and pushes to the margins the social conditions in which smoking persists.

It is not enough to ask why people still smoke. We must ask who continues to smoke, where, under what pressures, and with what real possibilities of escape.

That means reckoning, without caricature, with the harm-reduction paradigm. In many of the societies where most smokers are concentrated—above all in low- and middle-income countries—lower-risk alternatives remain blocked by regulatory uncertainty, illegality, criminalization, and stigma, as though any departure from the ideal of abstinence already amounted to a form of moral surrender.

The result is a politics that speaks in the language of protection yet often fails to offer a response proportionate to the risk faced by the very groups most exposed to combustion. And it does so in the name of an ideal of sanitary respectability, heavily marked by class values, that itself produces marginalization.

Smoking no longer sketches a general portrait of society. It draws a border. And, as Hilary Graham has shown, that border separates not so much smokers from non-smokers as those who were able to move away from harm and those who remained more exposed to it.

She counts the coins twice.
The first time is the gesture of someone who already knows the outcome.
The second is for someone who still hopes, against all evidence, that the numbers might have changed.

They haven’t.

The lighter fails twice; on the third, the flame comes up unsteady.
She lifts a leaflet from the health clinic as a shield.
On it, a darkened lung wavers in the wind.

“I keep borrowing from the future,” she says, to no one.
“I never know when it comes due.”

The sentence isn’t a metaphor; it’s a household budget.

Anna, twenty-eight, in a supermarket uniform, lives in the gap between what comes in and what runs out.

Here, the cigarette is not the abstract vice of anti-smoking campaigns. It is a small technology of survival: it structures waiting, marks a pause, holds open the distance between one bus and the next.

For decades, public health spoke in the language of the future: stop now to live later, defer pleasure in the name of a reward still to come.

Prevention rested on a quiet premise: that tomorrow was a credible horizon, something worth investing in.

But for millions, the future has lost weight; the horizon has shortened.

Between precarious work, fatigue, instability, and urgency, life is no longer organized around the promise of improvement, but around the management of the day.

It is on this terrain that prevention begins to lose its grip, not because people have become more ignorant or irresponsible, but because the logic of postponement requires a pact not everyone can enter into. When the present fills with exhaustion, fear, and improvisation, the long term no longer governs behavior with the same force.

The bus arrives. The doors open.
Anna steps on, drops in her coin, and moves toward the back.

The future is the interval between this cigarette and the next.

In a yellow-lit kitchen, an old fan turns without cooling the air.

August, seventy-three, shirt open at the chest, coughs over the sink; an old cough, one that already knows the way.

On the table, a full ashtray and a cup of cold coffee. On the refrigerator, a child’s drawing held by a magnet: a crooked sun, a house, three stick figures.

August picks up a pack. He begins the motion of lighting and stops. He looks at the drawing. He places the cigarettes in a glass jar, one by one, unhurried, as if storing something dangerous. Then he sets the jar on top of the cabinet, out of a child’s reach. His hand comes down slowly.

The scene belongs to the past, but it still pulses in the present. August is Anna’s grandfather. The interrupted gesture, the almost-lit cigarette, the jar lifted out of reach, condense something larger than an individual decision. The will was there. What was missing was ground.

For much of the twentieth century, the promise of progress was also a promise of time: present sacrifice would yield returns later on. To a large extent, collective life was organized around the idea that the future was worth the investment.

That arrangement has worn down in recent decades. Not all at once, but through erosion: successive crises, persistent precarity, accumulated distrust. Historians have called this narrowing of temporal experience presentism. Outside theory, though, the phenomenon is easy to recognize. When work is unstable, housing is uncertain, and rest is scarce, the long-term loses density. Planning ceases to be a habit and becomes a wager.

In Brazil, this contraction of the horizon is also distributed across territory and class. In São Paulo, the gap in average life expectancy between districts exceeds twenty years. It is as if two countries occupied the same space: one in which tomorrow stretches far enough to justify sacrifice, another in which it collapses from within. Smoking does not produce this divide, but it settles inside it.

The waiting room is a limbo of plastic and cold light.

An electronic display flickers numbers that don’t move.

On the wall, a blackened lung.
Next to it, a faded slogan:

“SUFFER NOW TO LIVE BETTER LATER.”

Someone coughs. Someone checks their phone. Anna holds a handful of coins inside her bag, as if she could protect them.

The doctor doesn’t look up from the chart.
“How long have you been smoking?”

Anna opens her mouth. “Since—”

She doesn’t finish. The doctor has already checked a box: training, neutrality. He slides a leaflet across the table, illustrated lungs, benefits, and a phone number.
Anna takes the paper with both hands, like someone receiving a promise she isn’t sure she can keep. She signs where she’s told. She doesn’t read.

For decades, public health has proposed the same bargain: give something up now — a pleasure, an immediate relief — in exchange for benefits later. Eat better, move more, quit smoking, adhere to treatment.

The exchange feels fair when the future is a livable horizon, when tomorrow still inspires trust. But prevention is not only a calculation of risk; it is also a moral contract, and that contract presumes stability. Above all, it presumes that delay is worth it.

In the waiting room, that contract already appears worn.

Anna signs without reading — not out of carelessness, but because the gesture of compliance has, for many, become an empty ritual, a formality that life quickly contradicts. Here, prevention fails not because of ignorance. It fails because it requires a kind of material and subjective ground that not everyone has.

There is a mismatch between the temporality of prevention and that of precarious life. The first operates in the long term: years without smoking, disciplined routines, benefits accumulated quietly. The second in the short: the money that runs out at the end of the month, the exhausted body that demands relief now, the urgency that does not wait.

As the public-health literature shows, quitting smoking is strongly associated with income, education, mental health, and access to support. Not because low-income smokers know less or want less, but because cessation is not simply an act of will. It requires time, care, margin, and protection against extreme stress, resources that are deeply unevenly distributed. On its own, will does not carry a person across a compressed present.

At the factory gate, the sky hangs low and dirty.

Damian, forty-two, his uniform stitched at the chest, wears a stopped watch on his wrist. He looks at it not to tell the time, but to confirm there is no time left.

The lighter fails twice; on the third, the flame comes up unsteady.
He cups his hand around it, shielding the fire from the wind.

The first drag is short, almost tentative. He coughs once, dry, then swallows it, glancing sideways, as if coughing were a minor fault.

Later, in another kitchen, another night. Anna is in sweatpants, her hair fallen loose with exhaustion. She washes a pan quickly, trying not to make a noise. She opens the window just enough to slip her arm through. The flame wavers, then catches. She inhales and holds the smoke for a second. It is not a pleasure. It is a suspension.

From the bedroom comes the sound of a child breathing.

In the hallway, a toy on the floor.
She almost trips. Stops. Looks.
Love, irritation, fatigue, all at once.

She exhales the smoke outward, trying to make it disappear before it can exist inside.

In both gestures — Damian at the factory gate, Anna at the window — the cigarette appears not as an abstract habit, but as a small everyday technology. It does not resolve suffering; it gives it shape. It marks an interval, introduces a ritual, and offers a brief, predictable reward in a day without contour. In lives where work, sleep, time, and care have lost their regularity, it functions as a minimal tool of self-regulation.

What appears irrational from a public-health standpoint becomes legible when one looks at what the cigarette provides in return. It is cheap, portable, and immediate. It requires no appointment, no line, no consultation, no free time. It is at hand. And for that reason, it often takes the place of other forms of relief and care that, for many, are expensive, scarce, or simply unavailable.

But its function is not only chemical.

The cigarette also organizes time: it marks the beginning and end of a pause.

In fragmented routines, irregular shifts, and schedules that disregard sleep, the minimal ceremony of lighting it opens an interval that still belongs to the smoker, however brief, however paid for with their own health.

In unequal contexts, smoking is more heavily concentrated among those pushed into precarious paths of income and schooling.

This difference does not stem only from unequal knowledge; it also reflects how rest, pleasure, and care are socially distributed.

In conditions of greater vulnerability, the cigarette takes the place of forms of listening, relief, and protection that are scarce, inaccessible, or simply nonexistent.

There is also a relational dimension.

The cigarette accompanies waiting, solitude, and the exhaustion of alienated work. It becomes a pretext to step out of a stifling room, a license for a minute away from children, bosses, and the demands that do not cease. For those who spend the day caring for others — children, the elderly, clients, patients — or converting their own time into income for others, it can become the only gesture that still feels like it belongs to their own body, even as it exacts a destructive cost.

On the ground, a faded yellow rectangle.

Inside it, a man lights a cigarette.
Clara approaches with grocery bags. She slows. Looks at the blue sign:

“SMOKING AREA.”

Looks at the rectangle.
She makes a small detour, as if the ground there were contaminated.
As she passes, she holds her breath for half a second.
Adjusts her coat with her fingertips.

Two steps later, she exhales. Her face does not register relief. It simply confirms.

In the elevator, the man steps in right after her. Clara presses the button for her floor. Without looking, she also presses the fan. The light comes on. A young woman pulls her backpack to her chest, like a shield. Someone shifts back an inch. No one speaks.

Later, in the building’s group chat, Clara writes: “Hi everyone, smoke has been coming up into my apartment. There are children and elderly people here. Please be considerate.” The reactions arrive within seconds: hearts, thumbs up, an “exactly.”

Clara is not a villain. She is someone who has internalized the moral language of public health as an almost natural extension of good manners.

In her gestures — the detour, the held breath, the press of the fan — there is no explicit cruelty. There is a boundary being drawn.

The smoker no longer appears as a subject with a history, a routine, an exhaustion. He becomes odor, nuisance, a failure of care.

Anti-smoking policy has produced real gains. The decline in smoking in Brazil, for example, is one of them. But part of its public language has remained tied to a moralizing imagination, in which the smoker appears as a deviation, a failure of will, and irresponsibility.

The social structure of suffering recedes from view; individual behavior takes over the entire stage. The result is the predominance of a pedagogy of shame.

This pedagogy does more than communicate risk; it teaches the smoker to feel out of place. The yellow rectangle on the ground, meant simply to contain harm, also marks an exception: one may remain there, so long as one remains apart.

The smoker’s body becomes a suspect body, polluting, displaced.

The phrase on the waiting-room wall — “SUFFER NOW TO LIVE BETTER LATER” — condenses this imperative. To suffer in the present appears as virtue; to refuse that suffering, as weakness. The problem is not informing people about harm, but turning the difficulty of quitting into a failure of character, as if smoking were merely an individual choice, rather than a socially produced condition, often shaped by exhaustion, precarity, and inequality.

There is also an economic dimension to this arrangement. Tobacco is heavily taxed, and the burden falls more heavily on those with less. The state regulates, collects, and warns; care, however, does not reach with the same breadth. For many, the equation looks like this: smoke, pay dearly, fall ill, carry the blame.

The effect of this combination — stigma, regressive taxation, uneven support — is the individualization of suffering. Not smoking ceases to be only a matter of health and becomes a marker of discipline, self-control, and belonging. What is at stake, then, is not only care. It is also status, distinction.

The nurse peels back the seal on the package.

The plastic snaps.

Anna sits with her hands in her lap; short nails, a pen mark on her finger.
She pulls up her sleeve without ceremony.

Cotton on the arm.
A dry touch.

The nurse applies the patch and smooths it with two fingers, counting silently. Anna watches the gesture: the way something is sealed that wants to come loose.

Days later, in the middle of the night, she is alone in the kitchen.

On the table, the box of patches and the crumpled leaflet. She pulls up her sleeve. The old patch is still there, one edge lifting. She removes it slowly.

The skin beneath holds the mark: a pale rectangle at the center of her arm.

She opens another. The plastic snaps softly. Applies it. Smooths it with two fingers. Presses the edge until it holds. Pulls her sleeve back down.

She stands there for a moment, as if waiting for her body to agree.

Later, at the bus stop, she takes a cigarette from the pack. Stops.

Her arm hangs suspended.
She puts the cigarette back.

From her bag, she takes a dark object, worn from use. She brings it to her mouth. A short pull. A small light flickers on and off.

The vapor dissolves into the cold air.

What these scenes show is not the redemptive victory of abstinence. It is something else: a movement of substitution, hesitant and imperfect, but guided by a logic that traditional public health takes too long to recognize. When someone cannot, or does not manage to stop immediately, care cannot simply withdraw.

Not everyone will interrupt harmful practices in the short term, and the conditions for doing so are unevenly distributed. Faced with that, the response is not to abandon those who continue to use, but to reorganize care around what is possible: to reduce risk, to lessen suffering, to widen the margin for breathing.

This is the moral turn of harm reduction. It replaces the question “how do we make someone stop?” with another, more modest and more concrete: “how do we make it so that, while they do not stop, they are harmed less?” It is not surrender. It is a refusal of the all-or-nothing logic. Care no longer demands purity in order to begin.

In the case of tobacco, this includes intermediate strategies: nicotine-replacement therapies, gradual reduction, and, for many, a shift to non-combustible forms of use. None of this eliminates risk. But for smokers who have repeatedly failed in attempts at complete cessation, these alternatives may mean less harm than continuing to smoke conventional cigarettes.

Resistance to this approach is not only technical. Part of it rests on some legitimate concerns: the long history of manipulation by the tobacco industry, uncertainty about the long-term effects of certain products, the risk of displacing, rather than dissolving, dependence, and the fear that intermediate strategies may reopen markets, normalize new forms of harm, or weaken decades of hard-won regulation.

But the resistance does not end there. It also arises from a moral discomfort with the idea that care might coexist with imperfection, with continued use, with bodies that do not purify themselves all at once.

Anna, at the bus stop, the vapor dissolving into the cold air, is not a success story by conventional standards. She still performs the gesture. She still depends on nicotine. But she no longer burns the clinic leaflet to light her cigarette. The change is ambiguous, negotiated, and still, it is the change that is possible.

In a well-kept garden bed, the leaves gleam with moisture.

A gardener, in thick gloves, trims the shrubs.

Snip. Snip.

Branches fall. Leaves fall.

He gathers everything with a shovel and pushes it into a black bag.

Two meters away, almost out of frame, a man sleeps wrapped in a thin blanket. From inside it comes a cough — small, persistent. The gardener does not look. He picks up the sprayer. Presses. The leaves take on a fresh shine. The man keeps coughing.

The scene is brief, but it condenses a question: What is the point of pruning dry leaves if the soil remains the same?

Harm reduction is an ethical and practical achievement. It allows care to continue where abstinence cannot begin. But it carries a risk: detached from structural transformation, it can become the humanized management of ruin.

The gardener tends to what is visible; what can be contained, trimmed, and made presentable. He does not alter the conditions that produce that body on the pavement. He does not alter the cold. He makes the garden appear habitable, while its actual inhabitant remains at the margins.

In health care, this logic reproduces itself easily. A patch, a brief consultation, an intermediate strategy — all of it is better than nothing. It reduces suffering, prevents greater harm, and widens the margin for survival. But if the social conditions that produce exhaustion, anxiety, and illness remain untouched, care risks being reduced to maintenance: it keeps the body functioning, however precariously, while leaving intact the ground that makes it ill.

The critique, then, is not of harm reduction but of what happens when it is stripped of its political dimension and returned to mere management. At that point, care ceases to be an opening and begins to function as containment: it intervenes on isolated bodies, manages symptoms, prolongs survival, but does not touch the world that distributes exhaustion, inequality, and illness. The collapse of the precarious is averted, without interrupting the order that produces it.

Anna, with the patch under her sleeve and the vapor dissolving into the cold air, has managed to exchange one technology for another. She has reduced the harm. But she remains at the same bus stop, with the same coins that don’t add up, the same faded uniform, the same endless waiting. The care she received has helped her not to worsen. It has not moved the world that keeps her there.

The bus sways.

Bodies lean together, in silence.

Anna rests her head against the fogged glass.
She wipes it with her sleeve, opening a small circle of visibility.

Outside, the street is coming into morning: people walking fast, a dog nosing through trash. In here, the silence of those already tired.

Anna’s hand goes to her arm by instinct.
She presses the patch, as if needing to confirm that it is still there.

Later, in the dark kitchen, she sits at the table.

The box of patches. The crumpled leaflet.

She pulls up her sleeve. The edge of the patch holds firm now. She smooths it once with her thumb. Opens the drawer. The crumpled pack is there.

She looks. Closes the drawer.
She rests her forehead against the cabinet for a second.

Breathes in through her nose. Lets the air out through her mouth, without a sound. Turns off the light.

There is no redemption in this scene: no heroic gesture, no solemn farewell.
Only a woman who looks at the pack and does not light it.

A hand that presses the patch, to feel that it is still holding.

The politics of the “still” is made of these minimal gestures. It promises no cure, demands no purity, expects no redemption. It works with what remains, insisting on doing something with that remainder.

Still alive. Still breathing. Still with some margin. Still capable of care.

It is a modest ethic, but not a minor one. In a time when the future has lost its density, it offers a form of care equal to exhausted lives: not the kind that abandons when someone fails, but the kind that remains, reduces harm, and sustains what is possible.

The politics of the “still” does not replace social justice. It does not make the coins add up, does not restore length to a horizon that has shortened. But it prevents the absence of social justice from becoming an alibi or a license for abandonment. While the ground does not change, it sustains those who are still standing on it.

Anna, in the dark kitchen, with the pack in the drawer and the patch on her arm, is not a success story. She is a case of persistence. And when the horizon contracts, persistence may be the only form of future that remains.

The bus moves on.
The glass fogs again.
Anna leans her head.
Her hand goes to her arm.

The patch is still there.

Note:

This essay began with a question: why does smoking remain so persistent among the poor?

Over time, the answer drifted away from the usual explanations: personal choice, lack of information, weak willpower. It began to emerge elsewhere: in exhaustion, in the brief pauses during precarious work, in money counted down to the last coin, in the constant pressure to get through the day, and in the difficulty of imagining a future that could justify sacrificing the present. In other words, in a life where both present and future have been compressed.

In that setting, smoking seems less like an abstract vice and more like something immediate and functional: a cheap anesthetic, a way to structure waiting, a small, reliable break. A minimal form of control in a world where almost nothing feels managed.

Between Breaths, a short-film script I wrote before this text, was an early attempt to explore that world from within, rather than from a distance of argument. The scenes are not reportage, but they are shaped by many real lives. They helped bring my attention closer to the concrete rhythm of those lives: fractured time, accumulated fatigue, and the small gestures through which a day is managed.

If the fiction attempts to stick with those gestures and pauses, this essay tries to make sense of what they reveal.

The deadliest nicotine product ever invented remains legal, visible, and routine. It is there in convenience stores, in the crumpled packs carried in a pocket, in the break during the workday, on the corner, in the habit itself. Almost everywhere, the combustible cigarette remains so readily available that its chemical violence nearly dissolves into the landscape.

The paradox requires no rhetoric. Around it, however, the language of prudence shifts in tone. Nicotine products that are substantially less dangerous, though backed by different kinds and degrees of evidence, such as vapes, snus, nicotine pouches, and heated tobacco, circulate in many countries under a regime of suspicion denser than the one reserved for the cigarette itself. In some places, they are banned. In others, they are tolerated grudgingly, hemmed in by restrictions or described in a public language that treats gradations of risk as though they were morally intolerable concessions.

This is where the Global Forum on Nicotine stops seeming like merely a niche conference. Since 2014, the gathering in Warsaw has become one of the clearest places in which this contradiction is examined without the easy protection of ready-made formulas. Researchers, physicians, regulators, consumers, industry representatives, web activists and harm-reduction advocates come together there not as a harmonious community but as a dissonant assembly, drawn by an impasse the global debate has yet to face with much honesty: how to lessen the deadly burden of smoking in a field where, for many institutions, distinguishing degrees of risk remains more uncomfortable than pretending they do not exist.

The question begins, in part, with Gerry Stimson, the British public-health social scientist and one of the defining figures in the history of harm reduction. In 2013, after years of watching part of the European debate treat tobacco and nicotine as though they belonged to the same moral order, Stimson arrived at a diagnosis almost too plain to be palatable: public health was failing to distinguish between what creates dependence and what, in combustion, causes death.

“We have known for a long time that people smoke for nicotine and die from the gases and tar.”

The line, which Stimson brought back at the Forum’s first gathering, needed no embellishment. It revealed a fault line. On one side stood the possibility of thinking in terms of relative risk, harm reduction, and regulatory innovation, without treating every nicotine product as if it were the burning cigarette. On the other stood a stubborn public grammar in which nicotine, combustion, and harm are still fused into the same condemnation.

From that fracture came the first Global Forum on Nicotine, held in Warsaw in June of 2014, with support from collaborators including Paddy Costall and Andrzej Sobczak. Some 220 participants from 26 countries attended the first gathering. The meeting was small. The problem was not. The Forum’s purpose was already clear: to create a space in which that distinction could be examined before it was moralized, flattened, or consigned to silence.

Since then, the GFN has become something more than an annual conference. It has served as a seismograph for the tensions reshaping the debate over nicotine, smoking, and harm reduction. With each edition, what returns is not simply a new theme but the same conflict particles in altered form: between evidence and orthodoxy, between the lived experience of people who smoke and the institutional languages that presume to speak for them, between the possibility of reducing harm and the persistent temptation to treat nuance itself as a form of weakness.

Over the years, the GFN began to take shape as a kind of recurring map of the tensions, shifts, and impasses reorganizing the debate over nicotine and smoking. Each edition captured less an isolated theme than the momentary state of a larger dispute.

In 2015, the dispute came into sharper focus. With “A Different Kind of Endgame” as its theme, the Forum began asking not only how smoking might end but also what sort of ending was being imagined. For years, the prevailing assumption had been that the cigarette would be defeated chiefly by ratcheting up pressure on people who smoke and on the industry. What the GFN began to frame more clearly at that point was another possibility: that lower-risk nicotine products might speed the cigarette’s decline by a route many still resisted recognizing, especially within public health itself.

The opening of the conference already made clear the axis of that shift. In the Michael Russell Oration, Derek Yach warned that the WHO Framework Convention on Tobacco Control would need a radical shift in emphasis to remain relevant. The point was straightforward: separating nicotine from tobacco-control policy was no longer some marginal provocation; it was becoming a precondition for thinking about the end of the cigarette itself without the usual rhetorical reflexes. By 2015, the GFN was beginning to show that the dispute was not just about products. It was about who would claim the authority to define the public-health horizon of the endgame.

By 2016, the ground was already beginning to shift. Under the banner Evidence, Accountability and Transparency, the Forum addressed a fast-changing landscape in which new nicotine-delivery systems were advancing faster than institutions could assess them without reverting to habit. The problem was no longer simply the arrival of new products, but the asymmetry between the speed of innovation and the slowness and, in some cases, the reluctance of regulatory response. In that setting, transparency and accountability referred not only to the data themselves. They also referred to the institutional and personal positions through which those data were being interpreted.

In his opening remarks, David Sweanor summed up the scale of the dispute: hundreds of millions of lives were at stake, along with hundreds of billions of dollars and the reputations of entire groups and individuals, all of it unfolding in an environment saturated with beliefs that were at once deeply entrenched and badly misinformed.

That year, the GFN was beginning to show that the debate over nicotine would be fought not only over evidence, but over who could be trusted to interpret it honestly and to expose, without pretense, the interests bound up in it. The European premiere of Aaron Biebert’s A Billion Lives pushed that shift further: the conflict was no longer calling only for regulation. It was also calling for a narrative.

By 2017, the Forum was speaking more plainly. With the theme Reducing Harm, Saving Lives, a sharper conviction was coming into view: ignoring lower-risk alternatives was not a way of preserving neutrality, but a way of consenting, through omission, to avoidable harm. As the science advanced and the regulatory landscape shifted by degrees, it became harder to keep treating harm reduction as a marginal hypothesis or a rhetorical concession. What was at stake was beginning to be stated with greater candor: if products less dangerous than the combustible cigarette exist, then rejecting them outright is also a choice, and one with a human cost.

That year’s Michael Russell Oration carried the shift further by another path. In “Drug Control and Tobacco Control: Parallels, Reform and Advocacy,” Ethan Nadelmann suggested that the debate over smoking had something to learn from the history of drug policy, particularly from the repeated failure of models that leave consumers out of the process and confuse protection with tutelage.

The first edition of the International Symposium on Nicotine Technology (ISoNTech), brought into the Forum that same year, extended the movement: the dispute was no longer only regulatory or epidemiological. It was also lodged in the material reality of innovation—the devices, their engineering, their evolution—and in the way technology might, in practice, reconfigure the possibilities of moving away from the cigarette.

With each edition, the same dissonance reappeared in a different form. On one side was a growing body of data, studies, successful regulatory experience, and testimony from consumers who had shifted away from cigarettes using noncombustible products. On the other hand, there was the persistence of a political culture hostile to nuance, in which distinguishing degrees of risk seemed more dangerous than preserving a single moral pedagogy.

By 2018, under the banner Rethinking Nicotine, the Forum was no longer arguing only about how to interpret the evidence, but about the very language in which the debate was conducted. The point was to rethink nicotine’s place in public health without falling back, by force of habit, on the inherited grammar of tobacco control as if every form of use had to bear, untouched, the cigarette’s historical guilt.

The growing presence of consumers, the creation of the Michael Russell Award, presented to Lars Ramström, and the launch of the Tobacco Harm Reduction Film Festival all suggested that the field was widening: it was no longer enough simply to produce data; it was necessary to contest the images, symbols, and narratives through which those data would be made legible.

In 2019, the forum returns under the theme “It’s Time to Talk About Nicotine.” It was no longer just a matter of rethinking nicotine, but of bringing it out of the regime of silence, discomfort, and simplification that public debate had built around it.

To talk about nicotine, in that context, was to reopen distinctions that much of the language of public health had learned to suppress: between the cigarette and nicotine, between combustion and consumption, between the ideal of abstinence and the possible reduction of harm.

It was meant to compel public health to recover a language capable of recognizing degrees of difference. And, with them, differences in fate.

The growing interest in that shift was already evident in the scale of the gathering: nearly 600 participants came to Warsaw that year, a significant increase over previous editions.

In accepting the Michael Russell Award, David Abrams distilled one of the crucial points the Forum had been trying to restore to the center of the debate: the issue was not only one of product, risk, or regulation, but whether people trying, in concrete ways, to change their relationship to nicotine would be met with acceptance, understanding, and compassion. “It’s about the people, the people and the people,” he said.

By 2019, the GFN was showing that the dispute over nicotine was not only about toxicology or policy. It was also about the moral imagination through which public health chooses to regard people who smoke.

Then the pandemic arrived, and with it a new kind of test.

In 2020, like nearly every international gathering, the GFN was pushed online. In its case, though, the shift did not reduce it to a digital replica. In some respects, it enlarged it. The need to build its own broadcast platform enabled the Forum to reach more people, launch GFN TV, and give its debate ecosystem a more continuous and visible form.

That year’s edition, with more than two thousand participants from over a hundred countries, made plain what had been visible for some time: the discussion around nicotine and tobacco was not only scientific or regulatory. It was also ethical, political, and deeply bound up with the language of rights and the everyday lives of ordinary people.

In a year defined by the theme “Nicotine: Science, Ethics and Human Rights,” the meeting brought together more than thirty speakers over two days to examine not only the growing body of evidence in favor of harm reduction but also the intensifying attacks on researchers, academics, and professionals associated with the field.

Entire organizations were being discredited; real or alleged ties were used as a mechanism of disqualification; and public debate seemed increasingly willing to descend into ad hominem attack.

It was in that atmosphere, saturated with fear, misinformation, and narrative struggle, that issues such as the lung-injury crisis known as EVALI took on particular weight, along with its mistaken attribution to nicotine vaping rather than to illicit THC products, the moral panic around youth use, and the influence of major philanthropists on the language and priorities of public health.

By 2020, the GFN was showing that the conflict no longer turned only on disputes over the evidence. It also turned on the very conditions that made debate possible.

In 2021, still under the shadow of the pandemic, the GFN began to press a question that carried the debate beyond the immediate crisis: what is the future of nicotine?

The formulation sounds abstract only at a distance. Up close, it drags behind it questions of science and investment, global inequality and consumer behavior, regulatory capacity and control policy, and at the center of it all, the persistent friction between orthodoxy and innovation.

Organized around The Future for Nicotine, that year’s program examined both the advances already visible in the world of lower-risk products and the often abrasive relationship between science and policy, the impact of technological innovation on public health, and the repeated failure of international bodies to hasten the end of the cigarette.

The Forum had not yet fully returned to an in-person format. The 2021 edition adopted a hybrid model, with a small core of speakers and attendees on site and broader participation online.

But that constraint revealed something else: the GFN was no longer functioning only as a gathering but as a platform for mediation, commentary, and archiving.

The creation of the GFN Commentary Team and the introduction of #GFNFives, which replaced academic posters with short videos submitted by participants, pointed to that change in scale.

By 2021, the Forum was making it clearer still that the dispute over nicotine would not be decided solely by the production of evidence or the drafting of rules. It would also depend on who managed to interpret, translate, and circulate that evidence in an increasingly fragmented public sphere.

When the Forum returned to Warsaw in person in 2022, it no longer made sense to think of it as merely an annual conference. The GFN had become an infrastructure for debate: a machine for producing, recording, translating, and circulating controversy.

The hybrid format, the broadcasts, the #GFNFives shorts, the GFN TV commentary, and the simultaneous translation expanded the Forum’s reach and altered its nature. What was at stake was no longer simply bringing people together in one city, but creating the conditions for certain ideas to travel beyond the room, cross borders, and remain open to public scrutiny. In a field so shaped by caricature, silencing, denial, and moral simplification, that was no mere technical detail. It was a form of intellectual intervention.

That year’s program gave real substance to the shift in scale. The Forum confronted misinformation around harm reduction head-on, examined the role of philanthropy in the field, returned to the uncomfortable question of the Framework Convention’s failure to bring smoking down in any meaningful way, debated the transformation of the industry without the usual comfort of ready-made formulas, and insisted that the problem was not exhausted by vaping, but pointed instead to an entire continuum of risk and displacement away from the combustible cigarette.

Other questions were also returning, now in sharper outline, questions that would no longer be marginal from that point forward: academic freedom in the field of tobacco control, and the question of whether regulation was actually helping to reduce smoking or simply narrowing the alternatives available.

The Michael Russell Award, given that year to Brad Rodu in recognition of more than two decades of research and advocacy for access to safer products, confirmed the sense that the GFN was no longer content merely to observe the dispute. It was becoming more and more one of the places where that dispute found language, contour, and public force.

The Forum’s tenth edition, in 2023, offered a rare chance to look back on its own trajectory without succumbing to self-congratulation.

A decade after its debut, the GFN could credibly claim a singular place in shaping the global debate over tobacco harm reduction. Over those years, it had helped draw researchers and advocates closer to one another, as well as regulators and consumers, voices from the Global South, and academic circuits still caught in the North’s gravitational field.

Above all, it had preserved a space for substantive disagreement, something that, in an age of performed polarization, had become not just rare but structurally at risk.

The anniversary, though, hardly warranted any naïve celebration. On one hand, the global use of vapes, snus, heated-tobacco products, and nicotine pouches continued to grow, as tens of millions of people sought out less risky alternatives. On the other hand, a persistent fog of regulatory and political confusion remained capable of blunting part of that movement.

The tenth edition unfolded in the shadow of a harder question: what happens when public uptake outpaces institutional imagination? The approach of the Framework Convention’s COP10, held later that same year in Panama, brought that tension into sharper relief.

In response, the GFN sought to broaden not only the debate itself, but also access to it. Alongside free streaming, live and on demand, came simultaneous interpretation into other languages, initially Spanish and Russian, and a more deliberate effort to open the space to people who had long orbited the debate without ever quite entering it.

The Michael Russell Oration, delivered by Professor Roberto Sussman and devoted to a rigorous critical assessment of the science around tobacco and nicotine, neatly captured the spirit of that moment: ten years on, the question was no longer simply how to produce more evidence, but who gets to interpret it, within what frame, and in service of what kind of future.

By 2023, the GFN was showing that it was no longer peripheral. It had become a force in the debate.

In 2024, under the banner Economics, Health and Tobacco Harm Reduction, the Forum pushed to the center a dimension that had long shaped the debate but had seldom been acknowledged as its organizing core: economics.

It was no longer enough to argue over evidence, relative risk, or regulatory design. The harder question was what it costs—in lives, money, and historical time—to regulate badly, or to prohibit, alternatives less dangerous than the combustible cigarette.

At that point, harm reduction had ceased to be merely a public-health or moral controversy. It was also revealing itself as a dispute over prices, access, taxation, incentives, and technological innovation. To talk about health without talking about political economy was to remain on the surface of the problem.

That year’s program made the point hard to ignore. What are the effects of overly restrictive regulation? Is it possible to quantify the health-care savings associated with the availability of safer products? Does the decline in tobacco-tax revenue, or the state’s dependence on that revenue, shape the regulation of alternatives? And to what extent do badly calibrated rules drive independent manufacturers out of the market and discourage the shift away from combustion?

The presence of figures such as Professor Andrzej Fal and the analyst Vivien Azer gave substance to that widening of perspective. The introduction of #ScienceLab, meanwhile, reinforced the effort to bring emerging research closer to public debate.

And the Michael Russell Oration, delivered by Cliff Douglas and centered on global action to end smoking, helped distill the impasse of that moment: the future of the combustible cigarette would no longer be decided only in the laboratory or the regulator’s office, but also on a less visible, and often less openly acknowledged terrain: that of markets and their asymmetries.

By 2025, the banner Challenging Perceptions: Effective Communication for Tobacco Harm Reduction read like a diagnosis of the times. The dispute was no longer unfolding only on the level of evidence, but in the realm of its public circulation, in whether it reaches people, or fails to reach them at a moment when journalistic rigor was losing its central place and social media, platforms, and the attention economy were beginning to shape collective perception through simplification, moral panic, and low-resolution truths.

Challenging perceptions had become the central task. Not because the science offered easy answers, but because the public sphere seemed less and less willing to tolerate nuance, context, and contradiction.

The paradox could no longer be dismissed as noise: as the scientific case for harm reduction grew more substantial, its public reception, in many places, was becoming murkier. Lower-risk nicotine products continued to erode the cigarette’s centrality. But that movement was advancing in an atmosphere of caricature, suspicion, and simplification that could delay, if not altogether block, the translation into policy.

That was the point at which communication ceased to be merely an adjunct to science. It became part of the conflict itself. It was no longer enough to produce evidence; it was necessary to contest the frame, correct enduring distortions, and ask who was still being left out of the conversation.

In an environment where discourse itself is an instrument of power, perception functions as a regulatory field, and institutional caution can serve as an alibi for inertia, the problem came to lie less in the absence of data than in the difficulty of making those data legible before they were immediately absorbed by the machinery of moral panic.

The choice of Fiona Patten for the Michael Russell Award distilled the spirit of that year with unusual clarity. An Australian politician, consumer, and longtime advocate of harm reduction, she brought together in a single figure lived experience, regulatory conflict, and the public struggle over language. By 2025, the GFN showed that the battle was no longer fought only over what science knows, but over what a society allows itself to hear.

That may be why the GFN provokes such strong reactions: the Forum inhabits a particularly uncomfortable corner of contemporary debate, where scientific evidence, lived experience, industrial interest, regulatory calculation, and moral judgment intersect without ever settling into ease.

Its critics surround it with suspicion; its defenders treat it as an indispensable space. In opposing registers, both recognize the same fact: the GFN is not peripheral. It carries weight in the debate.

It carries weight because smoking remains among the leading preventable causes of death in the world. It carries weight because millions of people continue to smoke not in the abstractions of the laboratory, but in lives marked by inequality, habit, pleasure, dependence, misinformation, and precarious access to alternatives. It carries weight because policies that fail to recognize relative risk can end up protecting the combustible cigarette in the name of regulatory purity. And above all, it carries weight because when public health loses its sense of nuance, it begins to drift away from the very people it most needs to reach.

With 2026 now underway, the trajectory of the GFN reads less like the history of a conference than like the portrait of a larger dispute. Since 2014, the Forum has returned, year after year, to a question that global policy still has not managed to resolve: what, exactly, is being protected when the deadliest product remains available while significantly less harmful alternatives are treated as a threat?

That is the question the thirteenth edition, under the banner Prohibition and Public Health, places once again at the center. Not as a doctrinal abstraction, but as a material, regulatory, and moral problem. If the combustible cigarette remains legal and widely accessible, why do successive waves of prohibition fall on lower-risk products across much of the world?

By insisting on that paradox, the GFN shifts the debate from the object to the logic that organizes it: examining how policies formulated in the name of protection can end up preserving, and even encouraging, exactly the harm they claim to want to reduce.

That might be the Forum’s strength: offering a space where facts can be examined with complexity before being overtaken by rhetoric. The question isn’t whether every alternative should be celebrated, but whether current policies, discourses, and mentalities accurately differentiate among products, use contexts, and actual risks. At that point, the GFN helps move the debate from the doctrinal to the public sphere.

* Photos: GFN/Gerry Stimson

This isn’t the screenplay of a film that already exists. It’s the screenplay for a film that might briefly exist, privately, in the reader’s mind.

It starts with a straightforward, uncomfortable question: when we talk about “good habits,” are we referring to health or to control?

The directions on these pages are not meant for a crew. They serve the narrative: what is seen, what is heard, what the body does, often without noticing itself.

The short film unfolding here is composed of movements, like irregular breathing. Sound—the hum, beeps, coughing, and crackle of plastic—builds the invisible landscape of everyday pressure. The camera stays on small gestures: a thumb turning a wedding band, fingers smoothing a nicotine patch, a hand covering the warning image as if hiding something private.

If you can, read this aloud, even quietly. See the peeling yellow rectangle on the ground. Hear the lighter fail. Feel, on your own arm, the edge of the patch starting to lift.

Cinema, here, is simply this: a discipline of attention.

* CHARACTERS: Anna, August, Damian, Clara, the Smoker, the Clinician, the Doctor, the Groundskeeper, the Man Under the Blanket, the Child, and many others who go unnamed.

I. The Promise, Undone

1 INT. WAITING ROOM — MORNING

Cold light. The HUM of a fluorescent fixture vibrates in the low ceiling.
Plastic chairs. A water cooler DRIPS.

A delayed electronic display blinks numbers that don’t advance.
On the wall: a blackened lung.

“STOP SMOKING.”

Beside it, crooked and peeling: “SUFFER NOW TO LIVE BETTER LATER.”

Someone COUGHS. Someone clears their throat.
A phone starts to ring and dies halfway.

ANNA (28), in a supermarket uniform, with a worn name badge, holds a crumpled bag. Her shoulder strap has carved a groove into her skin.

The mark stays.

She opens her bag. A thin wallet.
Coins. Not many.
She counts them with her thumb, slowly, one by one.
The display BEEPS.

METALLIC VOICE (O.S.)
Number forty-seven.

Anna stands.
The chair emits a damp, suction-like sound from the floor.

2 INT. EXAM ROOM — CONTINUOUS

A cluttered desk. Stacks of paper. A worn rubber stamp.
An old computer takes its time responding.
The printer CHOKES—metallic whine, like teeth chewing.

THE DOCTOR (50), white coat, a pen in her pocket, writes without looking up.

DOCTOR
How long have you been smoking?

Anna opens her mouth.

ANNA
Since—

She stops. Doesn’t finish.
The doctor has already checked a box —trained neutrality.

DOCTOR
Breaking the cycle lowers cardiovascular risk.
You’ll see benefits within weeks.

She slides a tri-fold pamphlet across the desk.
Illustrated lungs. A list of “benefits.” A phone number.

Anna takes it with both hands, as if it were a letter she isn’t allowed to crumple. She holds it the way one holds a promise.
A small nod—to herself, not to the doctor.
The doctor indicates a line.

Her short nail comes down to the paper and stays there.

DOCTOR
Sign here.

Anna signs without reading.
The printer SPITS out another sheet.
The doctor STAMPS

TACK.

Anna takes the paper and stands.
The chair scrapes the floor.

3 EXT. BUS STOP — MIDDAY6

Heat without shade. Asphalt gleaming like metal.
A bus speeds past. Doesn’t stop.
A cloud of DIESEL cuts the air.

Anna leans sideways against the bus stop pole, keeping herself from tipping into the street.

She opens her bag. Takes out the coins.
Counts.
Puts them away.
Counts again.
The numbers don’t match.

The pamphlet surfaces among her things—a white corner, insistent.
She pulls it out and folds it in half to make it fit her hand.

CRACK.

She folds harder. The paper resists. She insists.
As if the paper has to learn how to fit her life.

Anna takes a cigarette from the pack. The pack is soft, tired.

She tries the lighter.

CLICK. Nothing.

She shakes it.

CLICK. A brief spark. Dead.

Her mouth tightens—an old, learned gesture.

She uses the pamphlet as a shield, an improvised wall against the wind.

Tries again.
The flame catches. Flickers.
The paper trembles in her hand.
The cigarette lights.

A short drag.
She holds it.
Releases.

ANNA (V.O.)
I keep borrowing from the future.
I never know when it comes due.

A bus finally stops.
The doors open with a pneumatic SIGH.

People push off. People board without looking.
Anna steps on, the crumpled pamphlet in her hand.

The turnstile CHOKES on a coin.
Another slips free and ROLLS down the aisle.

Anna bends and retrieves it quickly.
Doesn’t complain.
Moves toward the back.

Doesn’t look behind her.
She’s done this before.

4 INT. KITCHEN — NIGHT (PAST)

Yellow light. An old fan creaks, useless.
On the refrigerator: a child’s drawing held by a magnet.

A crooked sun. A house. Three stick figures.

AUGUST (73), shirt unbuttoned at the chest, coughs into the sink.

A deep cough. An old one.

On the table: a full ashtray. A cup of cold coffee.
And a pamphlet identical to Anna’s—creased along the same folds.

August picks up the pamphlet. Unfold it carefully.
The paper makes a dry sound—

CRACK—

as if it were still alive.

Dried coffee stains the illustrated lung.
In the margin, a phone number was scribbled in pen.
Beside it: an OLD LIGHTER, heavy, scratched.

Worn metal. A tired spring.

August looks at it as if it belonged to someone else.
Picks it up.
Weighs it in his hand.

He opens a drawer.
Pushes the lighter to the back, behind the cutlery no one uses.
Closes the drawer with too much care.

He takes a cigarette.
Stops halfway through the gesture.
Look at the drawing on the refrigerator.
His hand lingers in the air a beat too long.

He opens another drawer. Takes out an empty glass jar.
Begins placing the cigarettes inside, one by one.

No hurry. No relief.

Contained violence, as if storing something dangerous.
The lid closes.

CLOC.

A child (Anna) runs past the hallway in the background, glancing in.
We only see her hair. A short laugh. Light footsteps.

August holds the jar for a moment, still.
Looks upward, as if measuring a distance.
He stretches his arm.
Places the jar on top of a cabinet.
Stands motionless.

His hand lowers slowly.

5 INT. SMALL BEDROOM — NIGHT (PRESENT)

A cramped room. Stained wall.
A fan that doesn’t help.
A box of clothes. A mattress on the floor.

On the bedside table: a past-due notice, folded and opened again.
Anna opens a drawer.
Inside: the OLD LIGHTER—heavy, scratched, worn metal.

The same tired spring.

A creased passport photo of August.
Anna picks up the lighter.
Doesn’t light it.
Just press the mechanism.

CLICK.

She lets go as if she’d burned the tip of her finger.
She touches the photo with her fingertips, as if it might tear.

From somewhere far off, the neighbor’s TV: canned laughter, outsourced joy.
Anna puts the photo back.
Closes the drawer.

6 FLASHES:

Coins clinking (a thin metallic chime) / The pamphlet trembling in the flame (CRACK, a faint hiss) / The glass jar filling (CLOC) / August’s cough / A coin rolling down the bus aisle / The passport photo / A coin rolling again / The CLOC of the jar lid.


SMASH CUT.

7 EXT. BUS STOP — NIGHT (PRESENT)

A different street. The same gesture.
Anna leans against the shelter wall.
Lights a cigarette. The flame flickers—holds.

Behind her, on the glass, a torn poster.
All that remains: “…OP SMOKING.”

She inhales. Air in. Air out. The cycle continues.

The bus arrives.
Doors open.
Anna steps on.
The doors close.

The engine sound pulls away, taking with it the little air she had.
What’s left is emptiness—and the city’s distant hum.

II. The World on Shift


8 EXT. FACTORY GATE — DAWN

Low sky, a dirty gray.
Wet ground. Puddles slicked with old oil.

A bus brakes—a long metallic hiss.
The doors open with a pneumatic sigh.

People step down in silence.
Footsteps. Turnstile clicks. Handrails. Backpacks scraping.

A metal gate.
A faded sign.

In the guard booth, a digital clock blinks the wrong number.

DAMIAN (42), name stitched across his uniform.
On his wrist: a stopped watch.
He looks at it—
not to check the time,
only to confirm there is none.

On his finger: a worn wedding band, deeply scratched.
He turns it once with his thumb.
A small rotation. Unnoticed.
He holds a plastic lunch container—lid warped.
And a crumpled pack of cigarettes, damp at the corner.

He leans against the wall.
Takes out a crooked cigarette, the tip bent.
Searches his pocket for the lighter. Impatient. Automatic.

CLICK. Nothing.

He shakes it.

CLICK. A brief spark. Dead.

Wind.

He cups his hand around it.
His hand trembles—cold and hurried.

CLICK.

Now it catches—a small, unstable flame.
The paper sticks slightly to his lip in the damp.
He adjusts it with his teeth, careful not to bite.
First drag—short. A test.

He coughs once—dry, contained—
and swallows it, glancing sideways,
as if coughing were a minor offense.

On the pack, the warning image is shown.
His thumb covers it without thinking.

Inside: a forklift BEEP, metal clanging, a short alarm.
Out here: the sound of his own lungs working.

His phone vibrates in his pocket.
He doesn’t take it out. Just feels it.
Another drag—deeper now—
as if pulling his body back into itself.

Ash falls into a puddle.
Turns to gray mud.
He crushes the cigarette underfoot, hard.
And goes in.

The sound of the factory swallows everything.

9 EXT. BUS STOP — MORNING

A scratched acrylic shelter.
An old advertisement peeling at the edges.
Light rain. Diesel in the air.

ANNA (33), supermarket uniform, badge crooked.
A bag with bread and a pack of diapers.

The heavy purse digs into her shoulder.
She steps two paces away from the group—
as if asking the air for permission.

The hand holding the cigarette is drier now, more worn.
A pale ring on the skin—
a mark where something once was.

She takes out a cigarette carefully.
Not from delicacy.
Because the pack is nearly empty and the cigarette breaks easily.

The lighter fails.

CLICK. CLICK.

A flame appears. The wind kills it.

A short exhale through her nose.
No broad gestures.
There’s no room for that.

CLICK.

This time it catches.

She inhales, watching the far end of the street—
where the bus should be.

The smoke slips from the corner of her mouth.
Not for elegance.

So it won’t drift toward the baby beside her.
The baby cries.

Someone rocks the stroller with a foot, without looking.
Eyes fixed on a watch.

A bus speeds past, sending up a gust of wind and dirty water.
The gust slaps the smoke from Anna’s mouth.
She closes her eyes for half a second.
Opens them quickly, as if rest were dangerous.

A deeper drag.

The filter nears her fingers.
Her hand carries the smell.

10 INT. SMALL APARTMENT — NIGHT

Old-building silence: pipes ticking, a neighbor walking,
a low television somewhere far off.
Cold kitchen light.
A full sink. A damp dish towel left out.

Anna is in sweatpants, hair loose with exhaustion.
She washes a pot quickly—so it won’t make too much noise.
The sponge scrapes the metal.

She opens the window only as far as her body needs.
Air comes in: distant frying grease, rain that’s been sitting around.

She lights a cigarette on the sill.
The flame flickers. Catches.

She inhales and holds the smoke for a second.
Not pleasure.

Suspension.

From the bedroom: a child’s breathing.
In the dark hallway: a toy on the floor.

Anna nearly trips.

Stops.

Looks.

Just a second—love, irritation, fatigue, all at once.

She doesn’t pick it up.
Keeps going.

She exhales the smoke outside,
trying to make it disappear before it can exist inside.

Ash falls onto the sill.
She runs a finger through it.
The ash sticks to her skin.

She wipes it on the dish towel.
A new stain.

She puts out the cigarette in a chipped saucer.
Slowly. Without sound.

Closes the window.

The glass makes a small *toc* against the frame.
In the quiet, it sounds loud.

She switches off the light.
Dark.

Only the dish towel was left on the edge of the sink.
Old stains.

The new one, still fresh.

In the dark, Anna braces her hands on the sink.
Still.

She presses the finger where a ring should be,
as if checking whether it still exists.

She rests her forehead against the cabinet for a moment.
Breathes in through her nose.
Lets the air out through her mouth, without a sound.
And walks away into the dark.

11 FLASHES:

Damian’s stopped watch / A thumb covering the pack’s warning image / Ash turning to sludge in an oil puddle / The strap gouging a groove into Anna’s shoulder.


SMASH CUT.

III. Good Habits


12 INT. OFFICE BREAK ROOM — MORNING

The coffee machine: PSHHT.
Paper cups lined up.
Napkins folded with care.

On the wall, a motivational poster:
GOOD HABITS, GOOD LIFE.

CLARA (35), impeccably dressed, opens a “clean” lunch:
salad cut evenly, fruit in a container, and her own utensils.

Before she touches a cup, hand sanitizer.

She rubs slowly until it dries—like a rite.
Her phone vibrates.

Group: “Condominium / Block B.”

She reads without changing her expression.
Only her eyebrow lifts a millimeter.

She puts the phone away with the same precision she used to snap the lunch lid shut.

A sip of coffee.

An inhale.

As if beginning the day “right.”

13 EXT. BUILDING ENTRANCE — LATE AFTERNOON

A blue sign:
SMOKING AREA.
On the ground, a peeling yellow rectangle.

A SMOKER stands inside the yellow boundary, leaning back.
The flame flickers. Holds. He inhales.
Clara approaches with grocery bags.

Slows.

Looks at the sign.
Looks at the rectangle.
She makes a small sidestep, avoiding the yellow.
Avoids it the way one avoids something that stains.

As she passes, she holds her breath for half a second—
without realizing she has.

She adjusts her coat with her fingertips,
as if protecting the fabric.

Two steps later, she exhales.

A brief, private relief.
Her face doesn’t celebrate.
It simply confirms.

14 INT. LOBBY / SANITIZER DISPENSER — CONTINUOUS

Automatic doors: PSHHT.
A steady hum of air-conditioning.
Clara steps inside.

The smell of the street stays behind; the smell of smoke tries to follow.

A MAN stops at the sanitizer dispenser.
Two pumps.
He rubs his hands methodically, staring ahead,
as if observing a rule no one needs to state.
Clara passes him

a little more upright than before.

15 INT. ELEVATOR — ASCENDING

A crowded elevator.
Clara steps in and takes her place near the doors,
hand on her bag.

The SMOKER enters right after.

A YOUNG WOMAN pulls her backpack to the front of her chest,
like a shield.

Farther back, someone retreats a centimeter:
a foot shifts, a knee locks—and holds.

Clara presses her floor button.

Without looking, she also presses the fan button.

The fan light comes on.
A neighbor steps in.
Clara smiles at him.
A clean, quick, competent smile.

The display climbs: 3… 4… 5…

No one speaks.

16 INT. HALLWAY — CONTINUOUS

White light.
Carpet that swallows footsteps.
Clara walks to her door.

Before going in, she takes a small spray from her bag.
Two bursts:
PSSHH. PSSHH.
She inhales.

Her face relaxes a millimeter.
She enters.

17 INT. LIVING ROOM / SOFA — NIGHT

TV low.
On the table, a glass with melting ice.
Clara scrolls.

A short video: someone smiling into the camera.
Caption: “Discipline is self-love.”

She likes it.
A heart appears.

Another video.
Another tip.
Another “good habit.”

She likes that one too, unhurried.

A notification from the building group chat.
Clara opens it and types:

CLARA (TEXT)
Hi, everyone… Please, the smoke has been drifting up into my apartment.
There are children and an elderly person here. Thank you.

She sends it.

Within seconds: reactions, little hearts, “agree,” “exactly.”
Clara holds the phone as if receiving a small certificate.

She rests her head against the sofa back.
Closes her eyes for a moment.
Breathes.

18 EXT. SMOKER’S WINDOW — NIGHT

A window opens just a hand’s width.
The SMOKER leans halfway out,
trying to be invisible.

He smokes quickly.
Short drags.
His phone vibrates.

On the screen: “Condominium / Block B.”
He looks.
Doesn’t open it.

He stubs the cigarette out halfway in a saucer.
His hand lingers in the air for a second,
uncertain what to do with the rest of the gesture.

He closes the window.

19 INT. HALLWAY / NOTICE BOARD — NEXT DAY

Clara comes out with a folder.
Stops at the notice board.
She tapes up a printed sheet:

REMINDER:
SMOKING ONLY IN THE DESIGNATED AREA.
PLEASE RESPECT THIS.

She smooths the paper with her palm, pressing out the bubbles.
Smooths it again.
Once more.
As if closing the matter.

20 INT. LIVING ROOM — NIGHT

Clara’s phone lights up: more reactions,
more “thank you for the notice.”

She turns the phone face down on the table;
a gesture of closure.

Takes a sip of water.
Breathes.

A micro-smile, meant only for herself.

SMASH CUT.

IV. The Garden and Its Limits

21 INT. SMALL EXAM ROOM — LATE AFTERNOON

White light. A noisy fan.

A Formica table scarred with old marks.
A jar of cotton balls. A box of patches.

The CLINICIAN opens a drawer.
The plastic packaging gives a dry sound.

Anna sits with her hands in her lap.
Short nails. A pen mark on one finger.
She pulls her sleeve up without ceremony.
Cotton on her arm.
A dry touch against skin.

The clinician applies the patch and smooths it with two fingers,
counting without speaking.

Anna watches the gesture.
The way one watches a wound being sealed from the outside.

The clinician points with a finger, no drama:

CLINICIAN
If you get dizzy, take it off. Water. Sleep without it.

Anna nods.
She puts the box and the pamphlet into her bag,
pushing to make it fit.

In another room, a phone rings.
Someone answers.

A baby cries somewhere far off. Stops.
Anna stands.
The plastic chair squeaks.

22 EXT. CLINIC EXIT / SIDEWALK — CONTINUOUS

The door closes with a tired click.
Traffic. Dust.

A bus roars past.
Anna steps down from the curb.

For a second, the white edge of the patch shows beneath her sleeve.

She crosses the street, avoiding a pothole filled with dark water.

On a pole, a street sign:
CHICO MENDES STREET.

The sign hangs crooked, bent at one corner.
Anna doesn’t look.
Her body is already elsewhere.

23 EXT. PLANTER IN FRONT OF A BUILDING — NIGHT

Streetlight.
A carefully designed planter,
contained by concrete borders.

Leaves shine with moisture.

A GROUNDSKEEPER, thick gloves on, trims the shrubs.

SNIP.

SNIP.

Branches fall. Leaves fall.

He gathers them with a shovel
and pushes them into a black trash bag.

Two meters away—almost out of frame—
a man sleeps curled beneath a thin blanket.

A cough comes from inside the blanket.
Small. Persistent.

The groundskeeper doesn’t look.
He takes a spray bottle.
Squeezes.

PSSHH.

The leaves take on a new shine.

24 INT. ANNA’S KITCHEN — NIGHT

Dim light. A sink full of dishes.
A damp dish towel left out.

The neighbor’s television bleeds through the wall.
Anna enters and drops her bag on a chair.
The chair creaks.

She takes out the pamphlet and leaves it unopened on the table.
Her sleeve rises: the patch is there— one edge lifting from sweat.

She presses it down with her thumb, firm,
|as if holding something that wants to slip away.

From the bedroom: a child’s breathing.
Anna opens the refrigerator.
Almost empty.

Closes it.

Sits.

For a moment, her hand rests on her arm,
feeling the patch through the skin.

Her phone vibrates.
She reads the message.
Doesn’t answer.

She takes a cigarette from the crumpled pack.
Stops halfway through the gesture.

Looks at the patch.
Looks at the window.
Searches for the lighter.

CLICK.

Nothing.

CLICK.

A brief spark. Dead.

CLICK.

It catches. The flame wavers.

She lights it.
A short drag.

She exhales quickly out the window,
as if erasing a trace.

Outside: a distant siren.
A dog barking.
An engine is climbing the street.

25 EXT. PLANTER — NIGHT (RETURN)

The groundskeeper ties the black trash bag.

He pulls.
The bag drags across the pavement—
a rough, scraping sound.
He walks away.

The planter remains immaculate.
Still.
Shining.

The coughing beneath the blanket continues.

26 INT. ANNA’S KITCHEN — NIGHT (RETURN)

Anna stubs out the cigarette in a chipped saucer.
Her nail scrapes the ceramic.

She rests her forehead against the cabinet for a second.
Breathes in through her nose.

Lets the air out through her mouth, without a sound.
Her hand returns to her arm.
Presses the patch down once more.
As if trying to hold something in place.

She switches off the light.

Dark.

V. The Still

27 INT. ANNA’S KITCHEN — PRE-DAWN

Blue darkness.
Her phone vibrates.

Anna silences it without checking the time.

From the next room: a child’s breathing.
She walks barefoot.
The floor is cold.

On the table: the box of patches,
the folded, crumpled pamphlet.

Anna pulls up her sleeve.

The old patch is still there; one edge lifted.
She peels it off slowly.
The skin beneath is marked:
|a pale rectangle, clean in the middle of her arm.

She opens a new one.
The plastic crackles softly.

Applies it.
Smooths it with two fingers.
Presses the stubborn edge until it holds.

Anna lowers her sleeve.

She stands still for a moment,
as if waiting for her body to agree.

28 EXT. BUS STOP — DAWN

Cold.
A streetlamp was still lit.
People are waiting with backpacks and coats.
No one looks at anyone.
Anna arrives.

Leans against the pole.
Her bag is heavy.
She takes a crumpled pack from her pocket.
Takes out a cigarette.

Stops.

Her hand hangs there for a second.
She puts the cigarette back in the pack.
Slips it away.

From her bag, she takes a small, dark object, worn from use.
Raises it to her mouth.

A short pull.
A small light glows, then disappears.

Vapor drifts out, faint, dissolving quickly in the cold.

The bus arrives.
Doors open.
Anna steps on.

29 INT. BUS — CONTINUOUS

The ticket reader BEEPS.
Bodies swaying.
Anna leans into the window.
The glass is fogged.

She wipes it with her sleeve,
clearing a small circle of view.

Outside: the street waking up,
people walking fast,
a dog nosing through trash.

Inside: the silence of tired people.

Her hand goes to her arm by instinct
and presses the patch,
as if confirming it’s still there.

The bus drops into a pothole.

JOLTS.

Anna closes her eyes
for half a second.
Opens them.

30 EXT. BUILDING ENTRANCE / SMOKING AREA — LATE AFTERNOON

Blue sign.
A peeling yellow rectangle on the ground.

The SMOKER stands inside the boundary.
Cigarette lit.
Shoulders slumped.

The wind pushes the smoke toward the entrance.

CLARA (the woman from the condominium) approaches with a grocery bag.
She makes her usual detour:
circles the yellow as one circles a habit.

She is about to keep walking.
Stops for a second.

Looks at the man—
not quite at his face,
more on the outline of him.

Then looks at her own hand gripping the bag,
as if remembering its weight.
She moves on.

31 INT. ANNA’S KITCHEN — NIGHT

Dim light.
A sink full of dishes.

The damp dish towel is in the same place.
The neighbor’s TV bleeds through the wall.
Anna comes in and drops her bag.

The chair creaks.

She rests her forehead against the cabinet for a second.
Breathes in through her nose.
Lets the air out through her mouth, without a sound.

She takes the small object from her pocket
and sets it on the table
as if setting down a key.

She pulls up her sleeve: the edge of the patch is firm now.
She smooths it once with her thumb.
She opens the drawer.

The crumpled pack is there.
She looks.
Closes the drawer.

She rests her forehead against the cabinet again.
Breathes in through her nose.
Lets the air out through her mouth, without a sound.

She switches off the light.
Dark.

The distant HUM
of a fluorescent lamp.

THE END

From that shift emerged the moral and regulatory prestige of smoke-free spaces, one of the most durable victories of tobacco control. The problem, Roberto Sussman suggests in his essay on the global intensification of vapor-free policies, begins when this logic is extended almost automatically to vaping and heated tobacco products as if vapor and smoke were simply different versions of the same phenomenon.

Over the course of two decades, smoke-free ceased to be merely a public-health slogan and became one of the most successful moral brands of our time. The phrase emerged from a concrete battle, grounded in robust evidence, against a product that killed on an industrial scale and exposed bystanders to risks they had never chosen to assume. In many countries, that victory changed the air and reshaped social etiquette, altering the very idea of coexistence. The cigarette lost its glamour and, with it, part of its cultural empire.

The problem begins when a victorious category stops being merely descriptive and starts operating as a reflex.

In his essay “On the Global Intensification of ‘Vapor-Free’ Policies (Part 1),” Roberto Sussman, a professor at UNAM, sets out to investigate precisely that shift. He asks how the logic that sustained the fight against cigarette smoke came to be extended almost automatically to vaping and heated tobacco products, even in open spaces, as if we were dealing with the same physical, chemical, and sanitary phenomenon.

His formulation is blunt. “The logic is crude and simple.” The reasoning, in essence, runs like this: if cigarettes are harmful to those who smoke and also to those who inhale the smoke, then any visible cloud exhaled in public should fall under the same principle. What Sussman disputes is not the idea of protecting shared air. It is the analogical short circuit that turns one problem into another without examination. “Passive vaping is not passive smoking.” And, more literally still, “e-cigarettes and HTPs do not emit ‘smoke.’”

This distinction, which may appear technical, is also political. Regulations do not arise from measurements alone. They emerge from discourse, from shared associations, and from images sedimented over time. And smoke carries a historical weight that vapor does not yet bear. Smoke evokes combustion, soot, and the smell that clings. It evokes known harm, decades of accumulated deaths, public campaigns, warning labels on cigarette packs, and darkened lungs. When vapor enters this imaginary by way of analogy, half the dispute has already been won before the comparison even begins.

Sussman’s effort is to interrupt precisely that automatism. His question is not whether vaping should circulate without rules. It is whether it makes sense to apply the same regulatory template designed for cigarettes to vaping and wholesale, without distinguishing risk, dose, context, and the nature of exposure.

Behind this lies a dispute that is less about nicotine than about method. What happens when public policy learns to respond by reflex?

When Science Stripped the Cigarette of Its Glamour

Sussman begins by acknowledging what worked, and rightly so. For much of the twentieth century, the fight against the conventional cigarette was not a hysterical crusade. It was a civilizational correction. There was a powerful adversary: wealthy and, on many occasions, profoundly dishonest. The constellation of interests surrounding tobacco normalized a lethal product through aggressive advertising, cultural capture, and the systematic denial of evidence. Against this, epidemiology, medicine, and public health played a historic role.

The story is familiar, but worth recalling.

Richard Doll and Austin Bradford Hill helped establish, with the growing weight of data (1950–1955), the causal link between smoking and lung cancer. Then came the reports of the Royal College of Physicians (1962) and the U.S. Surgeon General (1964), which helped consolidate the emerging public consensus. What had once been an elegant habit came to be recognized as a massive risk factor for cancer, cardiovascular disease, and respiratory illness.

Decades later, that institutional arc culminated in the Framework Convention on Tobacco Control. The treaty was adopted in 2003 and entered into force in 2005, becoming the first global public-health agreement of its kind.

That history matters because it lends legitimacy to what came next.

The authority earned in that battle was not gratuitous. It was deserved. But as Sussman suggests, every conceptual victory leaves behind an ambiguous inheritance. A cause that wins acquires not only historical vindication but also prestige, institutional apparatus, language, and confidence.

At some point, however, a risk appears. Evidence ceases to function solely as a criterion of correction and begins to operate as a form of identity.

From there, nuance may cease to sound like legitimate scrutiny. It is increasingly seen as infiltration, moral backsliding, or sabotage.

Consider the didactic formulation once promoted by Public Health England, that vaping is “95% less harmful,” which became both a marker of belonging and a target of criticism. Something similar happened with the Royal College of Physicians. Its institutional prestige helped legitimize the war against cigarettes. Later, when it endorsed harm reduction through vaping, the institution itself became the object of criticism, because part of the field rejects that strategy.

At that point, for Sussman, the problem ceases to be merely technical. It becomes a question of intellectual discipline. The question is no longer only what the data show. It is also: what does a field do when it becomes accustomed to being right?

When Virtue Acquires a Machine

In the genealogical reconstruction Sussman proposes, the turning point comes in the late 1990s and early 2000s, particularly in the United States. The political and financial ecosystem surrounding tobacco, once untouchable, had already been discredited and hemmed in by litigation.

Anti-smoking activism, which for many years had operated as a force of resistance, was beginning to move inside the institutional apparatus itself. The cause was shifting from frontal confrontation to the administration of power.

In Sussman’s reading, the 1998 Master Settlement Agreement marks this transition.

The agreement imposed billions of dollars in payments from tobacco companies to the states. It also introduced marketing restrictions and brought a kind of stabilization to the legal conflict. Sussman notes, without romanticism, that money publicly associated with anti-tobacco initiatives often ended up serving other fiscal purposes.

Indeed, reports from the Government Accountability Office indicated that a significant share of those revenues was used to balance state budgets or fund general priorities rather than tobacco-control programs. The point here is less accounting than politics. When virtue acquires a budget, it also acquires incentives to preserve itself.

There is nothing cynical about this observation. It is simply institutional sociology. Public health is not made by saints hovering above history. Institutions and coalitions make it. It is shaped by careers, struggles for influence, agendas, reputations, and resources.

None of this invalidates the cause. But it does prevent its idealization. And for Sussman, this is the blind spot in much of the debate: the belief that good intentions alone are enough to shield a field from the selective use of evidence.

The argument is uncomfortable because it strikes at a narrative the field itself holds dear, the narrative that being on the right side of history automatically protects it from methodological excess. But it does not. No field does.

The Moment the “Other” Enters the Equation

At this point in his reconstruction, Sussman introduces a Mexican recollection. In 1975, he writes, roughly forty percent of men in the country smoked. Among women, the rate hovered around three percent. The figures fit a broader regional pattern: across Latin America in the 1970s, male smoking prevalence often exceeded forty percent, while among women it generally remained below ten.

In popular culture, the association between cigarettes and cancer was already circulating strongly enough to produce a street nickname: “cancer tacos.” The detail matters because it shows that public awareness of tobacco’s risks preceded, to some extent, the tightening of regulations that came later. Science had already begun to exert a real cultural effect.

But the decline in smoking prevalence, Sussman argues, eventually slowed.

Even as Mexican legislation aligned itself with World Health Organization recommendations, smoking rates spent years oscillating around roughly the same levels.

Sussman’s reading is that information alone does part of the work, but not all of it. People do not smoke only out of ignorance. They smoke out of habit, pleasure, context, class, stress, routine, social bonds, and as a precarious form of self-management of distress. Public health speaks in probabilities about the future. The body, more often than not, decides under the pressure of the present.

It is on this terrain that secondhand smoke enters the picture as a decisive political device. As long as the message was that you harm yourself, regulation ran up against an important moral boundary: autonomy. Once the axis shifts to harming others, especially the innocent, the board changes.

Sussman locates a key moment in this shift in 1975, at a World Health Organization conference, recalling remarks by Sir George Godber, a pioneer of anti-smoking policy in the United Kingdom since the 1950s. Godber described smoking as a “preventable epidemic.” He criticized governmental passivity and advocated mass anti-smoking education, investment in primary care, and the need to foster the perception that smokers harm those around them—particularly family members, babies, and young children.

His perspective was embedded within a broader horizon shaped by the idea of “health for all,” which would later be formulated internationally at Alma-Ata.

That horizon combined tobacco control, the reduction of environmental risks, and community integration, and it would help shape the World Health Organization’s early resolutions on noncommunicable diseases.

It is not hard to see the political force of this shift. Once harm ceases to be merely self-imposed and is presented as something inflicted on others, especially vulnerable others, restrictions become more defensible, more intuitive, and more expansive. The smoker ceases to be merely someone who assumes a risk. He becomes someone who distributes it.

Consensus in Armor

At this point, Sussman revisits a study by James Enstrom and Geoffrey Kabat published in the British Medical Journal (BMJ) in 2003. The paper examined exposure to environmental tobacco smoke and mortality in a cohort of couples in California. He recalls the cautious wording of the article itself: the results did not support a robust causal relationship between environmental smoke exposure and tobacco-related mortality, though they also did not exclude the possibility of a small effect.

The point here is not to treat this single study as a refutation of the prevailing consensus. The paper itself must be read with that caution. Major health agencies maintain that, on the basis of a much broader body of evidence, environmental tobacco smoke causes significant harm, including cardiovascular and respiratory effects with meaningful population-level impact. That remains the dominant understanding.

Sussman’s point is different. He asks when a field stops tolerating the reexamination of specific points without interpreting it as heresy.

In his formulation, the subject of secondhand smoke has become “quasi-sacralized.” Not merely a strong consensus, but a consensus transformed into moral identity. And when that happens, disagreement ceases simply to be contested. It becomes suspect.

This may be the most useful passage in the essay, not because it resolves the dispute, but because it identifies a pattern that recurs across many fields: the ease with which public science, when it feels morally besieged, shifts from firmness to insulation.

From Chemistry to Political Reflex

This history matters because, for Sussman, it prepares the ground for the expansion of the smoke-free concept to contexts where the basis for comparison is far less obvious.

By the time e-cigarettes and heated tobacco products entered the scene more visibly—particularly over the past decade—an institutional repertoire was already in place: maximum precaution, absolute language, denormalization as a cultural strategy, and the protection of children as a highly resonant political justification.

The problem is that the object has changed. Conventional cigarettes involve combustion. Vaping does not. That does not make vapor harmless, nor “just water,” a caricature as simplistic as the one offered by the opposite side. But it does change the physics and chemistry of what is exhaled. And if the phenomenon changes, the yardstick should change with it.

It is in this context that Sussman also discusses so-called third-hand smoke, the residues from tobacco smoke that settle on surfaces and can react with compounds in the surrounding environment. He does not deny the phenomenon's chemistry. What he questions is the leap that turns laboratory plausibility into a sense of ubiquitous threat, without passing through the harder work of measuring dose, frequency, context, real exposure, clinical relevance, and the magnitude of risk.

Chemistry does not legislate on its own. What should guide regulation is the relationship between exposure and harm under real-world conditions.

In the same vein, Sussman criticizes the totalizing use of formulas such as “there is no safe level of exposure to ETS,” which functions less as scientific precision than as a language of political authorization.

The problem with absolutes is well known. They erase gradations and turn any residual presence into a potential justification for prohibition. Instead of governing risk, policy begins to govern through aversion.

It is in this climate that Sussman situates the expansion of bans to open areas and a variety of public spaces, often justified in the same terms used for conventional cigarettes.

His criticism is not that children do not deserve protection, nor that public life should be left unregulated. It is that protection can become a catch-all word. Once invoked, it seems to dispense with the need for more careful demonstration.

When Science Enters Campaign Mode

Sussman chooses an emblematic case: the study that linked the smoking ban in Helena, Montana, to an abrupt drop in the number of heart attacks treated at the local hospital.

The paper circulated quickly in the press and came to be presented, in many contexts, as a kind of portable proof of the immediate effects of smoke-free policies. The problem, he notes, is that the study design was far too small to sustain such sweeping conclusions without considerable caution. Statistical variability, temporal coincidence, and simple noise may have carried more weight than the narrative allowed.

Critics pointed to the small sample size, the high statistical variability, and the fact that a similar fluctuation had already occurred in 1998, when no smoking ban was in place. Subsequent commentary questioned the strength of the causal inference and the biological plausibility of such a large decline in so short a time, without accusing the authors of misconduct. Broader reviews later treated Helena as an early study with a striking effect but low precision, assigning greater weight to larger datasets and subsequent meta-analyses.

It is worth avoiding excessive accusatory language here. Terms such as “fraud” or “hoax,” used by Sussman, attribute intent and require a level of caution that serious journalism cannot abandon. A study does not have to be fraudulent to be absorbed into a narrative machine. But the broader point remains. When a public agenda enters campaign mode, studies with strong communicative impact tend to receive a selective advantage.

Not because they are necessarily false, but because they fit the story better.

This may be the most unsettling core of the genealogy Sussman proposes. What consolidates itself, he suggests, is not merely a body of results about environmental tobacco smoke, but an institutional style: one marked by a preference for maximalist language, a low tolerance for inconvenient contestation, the use of denormalization as a form of cultural engineering, and a readiness to convert uncertainty into an argument for tightening restrictions.

When this style encounters a new target—vaping—the transfer is swift. Sussman summarizes the operation almost verbatim: e-cigarettes and heated tobacco products come to be banned “in all public spaces, even open outdoor spaces, where smoking is prohibited,” under the justification of “health protection,” despite the “enormous differences between the environmental emissions.” His point is not that these differences eliminate every concern. It is that they make the problem, in comparative terms, more complex than policy tends to admit.

Taking the Other Side Seriously

At this point, it is necessary to resist any temptation to turn this critique into a pro-vape pamphlet. Bad science has no fixed side. If there are biases, overinterpretations, and shortcuts in the more orthodox wing of tobacco control, there are also conflicts of interest, indulgent formulations, and convenient framings in harm reduction. Studies funded by corporations, or linked directly or indirectly to their interests, deserve heightened scrutiny. That does not automatically invalidate them. It simply raises the standard of caution.

Taking the other side seriously does not weaken Sussman’s critique. On the contrary, it puts that critique under pressure.

The strongest arguments from the restrictive camp tend to organize themselves along two lines. The first is renormalization. Allowing vaping in spaces where smoking is prohibited could reintroduce into public space the visual choreography of the cigarette: the gesture, the pause, the cloud, the familiar aesthetic of the act. The second concerns the protection of children and adolescents. The aim is to reduce exposure, limit indirect advertising, and prevent certain behaviors from acquiring an aura of social normality.

None of these arguments is absurd. The problem lies in treating them as sufficient grounds for full regulatory equivalence. Because at that point, appearance and substance begin to blur. One thing is to debate public etiquette, contextual limits, marketing practices, and coexistence in enclosed or shared spaces. Another is to treat exhaled vapor as if it were, by definition, the same problem as cigarette smoke.

There is another point that the rhetoric of renormalization often sidesteps. If what becomes more visible in public space is not the combustible cigarette but an alternative of comparatively lower risk, that normalization should not automatically be read as a threat. In some contexts, it may represent precisely the kind of displacement that an evidence-oriented public health policy ought to recognize. To reduce it to a symbolic relapse may be a way of confusing cultural memory with the real hierarchy of harms.

A proportional response may lie less in general slogans than in contextual arrangements: where, when, under what conditions, with what standards of public information, and with what clear distinction between products of very different levels of risk. The key question isn't whether vaping is risk-free, but whether public policy has the right to overlook the relative scale of risks.

The Tragedy of Virtue

This is where Sussman’s essay touches a problem larger than vaping itself. Public policies can fail not only through omission but also through poorly calibrated moral excess. A rule designed to protect may end up protecting less than it imagines—or protecting the wrong target.

The study by Saffer and colleagues offers one example of this possibility. But it is not alone. Similar patterns have been observed in Abigail Friedman’s analysis of San Francisco, in recent studies of state-level flavor restrictions, and in research using large panels of young adults in the United States.

The designs vary. So does the scope. And the magnitude of the effects is far from uniform.

Even so, the convergence is enough to counsel caution toward any policy that treats sweeping flavor bans as an automatic benefit. When consumption migrates toward the more lethal product, the language of protection can no longer dispense with comparative accounting.

That is the difficult irony. A policy designed to steer young people away from nicotine may push some of them toward the form of consumption that kills the most. The good intention does not disappear. What disappears is its innocence.

Once policy begins to produce side effects of its own—some quiet, others cruel—the question changes. It is no longer enough to know which side someone is on. The question becomes another: how does one govern without becoming intoxicated by one’s own argument?

Sussman brings that question to the center. When does protecting become delegitimizing? When does prudence become standardization? When does uncertainty, which ought to call for measurement, monitoring, and revision, become the engine of total prohibition? These are not questions opposing regulation. They are questions about effective regulation.

In today’s communication environment, absolutes travel better than proportions. “Zero tolerance” is simple, marketable, and morally photogenic. Nuance sounds defensive. Revision looks like a weakness. But serious public policy cannot be designed to fit neatly into headlines. It has to fit the real world.

Ultimately, this highlights the value of Sussman's proposed genealogy. It doesn't settle the debate over vaping by itself. However, it offers a key institutional lesson. When fear is effective, it tends to be reused. When the word 'protection' is used to shield a policy from criticism, it often makes that policy more rigid. And when a field forgets that flawed science can come from all sides, it begins to lose the right to claim that rigor is a core principle.

The dilemma, therefore, is not about simply “to ban or to allow.” It is more complex and less satisfying than that. It involves creating regulations that are proportional to the risk, transparent in their criteria, and adaptable as new evidence emerges. Rules that protect without defaulting to automatic equivalence. Rules that differentiate without humiliation. Rules that don’t, out of rhetorical habit, turn vapor into smoke before understanding what is actually in the air.

Maybe the debate over vapor-free policies needs to move beyond its deadlock and focus on a simpler question: what exactly is public health willing to compare? And who answers when it chooses not to make that comparison?

Roberto’s Substack

On the global intensification of "vapor-free" policies (Part 1)

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2 months ago · 11 likes · Roberto Sussman

When a smoker lights a cigarette, the body has no choice; it complies. Within seconds, a cocktail of thousands of compounds moves through the airways and spills into the bloodstream, reaching the lungs, the brain, the heart.

Yes, there are carcinogens. But there are also irritants and toxins that begin sabotaging the organism long before any tumor announces itself: chronic inflammation, vascular dysfunction, emphysema, and acute events.

Some of the names sound almost didactic in their cruelty, as if chemistry, with a professor’s composure, had drafted a pedagogical script for catastrophe. Benzene, associated with hematologic damage, is no stranger: it also appears in gasoline, and when it enters the body through smoke, it travels through the bloodstream to the bone marrow. Acrolein, a fierce respiratory irritant that history has seen deployed in chemical weapons during the First World War, arrives in the lungs with the familiarity of something that knows the way. And NNAL, a metabolite linked to tobacco-specific nitrosamines, lingers as a signature of exposure, a stubborn mark that does not vanish overnight.

Now imagine that same smoker trading fire for a small white pouch tucked between lip and gum: a discreet envelope of nicotine and excipients dissolving in silence. There is no flame, no smoke, no ash in the tray. Thirty minutes later, plasma nicotine rises enough to blunt the craving, like turning down the volume on an internal alarm.

And the rest?

This is where the narrative begins to lose its sharp edges. When combustion exits the scene, the body no longer “signs off” on easy theses. Without tar, without carbon monoxide, without the toxic choreography of burning, some of the most familiar accusations lose their immediate target. What remains—and in what magnitude—demands a different vocabulary: less moralism, more pharmacology; less menacing smoke in the air, more dose in the blood; more molecule, stripped bare and insistent.

Among available biomarkers, benzene appears nearly absent. Acrolein declines sharply: by 78.8 percent in the biomarker 3-HPMA compared with smokers. And NNAL, the most feared trace of tobacco-specific nitrosamines, falls further still: roughly 91 percent lower in exclusive pouch users, with levels similar to those observed in former smokers who use no nicotine product at all. Here is the sentence politics, on its worst days, prefers to avoid: this is not “feeling” or a “hypothesis.” It is a fact.

This is not a promise printed on a package. It is the kind of story biomarkers tell: molecules that record exposure with the coldness of a lab report and, at times, with the quiet eloquence of a lie detector.

That is one of the keys to the review by Greek cardiologist Konstantinos Farsalinos, “Nicotine pouches: an aid in smoking cessation, or a new public health hazard?” (February 2026).

The axis of the argument is neither “trust the industry” nor “trust the panic.” It is a different imperative, less comfortable and more verifiable: observe what the body records when the smoke stops passing through it. At the same time, accept the gray zone, because biomarkers do not replace decades of epidemiology; at best, they light up the dashboard.

In the real world, this matters because smoking still exacts an obscene toll. Tobacco remains a machine of death on an industrial scale: more than eight million deaths each year, with a disproportionate burden that falls on low- and middle-income countries.

Decades of campaigns, laws, restrictions, and prohibitions were designed to squeeze both supply and demand. And yet a vast contingent of people remains who cannot—or do not wish to—stop consuming nicotine. It is in that gap between the ideal (“total abstinence”) and the real (life, with its shortcuts and relapses) that harm reduction enters not as a slogan but as a persistent tension.

The human body is a biochemical registry office: it stamps exposures. Some of those stamps are so specific to cigarette smoke that they approach testimonial evidence: was here, passed through, remained. The most famous bears a name that sounds lifted from science fiction: NNAL, shorthand for 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol.

NNAL is a metabolite linked to tobacco-specific nitrosamines, particularly NNK, and it has a quality that makes it an inconvenient witness: it is slow to leave. Put simply, the body metabolizes NNK and produces NNAL, and it is this end product that keeps “signing in” long after the cigarette exits the stage. Its trace can be detected 6 to 12 weeks after exposure ceases, because its terminal half-life ranges from 10 to 18 days. In street terms, it is not fooled by an “I quit yesterday.” It is the chemical equivalent of the smell of smoke on a coat: you leave the room, but it stays, and gives you away for weeks.

When a smoker switches from cigarettes to a nicotine pouch, that “tobacco-free” product that, in some places, has become a trend and, in others, a moral panic or a regulatory problem, the body enters an involuntary experiment.

And the first results tend to appear where politics has the least reach (or the least patience): in the laboratory.

It is precisely this kind of data, which shows up in the lab before it shows up in statistics, that structures the central question of Dr. Farsalinos’s review, simple and incendiary: are we looking at a cessation and harm-reduction tool, or at a new public-health risk?

Biomarkers do not answer everything. But they address what most unsettles the debate: what does the body register when combustion is no longer in the equation?

The Body Rewritten: What Changes When Smoke Exits the Scene

The classic promise of tobacco control has always carried a certain moral elegance—heroic, even, in its simplicity: “quit.” But human biology rarely cooperates with such elegance. Dependence is a repeated pharmacology—routine, immediate relief, a daily negotiation with discomfort, and daily life. The review makes a clear and useful distinction: nicotine sustains the bond; combustion carries the damage.

The most direct way to see that difference is not to debate “toxins” in the abstract, wholesale sense, but to follow—almost in real time—the shifts inside the body when someone switches from cigarettes to pouches.

A cross-sectional study of exclusive pouch users (Velo) compared biomarkers of exposure—and some markers of “potential harm”—with those of smokers. The figure that unsettles intuition is NNAL: roughly 91 percent lower among pouch users than among smokers, with levels approaching those of former smokers who use no nicotine product at all.

But the “lie detector” does not reside in a single number; it lives in the coherence of the whole. In the same study, markers tied to classic smoke toxins move in concert: the acrolein signal (3-HPMA) drops by 78.8 percent; benzene (S-PMA), by 97.2 percent; and 1,3-butadiene (MHBMA), by 93.5 percent.

These figures do something the public debate rarely tolerates: they pull “harm reduction” out of the territory of slogan and place it on the cold, impersonal ruler of measurement.

But the story does not end with toxins. Among markers of potential harm, carboxyhemoglobin declines by 46 percent in pouch users; white blood cell counts fall by 19 percent; and fractional exhaled nitric oxide—suppressed in smokers because smoke alters the airway epithelium—rises by 107 percent, approaching the levels observed in non-smokers.

Here, uncomfortable honesty is required: this study was conducted by researchers affiliated with British American Tobacco. That does not make biomarkers “false,” nor does it make scientists pamphleteers—laboratories measure molecules, not motives—but it changes how the findings must be interpreted. It demands transparency, independent replication, and vigilance.

When the switch is tested under controlled conditions, the pattern returns, with greater discipline. In a randomized study, smokers who switched to pouches (on!®) for seven days had significantly lower total urinary NNAL (creatinine-adjusted) and 18 of 19 exposure biomarkers than those who continued smoking, with reductions ranging from approximately 42 to 96 percent. In magnitude, the review notes, these declines align with those observed in the short term under complete cessation.

Yes, that trial, too, carries political economy on its back cover: it was conducted by researchers affiliated with Altria. And here the paradox that public conversation often prefers to soften becomes unavoidable: the industry that helped feed the fire now wants to sell the extinguisher. That does not absolve anyone. But neither does it erase the biological fact that the markers repeatedly suggest: when combustion is removed from the equation, exposure to toxicants plummets.

There is a physiological reality that public policy will have to confront, even when moral revulsion would prefer to look away.

A third layer—perhaps the most “real-world” of all—comes from population data.

An analysis of the PATH Study (Wave 7, 2022–2023) finds that exclusive pouch users have high nicotine exposure but sharply reduced levels of minor tobacco alkaloids—anabasine and anatabine—94 percent and 97 percent lower, respectively—and lower lead levels than smokers. In a nationally representative dataset, the practical separation between “nicotine” and “smoke” begins to take statistical form.

If caution remains necessary, it serves to sharpen the question: not “is this good?” but “where, exactly, does combustion still leave its signature?”

If exclusive pouch users show such large declines in the canonical markers of smoke, the debate must abandon the convenience of treating everything as a variation on the same harm.

Where, then, would an “equivalent” harm to cigarettes reside, and through what mechanisms would it operate if smoke no longer passes through the body?

Farsalinos’s review does not sell the fantasy of zero risk. What it argues—with the caution of someone who knows “safe” is an expensive word—is that, along the continuum of toxicological risk, pouches tend to occupy the lowest end and may approach nicotine-replacement therapies. One condition, however, changes everything: the dominant pattern must be substitution, not the opening of a new pathway to initiation.

The Ghost of Combustion

Combustion is the invisible character in this story. The presence that never appears in the frame yet ruins the film. Nicotine explains why the smoker returns; combustion explains why he gets sick.

What biomarkers do, quietly, is separate these characters. COHb falls because carbon monoxide is produced by the act of burning and by drawing that burn into the lungs. NNAL falls because the chain of tobacco-specific nitrosamines is no longer fed by smoke. And markers linked to benzene, acrolein, and butadiene plunge because they belong to the world of fire, not to that of an oral matrix without combustion.

The review also underscores a practical detail: pouches deliver nicotine efficiently, generally more slowly than cigarettes, yet fast enough to compete with cravings. In harm reduction, the goal is almost never to purify behavior; it is to remove the fire from the mechanism, reduce suffering, and divert from greater harm.

Here, the review reaches for a bridge: the Swedish experience with snus as proof of concept. Not because snus and pouches are identical, but because they share what matters for this story: oral use, nicotine absorbed through the mucosa, and the absence of smoke passing through the lungs.

Farsalinos crosses that bridge through a “worst-case” argument: if snus, which still contains tobacco, has not been associated with lung cancer and does not exhibit the respiratory-damage pattern typical of cigarettes, then a derivative product without processed tobacco leaf, with far lower levels of harmful constituents, appears plausibly even less risky.

“Plausible,” here, is a scientific term: it asks not for faith, but for confirmation.

But bridges develop cracks. And it is in those cracks—not in the span itself—that public policy tends to lose its footing.

What We Still Don’t Know

Two nearly symmetrical errors circle this debate. The marketing error is to turn biomarkers into a seal of “safety.” The panic error is to treat the absence of twenty years of epidemiology as if it nullified, by decree, robust evidence of reduced exposure.

“Biomarkers are powerful, but they are surrogates: they measure the pathway of harm, not the final outcome.” Lowering NNAL does not “prove” that cancer rates will decline decades from now. Yet, from a biological standpoint, it is difficult to argue that large, sustained reductions in exposure would not, over time, alter risk, as one toxicologist who requested anonymity told me.

Scientific honesty resides in gray zones. And here, those zones have names. Long-term epidemiology does not yet exist for pouches because the category is new, and the review calls for research and surveillance. Local effects and oral health: reports of irritation and lesions exist; long-term studies and well-designed comparisons remain limited. At the same time, technical refinements are emerging with increasingly strong supportive evidence—such as Stingfree—awaiting less proof than broader acceptance, large-scale replication, and investment. Dose and standardization: labeling, additives and flavors, and maximum nicotine limits remain rough terrain for regulators.

And then there is the herd of moral elephants in the room: addiction, dependence, habit, need, and pleasure.

Biomarkers do not measure autonomy; they measure molecules. A world with less combustion may, at the same time, be one with more people using nicotine, and that unsettles the debate because it shifts the frame from “absolute evil” to the slipperier ground of “relative harm.”

The review attempts to frame that tension as a public health equation: benefit when use reflects substitution and cessation, versus potential harm when uptake shifts to non-smokers—especially young people—and the still-disputed, never conclusively demonstrated hypothesis of a “gateway” effect.

Youth data, for example, is an alarm that should never be silenced. In the United States, the CDC estimated a 1.8 percent current-use rate of nicotine pouches among middle and high school students in 2024, with a meaningful share reporting frequent or daily use.

That does not prove a gateway to cigarettes—it may even point in the opposite direction—but it proves something simpler, perhaps older: nicotine has always found ways to circulate, adapting to the times by changing containers, rituals, and language. What changes now is not the human impulse, but how it is packaged, marketed, and diffused.

At the same time, regulators are signaling how they intend to treat the category. In January 2025, the FDA authorized the marketing of twenty ZYN products through the PMTA pathway, the first such authorization for nicotine pouches, according to the agency.

This enters the global storyline: countries will oscillate between prohibition and permission, taxation and tolerance, nicotine caps and flavor restrictions. And each decision rearranges the “dopamine market”: who enters, who exits, and who migrates between products, in ways biomarkers alone cannot see.

The Lie Detector of the Public Debate

Why do these kinds of findings so rarely make headlines with the force they might? Because nicotine is a political object. It carries the stigma of tobacco and the muscle memory of decades of industrial deception.

In the public imagination, “nicotine” and “cigarette” have become moral synonyms. But the body does not work with synonyms; it works with metabolic pathways, combustion byproducts, nitrosamines, and COHb.

Biomarkers function as lie detectors precisely because they do not participate in cultural theater. They sign no manifestos, neither for harm reduction nor for condemnation. They record. And so far, the record has been stubbornly consistent: when combustion disappears, the markers associated with smoke decline significantly.

At the same time, public distrust is not gratuitous; it has a history. And it has a present: the fear that discreet, palatable, potent products may expand the consumer base along the same track that ultimately leads to disease. This is the point at which science and politics face one another without recognition: one measures molecules; the other attempts to anticipate mass behavior.

Here is where Farsalinos’s review proves more useful to a reporter than to a pamphleteer: it does not resolve the moral dilemma. It shifts the terrain to where the evidence is hardest to assess: exposure. And it suggests that public impact will depend less on “basic chemistry” than on the social architecture of use: full substitution versus dual use; adult smokers versus curious adolescents; clear labeling versus confusion.

The human body is an implacable archivist. It keeps traces of what has passed through it, of what irritated what did not need to be irritated, of what ignited inflammation without necessity.

When a smoker switches from cigarettes to a pouch, that archive does not become a certificate of virtue; it begins to be rewritten in measurable terms, not as moral redemption but as a change in exposure.

The lie detector absolves no one. But neither does it allow combustion to masquerade as opinion.

• Farsalinos, K. Nicotine pouches: an aid in smoking cessation, or a new public health hazard?. Intern Emerg Med (2026). https://doi.org/10.1007/s11739-026-04278-1

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In empirical science, these choices are referred to by other names, such as variables, samples, specifications, and models, but they perform the same function. They decide how the world becomes legible as evidence.

“Ideological bias in the production of research findings,” a paper published in Science Advances, argues that in politically charged subjects, preferences (what researchers, in more technical language, call priors and expectations) can latch onto decisions that, from the outside, look like mere matters of craft: how a concept is operationalized, which cases make it into the sample, which controls are deemed necessary, and which family of models comes to feel “appropriate.”

And through that path, different empirical results can emerge from the same dataset, without fraud, without invented numbers, without anyone stepping outside what the discipline itself would call a defensible method.

Friction is not necessarily a matter of scientific integrity. It is a matter of process: the sequence of legitimate choices that turns a dataset into “evidence” and sometimes turns evidence into a mirror.

The study reanalyzes a collaborative experiment known as BRW, in which independent teams were given the same dataset and the same question. Its conclusion is unsettling because it shifts attention away from the result and onto the path.

Ideology doesn’t appear only as an interpretive gloss at the end of a paper; it can enter earlier, in the engineering of analysis in what is measured and named a variable, in what is controlled (and why), in what is excluded as “noise,” in what comes to count as the right model.

It is there, in that chain of defensible choices, that a common base begins to yield divergent findings.

So what does it mean to “produce evidence” in a world saturated with biases, algorithms, beliefs, and narrative disputes that compete for attention as if oxygen were scarce?

If every study entails choices, the urgent question may not be whether bias exists, but how it organizes itself; what methodological, institutional, and rhetorical filters make some results seem more robust, more publishable, more citable, and therefore more real than others. In other words: not only what the statue “shows,” but which photographs of it we learn to call evidence.

Before the First Regression

In photography, the difference between two images often says less about the statue than about the photographer’s hand and eye on the camera. One lens pulls you closer and flattens the background; another widens the field and bends the edges. One frame focuses on a detail of the protagonist; another allows the context to dissolve into the periphery. The rest falls into shadow. None of this implies deceit; it implies choice. And choices, even when defensible, have consequences.

In science, the gesture is similar. A dataset, like the statue, doesn’t offer a single angle; it opens a constellation of defensible paths: how to measure a concept, which units make it into the sample, which controls count as pertinent, which family of models comes to feel most appropriate.

What Borjas and Breznau do is make that path visible under rare, quasi-laboratory conditions: a large collaborative experiment in which independent teams answer the same question using the same data.

In the reanalysis published on January 1, 2026, George J. Borjas and Nate Breznau return to BRW, which placed 71 teams (158 researchers) before the same dataset and the same question: Does immigration affect public support for social programs and the welfare state?

The teams worked independently, without coordinating with one another. After reproducing an earlier result, they were invited to extend the analysis “in whatever way they thought best,” with broad latitude to define variables, samples, operationalizations, and models.

The raw material was the same: five waves of the ISSP (International Social Survey Programme), from 1985 to 2016, with updated measures of immigration. But the path to evidence was left open like a square where the statue is singular, and the viewpoints are, inevitably, plural.

Before the first regression, before the spreadsheet could even begin to “answer,” participants were asked to state their starting point: in the country where they lived, should immigration laws be tightened or relaxed?

The metascientific question then ceases to be just a curiosity and becomes a mechanism: do these prior positions align with the results each team produces? And if they do, through which intermediate choices, through which samples, controls, and operationalizations does that alignment become evidence?

The study suggests that this association doesn’t appear as “opinion” pasted onto the footnote of interpretation. It appears to be a regularity in the architecture of design: teams with different priors tend to adopt different combinations of methodological decisions, each defensible in isolation, that, taken together, bias the estimate in one direction or another.

It isn’t that “the data change.” It’s that the path deemed acceptable for reading them changes, and with it, the kind of result that reaches the reader.

A second metaphor clarifies why this matters. Think of map projections: the planet is the same, but each projection (Mercator, Gall–Peters, others) redistributes it, distorting areas, compressing shapes, deciding what looks “large” and what looks “peripheral.”

If someone insists there is “no distortion” because they statistically controlled for the projection, they may be making precisely the error Borjas and Breznau identify in the BRW debate: treating as mere noise what is, in fact, part of the mechanism.

Specification choices are not an external “adjustment” to the result. They are endogenous to the process. They compose the path through which evidence is produced.

This discussion doesn’t call for cynicism; it calls for light. When the path is hidden, a single “click”, a modeling choice, a sampling decision, a package of controls, can acquire the aura of universal evidence.

When the path is shown, the alternatives considered, specification curves, and reanalyses by different teams are presented, science moves closer to what it promises to be: not a definitive portrait of the world, but a public method for turning disagreement into measurement and reducing uncertainty step by step.

When Seventy-One Teams Answer the Same Question —and Disagree

BRW was built to expose that distance: what happens when many competent hands take the same data and follow it down different paths. In BRW, the “statue in the square” is almost literal: the same dataset, handed to dozens of teams, with the same analytical brief.

The experiment was designed to shed light on what the published paper typically leaves in the shadows: the distance between data and conclusion, the zone where routine choices begin to determine what will be called a result.

In science, that zone goes by technical names—operationalization, sampling, specification, and model—but its function is old and human: to turn the world into evidence.

This is the material George J. Borjas and Nate Breznau return to in their January 2026 paper in Science Advances. The question—thorny, and unmistakably contemporary—is easy to phrase and hard to face: can researchers’ preferences and priors be associated with the kind of estimate that reaches the reader even when there is no fraud, no gross error, no visible hand bending the number?

To observe that mechanism from the inside, they rely on a rare opportunity: BRW, in which 71 teams (158 researchers) received the same data and the same hypothesis to test whether immigration reduces public support for the policies that constitute the welfare state.

The teams worked independently, with wide latitude to decide how the world would be represented in the model: how to measure concepts, which countries and survey waves to include, which controls to adopt, and what statistical structure to use. In short, how to choose the “design of the photo.”

Before any modeling, participants recorded their stance on immigration policy in their country of residence: whether immigration laws should be tightened or relaxed.

At first glance, it appears to be a side variable, almost a demographic detail. In Borjas and Breznau’s design, it becomes a key for mapping a pattern more unsettling than the psychology of any single team: not what someone “wanted” to prove, but how prior beliefs can line up with final specification choices. The point at which the technical path tilts the estimate before it becomes a public conclusion.

The result is an analytical multiverse. As the teams extended the analysis, they estimated 1,253 regression models, which BRW translated into a common metric: the AME (Average Marginal Effect), the change in the probability of supporting social policies associated with a one–percentage-point increase in the share of immigrants.

Instead of a single number, a distribution emerged. The AMEs cluster around zero, but they don’t end there; the spread includes numerically large and statistically significant values.

At the extremes, the paper itself gives a sense of scale: the 10th percentile is −0.071 and the 90th is 0.052—which, in the language of public debate, means that a shift from 10% to 11% in the share of immigrants could be associated with something like a seven-point drop or a five-point rise in support for social programs, depending on the analytical path chosen.

But the study’s most provocative point isn’t merely that the estimates vary. It’s the shape of that variation, the pattern that emerges when you look at the whole constellation rather than a single, isolated star.

Where the Results Tilt

Variation alone isn’t the story. The question is whether the variation has a signature: whether it aligns, in a repeatable way, with something the researchers brought with them before they opened the spreadsheet.

The central finding is straightforward: researchers’ ideological positions were systematically associated with the direction of the estimates. Teams composed of more pro-immigration participants tended to report more positive effects of immigration on support for social programs, whereas anti-immigration teams reported more negative effects.

What makes this association intellectually unsettling and journalistically combustible is its manner of occurrence. The authors argue that the difference arises because teams adopt different specifications and follow different paths within what the discipline still recognizes as a defensible method.

The most important and intellectually honest note is negative: the paper does not need to posit bad faith to explain the phenomenon. What it describes is a subtler mechanism, and therefore a harder one to police. Ideology does not appear only in the final paragraph, when a coefficient is “interpreted”; it can slip in earlier, in the design of the analysis itself: how immigration is measured, which countries and survey waves are included, and what statistical structure is adopted.

“In sum: research design is endogenous,” the authors write: design is part of the process, not external noise. It is through that channel, through choices that look merely technical, that prior beliefs can align with the kind of result that reaches the reader.

There is a decisive limit, one that the authors themselves emphasize: the experiment captures the final specification, not the full path that led to it.

The data do not allow us to observe how many alternatives each team tested, when it abandoned one path for another, or why; the garden of forking paths of empirical work, where hypotheses branch and some versions of the world die quietly. Nor can we determine whether researchers, consciously or unconsciously, gravitated toward models more compatible with their preferred conclusions, a question the paper deems crucial and one the BRW design cannot address.

What they can show, given the available data, is an association: final specification decisions correlate with ideological priors measured before any analysis, in the first wave of the questionnaire. That supports the thesis of bias-by-path, but it does not license strong causal inference (ideology was not randomized as a treatment).

To make this path less abstract, Borjas and Breznau perform a surgical cut. From a universe of 103 specification decisions recorded in BRW, they single out five crossroads. Choices that, in combination, explain much of how the same dataset can generate estimates that contradict one another without anyone “forcing” anything.

1. How to scale the outcome: Do responses about different government responsibilities (health care, housing, unemployment, etc.) become a composite index (by averaging or factor analysis), or remain as separate items?

2. How to measure immigration: as stock (% foreign-born/foreign nationals) or as flow (net migration)?

3. What statistical structure to use: whether or not to use multilevel modeling to capture variation in country–year units.

4. Which countries to include: all available countries in the dataset, or a subset.

5. Which survey waves to include: whether to include the 2016 wave—beyond the waves anchoring the original analysis—and thereby shift the historical window being observed.

In combination, these five decisions generate 58 “non-empty” alternative specifications. An atlas of possible paths to the same question.

The point is not that any one choice, in isolation, “determines” the result. The authors insist on the plural: what matters are combinations, second-order interactions, and paths that make sense only once decisions lock into one another.

When Borjas and Breznau compress this space into a comparable set of recurring specifications, 58 “non-empty” paths are ranked by the expected AME (the mean of the AMEs within each specification), and the pattern appears. Anti-immigration teams were the only ones to adopt the combinations that produce the smallest expected effects; pro-immigration teams, the only ones to use those that produce the largest.

And this five-decision package, taken together, explains a substantive share of the distance between the extremes: about 68% of the average gap between pro- and anti-immigration teams in the experiment, according to their decomposition between “observed” AME and “expected” AME.

The Numbers That Travel

Not every estimate has the same afterlife. In public debate, the center of the distribution rarely gets the microphone; the edges do. Estimates cluster near zero. But they don’t end there. Borjas and Breznau describe a landscape in which the histogram clings to the null and still yields numerically large, statistically significant results at the extremes.

In percentile terms, the contrast is almost pedagogical: the 10th percentile is −0.071, and the 90th is 0.052. In the language of public debate, this suggests that a shift from 10% to 11% in the share of immigrants could be associated with a seven-point drop or a five-point rise in support for social programs, depending on the analytical path taken.

This is where the tails matter. Not because they represent the majority, but because they are legible, publishable, politically reusable. Two antagonistic readings can be drawn from the same dataset, and both can sit, with some comfort, inside the universe of plausible choices the experiment makes visible.

The invitation, here, is to treat the tails as a social phenomenon, not merely a statistical one. Extreme results travel better: they become headlines, slogans, policy “evidence” with a speed the null effect, shy, conditional, thick with footnotes, rarely achieves.

The paper does not measure headlines. But it measures something that feeds them: the production of extremes is not randomly distributed across teams. In models that ask who ends up in the tails with large, significant effects, anti-immigration teams are less likely to appear in the positive tail, while pro-immigration teams are less likely to appear in the negative tail; the odds of landing in a tail aligned with one’s orientation differ substantively across groups.

Hence, a sentence that should unsettle any hurried reader: given that all teams began by replicating the same null reference result, the most ideological teams tend to move away from it, adopting specifications that push the estimate toward one extreme or the other. Toward the kind of number that crosses, more easily, the border between academia and public argument.

The implication is double, and uncomfortable at both ends.

First: even a science conducted through technically defensible choices can inadvertently become a vector of polarization when different analytical paths generate “ammunition” in opposite directions, each stamped with methodological plausibility.

Second, the study underscores the need for infrastructures of transparency that can reveal the full distribution, not only the most photogenic spikes, the easiest results to circulate, so that public debate does not mistake the tail for the rule.

And if this is what happens under quasi-laboratory conditions, it’s worth asking what the same mechanism does in the open air, where incentives, institutions, and moral stakes are louder.

A Stress Test Outside the Lab

From here, the piece shifts terrain. We are no longer within Borjas and Breznau’s study, nor within its immediate object: immigration and the welfare state.

What follows is an editorial extrapolation: applying the mechanism they describe—the idea that legitimate design choices, compounded by institutional filters, can steer what circulates as “evidence”—to an analogous, highly politicized domain. This is not a substitute for reporting. Any specific claim here would require its own legwork: independent sources and point-by-point verification.

If metascience insists that data do not speak for themselves, what remains is a political question in the broad sense: who is authorized to speak for them, and under what rules does that speech become valid?

Tobacco control, science, public health, and industry meet on ground where the dispute is rarely limited to toxicology or epidemiology. It also intersects with moral grammars and political and economic ends: abstinence as the sole regulatory ideal, or harm reduction as a pragmatic strategy for those who cannot—or do not wish to—quit entirely.

In this environment, “method” and “moral” often intersect. Not because one side invents science, but because science is always filtered through the rules of passage.

Evidentiary standards, publication norms, outcome priorities, and the language of guidelines themselves can operate as gates: they determine which questions enter the agenda, which comparisons seem acceptable, which risks become tolerable, and which are treated as politically unassimilable.

The literature on non-combustible nicotine products puts this tension in sharp relief.

On one side, studies suggest that for smokers who move from cigarettes to devices such as vaping, exposure to certain toxic substances tends to be lower than under tobacco combustion, and that for some users these products can function as tools for cessation or substitution.

On the other side, none of this amounts to innocence. These products are not risk-free, and use by non-smokers, especially very young people, is treated by many policymakers as a public-health crisis: a reopened gateway and a normalization of nicotine.

Some countries—the United Kingdom is often cited as the leading example—have taken a relatively more pragmatic stance, incorporating such devices into cessation repertoires, with caveats and a focus on adult smokers.

In some multilateral forums, the tone tends to be more cautious. Alongside calls for draconian regulation, these bodies warn of a risk less chemical than rhetorical: narrative capture, when the language of “harm reduction” becomes an instrument of commercial strategy, with possible side effects such as the initiation of new users and the erosion of controls.

In some regulatory debates, concern has also drifted toward non-combustible products that are less conspicuous than vaping: nicotine pouches—small sachets of nicotine—are frequently raised as a point of worry, particularly because of high concentrations and their perceived appeal among adolescents.

The case of snus—and, by extension, oral nicotine products—functions as a laboratory of controversy. Sweden is often cited for historically low smoking prevalence in certain strata and for enviable indicators linked to the burden of mortality and disease attributed to cigarettes.

Part of the literature reads this picture as, at least in part, an effect of substitution: less combustion, more nicotine in oral forms. At the same time, the ground is contested. Critics point to the risk of simplifying narratives, conflicts of interest, and hasty extrapolations from one national context to others.

And the clinical literature is not a single block: for many researchers, some outcomes, especially cardiovascular and population-level ones, remain surrounded by uncertainty, methodological heterogeneity, and interpretive dispute.

The point here is not to arbitrate a winner. It is to watch the mechanism.

Before it becomes consensus, evidence passes through filters: editorial rules, guideline committees, norms about what counts as a “good question,” reputational barriers, legitimate fears of regulatory capture, real conflicts of interest, and, beneath it all, societal values about what a society decides to tolerate.

In fields like this, the mirror doesn’t merely distort. At times, it legislates: it decides which reflections are allowed to exist.

When Controls Swallow the Mechanism

If this is what the mechanism looks like in the open air, what happens when the debate returns to the lab, where reassurance can come in the form of a regression, and where “controlling for everything” may end up controlling away the very channel at issue?

Borjas and Breznau’s paper doesn’t merely reexamine a rare trove of evidence; it also challenges BRW’s more soothing reading of its own experiment. In the original study, the organizers concluded that “researcher characteristics do not explain outcome variance”; that is, researchers’ characteristics did not account for the variation in results.

Borjas and Breznau argue that this peace is illusory. It may be purchased at the price of a classic statistical move—controlling for almost everything—which, in this setting, risks controlling away the very mechanism producing the divergence.

Their reanalysis identifies a substantive reason for the disagreement.

BRW privileged a kitchen-sink strategy: it regressed each team’s final estimate (the effect of immigration on an indicator of “social cohesion,” operationalized as support for social policies) on ideology, along with a broad vector of controls that included, among other things, descriptors of the team’s own specification (for instance, logit versus OLS; the inclusion of country and year fixed effects). In that expanded setup, the coefficient for ideology was not statistically significant.

Here is the critique that changes the game: if modeling choices are endogenous, if they are part of the mechanism by which beliefs and priors become estimates, then “controlling” for those choices may mean controlling the very channel through which ideology operates.

This is not a technical quibble; it is a causal inversion. That is why, they write, their result conflicts with BRW’s: the reanalysis “takes into account the possibility that variables that indicate design choices are endogenous to the process.” Put differently, when a kitchen-sink regression throws specification descriptors into the bundle, it risks neutralizing what it set out to test because “the variables that indicate aspects of the specification are endogenous and are the mechanism by which ideology influences the estimates.”

Intuitively, a kitchen-sink regression can be useful for describing how much variation is associated with a broad bundle of observable features. But when some of those “controls” are not noise—when they are the mechanism itself—the model can erase the effect it is meant to detect.

In the language of causal inference (offered here as an editorial translation, not as the paper’s own label), this is the classic mistake of controlling for a mediator: you neutralize the channel, and then conclude the channel never existed.

The implication is epistemological.

If bias in the weak sense—inclinations, intuitions, priorities—can be inscribed in the decisions between data and model, then “who controls what” stops being a technical detail and becomes an architecture of knowledge.

At the same time, the authors underscore a limitation inherent in what BRW can show: the experiment records the final specification, not the full workflow. We do not know how many alternatives were tried, when and why certain routes were abandoned, or whether researchers, “consciously or unconsciously,” gravitated toward models that supported preferred conclusions.

What remains observable, with some confidence, is a temporally ordered association: final specification choices correlate with ideological priors measured before any analysis, in the first wave of the questionnaire, and it is this fit (not proof of intention) that sustains the bias-by-path hypothesis.

Between Method and World

Once the possibility of “controlling away” the channel is on the table, the argument ceases to be a dispute over models and becomes a dispute over what evidence is and what we ask it to do.

There is something deeply unsettling about Borjas and Breznau’s reanalysis, not because it uncovers scientific misconduct, but precisely because it doesn’t need to. What it puts on stage is more disturbing: the possibility that legitimate, technical, defensible decisions can produce distinct analytical worlds, and that part of this divergence aligns, systematically, with prior beliefs about the subject.

The paper itself, however, taps the brakes. Ideology was not a randomized “treatment”; it was a measured characteristic across a moderate number of teams, which limits the strength of causal inference.

In other words, the study does not claim, with the rigidity of a classic experiment, that “ideology causes X.” It shows a persistent association between priors and the choices that culminate in estimates, and it acknowledges uncertainty, including wide confidence intervals.

Still, the finding returns empirical science—especially in politically sensitive topics—to a stubborn tension: data do not speak for themselves. Not because “anything goes,” but because there is a labyrinth of plausible choices between the spreadsheet and the result. And if research design is endogenous, that labyrinth is not neutral: the final specification can correlate with beliefs that predate the analysis.

Here, metascience ceases to be a debate about robustness and becomes a debate about process. The authors themselves acknowledge a decisive gap: the experiment does not record the full path. It does not indicate how many alternatives were tried and discarded, when they were tried, or why. Hence, the agenda they gesture toward: observing and documenting workflows tracking the garden of forking paths that still remains, largely, outside the published paper.

There is another uncomfortable detail in any discussion of what counts as “valid evidence.” Within the experiment, each modeling strategy underwent randomized, double-blind peer review, yielding a referee score for each model.

Under that filter, moderate teams earned the highest mean score (0.35), above anti-immigration teams (0.03) and pro-immigration teams (−0.33). This doesn’t decide who is “right.” The authors themselves warn that the run-of-the-mill may be merely the most comfortable, not necessarily the most true. But it does suggest something structural: filters of quality—or of conventionality—also participate in selecting what rises to the status of an “acceptable” result, especially when “non-traditional” choices produce outliers and are, for that reason, penalized in peer judgment.

None of this has to curdle into cynicism. The authors insist on an exit that is, at once, more laborious and more honest: treating robustness as aggregated evidence, not as an anointed coefficient.

To that end, they run an “agnostic” robustness test: they estimate the effect of ideology across 883 models, covering all combinations of specifications used in the main tables and supplementary material, and display a specification curve.

The result is eloquent in scale: ideology appears with a statistically significant effect (P < 0.10) in 88.2% of models, a share that rises to 92.4% when models potentially affected by omitted-variable bias are excluded (those that do not include disciplinary fixed effects).

In other words, the association between ideological position and the estimate produced does not hinge on a single way of modeling, nor on a particular sampling choice that could be dismissed as a special case.

As the authors traverse the multiverse of specifications—swapping, combining, recombining defensible decisions—the signal returns along the overwhelming majority of paths: you change the lens, you change the frame, you change the bundle of controls, and ideology still shows up as a factor associated with the result.

And when a subset of models more vulnerable to distortion by omission is removed, the pattern becomes more frequent, suggesting, in plain terms, that this is not a fragile artifact of specification, but a feature that persists precisely when the test becomes more demanding.

After hundreds of models and a curve that refuses to settle into a single story, the argument widens. It’s no longer only about robustness; it’s about who gets to see the path, and who benefits when it stays hidden.

The Mirror, the Angle, and the Invisible Reader

Ultimately, Borjas and Breznau’s reanalysis may say less about immigration and social policy than about the nature of scientific evidence in charged domains. Those in which empirical reality arrives at the lab are already accompanied by dispute.

It suggests that “statistical truth,” like an image in a curved mirror, shifts with the angle of the viewer—or, more precisely, with the sequence of choices that determine what will be measured, compared, controlled, and published.

And there is a third vertex, almost always outside the frame: the invisible reader (the institution, the newsroom, the court of public opinion) for whom certain images circulate more easily than others.

There are no heretics in this story.

Each team adhered to established protocols, applied methods taught in graduate programs, and used tools accepted by disciplinary tradition. The problem is not bad faith; it is the invisibility of the route: the decisions that don’t fit in the final paper, the models tried and abandoned, the alternatives that disappear without leaving a trace, and that, taken together, determine what the reader will receive as evidence.

Like a newsroom in which everyone is handed the same raw material but only one story makes the cover, scientific production is also a process of selection and disappearance. Some forks close without a sound; others, through repetition and reputation, become the norm. What remains, the final coefficient, the “clean” figure, the number that becomes an argument, is only one among many possible versions of the same world.

So the challenge ahead may not be to insulate science from bias—an impossible task—but to build institutions capable of living with it without naturalizing it.

That calls for less fetishizing of neutrality and more transparency about choices; less idolatry of a single result and more attention to distributions; less worship of the closed paper and more openness of process.

If there is an antidote—one I learned from Borjas and Breznau—it doesn’t look like censorship, but like its opposite: pluralism.

More teams, more angles, more models, more cross-examination, not to turn every conclusion into opinion, but to make the route visible, light up the forks, and reduce the quiet power of a single tilted mirror.

• Borjas, G. J., & Breznau, N. (2026). Ideological bias in the production of research findings. Science Advances, 12(1), eadz7173. https://doi.org/10.1126/sciadv.adz7173

About the Researchers:

George J. Borjas is affiliated with the Harvard Kennedy School and the National Bureau of Economic Research (NBER).

Nate Breznau is affiliated with the German Institute for Adult Education—the Leibniz Centre for Lifelong Learning in Bonn (Department of Organization and Program Planning).

An Annotated Interview / Backstage Notebook

In the Multiverse’s Editing Room, with Borjas and Breznau

On the screen, science looks like a calm object. A specification curve, a row of models, arranges chaos into something like a landscape. From a distance, it’s easy to believe the debate is about numbers. But in my exchange with Borjas and Breznau on February 6, the subject kept returning to the same place: before the number, there is a path. And that path is where evidence acquires direction.

I. Endogeneity of Design: Unconscious or Deliberate?

I began with the phrase that, in their paper, works like a hinge: endogeneity of design. Is this process mostly unconscious—the researcher’s quiet drift—or is there room for more deliberate (yet still legitimate) alignments between theoretical expectations and modeling choices?

They didn’t answer with psychology. They answered with architecture:

“The process of conducting empirical research has many steps: How to frame the question? Which data to analyze? How to measure the variables to be used? Which methodological technique to use? And so on.

Each of these decisions opens a fork in the road, and the combination of all the different decisions leads to very specific results that differ from what would have been obtained with another set of decisions.

Everyone who does empirical research knows this and ‘sees’ the specific impact of a set of decisions during the research process.

Unfortunately, the decisions can be manipulated by someone who wishes to reach a particular endpoint. That is why it is extremely important for the researcher to be totally transparent in what research design choices were made.”

Here, transparency doesn’t read as a decorative virtue; it reads as an institutional counterweight to a banal, explosive fact: there are many plausible routes, and some routes make the world look like something else.

II. Learning What “Pushes” Results

The next question presses on a more delicate point: in contexts of high analytical flexibility, do researchers inevitably learn which decisions “push” results in one direction or another?

Their reply arrives without padding:

“If, during the research process, a researcher does not learn that certain research design choices tend to push results in a particular direction, that researcher is not very competent to begin with.”

It’s a sentence that invites slow reading. It doesn’t merely say that learning is inevitable; it defines competence as the ability to see, in real time, what choices do to the estimate.

The problem, then, is not discovering that choices tilt outcomes. It’s what one does with that discovery, and how much of it stays outside the final paper, invisible to the reader who receives the coefficient already cleaned up, already edited, already converted into a conclusion.

III. Ideological Asymmetry: A Dominant Bias in the Social Sciences?

BRW’s ideological asymmetry—few anti-immigration teams—raises a question that is hard to keep purely technical. Does it suggest a dominant ideological bias in certain fields?

They answer with a conjecture anchored in an American backdrop:

“Given the widely publicized data in the US of how nearly all the money donated to political parties by faculty in universities goes in a single direction (left), it is difficult to dispute the conjecture that ‘social sciences today operate under a dominant ideological bias’.”

Editorial cut: they call it a conjecture, not a result of the experiment. But the line carries an infrastructural implication: if a field is asymmetric, then the plurality of routes (and of questions) may be filtered from the start, not only by method, but by the sociology of who gets into the lab.

IV. An Epistemological Problem—or a Sociological One?

If the asymmetry is real, I ask, what is it an epistemological problem in itself, or a reflection of the scientific community’s composition?

They step back into terrain where metascience still lacks a firm footing:

“We don’t know.”

Then a hypothesis:

“There’s probably a lot of ‘ideological bias’ in faculty hiring in universities.”

And from there, a research agenda:

“We need more research into how ideology shapes the entire research process from epistemology through methods onto results.”

The arc is clear: from recruitment to method, from method to result, a whole chain of selection in which what we call “evidence” is also an institutional photograph of what was permitted to be asked.

V. Tails, Extremes, and Polarization

When the conversation returns to the tails, the extreme, statistically significant results that travel most easily into policy and public argument, I ask what this does to polarization.

The answer comes as an avowed prior:

“Our prior is always to be skeptical of evidence in highly contentious and politicized fields.”

Then the critique shifts from the dataset to the ecosystem:

“Unfortunately, the hiring process in universities and the peer review process are also contaminated by ideological bias, so what one gets to read is already heavily filtered.”

And then comes the line that lands with the force of an accusation, even if it’s offered as a diagnosis:

“So it would not be too far-fetched to say that a lot of the distrust in science has probably been ‘earned’ through the years of scientists selling results that might have been manipulated to reach specific conclusions.”

Editorial cut: the paper measures associations and patterns; here, the conversation brushes up against public trust and the way a “result” becomes a political commodity. The line is not a statistic. It is a moral reading of an ecosystem of filters.

VI. Mitigating Selective Circulation—Without Censorship

If extremes travel, can anything be done about selective circulation without sliding into censorship or neutralizing dissent?

They don’t offer a simple solution, but they point in a direction:

“Although we don’t see a simple solution, we would say that the answer (if it exists) is exactly the opposite of censorship. Let a question be analyzed by many researchers from many different angles.”

Pluralism as an antidote, not to say that “anything goes,” but to insist that when there are many plausible routes, intellectual honesty is not choosing one and pretending the others never existed; it is making the forks visible.

VII. If Many Results Are Possible, Does Replicability Collapse?

If “the” empirical result is only one realization among many, does the classical ideal of replicability fall apart?

They resist the clean answer:

“We don’t know.”

But an ethos appears:

“But the scientific method involves checking and re-checking results, and paying attention to robustness.”

And with it, a criterion for discomfort:

“If there are many results in many different directions, then we either have no clear effect of something, or we need to do more work to identify the correct test.”

Replicability, here, isn’t a stamp. It’s repeated labor, and a diagnosis: either the effect isn’t there, or the test has not yet found its proper form.

VIII. Controlled Pluralism: Multiverses, Curves, Radical Transparency?

Instead of replication in the strict sense, should the field move toward controlled pluralism, multiverse analyses, specification curves, and radical transparency?

They don’t pick a side. They pick both:

“Both. We should perform replication and reanalyses—where we adjust previous models.”

This isn’t methodological fashion; it’s discipline: replicate and reanalyze and, in reanalysis, adjust earlier models, making choices and consequences explicit.

IX. Does This Apply to Public Health—Nicotine, Tobacco, Drugs?

I push the mechanism outside the lab and into domains where method and moral judgment knot together —public health, tobacco control, drug policy, etc. Is this a special case?

They refuse the comfort of the exception:

“Show me a field of science where evidence and moral judgments do not intertwine. This is not a problem unique to any one area.”

If the entanglement is structural, then the question isn’t where it happens, but under what rules it is governed.

X. When the Risk Is Epistemic Hegemony—Without Falling into Relativism

Finally, I ask whether, in areas of strong institutional consensus, the main risk may not be individual bias but the epistemic hegemony of certain frameworks, and how science can address that without sliding into relativism.

The answer ends at a limit:

“No idea.”

That last sentence functions like a window. It suggests that when the conversation reaches its hardest point—not the ideology of individuals but the hegemony of structures—the language we have remains insufficient.

The paper measures what it can measure. The interview, at times, brushes up against what we do not yet even know how to ask.

And that is where this notebook finds its purpose: to show that behind every coefficient there is a system of choices; behind every choice, a set of filters; and behind the filters, an invisible reader: the institution, the editor, the guideline, public policy, us; waiting for the number that travels best.

Editor’s note: Quotations have been lightly edited for spelling and punctuation, with wording and meaning otherwise preserved. Illustrations by GR.

There are moments when data do more than inform: they shift the ground beneath public debate. They do not merely add nuance; they rupture consensus, erode certainties, and force repositioning.

The newly released Health Survey for England: 2024 marks one of these rare inflection points. Smoking in England has fallen to its lowest level since records began: just 11 percent of adults identify as smokers, a proportion that, according to the survey itself, continues on a downward trajectory.

As combustible cigarettes retreat, the use of electronic nicotine devices moves in the opposite direction.

E-cigarettes now reach 10 percent of the population, with the steepest increase among young people aged 16 to 24. In this age group, vaping has ceased to be an exception and has become a declared habit: 19 percent of women and 16 percent of men report current use.

The numbers speak. But it is when they seem to whisper that they announce the most profound changes.

At first glance, all this may appear to be little more than a shift in habit, a behavioral detail, almost cosmetic. But data rarely settle for the surface. They move faster than the policies that attempt to keep pace with them, exposing a deeper sociopolitical, ethical, and epistemological realignment.

“We are seeing patterns of nicotine use change across the entire population,” says Cliff Douglas, former vice president of the American Cancer Society and a central figure in the shaping of contemporary tobacco-control policy.

“The most telling data point is that e-cigarette use among adults who have never smoked remains very low. That points less to the emergence of a new epidemic and more to a movement toward risk reduction among smokers.”

What transforms the body almost always precedes what transforms the law.

Douglas’s reading gains substance in a figure that demands silence before interpretation: only 4 percent of adults who have never smoked report currently using vapes.

At the same time, vaping is advancing precisely where cigarettes still cling to life and where life itself is harsher. In the poorest areas, 13 percent of adults have adopted these devices, compared with just 7 percent in the wealthiest regions.

This is not merely a trend or a generational whim. It is a survival strategy in landscapes shaped by precarity: places where health is an intermittent luxury and relief an everyday urgency. In these territories, each inhale is also a pause from pain. These, too, are data.

“If it weren’t for the moral panic surrounding e-cigarettes, many more vulnerable people would already have managed to quit smoking,” says Louise Ross, former director of the Leicester Stop Smoking Service and one of the pioneers of a vape-friendly approach within Britain’s public health system.

“Instead,” she reports, “we repeatedly hear people say, ‘At least with cigarettes, we know what’s in them.’”

“That is misinformation,” Ross concludes. “And it costs lives.”

The idea of harm reduction is not new. But in light of the evidence, it has become inescapable. The data reveal what many authorities still hesitate to admit: a growing share of the population is abandoning a demonstrably lethal product for another that is significantly less harmful, despite institutional reluctance, ambiguous or openly adversarial public messaging, and a regulatory framework that oscillates between delay and fear.

The war on smoking, which at many moments spilled over into a war on nicotine itself, now demands more than statistics. It demands a direct confrontation with misinformation and paternalism that deny informed choice; with a morality disguised as care; and with a public language that clings to abstract ideals even when the cost is concrete, measurable, and real.

Nicotine persists. Cigarettes, perhaps not.

But the air still carries ghosts.

And the state, its interests and its vices.

What is at stake is whether policy will continue to fight substances or finally begin to protect people.

The Data Breaks the Silence; and Panic Intervenes

Almost without fanfare, the Health Survey for England: 2024 was released by the National Health Service on January 27. It is an extensive survey, with regional reach and a validated methodology, one of those bureaucratic instruments that seem cold until, when read closely, they begin to reveal human warmth.

Seen up close, the report functions like a silent seismograph: it does not announce earthquakes, but it repositions the country from within, capturing shifts in bodies, in repeated gestures of consumption, in routines of risk, and in the often discreet forms of survival that shape the lives of the British population.

Among dozens of tables and charts, two figures interrupt the reading. Not because of their magnitude, but because of the friction they produce. Eleven percent of adults in England still smoke, the lowest rate ever recorded. Ten percent now use e-cigarettes. For the first time since the series began, the country has nearly as many vapers as smokers.

This is not a statistical coincidence but a historic inflection point. For more than a century, combustion served as nicotine’s primary vehicle, but it is now losing its hegemony to vapor: adjustable, customizable, flavored. A technology of consumption that is not merely technical but also a language, a market, and a field of dispute.

At first glance, this may seem like a simple exchange of habits. But beneath the gesture, that almost unconscious motion of bringing something to the lips, the grammar of pleasure and risk shifts. The cigarette, once an emblem of rebellion and status, of addiction and a rite of passage, is becoming an exception: a custom retreating to the margins. In its place, another form of consumption, more discreet, flavored, and customizable, emerges, appearing with increasing frequency precisely among those whom conventional cessation campaigns have rarely managed to reach.

This, however, is no pure or uncomplicated triumph. The transition now underway, from combustion to vapor, is crossed by tensions between health and market, science and morality, and risk and pleasure. Even so, one fact remains unavoidable: harm reduction is occurring, with or without the blessing of authorities. And perhaps, increasingly, despite them.

The British Paradox: From the Harm Reduction Lab to the Theater of Containment

For more than a decade, the United Kingdom stood as a global reference for tobacco harm-reduction strategies. In 2015, a formulation by Public Health England helped redefine the international debate by stating that vaping was substantially less harmful than smoking, an estimate distilled into a phrase that circled the world: “vaping is 95% less harmful than smoking.”

From that point on, the country adopted an explicitly pragmatic, evidence-based approach. Vapes were distributed in hospitals, incorporated into smoking-cessation programs, and promoted in public campaigns as an alternative to cigarettes.

And the results did not take long to appear.

According to the Office for National Statistics, the proportion of smokers declined from 17.2 percent in 2015 to 12.9 percent in 2022. A sustained decline, and a rare one among high-income countries. But this model began to wobble in 2025, when policy became increasingly captured by the dramaturgy of fear.

In August of that year, The Guardian published an alarmist report claiming that young people who used vapes were “three times more likely” to start smoking, alongside a list of alleged risks: asthma, depression, and mental disorders.

The article acknowledged that the evidence was observational and incapable of establishing causal relationships. But the media framing had already done its work.

Under pressure from the media and from the political and discursive ecosystem surrounding the World Health Organization, the British government fast-tracked the Tobacco and Vapes Bill. The response included a ban on disposable vapes, severe limits on flavors, and standardized packaging. The tone was one of alarm: media spoke of a “youth nicotine epidemic”, a phrase that mobilized moral anxiety far more than it rested on consistent empirical support.

A country that, for years, had led innovation in public-health policy was now legislating in a reactive mode, responding as if to chaos, despite a robust domestic scientific literature and data pointing in the opposite direction.

One example is telling. The Health Survey for England: 2024 shows that only 4 percent of adults who have never smoked report current vape use. Among children aged 8 to 15, just 2 percent say they have ever tried conventional cigarettes, while 9 percent report having experimented with vapes at least once. A relevant difference, but one that does not amount to regular use, nor to a transition into smoking.

Far from signaling a new generation of dependents, these figures suggest a shift in the initiation pathway: the cigarette has lost its historic role as an entry rite. Nicotine now arrives through a more discreet route that is substantially less toxic and, to date, after roughly two decades of population-level use, has not been consistently linked to direct lethality.

And perhaps that alone already constitutes a silent achievement.

Professor Ann McNeill, an expert in nicotine dependence at King’s College London, publicly challenged the scientific foundations of the new legislation. In her analysis, 53 of the 56 systematic reviews used to justify the restrictions were classified as being of “low” or “very low methodological quality.”

The error, she argued, was elementary: confusing association with causation, reading correlation as destiny.

The paradox is plain: where vaping rises, smoking continues to fall.

Even so, evidence was overrun by rhetoric. In the name of protecting young people, the risk is punishing those who have finally found a less lethal route of escape. The NHS, meanwhile, continues to support vaping as an effective cessation tool, backed by systematic reviews from Cochrane.

In Westminster, however, political alarm intensifies. The country that once served as a laboratory for harm reduction now hesitates despite its own evidence.

‘Nicotine Doesn’t Kill; Moralism Might.’

Part of the regulatory impasse and the social noise surrounding vaping stems from a persistent semantic confusion that has cost public health decades: treating nicotine and cigarettes as synonyms.

It is combustion, not the substance itself, that constitutes the lethal axis. Tobacco smoke contains roughly 7,000 chemical compounds, at least 70 of which are known carcinogens. By contrast, nicotine is not the agent responsible for cancer, heart attacks, or chronic obstructive pulmonary disease, the principal lethal outcomes associated with smoking.

This does not mean nicotine is free of physiological effects. It means nicotine does not explain the mortality associated with smoking. What nicotine produces, above all, is dependence. And dependence, though frequently conflated with addiction, is not, by definition, synonymous with destruction.

Clinically, addiction severely compromises autonomy, functioning, and physical or mental health. By contrast, dependence can be stable, functional, and—in many contexts—socially integrated, as with caffeine, certain antidepressants, long-term controlled use of benzodiazepines, or even regulated sugar consumption.

In the case of nicotine, the decisive difference lies in the mode of delivery. A cigarette delivers the substance abruptly, along with a toxic cocktail generated by combustion. By contrast, vaping allows greater dose control, intermittent use patterns, and a lower associated physiological burden. The same applies to pouches, gums, patches, and oral sprays. Yet precisely because vaping is effective, pleasurable, and popular, it has become the primary target of public suspicion.

As Cliff Douglas, one of the most influential figures in contemporary tobacco regulation and a global reference in public health, puts it:

“Nicotine doesn’t kill—smoke does.”

Douglas, a trained jurist, devoted more than three decades to tobacco regulation. He led historic campaigns, including the ban on smoking on commercial flights in the United States, and played a central role in defending Uruguay against Philip Morris’s attempt to overturn Uruguay’s public-health laws.

For him, Britain’s progress in reducing smoking rates is inseparable from access to less harmful products.

“Smoking rates continue to fall in England and are now at record lows, thanks in part to the substitution of vaping products for combustible cigarettes,” he said in an interview.

“What is most striking,” he adds, “is that vape use among adults who have never smoked remains very low. This shows that we are not creating a new epidemic but rather accelerating smoking cessation among the most vulnerable.”

That vulnerability, moreover, has been intensified by a cruel paradox: by demonizing nicotine, policy perpetuates the consumption of its most lethal form—the cigarette—among the poorest.

This is precisely what Louise Ross, one of the most respected voices in smoking cessation in the United Kingdom and a leading authority on harm reduction, has warned against. A nurse by training, Ross spent years on the front lines of Britain’s public health system.

Now leading the Stop Smoking initiative at Smoke Free Digital, she became a firm advocate for safe substitution through direct clinical experience: over time, she observed consistently higher quit rates among smokers who combined vaping with structured clinical support.

“The scare stories around vaping have created a perverse effect,” Ross says. “People in vulnerable situations end up saying, ‘At least with cigarettes, we know what’s in them.’ That is a direct result of misinformation—including from health professionals.”

For Ross, nicotine should be treated with the same level of rationality applied to other substances used chronically.

“The central goal is to be free from smoke, not from nicotine. Gradual reduction is possible, yes—as long as it is voluntary, not punitive. What we cannot do is force abstinence in the name of an abstract purity and, in doing so, push people back toward cigarettes.”

The history of nicotine may need to be retold. Not as the story of a vice, but as a poorly told chronicle of misplaced focus. By demonizing the substance, we ignore the true vector of harm and, in doing so, forfeit a concrete chance to save lives.

Care, in this case, begins with an increasingly rare gesture: the political humility to listen to data before obeying instinct.

The Uneven Geography of Combustion

Not every decline is uniform. If the smoking curve plunges in the aggregate, it stumbles at the margins. There are territories where the cigarette still endures as a symptom of inequality, abandonment, and absence, not as a choice.

And it is precisely in these interstices that vaping begins to seep in, not merely as a technological promise but as a possible form of relief. A smoke-free future may be arriving. But, as always, it does not arrive at the same time for everyone.

The historic decline in smoking in England from nearly 30 percent in the early 2000s to 11 percent in 2024 marks an undeniable public-health milestone. However, this achievement has not been distributed evenly.

In the wealthiest neighborhoods, where access to information, time, and care is less fiercely contested, cigarettes have all but vanished: only 7 percent of adults still smoke. In poorer communities, however, the rate more than doubles, reaching 17 percent. Among men in the most vulnerable circumstances, the rate rises to 20 percent, nearly three times that of men in the highest income brackets.

In these territories, combustion is more than a habit: it is a symptom. A visible marker of chronic stress, accumulated exclusion, and scarcity of viable alternatives. Lighting a cigarette in the Northeast of England or in working-class neighborhoods of Yorkshire is not merely an act of nicotine consumption. It is a form of coping. For many, it is the only constant in lives shaped by uncertainty.

It is precisely in these same territories that vaping is growing most rapidly.

In poorer areas, 13 percent of adults now use e-cigarettes, almost twice the rate observed in more affluent regions, where the figure stands at 7 percent.

The contrast reveals more than a simple technological substitution. It suggests that vaping is filling a void left by traditional cessation campaigns, or perhaps by the NHS finally getting it right. In places where cigarettes persist as a cultural and affective marker, electronic devices offer an escape: for many, partial and imperfect, but concretely real.

This is the side of the statistics that rarely makes headlines. In these territories, vaping is neither an adolescent fad nor a marketing ploy. It is a survival strategy, a substitute that, even without the sheen of novelty, promises less pain, less disease, and less loss. As one expert quoted in the NHS survey put it: “We may be winning the war against cigarettes at the national level, but not everyone is reaping the benefits of that victory.”

Ignoring this asymmetry repeats a familiar error: designing universal policies for a structurally unequal reality. If nicotine has ceased to mean combustion, care, too, must cease to mean command. It must become listening to recognize that, at the margins where embers still glow, vapor may not be a threat but a relief.

The New Moral Anxiety

If, at the margins, the cigarette endures as shelter, at the center, it disappears as a symbol. Among the young, the rite has lost its ritual. For decades, the traditional cigarette played a precise symbolic role: it was the rite of passage of British adolescence. The first drag behind the school. The gesture copied from parents or idols. The smell as a social signature.

In 1997, 19 percent of children ages 8 to 15 had already smoked. Today, that number has fallen to 2 percent. The drop is so steep it borders on the improbable, yet it is, in fact, historic. By contrast, 9 percent of children in that same age group report having experimented with an e-cigarette.

The inversion is evident, but it does not point, as many assume, to a simple substitution of addiction. What is underway is a shift in form, aesthetics, and language. Embers have been replaced by vapor. The ritual has been redesigned.

Instead of an object that betrays itself through smell, color, and stigma, the vape is discreet, flavored, and customizable. It fits both in the pocket and in the imagination of a generation raised under the hegemony of public health and the permanent surveillance of behavior.

“Vaping is now the dominant form of nicotine use among young adults in England,” a consumer said, citing the 2024 data. The survey confirms it: among those ages 16 to 24, 19 percent of women and 16 percent of men report current e-cigarette use—more than double the national average. In contrast, cigarettes are no longer even the predominant option in this age group: only 10 to 11 percent still smoke.

These numbers reveal more than preferences. They cross ethical and political thresholds, posing an uncomfortable question: 

What, precisely, unsettles us about youth vaping?

Is it the presence of nicotine or the absence of visible punishment?

Is it fear of a real addiction, the risk of dependence, or discomfort from a form of pleasure that escapes adult control?

Throughout 2025, this anxiety took on institutional form. As noted earlier, the British government subverted its own evidence-based logic and proposed one of the most restrictive legislative frameworks in Europe, including a ban on disposable vapes, severe limits on flavors, and standardized packaging.

The official justification, as always, was the protection of young people. But the rhetorical operation suggests another impulse: a return to performative prohibitionism, in which legislation serves less to reduce harm than to reaffirm authority.

The central question, however, has already been partially answered by Britain’s sociopolitical experience and scientific production: how to protect without punishing? How to craft policies that recognize risk, user agency, social context, and the value of pleasure?

For if the cigarette was long a symbol of transgression, the vape may now be a symbol of ambivalence. And ambivalence demands a more sophisticated vocabulary than the old binary of health and danger.

The United Kingdom does not lack evidence. It lacks political coherence.

A Statistical Victory Is Not Yet an Ethical One

Crossing a threshold is not the same as reaching a destination. If cigarettes no longer occupy the center of nicotine consumption, what remains to be decided is what will take their place: science or fear, evidence-based policy or moral reflex.

The data no longer allows for ambiguity. Vaping has become the primary tool for smoking cessation in the United Kingdom. What is increasingly evident is the absence of a policy that clearly and courageously recognizes this fact.

In 2024, when England recorded—for the first time—more vapers than smokers, the country did more than update its statistics: it turned a page. What remains open is what will be written next.

The traditional cigarette no longer dominates bodies or culture as it once did. Yet it still burns at the margins, among the poor, the underserved, and those forgotten by public campaigns. Its disappearance is uneven. What persists is residual combustion, sustained by timid policies, durable stigmas, and a refusal to treat nicotine with the complexity it demands.

Each year, 28.6 billion cigarettes are consumed in the United Kingdom. More than a statistic, this number is a portrait of persistent inequality and of a dependence perpetuated by policies that still hesitate between care and control.

As a compelling study by Jamie Brown, Sarah Jackson, Sharon Cox, and Vera Buss of University College London has shown, the cigarette persists not because of ignorance but because of institutional inertia.

It has become a zombie product: clinically obsolete yet economically sustained. It remains lit out of convenience and continues to kill through omission. Vaping—imperfect and uneven as it may be—represents a concrete step toward genuine risk and harm reduction.

A step that requires neither perfection nor purity, but political courage: legislating on the basis of science, listening to those who produce evidence and those who use nicotine, and recognizing that pleasure, desire, and need are also components of health.

England is winning the battle against combustion, but it has not yet overcome moralism. Nicotine remains, and with it comes a political challenge: to protect without punishing, to inform without manipulating, to care without prohibiting.

The error now would be to confuse victory with an ending.

No statistic can replace the work of listening. No ban can compensate for the absence of the right to know, choose, and use with lower risk. The only policy that works is one that begins with humility in the face of real life.

As the Canadian physician and writer Mark Tyndall reminds us, “the fight against tobacco is not only a public health challenge—it is an urgent matter of social justice.”

The future of public health may depend less on vertical prohibitions than on an ethic of trust, one that recognizes that, when faced with the choice between smoke and vapor, it is the state’s responsibility to ensure the conditions under which people can decide clearly, justly, and without fear.

A significant portion of preclinical exposure studies using high-powered, low-resistance (sub-ohm) devices operate under airflow regimes inappropriate for this device class. As a result, they frequently generate overheated, failure-mode aerosols that do not reflect routine human use.

Evidence at a Glance

• Common laboratory regimen: 3-second puffs, 55 mL, every 30 seconds (CORESTA CRM81/RM81-like), equivalent to ~1.1 L/min airflow.

• Engineering requirement: For sub-ohm devices, airflow closer to ~10 L/min is needed to prevent coil overheating.

• Observed outputs: Elevated aldehydes and, in some cases, carbon monoxide—signals consistent with thermal failure, not typical vaping.

• Scope: The paper evaluates methodological validity, not clinical efficacy or safety.

Why This Matters for Policy

Scientific Validity

If the experimental agent is an aerosol, then invalid aerosol generation invalidates downstream risk inference. Toxicology built on failure modes cannot be generalized to real-world exposure.

Regulatory Integrity

When laboratory-induced artifacts are treated as “typical vaping,” regulatory risk is shaped by invalid proxies rather than by representative evidence.

Equity Implications

Mischaracterizing alternatives to smoking disproportionately affects populations already bearing the highest burden of combustible tobacco use—those with fewer resources, fewer cessation options, and higher baseline risk.

Policy Implications

1. Evidence weighting must account for the validity of aerosol generation, not toxic endpoints alone.

2. Failure modes should not be silently generalized to standard exposure conditions.

3. Methodological shortcuts carry human costs by reinforcing policies that may prolong smoking rather than reduce harm.

Recommended Actions

For Regulators & Public-Health Agencies

• Require exposure studies to report:

  • Delivered (measured) power at the coil

  • Airflow rates

  • Device and coil specifications

  • Operational regime (optimal vs. overheating)

• Explicitly distinguish extreme or failure conditions from representative use in risk assessment.

For Journals & Research Funders

• Tighten reporting standards and checklists to reduce irreproducible or engineering-invalid exposure studies.

• Prioritize replication studies that map airflow × power × resistance to valid vs. overheating zones.

For Standards Bodies & Laboratories

• Develop device-class–specific protocols (pods ≠ sub-ohm).

• Implement pre-calibration workflows to prevent “screen watts” from substituting for delivered watts.

For Journalists & Opinion Leaders

• Interrogate methods before amplifying results

  When reporting on vaping studies, explicitly ask how the aerosol was generated: airflow, delivered power, device class, and operating regime. Toxicological findings without methodological context are not facts—they are poorly grounded claims.

• Avoid generalizing failure scenarios as typical of use

  Aerosols produced under extreme or overheating conditions should not be described as representative of everyday vaping. When studies probe limits or failure modes, this distinction must be made explicit to audiences.

• Distinguish plausible risk from manufactured risk

  Not every alarming result reflects a real-world exposure. Responsible science journalism does not elevate experimental artifacts into population-level conclusions.

• Contextualize social and distributive consequences
  Frames that collapse all alternatives to combustible smoking into a single risk category obscure who bears the cost of oversimplification: populations with higher smoking prevalence, fewer cessation options, and greater structural vulnerability.

• Resist moral certainty where technical uncertainty persists

  When methods are contested or incomplete, journalism should clarify limits—not replace them with moralized conclusions. Explaining uncertainty is not a weakness; it is a public service.

Bottom Line

A toxicological result is only as credible as the aerosol that produced it.
When laboratory protocols turn thermal failure into “evidence,” policy inherits the error—and vulnerable populations pay the price.

For Further Reading:

David Nutt doesn’t apologize for the tone. He doesn’t soften. Doesn’t ease in. Doesn’t hedge. He writes like someone who has run out of polite ways to be ignored. Like someone who’s lost faith in long form—and maybe in listening itself.

Meanwhile, on the institutional side of history, the WHO’s COP11 was wrapping up its resolutions: vapor and smoke, treated as one and the same, banned from the halls of the UN. No nuance. No distinction.

It’s a decision that sounds morally aligned. Who would argue against protection? But for Nutt, to protect without distinction is just surrender by another name. And in this case, a surrender of evidence.

For years, he’s been drawing scales, assigning weights, and measuring. And he keeps repeating, as if no one has quite heard him yet: the problem was never nicotine. It was always the fire.

David Nutt answers like a man who already knows the fate of his words. He doesn’t soften, doesn’t build a path toward the point. He just delivers it all caps, no ceremony. Like telegrams from a trench where evidence no longer persuades, only endures.

The messages land like terse autopsy notes, each one reading as if written after many others were ignored:
“FAILURE – MORE DEATHS.”
“NICOTINE HARMS ARE GROSSLY EXAGGERATED.”
“USE MCDA IN ALL DECISIONS.”

It’s a remote interview that sounds like something between a technical memo and a fire alarm. No hedging, no “yes and no, depending on context.”

Nutt doesn’t write. He interrupts.

And in that gesture — impatient, nearly blunt — there’s a silent confession: in the public debate on drugs, long form has become a luxury reserved for those still naïve enough to think they’re being heard.

There are truths public policy avoids not because they’re uncertain, but because they’re too inconvenient to say out loud. While treaties condemn, Professor Nutt insists on comparing combustion and vapor, and on the error of conflating them.

In the intellectual biography of David Nutt, the pursuit was never just for data, but for structure. For a scale. For a ruler, you could lie flat on the table.

In 2014, David Nutt co-authored a paper that set out to do something both banal and subversive: compare the degree of harm across nicotine products, using a decision-engineering tool as dry as it is precise: Multi-Criteria Decision Analysis (MCDA).

• Nutt, D. J., Phillips, L. D., Balfour, D., Curran, H. V., Dockrell, M., Foulds, J., Fagerstrom, K., Letlape, K., Milton, A., Polosa, R., Ramsey, J., & Sweanor, D. (2014). Estimating the harms of nicotine-containing products using the MCDA approach. European addiction research, 20(5), 218–225. https://doi.org/10.1159/000360220

The logic was simple, and for that very reason, explosive: if public policies are made in the name of “harm,” then why not measure harm?

MCDA was built for that: a way to compare variables in fields with no fixed metrics. The process follows a structured sequence: define the context, select the products, agree on criteria, score each item, assign weights, and then calculate an overall harm index. It’s a method that enables something rare in moral debates: showing where the differences lie, and by how much.

The method works like a small exorcism, not of politics, but of moralism disguised as science. Or perhaps, a bureaucratic exorcism.

You define what “harm” means, list the criteria, weigh the impacts, and show the math. The point isn’t to eliminate judgment, but to own it. To make it visible. Measurable. To lay it, finally, on the table.

David Nutt has paid a price for insisting that facts, once measured, should not bend to political protocol.

In 2009, while chairing the UK government’s Advisory Council on the Misuse of Drugs (ACMD), he publicly accused the drug classification system of distorting scientific evidence. He was asked to resign and, effectively, fired for stating the obvious: that data doesn’t answer to the chain of command.

The episode cast him as a kind of enlightened heretic: the scientist who believes his job is not to serve power, but to trouble ignorance.

He founded DrugScience soon after, not just as an institution, but as a message. A reminder that when evidence gets too close to power, it needs shelter. Or at least, a door that locks from the inside.

The Deliberate Refusal to Distinguish Between Fire and the Fire Alarm

Watching COP11 — the 11th Conference of the Parties to the WHO Framework Convention on Tobacco Control — David Nutt sees, beneath the new rhetoric, an old impulse: morality that prefers banning to understanding.

What he sees isn’t caution, but a kind of overconfidence: binary logic dressed up as precaution. The refusal to classify becomes a license to condemn everything at once.

Held in Geneva in November 2025, COP11 produced a series of technical resolutions — on environmental impacts, legal liability, funding, and other fronts detailed in the trilogy The Purity Regime: Liturgy, Shielding, and Doctrine. But it was a symbolic decision that echoed loudest: the declaration that all United Nations spaces must be free of “smoke and vapor.”

The minutes from the European Union delegation record, without ambiguity, how that symbolism turns into policy: a COP directive urging Parties to implement a full ban on the use and sale of tobacco products, including heated tobacco, and “novel and emerging nicotine products” such as e-cigarettes, pouches, and disposable vapes, across all UN-governed spaces.

To many delegates, the decision felt like institutional prudence, almost a hygienic reflex. In a landscape flooded with aggressive marketing, early uptake, and toxicological unknowns, the impulse seemed obvious: ban it all. Smoke and vapor are treated as a single vector of harm.

But to Nutt, that simplicity conceals something else: a deliberate refusal to distinguish between fire and the fire alarm.

Faith in the Measure

When I ask how he would apply his harm-assessment framework to nicotine products — cigarettes, vapes, heated tobacco, oral nicotine — David Nutt doesn’t elaborate. He just redirects.

“WE ALREADY DID — SEE THIS PAPER.”

The study, published in 2014 and mentioned earlier, carries a clarity that now feels almost anachronistic; like a remnant from a time when methodical comparison still held the power to discipline debate. Conducted by an international panel convened by DrugScience — including Nutt, Lawrence Phillips, David Balfour, H. Valerie Curran, Martin Dockrell, Jonathan Foulds, Karl Fagerström, Kgosi Letlape, Anders Milton, Riccardo Polosa, John Ramsey, and David Sweanor — the group evaluated twelve nicotine products across fourteen harm criteria: seven for users, seven for society. Weighted scores were applied to calculate an overall harm index for each.

The result was crystal clear. Cigarettes scored 100. Small cigars, 64. Pipes, 21. Everything else — e-cigarettes, oral tobacco, nicotine replacement therapies — landed at 15 or below. A difference not of degree, but of kind.

This type of ranking, if applied to anything else, such as cars, pharmaceuticals, or surgical techniques, would be treated as the start of regulation, not the end of it. It would lead to tiered policies: tighter controls on the most harmful, incentives to shift toward safer alternatives, and public messaging capable of holding two truths at once.

Less harmful isn’t harmless. But it’s still less harmful.

Nicotine, as Nutt insists, doesn’t live in the same moral universe as most regulated substances. It sits on a threshold, the place where public health meets sin, where policy slips from pragmatism into liturgy.

I ask Nutt what public health officials most misunderstand about nicotine risk. He doesn’t pause:

“THE HARMS OF NICOTINE ARE GROSSLY EXAGGERATED.”

And then, as if underlining it in red:

“THEY OVERESTIMATE THE HARMS OF PURE NICOTINE AND EQUATE IT TO SMOKED TOBACCO.”

For Nutt, the mistake isn’t just chemical: it’s narrative. Nicotine has become the cigarette’s proper name, the part you can say without having to say “cancer,” “class,” “boredom,” or “addiction.”

Smoke is chaos; nicotine is precise.

It’s the legible part of the habit, and therefore the most convenient to demonize.

The confusion isn’t just political. It’s structural. It’s embedded in media, in culture, in the social strata where smoking endures. The mistake is diffuse, reinforced, and culturally sedimented.

There’s data to prove it. A 2021 evidence update from the UK government found that only 11% of adult smokers knew that none, or only a small part, of smoking’s risk comes from nicotine.

With his technical stubbornness and the conviction that a systemic injustice is underway, Nutt reads that number the way a defense lawyer reads a case of mistaken identity: if the villain is misnamed, the verdict will be wrong, and substitution will fail.

If nicotine is seen as the killer, then the transition loses meaning. And smokers will keep doing what they’ve always done: burn.

Against Aerosol, Even Without Fire

The language of COP11 on cigarette alternatives — language that avoids distinguishing between smoke and vapor, and often treats nuance itself as a threat to enforcement — doesn’t strike David Nutt as a technical misstep. To him, it’s a regression.

“VERY REGRESSIVE, BECAUSE WE WILL NEVER ELIMINATE SMOKING,” he writes.

I ask whether COP11 signals a turning point: the abandonment of harm reduction in favor of an ideology of elimination.

Nutt responds like someone who’s seen this movie before, and counted the deaths at the end: “FAILURE – MORE DEATHS – THIS APPROACH HAS BEEN TRIED UNSUCCESSFULLY FOR 50 YEARS.”

It’s clear that Nutt sees “elimination” not as idealism, but as failure repeated. The all-caps reply is both message and medium; it performs the fatigue of saying the same thing for decades.

The argument is rooted in a blunt anthropology: nicotine use doesn’t vanish just because a treaty wants it to. The real question in this world isn’t whether purity can be manufactured but whether less death still can.

I ask Nutt how COP11’s stance might affect adult smokers looking for safer alternatives, especially in countries with limited cessation support.

He answers without pause, as if there’s no room left for diplomatic phrasing:

“IT WILL ENCOURAGE CONTINUED SMOKING AND DISCOURAGE SWITCHING TO SAFER ALTERNATIVES SUCH AS VAPING.”

That sentence captures the central fear of harm reduction: that a policy designed to reduce risk ends up shielding risk by blocking its alternatives.

COP11’s decision to declare all UN spaces “free of smoke and aerosol” may be its most telling gesture. It’s not just a policy of restriction, it’s a policy of equivalence.

Cigarettes and vaporizers. Combustion and vapor. Treated as if they posed the same threat. As if the fire alarm and the fire should be evacuated with the same protocol.

To Nutt, that equivalence doesn’t just obscure. It sabotages prevention.

Equivalence is the enemy of prevention.

Against Sin and the Sinner — Not Against Risk

David Nutt is under no illusions about what’s at stake. The question “Why aren’t we following the science?” strikes him as misframed, as does “Why do people still smoke?”

He’s spent decades dissecting the moral residue that seeps into drug policy. And in the regulation of nicotine, he sees a starker version of that ethical contamination.

“IN FACT, IT’S EVEN MORE MORALISTIC THAN OTHER DRUGS,” he writes.

Nicotine carries a deeply embedded stigma: it’s the habit you can smell, see, and touch. The staleness in the air. The yellowed fingertips. A visible addiction that has escaped the warning posters and settled into the smoker’s body.

To treat nicotine as a spectrum of risk sounds, to many, like indulgence. As if, by parsing nuance, we’re being seduced by the substance or its defenders.

The World Health Organization’s public stance reflects — and amplifies — this moral heat.

In its FAQ on e-cigarettes, the WHO states that nicotine is “highly addictive and harmful to health”; that there’s growing evidence these devices are dangerous and unsafe; and that epidemiological studies show young people who vape are up to three times more likely to start smoking cigarettes.

The 2023 “Call to Action” echoes that alarm, this time with the vocabulary of urgency. It demands “decisive” preventative action, focusing on protecting children, curbing use among non-smokers, and promising population-level harm reduction.

(Interlude)

Anyone willing to follow this rhetorical thread to its limit will find in Clive Bates an impatient and surgical guide. On two occasions, he dismantled the WHO’s e-cigarette claims line by line — not as academic disagreement, but as an open accusation of institutional bad faith.

In “World Health Organization fails at science and fails at propaganda – the sad case of WHO’s anti-vaping Q&A,” Bates parses the WHO’s “E‑cigarettes: how risky are they?” page, arguing that every answer is false, misleading, or simplistically evasive. He accuses the WHO of conflating absolute and relative risk, ignoring the difference between vapor and smoke, and overstating dangers to youth and bystanders.

Later, in “Fake news alert: WHO updates its post-truth fact sheet on e-cigarettes,” he returns to the same page — now revised — only to show how the edits are cosmetic. He claims the WHO continues to distort the literature on relative risk, gateway effects, adolescent brain damage, and other core issues. His conclusion is blunt: the FAQ isn’t a tool for public education, it’s a propaganda piece.

*

But what’s at stake in this battle isn’t just the accuracy of a paragraph or the curation of sources. The conflict is structural. The disagreement extends beyond science — it’s fundamentally philosophical. And deep.

Nutt wants a scale: to measure, to weigh, to rank. The WHO wants a wall: to block, to prevent, to stop anything before harm has a chance to enter. It’s the difference between mapping risks and outlawing them by decree. Between recognizing gradations and refusing to name them.

To Nutt, every risk should be compared. To the WHO, some risks should be silenced or leveled, so that none escape.

A report by the National Academies of Sciences, Engineering, and Medicine tries to reframe this dilemma in less inflammatory terms. Instead of slogans or blanket condemnations, it offers an equation: the net public health impact of e-cigarettes will depend on the balance of three forces in tension: youth initiation, adult cessation, and the intrinsic toxicity of the products.

The question, then, isn’t whether there is harm. The real dispute is over the net effect: whether the population curve bends toward fewer smokers or more nicotine users. And which of those curves should guide public policy.

Nutt’s answer to that balancing act is almost brutal in its simplicity. When asked how scientists can correct misconceptions about nicotine without encouraging underage use, he replies:

“TELL THE TRUTH.
AND SO WHAT IF MORE PEOPLE VAPE — IF IT’S NOT HARMFUL?”

There’s no nod to diplomacy. Just a stark question which, for him, says it all: do we prefer the comforting error or the inconvenient truth?

My admiration for Nutt didn’t arrive all at once. It grew the way hard convictions often do: slowly, through repetition. No nuance. No hedging. For him, truth isn’t something he settles for — it’s a requirement. Even if it brings unwelcome side effects.

That may be his most revealing line, not because it shocks, but because it names, plainly, a choice many prefer to leave unspoken: is it riskier to inform too much, or to protect too poorly?

It reads like a challenge. And maybe that’s what makes it so telling. Nutt seems more willing to be accused of recklessness than to be complicit in what he sees as a protective lie.

Where the Scale Prevails

If there’s one line that distills David Nutt’s ethos, it’s this: better to risk informing too much than to protect too little. However, in some locations, this logic is not just accepted but officially mandated.

When I ask for examples of ecosystems that prioritize evidence over moral condemnation, Nutt answers without hesitation:

“ONE LED BY INDEPENDENT SCIENTISTS, SUCH AS IN THE UK AND NEW ZEALAND, WHICH ENDORSE AND ENCOURAGE VAPING, ETC.”

New Zealand was blunt in its guidelines: vaping is not harmless, but it is less harmful than smoking. It can aid in quitting. And it’s not for non-smokers.

It’s a policy that deliberately tries to hold two truths at once: to acknowledge risk and still accept it as a tool.

Both the UK and New Zealand recognize a critical point often lost in the caricatures of the debate: reducing harm does not mean giving up on regulation.

British health updates emphasize, with almost pedagogical insistence, the need to correct distorted perceptions of risk. But they also treat youth vaping as a real concern, not just statistically, but ethically.

New Zealand, despite its explicit endorsement of vaping as a cessation tool, moved to restrict disposable devices — an effort to curb their appeal among young people. It’s a gesture that acknowledges a fundamental truth: the market doesn’t always follow policy. Sometimes, it skirts around it. Sometimes, it undermines it.

That’s the point so often lost in the moral simplification of harm reduction: in practice, it’s not a free pass or surrender. It’s a balancing act.

A country can say, based on evidence, that vaping is less harmful for adult smokers, and still restrict disposable vapes that show up in school bathrooms. It can say “switch” and “don’t start” in the same breath. And accept that this message will be contested. Reinterpreted. Fought over.

That kind of ambivalence, between the ideal and the possible, between risk and relief, is where public policy has to live. But not every country has the institutional stamina to hold that tension.

For low- and middle-income countries, places where resources are scarce but ash is plentiful, Nutt doesn’t offer suggestions. He gives commands.

How should FCTC/WHO recommendations be adapted to local realities?

“ALLOW VAPING AND SNUS.”

What would a realistic harm-reduction strategy look like in countries with limited health infrastructure and high use of combustible products?

“TAX SNUS AND VAPING MUCH LESS THAN CIGARETTES.”

For Nutt, taxation isn’t just about revenue: it’s pedagogy. Price teaches. What’s heavily taxed should disappear. What’s lightly taxed should replace it. He views fiscal policy as more than just an economic matter; he considers it a moral one. A silent lever of behavior.

Price is public health’s encrypted language: what gets expensive discourages. What gets cheaper guides.

What Grows When You Ban

Even where morality recedes and science advances, there’s a third force David Nutt never forgets: the market.

Because when policy fails to reckon with actual behavior and its own institutional limits, it’s the market that steps in to fill the vacuum.

I ask Nutt about the risks of low-income countries copying prohibitionist models from wealthier nations, without considering local epidemiology or enforcement capacity.

As always, his response offers no cushioning:

“IT WILL ENCOURAGE SMUGGLING AND MORE HARMFUL ILLEGAL CIGARETTES.”

It’s an old story in a new wrapper: banning without offering alternatives doesn’t eliminate the product. It eliminates control. A regulatory void doesn’t erase demand. It reroutes it. What fills that space is still a market, but one stripped of oversight, traceability, or brakes.

Even COP11 acknowledged — if only indirectly — the danger of losing control. By reaffirming the Protocol to Eliminate Illicit Trade in Tobacco Products, the treaty seemed to admit, between the lines, that prohibition isn’t enough.

Without regulated alternatives, consumption doesn’t vanish. It simply changes the course and label.

For Nutt, this makes the “elimination” strategy not only ineffective but dangerously naïve. If legal access to lower-risk nicotine is blocked, use won’t stop. It will just change suppliers. And the new supplier, he warns, won’t have a label, or quality standards, or any obligation to public health. Just a market.

Sweden, Japan, the UK: Follow Them

David Nutt’s favorite kind of evidence doesn’t always come from a clinical trial. Sometimes, it comes from a country.

“Countries like Sweden (snus), Japan (heated tobacco), and the UK (vaping) have seen declines in smoking linked to alternative nicotine products. What lessons should global bodies take from that?” I ask.

He answers with a single word:

“FOLLOW THEM.”

It’s a reply that distills his impatience with what he calls institutional blindness to observable reality.

But each of those examples, as Nutt well knows, is also a contested space.

Sweden, with its historically low smoking rates among men, is often cited as a model for snus integration. But the narrative is far from settled, and the correlation itself has become a battleground.

Japan’s case is even more tangled. Cigarette sales have plummeted over the past decade, yet the precise role of heated tobacco in that decline remains up for debate. Researchers disagree on how much is due to the new product and how much to broader trends — cultural shifts, policy accumulation, or changes long in motion.

None of these countries offers a clean natural experiment. But Nutt’s argument has never been about methodological purity: it’s about political humility.

In his view, global policy doesn’t need perfect control over every variable. It needs to watch what works, even if it works imperfectly.

The Least Visible Lobby

If Sweden, Japan, and the UK show that reality can challenge dogma, what keeps global policy from responding?

When I ask why harm reduction remains a zone of controversy within institutions like the FCTC, Nutt replies with the same bluntness that made him both famous and divisive:

“PRESSURE FROM WHO AND THE CHINESE GOVERNMENT, WHICH DOESN’T WANT COMPETITION FOR ITS STATE-RUN CIGARETTE INDUSTRY.”

Said like that, it sounds like an accusation. But what we can assert more safely is this: state ownership of tobacco creates structural conflicts of interest.

An official FCTC factsheet acknowledges that many countries maintain direct stakes in tobacco companies, explicitly naming the China National Tobacco Corporation as a state monopoly and the world’s largest cigarette producer.

There may be a whiff of Sinophobia in the framing, or maybe not. But the fact is on the table.

What’s missing, however, are the visible gears of this alleged pressure. Who applies it? In which meetings? In which draft versions of which texts?

Here, Nutt offers not evidence but instinct and intuition consistent with his worldview: if an incentive exists, it will eventually find a way to express itself.

If Nutt’s geopolitical claim is hard to verify, his methodological critique is crystal clear. And it always returns to the same point: the problem isn’t just in the products, it’s in the structure of decision-making itself.

To him, the failure is not just political. It’s one of design.

When I ask about the biggest communication failures in the nicotine space, he doesn’t hesitate:

“FAILURE BY WHO/COP11 TO USE MCDA APPROACHES — AS IN THE PAPER MENTIONED ABOVE.”

And when I ask what single structural reform would most improve global nicotine policy, his answer is again a directive:

“USE MCDA IN ALL DECISIONS.”

Nutt wants the COP to operate like an ethical spreadsheet: define criteria, assign weights, accept trade-offs, and make the whole process visible.

In that sense, Nutt is almost an anachronism, a scientist demanding that a moral institution behave like a system of calculation. A body that weighs, ranks, compares. That seeks evidence as if evidence still leads.

FCTC/COP, instead of distinguishing, collapsed distinctions. It advanced sweeping mandates and symbolic bans, folding combustible cigarettes and “novel nicotine products” into a single category of contamination not banned for their comparative risks, but for belonging to the same imagined threat.

The WHO, for its part, continues to spotlight potential harms, especially among what’s come to be defined as youth, and the persistent uncertainty around long-term effects.

This is the divide: one side calls for classification. The other, containment. Between these two impulses — to measure or to block — global nicotine policy wavers.

That’s the impasse: one side says, “sort it.” The other, “stop it.”

The Mistake Beneath All Others

If global policy is caught between measuring and blocking, the most fundamental distortion may not lie in strategy, but in its starting point. The villain is named wrong.

The final question was simple, almost technical: “What is the most widely misunderstood scientific fact about nicotine today?”

Nutt’s reply read like a diagnosis:
“THAT IS THE HARMFUL ELEMENT IN CIGARETTES.”

It’s not a trivial confusion. It’s the distortion that props up all the rest. If nicotine is seen as the absolute villain, everything associated with it — therapeutic replacement, vaping, transition — inherits the same stigma. And the smoker, facing uncertainty, stays put. Chooses the known harm. Because at least the devil you know has a name.

Nutt’s whole insistence — the capital letters, the fixation on scales, the refusal to partake in moral fiction — can be read as a single effort: to give public health back something it seems to have lost. The courage to distinguish.

He believes that accepting a spectrum of risk isn’t surrendering to industry. It’s surrendering to human behavior. People substitute. They always have. And in the end, only one ethical question remains simple and irreducible:
Will this substitution kill fewer people or more?

The FCTC-COP, meanwhile, excludes the person from the equation. It decides in a monologue. It sees the aggressive marketing, the vulnerable youth, the long history of corporate manipulation, and perhaps sees, in tolerance, the seed of relapse.

Its language — veteran and repetitive: “harmful,” “not safe,” “too early to tell” — doesn’t only sound cautious. To many, it reveals something else: a preventative refusal to think in gradients. A fear not so much of being wrong, but of leaving the door ajar. Of seeming complicit. Of looking captured. Of losing moral authority. Of disappearing as a guardian.

The tragedy, perhaps, is that both fears are real, though not equally so. And that’s why, among all of Nutt’s phrases, the most revealing wasn’t the loudest. It was the most bureaucratic:

“ALL OF THE ABOVE...”

That’s how he answered when I asked which research gaps should be addressed before COP12, scheduled for 2027 in Yerevan, Armenia.

“All of the above” is what you say when the questions no longer fit into separate columns.

When the evidence piles up, but institutional listening stays selective.

It’s also a quiet confession: A scale on the table only matters if someone in the room is willing to look at it.

~ https://en.wikipedia.org/wiki/David_Nutt

Hospitals manufacture this kind of physicality in a choreography of pauses. Time there isn’t measured by hands on a clock but by textures: the crease in plastic that leaves its imprint, the paper that rasps at your fingertips, the damp fabric that sticks to your forearm. And the disposable cup, still faintly warm, persistent insisting on occupying its patch of the world.

Lorraine, a fictitious name, like so many that public health invents to protect real privacy, didn’t come to the hospital to quit smoking. She came to accompany someone.

But science doesn’t interrogate only the sick. It interrogates whoever is nearby. The questions arrive down the same corridor as the gurneys: printed on the intake form, tucked into a field on a screen, spoken aloud by the voice that calls the next ticket with the calm of someone who isn’t calling people, but numbers. A borrowed biography will do. A body in waiting will do, too.

There, in the gap between one form and the next, a researcher with a badge on a lanyard asks what may be the simplest—and most political—question of all. The kind that can tilt the plot of a life.

“Do you smoke?”

The “yes” doesn’t answer. It unlocks. It’s a key that opens a fork in the road.

Lorraine gets a brief conversation, a digital referral to the NHS stop-smoking service, and a vape kit handed over with the mechanical ease of someone merely executing the next step. A DotPro with disposable pods. Calibrated nicotine: measured, dosed, and offered up as a promise to keep withdrawal’s dread in check.

The question driving the British clinical trial CoSTED borders on indecent in its modesty: could a few minutes of intervention, offered at the system’s most improvised point, shift a habit that has resisted for decades?

It isn’t a question for a political pulpit. It’s a question from the margins, from a waiting room, asked in a rush, asked where no one came for this: Asked with an object in your hand and a link on your phone. The method bets on the interval.

Six months later, continuous abstinence was higher in the group that received the kit than in the group that left with nothing but a leaflet.

In public health, small differences aren’t marginal. They multiply. Modest numbers cast the shadow of thousands of bodies. One extra point in a table becomes a shorter queue in the future. Fewer coughs on repeated mornings. Fewer hands reach for a pack by reflex. Statistics have no face, but they operate on faces.

That’s the point of departure. It’s also the tension that ran through the year.

Because 2025 was, over and over, exactly this: the moment when the system, without even touching the body, decided what to ban, what to tolerate, what (and whom) to push to the margins.

While technology was placed in Lorraine’s hand as a pragmatic chance, a device in the palm, a link on the phone, a protocol that doesn’t debate morality, in the offices of ministries and committees, it was treated as a threat. Instead of a shortcut to harm reduction, it became a target to be driven from the market by decree: by restriction, by outright ban, or by bans that didn’t need to say their own name.

Throughout the year, it oscillated between these competing grammars: care versus purity. On one side, the clinical language of the everyday: “referral,” “kit,” “cessation,” “minutes,” “group.” On the other hand, the abstract language of political morality: “risk,” “protection,” “doctrine,” “limit,” “compliance.”

In the corridor, the body asks for a solution.
In the cabinet, the text demands obedience.
And the air-conditioning doesn’t make anyone cough.

That’s when I began to distrust small numbers.

Not because they’re insignificant but because, in public policy, they tend to work as wildly disproportionate levers.

A milligram limit. A percentage in a warning label. A standstill period. A decree that swaps one word for another and, in that minimal gesture, shifts the world.

Tiny things that, from far away, look like prudence. Up close, they’re engineering. Doors closing, slowly, but with a lock.

The old war and the new best enemy

January

The politics of the cigarette remain legal. The attempt to leave it behind is not always.

As 2024 turned into 2025, my work didn’t shift gears. It simply tightened the same tempo. I went through a folder of notes, subdivided by provenance: where it came from; whose hands it passed through; on what date it first made contact with the world.

I kept a spreadsheet of events and sources, rows I fed and re-fed. I checked Clive Bates’s calendar and left a row of tabs open in my browser, arranged like an aircraft cockpit.

WhatsApp for Latin America. Signal for sources who prefer to whisper: brief exchanges, screen pressed close to the body, the trail handled like a hazard. The low volume. Email for the braver ones, for the reliable obsessives, and for the bureaucrats who reply with the entire body of the law pasted into the footer, as if authority lived in the text’s vertical sprawl.

With the first coffee of the year, I opened a new notebook. Two hundred pages, thick paper, plain cover. No ambition to become a cherished object. No desire to be kept.

On the table, the everyday as residue: the ring left by last year’s cup, a pen that dies mid-word, the dry click of a spoon against glass.

Outside, people are in a hurry. 2025 was already moving like someone with an appointment.

I began the month thinking the subject—nicotine, vaping, nicotine pouches, heated tobacco—was still safely confined to a niche. Until I opened a public-health document. In almost all of them, the contradiction was there: calm, official, repeated. The cigarette, the great killer, remained legal. Manageable. Normalized. A habit with a guaranteed place on the shelf and in the language.

At the gate of the neighboring school, teenagers who should already have been on vacation smoked with the naturalness of breathing. Without ceremony.

I watched them from the window.

Meanwhile, the alternatives designed to reduce harm for those who can’t quit were being pushed back into the same moral territory of sin, not by evidence, but by a normalized moral grammar. By framing. By tone.

In my notebook, I wrote a sentence that wasn’t a conclusion. It was a warning:

This year won’t be about science. It will be about control.

The war against cigarettes has a history of real victories. The Framework Convention on Tobacco Control (FCTC) consolidated a global consensus: 183 countries joined as Parties. An accession that became a number in reports and a visible rule on airport doors, in bars, in hospital corridors. There it is stark, in white letters: NO SMOKING.

The treaty is paper. But it’s also a habit.

Its most emblematic instrument, the MPOWER package, became a canonical playbook for good governance: a primer on high taxes, smoke-free environments, advertising restrictions, graphic warnings, and access to treatment.

However, access to treatment remains scarce, concentrated primarily in wealthier countries. In former colonies and in the health systems of the Global South, it becomes a promise or a lost line in a document: rhetorical, irregular, nearly nonexistent. A service that, in practice, has no staff, no stock, no front door.

It was an architecture of control that worked, at least partly, until the ecosystem changed. Every successful policy risks falling in love with its own myth. When the world shifts, it doesn’t move with it; it tries to force it into shape. Instead of rewriting the manual, it tries to bend reality to its doctrine.

Even before 2025, the board no longer reduced the issue to “cigarette versus abstinence.” It was something else: pouches, heated tobacco products, vapes, pharmaceutical nicotine, licit and illicit markets, regional inequalities, and a question systematically ignored by those who prefer slogans to reality: What do we do with people who can’t (or don’t want to) quit right now, but want to stop smoking?

Many governments responded by reverting to a prohibitionist reflex, as if history were a straight line. And not a labyrinth: full of returns, dead ends, choices with no exit.

The Global Dispatches series would capture that movement as it forms into a wave over the year: rules announced as “protection” but operating as the suffocation of alternatives.

The detail matters. Because it’s in the detail that policy hides its own gesture. It doesn’t have to say “banned.” It’s enough to draw an impossible limit.

February

What begins as technical vocabulary ends as a moral veto. And language does more than regulate: it excludes.

February smelled like airports and bus terminals. I spent more time in lines than in chairs while my family finished their vacation. The laptop opened and shut with the intimacy of something that has nearly become a sympathetic organ. Between one gate and the next, I reviewed the same materials: websites, messages, press releases, draft texts, and legislative rumors.

Press releases, drafts, legislative rumors. A source in Brussels, who could just as well have been in Lima or Madrid, one of those people who speak with the cadence of someone afraid of being interrupted, wrote to me on Signal: “Nothing will be that different. Just worse. They’ve discovered a magic word: youth. With it, anything goes.”

I replied with an emoji that meant nothing. It was the sort of answer you send when you’re in a concourse, and you know the conversation is too serious to deserve a trace.

Then I opened TRIS. The way you look at the sky before a turbulent flight.

TRIS: the European system in which governments notify technical proposals that, weeks later, can become reality in twenty-seven countries at once.

TRIS has no voice, but it has a way of showing up. It arrives like a pop-up window that doesn’t ask permission: “A new notification has been published.” The rest is you, alone, reading the future in the language of Article 3, point (b).

*
That month, what struck me most was the drift in vocabulary. Nobody spoke anymore of a risk continuum—combustion versus vapor, smoke versus aerosol—not even obliquely. They spoke of “normalization.”

It was a useful word. It doesn’t demand numbers. It doesn’t demand comparison. It asks only for a moral intuition. And moral intuition is usually much faster than evidence.

I jotted down another sentence that day, almost as if I were preparing an epigraph: When the debate turns moral, evidence becomes a detail.

On March 11, I was in an airport with threadbare carpet and cold light. One power outlet is fought over by three people. A lukewarm coffee. More bitter than helpful.

I opened TRIS almost by reflex. And there it was: Luxembourg was notifying a draft law to impose a limit of 0.048 mg of nicotine per pouch. I read the number twice. Then a third time. 0.048 mg. Forty-eight micrograms. A value that fits inside a sliver of a line, a tiny unit, a decimal point that looks innocent.

To a lay reader, it appears to be a technicality. To anyone who follows the market and the mechanics of regulation, it sounds like a verdict. Is there a product that survives that?

I closed the laptop for a moment, as if that could suspend reality. Then I opened it again and asked someone who understands more than I do:

“Yes. That limit makes pouches practically ineffective. In practice, it’s a ban.”

They explained it right away: ordinary pouches contain between 3 and 20 mg of nicotine. The proposed limit—0.048 mg—constitutes between 0.2% and 1.6% of that value. In a 6 mg pouch, for instance, it would be just 0.8%. In practice, there’s no perceptible stimulus. It’s a ceiling designed to make the product unworkable.

That same day, another move. In the Netherlands, the government mandated retailer registration. The state governed by registry: by lists, by maps of points of sale. It wasn’t a ban. It was the geometry of a siege.

March

Flavors, packaging, gestures. The rhetoric of youth becomes the password for policies that listen to neither the young nor the adults.

March began to behave like a conveyor belt. On March 17, Poland announced its intention to ban disposable vapes and restrict flavors in nicotine pouches. A sentence like that, in politics, functions like the opening of a highway: the government announces the route before a single layer of asphalt has been poured.

On my WhatsApp, a contact in Warsaw summed up the dilemma with surgical accuracy, in a message that was short and dry: “They call it protection. We call it a return to cigarettes.”

That same day, on the other side of the Atlantic, New Jersey introduced a bill with a different logic. The proposal didn’t try to demonize the product; it tried to make the producer accountable for the trash. I liked the dissonance. It was like hearing, in a room full of shouting, someone propose the tone of a conversation.

On March 18, my neighborhood stirred.

Paraguay’s Chamber of Deputies approved a bill packed with restrictions: large graphic warnings, a ban on online sales, and a veto on sensory descriptors like “fruit,” “caramel,” and “chocolate.”

I pictured the text as a door with too many locks. It’s not that you can’t go in. It’s that you try, you tire, you give up, and you head to the street next door, where cigarettes are still for sale. No password. No barrier.

On the 19th, in the United Arab Emirates, standards for pouches were defined: a nicotine limit per unit, mandatory warnings, and composition rules.

The tone was technical, almost bureaucratic. Less “moral panic,” more “industrial manual.” And yet it was still part of the same phenomenon: states rearranging themselves to fit alternatives into a frame not to understand them.

On the 20th, in Thailand, Parliament chose to maintain a total ban, rejecting any path toward legalization. Narratively, it was the month’s most paradoxical scene: a country where conventional cigarettes remain legal, popular, and accessible, while the alternative remains prohibited.

A prohibition sustained not by conviction, but by inertia. And inertia, sometimes, is the most brutal form of decision.

On the 24th, Malaysia decided to postpone the ban on the display of vapes at retail. Postponement tends to be underestimated. But often it’s postponement that reveals the friction between moral ideal and brute reality: logistics, enforcement, commerce. There is still enough resistance in the physical world to slow the normative impulse.

March ended with a clean, unmistakable feeling: this was no longer a sequence of isolated cases. It was as if someone, somewhere, had issued a global command: tighten the siege.

All of it before World No Tobacco Day. Before World Vape Day.

As the siege tightened from the outside, the fight sharpened from within.

Still in March, a study published in JAMA Network Open concluded that vaping doesn’t help people quit smoking. The text suggested that outcomes depended less on social reality and more on methodological choices and interpretation.

This kind of dispute isn’t new. And it isn’t merely academic. In public health, a paper becomes a headline. The headline becomes “evidence” for policy. Policy becomes daily life. What breaks in Excel or Word ends up in the lungs.

The year would deliver an even more dramatic example. A study published in Mexico claimed extreme levels of BTX (benzene, toluene, and xylenes) in disposable vapes. But a methodological autopsy, performed by independent critics, found serious errors: swapped units, invalid comparisons, scales inflated by orders of magnitude. The final recommendation was blunt: retraction.

The pattern is dark. When a dispute has already been moralized, a flimsy study isn’t merely tolerated but is useful.

The rush for “impact” meets the hunger for justification. And public health, which ought to be an antidote to panic, sometimes turns into its own laboratory.

April

The aesthetic of purity. Pharmaceutical, clean, standardized. The new morality of nicotine prefers the laboratory to the street.

April began with a small relief. Bulgaria, at first, rejected the proposal to extend the smoking ban to vapes in outdoor areas. I remember thinking: maybe there was still room for nuance.

But the relief didn’t last long. 2025 was not going to be a kind year to nuance.

In New South Wales, Australia, a new producer-responsibility law for recycling strengthened the environmental argument. That became a recurring subtheme throughout the year. Disposables had turned into convenient symbols: visible, colorful, easy to demonize, and even easier to photograph next to a turtle.

Elsewhere on the map, a new object of power was taking shape: the so-called “positive list” of ingredients allowed in e-liquids. Anything not on it becomes, by definition, prohibited.

This isn’t only regulation. It’s an aesthetic of cleanliness. The state speaks in the name of interests that only it can recognize, and decrees the existence of only what it knows how to name.

In my notebook, I drew the image of a bottle that, little by little, became a laboratory vial. White label, black letters. No excess. Next to it, I wrote a short line, almost a caption: The future they want looks like a pharmacy.

In Hong Kong, a bill to ban the possession and use of vapes in public spaces revealed a different ambition. It wasn’t just about controlling commerce. It was the gesture itself that had to be outlawed.

April was that: less “debate” and more “sanitation.” Less effort to reduce harm, more zeal to reduce visibility.

May

The generational ban is beautiful on paper. But the informal market doesn’t read decrees. The cigarette-free generation and the smuggling generation.

In May, policy developed an itch to write the future as if it were a contract. The idea of a generational ban, prohibiting the sale of tobacco to anyone born after a certain cutoff, gained appeal as a form of clean engineering.

In the Maldives, the measure was ratified for everyone born on or after 2007. There is a kind of mathematical beauty in it: by denying access to future generations, the state promises a new world without confronting the old one. It’s the most comfortable utopia. The bill comes due later.

I was at a cheap hotel desk—walls too white, air-conditioning too cold—working on something that didn’t interest me, and that had nothing to do with harm reduction, when I read the news.

My pen froze midair.

I thought about how the history of tobacco is also the history of parallel markets, inequality, those who evade, and those who get punished. A tobacco-free generation, written into law, can very easily become, in practice, a generation raised on contraband.

That same week, in Iraq, the government reversed an import ban on vapes after admitting the measure was feeding the black market. It was one of the year’s most honest moments.

Not out of virtue, but out of embarrassment, reality imposed itself, as it tends to do when it’s been ignored for too long.

And still in May, Chile’s law—the one my friend Ignacio Leiva worked so hard to build—went into effect. But with a detour: the approach was more “conventional.” Vapes and heated products were bundled under the same umbrella of prohibitions and restrictions applied to tobacco. A clear milestone, with a date stamped on it.

I like clear dates. They make accountability possible. But clarity, sometimes, also hides a mistake: treating different risks as if they were the same.

June

The product disappears. The habit—and the desire—do not.
And in the vacuum that regulation creates, informality blooms.

June brought a cut in the calendar: the United Kingdom implemented a ban on disposable vapes. The scene felt lifted from an Italian neorealist film: a date circled in red, retailers adjusting their stock, official notices wrapped in the familiar language of “protection” and “the environment.”

But in daily life, measures like this acquire a body. They have texture.

The impact spreads in small ruptures: the interrupted gesture, the habit forced to find another form, the product that vanishes from the shelf with no visible explanation.

Over a video call, I visited a small shop on a side street.

The owner—an Arab man, who used to show up always cheerful, full of positivity—held up a box of disposable vapes the way you might display a dead animal.

He said only: “I know this is trash. But do you know what takes its place?”

He wasn’t defending disposables. He was afraid of the vacuum. And into a vacuum, the informal market enters with its usual elegance: no warnings, no standards, no taxes, no oversight.

While the U.K. tightened the noose around disposables (the easiest format to hate), the more ambitious project, the Tobacco and Vapes Bill, which proposes a generational ban, continued its legislative crawl. Still unfinished. The country of CoSTED seemed to live in two times at once: the time of immediate action and the time of historic promise. And in public health, the symbol often arrives wearing the costume of a result.

July

The veto is written in milligrams. Small limits, gigantic consequences: when technicalities operate as a silent prohibition.

July was the month I stopped calling it a “wave.” I started calling it a system.

It’s the month when flow hardens into structure. You let go of the image of the “wave”—episodic, oscillating, episodic—and accept that what’s running now is a system with its own grammar, whose effects present themselves as technicalities but function as effective bans. It is, perhaps, the most quietly devastating month of the year. So far.

In Denmark, a limit of 9 mg of nicotine per pouch came into force. Limits are almost always presented as forms of protection. And sometimes they are.

But in public health, a limit can also function as an obstacle. It can make the product less useful precisely for the people who need it most: the heavy smoker, the exhausted worker, the person for whom abstinence isn’t an abstraction but an actual tremor.

In Australia, as expected, the pharmaceutical model was consolidating. Tighter rules, restricted flavors, standardized packaging, and the product pushed behind the clinical counter. It’s a political and cultural choice. A way of removing it from everyday life, from pleasure, from identity.

And then, Kyrgyzstan. A country I knew nothing about, unfortunately. A total ban took effect. Total bans have a brutal simplicity. They don’t ask for nuance. Or sophisticated enforcement. Or a risk continuum. They ask for only two things: police and silence.

In the background, the European Union, with its habitual air of civilization, debated taxation, directives, and the possibility of placing reduced-risk products inside the same fiscal universe as tobacco.

Few things shape behavior as powerfully as price. And a few things shape price, like tax. That part of the debate is always the most decisive, and almost always the least sexy.

August

Sanitizing the gesture, not the risk. Smoke and vapor blurred under the same gaze. The politics of scenery, trying to erase addiction from the landscape.

August brought the politics of public space to the fore. The idea of smoke-free areas expanded beyond indoor environments, extending to beaches, parks, and the perimeters around schools.

The logic is clear: protect children, reduce normalization, change habits, and, at the limit, remove from view the aesthetic of smoke. Sanitize the landscape.

And it works—especially in the case of cigarettes.

But 2025 did something curious. It widened the perimeter of restriction and, at the same time, blurred the difference between smoke and vapor, as if every visible gesture necessarily carried the same invisible harm.

A public-health source in my country told me on the phone, tired: “We’re trying to get cigarettes out of the scene.” I understand. I support it, in part. But I also saw something else: when you remove everything from the scene, you may end up dismantling the raft while the current is still carrying people.

In 2025, it became necessary to make explicit, almost didactic, almost embarrassing, that nicotine is not tobacco.

It also became necessary to insist on the obvious thing policy prefers to scramble: consuming nicotine is not the same as consuming the smoke of industrial leaf in combustion. In the hierarchy of risk, smoke occupies a different place than aerosol, for instance.

But politics has a habit of trading gradations for absolutes whenever it finds a word that works. In 2025, the word was “youth.” And, as if that weren’t enough, “children.” The other was “normalization,” repeated until it became evidence by sheer insistence.

Once those words become a password, harm comparison turns into a technical detail. And technical details are the first things to be discarded.

August is the month when the politics of the body becomes the politics of the gaze. It’s no longer only about restricting substances, but about stripping appearances of legitimacy, vetoing gestures, erasing traces from the landscape.

September

Ex-smokers, micro-businesses, solitary attempts. Lives outside the frame of the paper, the official document, and the livestream.

September brought two types of documents. They looked nothing alike. One was public. The other, intimate.

The public one was a letter signed by dozens of experts—an alert against equalizing the taxes and regulatory regimes for cigarettes and vapes. An attempt to keep public policy from sliding into fiscal morality.

The intimate one was the messages I received from ex-smokers. Some had become vape shop owners. Others were occasional defenders—no script, no title. Others were simply people who still use nicotine and try, in their own way, to keep their distance from combustion.

The messages arrived on WhatsApp, without ceremony. And I’m terrible with these technologies. I maintain intact my reflexes of an analog creature. “I’m not an activist. I just don’t smoke anymore.” “If they ban it here, I’ll go back. That’s it.” “It’s what worked for me.” These people never show up at press conferences. They have no lobby. No scientific committee. They have the everyday: stress, work, dependence. Attempt, relapse, attempt.

That same month, New Zealand backed away from a technical requirement: the requirement for removable batteries. They avoided a market collapse. It was a useful reminder: the state may want to draw the world like an architectural blueprint, but the world insists on being a construction site.

And underneath everything, inequality kept running as combustion’s engine.

In the United Kingdom, a statistic turned into a moral map: 28.6 billion cigarettes a year. Consumption is concentrated among the most disadvantaged classes in regions marked by economic scarring. It’s no longer a “mass habit.” It’s a marker of inequality.

That point is decisive if you want to understand the year’s political tragedy.

When governments close off or make it harder to access lower-risk alternatives, the bill isn’t paid by an abstraction, “the user,” “the consumer.” It’s paid by a social profile.

People with lower incomes are more exposed to the physical grind of work and to chronic stress. People with less access to cessation services. People are more vulnerable to informality and the illicit market.

That’s why Lorraine’s scene matters so much.

There, the vape isn’t a gadget.

It’s equity policy, shrink-wrapped as a kit.

October

Compliance as punishment, and administrative sorrow. When harm isn’t a mistake but obedience, policies that do everything except what they’re for.

October was execution.

No more surprise, no scandal, no visible resistance. Just mechanical compliance: policy as a stamp, law as an autonomous device that no longer requires explanation. The conflict’s center of gravity shifts into a particular kind of attrition; the kind produced by normative obedience that detaches itself from the public function it was meant to serve.

In Luxembourg, what in March had sounded like a surreal number acquired the texture of law. TRIS, which at the start of the year was an omen, became a timetable.

They alerted me by email. I opened the notification once more and felt something odd. It wasn’t anger. It was a kind of administrative sorrow, as if I were watching a decision that no longer needed to justify itself. It only needed to be carried out.

And execution has a specific cruelty. It is quiet. Harm appears to be merely a consequence of compliance.

November

Banning what doesn’t yet exist. Laws too broad for reality. The future was regulated as if it were a threat.

November brought Mexico, one of the countries I admire most, and one I’ve loved visiting, and a prohibition drafted to reach even what does not yet exist.

The wording was broad enough to encompass future “vaporization systems.”

That’s revealing. You don’t merely ban an object. You ban the mental category of the object. You ban innovation in advance.

I spoke with a Latin American researcher I talk to often. He sounded tired of repeating the same argument: “You can hate vaping. But banning it doesn’t erase demand. It only changes who supplies it.”

That is what 2025 seemed to forget, in several corners of the world: demand is not a light switch. It’s a current.

In autumn or spring—depending on the hemisphere—the WHO published the sixth edition of its report on tobacco-prevalence trends. It included estimates from 2000 to 2024, projections through 2030, and a global summary of product use among 13- to 15-year-olds, including e-cigarettes.

That snapshot of the world permitted two readings at once. And 2025 lived inside that tension. The good news was clear: prevalence was falling in many regions, and tobacco control, in the classic sense, worked in your minimal part (timidly, like a tide that is about to withdraw).

The conflict zone was also clear: new products are reconfiguring the hierarchy of risk, the very idea of an alternative, and the market of desire itself. The debate stops being only about combustion. It becomes a moral dispute over nicotine.

The distinction between nicotine and smoke—which I found myself repeating all year with an almost pedagogical insistence—turned into a contest of power. Who gets to name risk?

Underneath that contest lies a datum no one can erase.

The WHO describes tobacco as a product capable of killing up to half of its users. It also says it kills “more than 7 million” people a year, including about 1.6 million non-smokers exposed to secondhand smoke. In other informational materials—by the WHO itself and by PAHO/WHO—the magnitude is sometimes rounded to “around 8 million” when estimates are aggregated.

I noted, for later, whether that statistical rounding might be part of the anatomy of the political error born of fear. But the numerical variation doesn’t change what matters. What matters is the scale of the catastrophe.

That is what makes 2025 so brutal.

Cigarettes remain the planet’s leading mechanism of preventable death.

But part of the public—and political—debate preferred to train its efforts on a war of symbols, in which nicotine, reduced to the status of a cursed molecule, was made to occupy the place of the absolute enemy.

Only it isn’t nicotine that kills.

What kills, above all, is combustion.

The rest is the risk hierarchy.

And hard choices.

December

Two closing scenes: between the hospital and the minister’s office, the choice of policy: build the bridge, or barricade the road.

I’m writing at the end of December, carried along by the Christmas atmosphere, close to my children. And an honest retrospective of the year has to begin with a simple acknowledgment: yes, there is a real problem to face.

Youth misuse exists. There are products designed with adolescent appeal. There is marketing disguised as influence. There are disposables that become trash and fashion at the same time, an aesthetic that seduces as it pollutes.

But 2025 revealed something more structurally unsettling. Governments proved themselves perfectly capable of instrumentalizing the idea of “protecting youth” as a rhetorical scarecrow, a mobilizing ghost used to justify policies that, in practice, punish adults and teenagers and the elderly alike.

They push part of consumption into informal circuits, where there is no standard, no control, no exit door. And more than that: youth, invoked as an argument, is rarely seen—or heard—as a subject. It serves more as a moral shield and sword than as the real addressee of decisions.

That is the machinery of elegant prohibitionism.

You don’t need to say “banned.”
You just need to draw an impossible limit.

You don’t need to arrest anyone.
You just need to make it unworkable.

You don’t need to debate.
You just need to parameterize.

And you don’t need to admit you chose smoke.
You just need to say you chose caution.

On the other side, 2025 also exposed the risk of pro-vape tribalism. When every criticism is dismissed as moralism, and every regulator becomes a caricature or an enemy, you lose the chance to build what actually saves lives: intelligent regulation, capable of balancing protection and access, risk and pragmatism.

In 2025, after moving through the slick carpet of COP11—the Conference of the Parties—through the solemnity of speeches, the laminated badges, the white hum of promises and their closed doors, I ended up back in the hospital corridor. The one where Lorraine waited, not knowing whether she was waiting for someone or for something.

I went back to the street with no noble name, to the grimy floor, to the coffee that no longer warms. Because that’s where policy stops being an abstraction. Not in the plenary hall. Not in the paper. Not in the lives, the podcasts, the shorts with animated charts.

Decisions gain density in a theater without an audience. That’s where they take shape. Acquire weight. Because that’s where a regulatory choice stops being language and becomes matter. And matter has a smell. It has a body. It has consequences.

December is a closing. But it isn’t an epilogue.

Happy New Year, Hierarchy of Virtue, Economy of Silence

There are two possible final scenes for this year. In the first, public health returns to the hospital—not as a symbol, but as a practice. It offers tools, measures outcomes, learns from its limitations, and adjusts course. The vape is neither celebrated nor demonized. It is treated for what it is: a bridge.

Every bridge is a delicate and impure artifice. It does more than connect shores; it inaugurates displacements. It exists to cross what is still an abyss, to allow passage over the unresolved, over what still burns, hesitates, or remains. To cross a bridge is always an act of passage: from the place one knows to the one suspected or see advance; from who we were to who we might become. Some bridges propel us forward, others lead us back, but never to the same point.

In the second, public health stays in the office. It legislates as if the world were a well-laid-out manual. It turns nicotine into sin, the smoker into a deviation, harm reduction into an embarrassed concession. It protects what it calls youth with solemn words, while quietly delivering the people who need it to the continuity of combustion.

As if caution were neutrality. As if refusing a bridge were merely waiting, and not letting someone fall.

December is always the month of closing accounts. And, in my case, in my corner of the world, in the Southern Hemisphere, of trying to steal a few days at the beach until February. But in 2025, it ended with a kind of coherence that frightens.

Measures approved with future effective dates. Definitions broadened until they swallow the exceptions. Restrictions that looked small until they became the standard.

It was a year-end in which the machinery was already turning on its own: less debate, more automatism. And more authoritarianism. As if politics had found its formula, and all that remained was to replicate it.

On the second-to-last night of the year, I sat with my notebook—the one from early January—now crumpled, its corners worn down, its cover stained from use- and I reread sentences written without ambition, without knowing they would end up as a summary.

“This year won’t be about science. It will be about control.”
“When the debate turns moral, evidence becomes a detail.”

They weren’t conclusions. They were early warning drafts of a reality that gradually confirmed itself: first as a hypothesis (perhaps even a naïve one), then as a pattern.

I thought about the cigarette—this old, insistent object, moving through centuries with an almost absurd immunity—and about how I lived with it for thirty years. I thought about the brutal contrast that 2025 laid bare.

The product that kills the most remains legal, managed, and available. And the one that could reduce harm is pushed into suspicion, unworkability, crime, and silence. As if the consecrated habit deserved administration, while the attempt at change counted as a threat.

And then I remembered the number. That small number that opens and closes worlds: 0.048 mg. In Norwich’s waiting room, policy fit inside a kit handed over in a few minutes. In Brussels, Warsaw, Luxembourg, and London, it hid inside a parameter, a list, a technical limit that looks neutral until it functions as a veto.

Between a clinical question and a unit of measure, 2025 left behind a kind of evidence that is hard to refute; less scientific than narrative:

When policy abandons the hierarchy of risk and adopts the hierarchy of virtue, it does not eliminate harm. It merely displaces it. It merely chooses where it will concentrate. And almost always it concentrates where the voice is lowest.

Essentially, 2025 preserved cigarettes while criminalizing their alternatives.

~ https://www.disobedientmargins.com/s/global-dispatches

The Machine Spins Before You Even Notice

Some clauses in international treaties are born to live in the footnotes. Article 2.1 of the FCTC seemed to be one of them. Drafted over two decades ago, it read like a gesture of diplomatic elegance and an encouragement for countries to go beyond the treaty text, so long as they respected international law. A short note of freedom: symbolic, harmless. The kind of sentence no one contests, mostly because no one expects it to matter.

But sometimes it’s the footnote that opens the passage. Article 2.1 began to operate as a side door: It allows the Convention’s reach to expand without altering a single word of the base text.

If Article 5.3 builds the bunker, filtering who matters and who gets to speak, Article 2.1 opens the corridor through which the regime advances, without ever needing to debate its own expansion. Closed to voices. Open to drift.

At COP11, that footnote became a conduit for normative expansion. In decision FCTC/COP11(5), the Conference “welcomes” a report of “forward-looking measures,” drafted by a group of experts and explicitly positioned beyond the treaty’s foundational scope.

The proposals, ranging from total bans and criminalization to commercial restrictions and extraterritorial norms, come wrapped in soft, seemingly optional language: “voluntary,” “enhancing,” “expansive.”

Light words. Heavy moves.

But the decisive gesture hides in a quiet administrative verb: the Secretariat is now authorized to disseminate these proposals through national reports, technical workshops, knowledge hubs, cooperation platforms, and support missions to “interested” countries.

The treaty text doesn’t change. But practice relocates.

International regimes rarely operate through explicit orders. They work through circuits of invitation and adhesion: the COP “invites,” the Secretariat “supports,” the hubs “implement,” countries “comply.”

What begins as a suggestion, driven by institutional loyalty, more royalist than the king, soon becomes the de facto standard of regulatory virtue. The official name remains. The substance, silently, is already something else.

“In practice, what’s being signed today isn’t exactly what was ratified years ago,” summarized my source, who has followed the Convention since its earliest COPs. “The language keeps saying everything is optional. But that’s just form.”

Pause.

Then, with the clarity of someone who’s seen the trick before: “They preserve the form to protect the change, you see?”

He didn’t use the term, but he was describing a well-known phenomenon in international law: treaty drift, the gradual shift in a treaty’s meaning or application, drifting from original intent without formal revision.

Sometimes the drift is functional: open clauses must adapt. Sometimes, it’s corrosive, reconfiguring the treaty from within, through administrative sedimentation, successive interpretations, and shifting consensuses.

There are mechanisms to contain it: joint authentic interpretations, formal amendments, revision protocols, sunset clauses. The theory is there. What’s missing is the brake.

In the FCTC, none of those mechanisms are currently active. And the drift continues, soft, steady, and perhaps already irreversible.

What COP11 reveals is a model of expansion that no longer needs to persuade. It only needs to institutionalize. To turn an idea into a guideline. A guideline into a workshop. A workshop into “best practices.” Best practices into expectation. Expectation into normative pressure.

No policing. No sanctions. Just something more effective: the diplomatic shame of the non-implemented.

And when this logic joins the shielding of Article 5.3, the structure becomes clear: a system that lowers its permeability to dissent while increasing its permeability to expansion.

A regime that shields itself from questions and grows through the footnote. A bunker with a side door inside an armoire. That’s how drift gains ground in the showcases of virtue: clauses once drafted for tobacco smoke and agricultural fields begin to shape an entirely different material world.

And from within, the treaty's scope is rewritten without rewriting the treaty.

Laboratories of Virtue

Article 8 offers a precise example of silent expansion. Originally designed to address exposure to smoke from the combustion of tobacco — a technically grounded, measurable risk, with decades of scientific consensus — Article 8 has become a platform for something else.

In decision FCTC/COP11(9), the COP extends its scope to include vapors and aerosols emitted by electronic devices, even in the absence of combustion. The shift occurs without altering the base text, and despite evidence that most scientific literature points to significantly lower risks than those associated with conventional cigarettes.

The textual foundation for this inflection lies in a single, vague, almost modest phrase, but one strong enough to shift the axis: “Emissions from electronic nicotine delivery systems may also pose health risks to non-users.”

In the plenary, the phrase does not arrive as controversy. It arrives as procedure. Cold light over long tables. Thin-stem microphones tilted toward trained mouths. Paper cups already crumpled. Headsets adjusted without eye contact. And there, low, square, and non-metaphorical, the “WHO FCTC LEGAL” nameplate reminds everyone that the text does not merely describe a risk. It draws a boundary.

With that sentence, the Conference calls upon the entire United Nations system to ban tobacco and nicotine products, whether combustible or not, from all its premises. This is Article 8 in expanded mode: it preserves the appearance of continuity while shifting the content. What was once a measurable risk now operates as symbol. “Setting an example” becomes method.

In practical terms, with this decision, the UN no longer acts solely as an employer protecting its staff. It acts as a showcase of virtue, a symbolic laboratory where nicotine use, in any form, is meant to become socially unacceptable.

Public policy no longer operates solely on the basis of harm. It begins to regulate the moral value of visibility.

This is where the metrics start to blur. What was once a risk scale is compressed into a single regulatory category. Different levels of harm, vastly unequal in real terms, are treated as a single category. Conflation of risk: the merging of distinctions.

Nuance disappears. Gradients collapse. And with them, the distinctions that, in some contexts, could save lives. You’re no longer comparing with what kills. You’re comparing with an abstract ideal: the nicotine-free citizen.

Precaution, here, is no longer a tool. It becomes doctrine.

The Umbrella of Repudiation: From Smoke to Disgust

Article 18 follows a different path, but arrives at a similar destination.

Originally designed to address the environmental impacts of tobacco cultivation — deforestation, pesticide use, soil degradation — it gains new scope in decision FCTC/COP11(10). The text pulls the issue out of the fields and brings it, without apology, into another material inventory: batteries, electronic components, devices, and waste that is difficult to dispose of or recycle.

The FCTC begins to speak the language of environmental conventions— such as the Basel and Stockholm Conventions —and aligns itself with the Sustainable Development Goals. As if changing neighborhoods to change jurisdictions. In the plenary, this doesn’t arrive with fanfare. It enters the way everything does there: through formal recall, through paragraphs that appear to be mere context. Cold, diffused light. The long table. Thin microphones. The same trained silence. And somewhere on the table, the plaque that doesn’t describe but demarcates: FCTC/LEGAL. The environment is no longer a topic. It becomes a track.

The decision notes the insufficient legal and regulatory infrastructure in many countries to deal with waste generated by tobacco and nicotine products, including related electronic devices. And it pushes the system toward a gesture that, though technical, is already political: to consider the possible classification of such waste based on scientific evidence, including waste containing nicotine, heavy metals, or other toxic substances.

This is where the scope truly stretches.

At the same time, it invites and encourages the COP to request that the Secretariat prepare a report with recommendations, including legal and institutional pathways for the possible classification of such waste under international environmental and hazardous materials conventions.

The phrasing is bureaucratic. The reach, potentially extraterritorial. An ecologization of prohibition.

Article 18 becomes a full-cycle umbrella: from pesticide in the field to battery disposal post-consumption. Waste rises to the center. And countries are now called to act “at home,” with the environmental banner raised as a lever of legitimacy.

Here, it’s worth noting the shift. Quiet, but profound: the health argument demands demonstration; the environmental one operates faster through image.

To sustain causal claims in public health, you must grind through data: longitudinal series, meta-analyses, biological plausibility, and confounder control. To sustain “environmental harm,” often a single discarded object in the right landscape is enough.

Aesthetics does the work of urgency.

The point is not to deny that the waste issue is real. It is. The text itself acknowledges that. The point is the asymmetry: the environmental frame becomes an efficient language for prohibition because it generates consensus with less evidentiary friction. And through that shortcut, the debate on relative risk gives way to a debate on repulsion.

There is also a tactical advantage: the FCTC extends its influence beyond the perimeter of “tobacco” and enters a terrain where environmental treaties and sustainability agendas already operate with high legitimacy and low tolerance for dissent.

The name remains FCTC. But its content already moves like a governance regime for materials, waste, logistics, and trade, a cross-border regulatory infrastructure.

Regimes such as the FCTC constantly require fuel. Here, that fuel comes in the form of disposal. Sanitary certainty gives way to aesthetic disgust. Policy is no longer grounded in evidence. It is grounded in trash.

The Politics of Deficit Is the Bunker’s Fuel

None of this happens in a vacuum. Normative expansion comes with ballast, structure, and budget. For the 2026–2027 biennium, COP11 approved a total of $19,946,395, a sum organized, as it should be, into two moral columns: Assessed Contributions, on one side; Extra-budgetary Contributions, on the other.

More than half comes from the voluntary layer: $11,145,302 in non-mandatory contributions, allocated to fund what moves: missions, workshops, hubs, platforms, technical assistance, materials, and replicable “tools.” The parallel treaty doesn’t need amendments. It needs flow. Money doesn’t just sustain the regime. It shapes it.

The architecture is asymmetric. The mandatory contributions from Parties were set at $8,801,093. The rest, about 56% of the budget, depends on voluntary fundraising. The decision does not name donors. It simply authorizes the Secretariat to “seek and receive voluntary Extra-budgetary Contributions” to implement the work plan.

Thus, the regime acquires a stable base and an expansive layer whose origin, in practice, escapes traceability through public documents. It’s in this zone, between the mandatory and the voluntary, that the parallel treaty finds room to grow.

And this is where a nearly invisible mechanism enters, with a predictable effect: VIPRS — Voluntary Implementation Peer Review and Support. In the work plan, it appears as a “voluntary” tool for peer review and support, with limited participation and a projected cost.

On paper, it’s acceptance. In practice, it’s a mirror: it induces alignment, discourages deviation, and reinforces orthodoxy without ever saying so outright. There is no formal coercion. The country “agrees” to be evaluated. The report “suggests.” The Secretariat “supports.” And orthodoxy consolidates through expectation: a normative constraint disguised as voluntariness.

This is where the machine reveals its engine: the logic of deficit.

Each new guideline justifies a mission. Each mission confirms that “it’s still not enough.” And the ‘still not’ becomes fuel.

The system feeds on its own insufficiency.

A Doctrine of Purity

In theory, all of this still fits under the discreet umbrella of “promoting public health.” In practice, the language that emerges from COP11 points to something else: purity.

Nicotine is gradually ceasing to be treated as a psychoactive substance consumed with varying levels of risk. It is assuming the status of a moral impurity. Something to be removed from social space.

Whether in combustible cigarettes, lower-risk electronic devices, or even nicotine replacement therapies used to quit smoking, it tends to carry the same mark: undesirable presence, presumed guilty by default.

Defenders of the Convention reject this interpretation.

To them, the conflation of risks is not a conceptual error; it’s historical prudence. They recall that, for decades, the tobacco industry used the rhetoric of “harm reduction” to delay regulation, sold “light cigarettes” as a safer alternative without solid evidence, and systematically targeted adolescents and vulnerable groups through marketing. In light of that history, they argue, treating any nicotine product with maximum suspicion isn’t distortion, it’s a vaccine against naïveté.

The argument is compelling. But it also has limits.

There’s a difference between distrusting a sector with a record of manipulation and treating every scientific or clinical nuance as a Trojan horse. The first is prudence. The second is dogma.

And when dogma becomes public policy, it produces a predictable effect: it turns the world into “yes/no” binaries and calls it “health” when, in practice, it operates more like moral discipline.

In Panama or Geneva, I heard the same sentence — with minimal variation — from doctors, researchers, and users of lower-risk products, all of them excluded from formal COP discussions: “We’re not here to defend the industry. That’s a ridiculous argument. We just want to talk about gradients of harm.”

On the other side, the plenary’s response was invariably the same: If there is risk, it is unacceptable. But when everything that is not harmless is treated as equally intolerable, the very idea of harm reduction becomes impossible.

The key question — compared to what? — almost never appears in the decisions.

A heated cigarette is not evaluated in comparison to a pack-a-day smoking habit. It is evaluated against an abstract ideal: the nicotine-free citizen. A vape, in the hand of a chronic smoker, is not weighed against a history of failed attempts with patches and gums, but against a hypothetical life without dependency.

Normative morality replaces epidemiology.

In the name of health, or more precisely, in the name of an ideal of health, we risk forgetting that, outside the walls of the COP, the world is made of imperfections: relapses, hybrid strategies, smaller survival bargains, attempts that fail before they succeed.

A policy that ignores this terrain becomes a policy for imaginary people.

Within the main auditorium, none of this appears to constitute open conflict. On the last day of COP11, the texts were passed in blocks. No amendment moved beyond the hallways. No dissenting voice rose with enough force to break the consensus.

“There was room for negotiation before… for months,” explained the Latin American delegate. “Once it gets to the plenary, what comes in is already set to pass. And anyone who tries to question it at that point risks being seen as obstructive.”

That’s how the machine maintains its efficiency: it moves the conflict backstage, before the plenary lights go on. By the time the public is let in, the script is already closed. The COP produces decisions, agendas, missions, and reports.

It works.

But its technical efficiency masks a political fragility: the more the regime shields itself from criticism and interference, the more it distances itself from listening, and without listening, public health ceases to be politics. It becomes a theater of virtue.

And then the text returns, inevitably, to the outside: to the bus stop, to the cigarette lit without permission, to the vape hidden in the palm of a hand, to the ashtray overflowing with cigarette butts at the building’s door. The regime can erase nuance on paper, but it can’t erase it from people’s pockets.

Life Goes On at the Margins of the Symbolic Ararat

And then the text returns, as it must, to the outside: to the bus stop, to the cigarette lit without asking permission, to the vape hidden in the palm of a hand, to the ashtray by the building entrance. The regime can erase nuance from the page. It can’t erase it from everyday life. What lives in pockets, lungs, and habits survives the page, and outlasts it.

When I left the building for the last time, the wind had picked up. It swept across the parking lot like someone wiping a chalkboard before the next shift.

I didn’t see the interpreters turning off the lights in their booths, or the barriers being removed, or the COP11 totem being dismantled. But I know how this ends: the screen goes dark. The consensus folds up. The final sentence becomes archive. And the city outside resumes its rhythm, as indifferent as Mont Blanc in the background.

Henri finishes another kitchen shift at the hotel. He’s on the sidewalk, cigarette between his fingers, waiting for the number 8. I know this because the world insists on repeating its simplest gestures. Smoke rises into the cold like a report that will never be filed.

We are not on the observer list for COP12.
We will not exist in the “needs assessment” missions.

In the next reporting cycle, our countries will send the Secretariat the usual: a clean package of percentages, prevalence rates, taxes, passed laws, and measures declared “implemented.” No room for doubt. No scent of the street.

The Secretariat will stack the responses.

Then will translate them. Turn lives into tables. Tables into spreadsheets. Spreadsheets into graphs. The graphs will reveal “gaps.” The gaps will become guidelines. Guidelines become workshops. Workshops, “best practices.” Best practices become expectations. Expectations become pressure. And the pressure, with a technical smile, is called voluntary. Beneficence. Benevolence.

The paper remains immaculate. The pocket, smudged. Somewhere between Henri’s cigarette ash and the sterile grid of an Excel spreadsheet, something slips quietly, irrevocably. Something will be lost.

Not a data point. A world. Relapses. Informal pacts of survival. Tentative, hybrid lives. The kind of decision no policy language can capture without amputating its truth.

The Convention is already preparing its next gathering, this time in Armenia.

In Yerevan, if all proceeds as announced, another glass fortress will rise to receive dark-suited delegates, light-suited experts, and a pre-approved civil society.

On some cold afternoon, decisions will scroll across giant LED screens and be adopted by consensus: the right language, gleaming with procedural virtue.

Outside, someone will light another cigarette.
Someone will try to replace it with a device hidden in the lining of a pocket.
Someone will stop trying.
Someone will simply stop.

It is between these two worlds, the calibrated lexicon of resolutions and the lungs and pockets that absorb the consequences, that the question returns, stubborn as a cigarette butt that won’t extinguish: Can a regime that governs without truly listening still be called a public health policy?

If the answer hesitates, the problem lies not only in what COP11 resolved. But in what has become acceptable to forget, and in what the regime must unsee in order to keep operating.

References:

All official documents, decisions, and supplementary materials from the Eleventh Session of the Conference of the Parties (COP11) to the WHO Framework Convention on Tobacco Control (FCTC), held in Geneva in November 2025, are publicly available on the WHO FCTC website.

COP11 Main page: https://fctc.who.int/convention/conference-of-the-parties/sessions/eleventh-session-of-the-conference-of-the-parties/

Decisions adopted at COP11: https://fctc.who.int/convention/conference-of-the-parties/sessions/eleventh-session-of-the-conference-of-the-parties/decisions

Main documents: https://fctc.who.int/convention/conference-of-the-parties/sessions/eleventh-session-of-the-conference-of-the-parties/main-documents

Supplementary information: https://fctc.who.int/convention/conference-of-the-parties/sessions/eleventh-session-of-the-conference-of-the-parties/supplementary-information

Key documents referred to in this article include:

FCTC/COP11(1) Adoption of the agenda

FCTC/COP11(2) Observer applications

FCTC/COP11(3) Election of Committee Officers

FCTC/COP11(5) Forward-looking tobacco control measures

FCTC/COP11(7) Assessed Contributions

FCTC/COP11(9) Smoke- and aerosol-free United Nations

FCTC/COP11(10) Article 18 – Environmental impacts

FCTC/COP11(11) Workplan and Budget 2026–2027

FCTC/COP11(14) Election of the President and Vice-Presidents

Complete list available at: https://fctc.who.int/convention/conference-of-the-parties/sessions/eleventh-session-of-the-conference-of-the-parties/decisions

Rigid on the Outside, Elastic Within

On the way to the central station, I review notes and photos in the dim glow of my phone. The bus is nearly empty, overheated against the cold outside.

The window rattles with every seam in the asphalt. Public vehicle silence: a muffled cough, a coat brushing against vinyl, warm air rising from the floor. And the engine, doing its job without asking for consent.

The building hosting COP11 is, formally, just a temporary seat of deliberation.

Temporary.

But in practice, it functions as a command center: from there, layers of language flow downward from screen to life. And it’s been a long time since this was only about “tobacco control” in the narrow sense.

The Framework Convention on Tobacco Control was conceived in the early 2000s, in a world where the industry still funded lawmakers, seduced physicians, and cultivated scientific doubt as a survival strategy. Doubt as a product. It methodically delayed the recognition of a truth already brought to light by the Royal College of Physicians in the 1960s: cigarettes kill.

The founding goal seemed almost obvious, nearly irrefutable: to shield public health policy from the interference of a sector too powerful to ignore.

Two decades later, the world around the Convention has grown more complex. Much of the industry now recognizes itself and seeks to rebrand to transform its portfolio in order to survive.

So does the treaty: rigid on the outside, elastic within. It no longer confines itself to raising taxes, enforcing smoke-free environments, or banning advertising. It now operates as a technocratic corporation within a growing regulatory ecosystem that comprises thematic committees, expert groups, technical missions, implementation reports, and peer-review mechanisms.

Every two years, COP adds another layer: “voluntary” guidelines, “enhancing” recommendations, decisions that, without altering a single line of the foundational text, quietly extend its scope of action, infiltrating domains from agriculture to e-waste management.

And yet, in the corridor, on the sidewalk outside the discreet side exit, none of it carries the solemnity of the page. Consensus comes with fatigue. With eyes that avoid the camera. With closed sessions. With people trained to say nothing.

I think about this as I recall the delegate who crossed my path at the side exit: eyes dried out from hours under white lights.

He lowered his voice to say he was forbidden to speak to the press. He didn’t say by whom. He didn’t have to. The prohibition was already there, in the way he quickened his pace, and in the way the sentence emerged: not as a warning, but as an apology.

Autumn as Protocol

In Geneva, power rarely enters through the front door. It enters through the agenda. And outside, the city’s own history tells that story, without asking permission.

In the same way, I return: no badge, no invitation, no clearance.

Arrival at the Centre International de Conférences Genève carries the neutrality of a place trained to host the world: concrete, glass, a canopy far too wide for any spontaneous gesture. The flags don’t decorate. They mark jurisdiction.

The recent rain leaves the asphalt with an archival sheen: a surface that already feels read, stamped, returned to its place.

On the façade, the building’s name stretches with the serenity of an institution that has watched a thousand urgencies come and go. COP11 appears as a hanging logo, a timestamped sticker affixed to an architecture that promises permanence.

The building does not celebrate. It authorizes.

Now that I walk the path in reverse, I notice: from the tram stop to the entrance, the world seems arranged not to raise its voice. Tracks. Clean sidewalks. Signposts. A normative blue indicating pedestrian priority; a pictogram of an adult and a child summarizing the pedagogy of obedience.

And just there, in the same neighborhood, the acronym UNHCR, in giant blue letters pinned to a low-curved building, a reminder that, in this part of town, human suffering is also managed through acronyms, protocols, committees.

The world becomes an acronym.
The body, a data point.
Another body, a case.
The beginning of winter, managed.

Fallen leaves — yellow, insistent — gather on the ground under the discipline of the wind, as if the city were storing autumn for administrative use.

The Agenda of Those Who Control Time

But the wound lies in the more minor detail, and for that reason, it governs. At the entrance, I didn’t find the metal ashtray overflowing with cigarette butts that once stood before a conference devoted to ending smoking worldwide. Edoxie Allier’s still life must have been swiftly removed.

The residue of habit in front of the emblem of the norm: crushed filters, damp paper, accumulated ash. Policy leaves clean pages. The body always leaves remains.

On the cold morning of November 22, 2025, under the diffused plenary light — cold and institutional — COP11 performed one of its most discreet and consequential rituals: the selection of who would operate the machine. There was no visible suspense. No raised voices. There was a procedure.

The choreography was brief, sanitized: headsets in place, thin-stem microphones angled toward trained mouths, laptops open like miniature control stations, paper cups crushed as if even water had to appear provisional.

In the background, a burgundy wall did the institution’s work: rigid, repetitive, making the human appear transient, the structure unmoved.

There, the door is not the door. It is the agenda.

From the outside, the conference sells itself as a diplomatic democracy: each country with its placard, its simultaneous translation, its minute to speak. Its surface.

The plenary offers equality as a set design. The real decision happens before and around.

The mechanism isn’t the microphone; it’s what decides who reaches the microphone. What makes it onto the agenda. When it arrives. In what textual form. At what point is the discussion “closed”. Which paragraph returns for revision, and which one dies for lack of time. And above all: What kind of disagreement the system is still willing to tolerate before it shuts down.

The Art of Making Things Exist

Formally, it is the Conference of the Parties that “rules.” Operationally, it gives itself a brain: the Bureau. The Bureau is no ceremonial ornament. It manages the agenda, allocates time, and decides when an item has been “sufficiently discussed” to become text, or to die of exhaustion.

At COP11, this mechanism was established in under an hour, through a one-page decision, dry, logistical, impeccable. It is there that power receives both name and title.

The elected President of the Bureau was Jawad Al Lawati (Oman). Vice-Presidents by region: Pedro Gullón (Spain), Hekali V. Zhimomi (India), Judith Segnon-Agueh (Benin), Derrick Heng Mok Kwee (Singapore), and Vera Luiza da Costa e Silva (Brazil). The same decision designates Vera Luiza, among the Vice-Presidents, as Rapporteur.

This is where many reports go wrong: they underestimate the least showy role. The Rapporteur doesn’t decorate the conference. They certify its memory. They organize. They frame. They consolidate.

In a multilateral body, whoever certifies the text also certifies the event: what enters as a “decision,” what becomes a “record,” what is relegated to a footnote, and what disappears without a sound.

If you control the flow, you control the outcome. Not only because you shape the evidence, but because, in a conference, the outcome rarely emerges from the strongest argument. It emerges from the surviving paragraph.

The Intact Machinery of Gavels

The second nucleus of power lies in the Committees. Here, the anatomy is unmasked. It’s in the committees that debate takes shape, sheds its excess, and becomes wording. Here, the gavel gets to work. And to work, in this case, is to choose what continues to exist.

At the start of the week, COP11 elected the chairs of Committees A and B. The decision was even shorter: half a page of names. On paper, an administrative gesture. In practice, the selection of who arbitrates what is “substantive,” what is “financial,” and what can be postponed without moral cost. Who controls time. Time doesn’t sign; it vetoes.

In Committee A — where the substantive and politically charged issues of the treaty are concentrated — the chair went to Damini Mohur (Mauritius), joined by vice-chairs Nuntavarn Vichit-Vadakan (Thailand) and Maya Roumani (Lebanon).

In Committee B — responsible for institutional architecture and budget nerve — the chair was assigned to Marcos Dotta (Uruguay), with vice-chairs David Yim (European Union) and Mary Ann Palermo-Maestral (Philippines).

The document formalizing these choices takes up just over a page. It registers no controversy. It contains no dissent. It reveals no fracture. It is the aesthetic of perfect governance: everything approved, everything “in order.”

But “in order,” here, describes the handwriting of the text, not the politics. It looks like bureaucracy. But it’s a mechanism.

The chair controls the microphone and the clock. Decides the order of interventions. The exact moment when “the room” has spoken enough. The instant a paragraph returns for adjustments, and the moment the agenda moves forward, pulling the undecided along with it.

That’s how disagreement becomes neutral language. How dissent is buried under fatigue and proceduralism.

Those familiar with the internal grammar of COP know: each name carries a cartography of precedents.

It’s not a conspiracy. It’s institutional sociology. A country-member does not arrive at the table as a neutral body. It arrives with moral victories, traumas, bureaucratic obsessions, alliances, and invisible borders. What changes is not just who holds the gavel, but what now counts as “reasonable,” “inadmissible,” or “out of scope.”

“It was well calculated,” a Latin American political actor told me under condition of anonymity, someone who closely followed the negotiations. “Mauritius, Thailand, Uruguay, European Union, Brazil… all are considered reliable for keeping the Convention cohesive.”

The word cohesive does the heavy lifting. In these settings, cohesion usually means: less noise. Less ambiguity. Less room for nuance. Sometimes, less dialogue. Sometimes, less agreement. The kind deemed unnecessary.

The real question is: what does cohesion cost? I ask whether this narrows the range of debate too much.

He hesitates, not for lack of opinion, but to calculate what he was about to say.

“That’s the price,” he replies.
And stops just before choosing a side for the sentence.

Protection, for some.
Closure, for others.

The Closed Glossary Method

From there, the rest follows. COP doesn’t need to say “no” out loud. It only needs to decide who organizes the “yes.”

And organizing the “yes” means designing the tutorial of permissible vocabulary: the phrases that pass, the terms that stick, the premises that no longer need to be debated.

Thailand enters Committee A with the authority of a full vape ban as an exportable showcase. A gesture that circulates well because it doesn’t need to prove effectiveness on the ground; it only needs to demonstrate firmness in the text.

Uruguay brings the prestige of having faced Philip Morris and won. A legal battle turned into a founding myth: heroic state versus predatory corporation.

The European Union arrives with the weight of its legal apparatus and a taste for standardization, a kind of power that doesn’t shout, but advances through drafting, through harmonization, through consistency.

And Brazil, with its historic stance of banning rather than regulating reduced-risk products, often plays the role of gatekeeper: any nuance risks being labeled a loophole.

Loophole is a police word.

All of this fits elegantly into the official lexicon: equitable participation, international cooperation, health promotion. But equity here is not distributed across the world; it’s distributed across language.

To enter the room, one must speak the right language. And more than speaking it, accept the premises that language carries and conceals. The regime operates through a filter of representation. It’s not just administrative exclusion. It’s a formal selection.

Whoever reaches the microphone has already been filtered. Listening, when it occurs, comes pre-edited. In practice, there is little to no space for smokers, users of reduced-risk products, frontline physicians, or scientists who do not share the orthodoxy of control. These groups appear as statistics and as threats. Rarely as subjects.

The result is a paradox: a global treaty that governs billions of bodies without consulting them. A regime that calls itself public health, and yet operates, simultaneously, as a system of belonging. Anyone outside the glossary becomes a risk.

“That made sense at one point. But now it’s become a historical flaw,” said the same delegate, still off the record. “The Convention was born in a context where the urgency was shielding public policy from industry interference.” He pauses, measuring the temperature of his own sentence. “The shield became a system of exclusion. For many, it’s still a necessary protection. For some, it’s overreach.”

And then comes the sentence that explains the entire building: “But no one wants to touch that issue.”

Because touching that issue is to touch the mechanism that keeps the Conference cohesive: the idea that any interlocutor outside the framework of Control poses a risk. And when a system turns risk into identity, when suspect becomes a moral category, norms cease to be tools. They become borders.

At that point, the Secretariat is no longer a detail. It becomes architecture.

COP rules not only through its decisions. It rules by rendering undecidable what it rules. You see it in the smallest things, where the method appears without rhetoric: the delegate adjusting their headset without lifting their eyes from the table; the placard that reduces an entire country to five letters; the hand that hovers above the keyboard, then retreats; the muted applause that validates the procedure, not the person.

The institution manufactures its own optics. Optics, repeated, becomes a habit. Habit, repeated, becomes solid ground. From then on, the official text no longer needed to record controversy.

No vote. No dissent. The disagreement has already been filtered before the plenary. It arrives reclassified, domesticated, converted into a language the system knows how to process.

Interference.

The term for this is not “conspiracy”. It’s a method. And the center of that method, the line that holds the entire structure, fits into thirty-five words and a number: Article 5.3.

The Bunker 5.3

Nothing here is casual. Everything is structured. Almost everything takes the form of a number: clause, article, guideline. With the weight of scripture.

At the heart of the FCTC’s shield lies a rule concise enough to fit in a small paragraph, yet strong enough to support an entire structure of exclusion.

The text of Article 5.3 instructs countries to protect their public health policies from the “commercial and other vested interests” of the tobacco industry. The official guidelines go further and crystallize the regime’s foundational idea into a phrase without concessions: there is a fundamental and irreconcilable conflict between the interests of the industry and those of public health.

This is not just a warning. It is a division. A cosmology: a world split by contagion. On one side, the acceptable. On the other hand, the compromised. And the border runs through language.

In practical terms, 5.3 functions as a code of conduct: avoid meetings, reject partnerships, disqualify industry-funded research, and treat any contact as potential infiltration.

The rule doesn’t only say what to do. It says who not to be with.

Institutional hygiene, on paper.

And history provides sufficient justification: decades of deception, scientific manipulation, and strategic philanthropy. For a long time, that vigilance was not an overreaction. It was survival. The problem begins when the shield becomes a trench, and the trench ceases to be a measure and becomes an identity.

The implementation of Article 5.3 expanded its scope and hardened its grip. What was born to block abuse now also blocks dissent and dialogue.

When the precautionary principle becomes a principle of exclusion, the system begins to corrode its own legitimacy, replacing debate with triage and dialogue with a purity test.

At COP/FCTC, that purity doesn’t appear as a slogan. It appears as practice. A filter of admissibility separating “acceptable” from “suspect,” “inside” from “outside.”

Under Rule 5.3, it’s not just tobacco industry executives who are excluded. The filter extends to researchers of reduced-risk products, consumer advocates, frontline physicians, and scientists who don’t align with the orthodoxy of control and prohibitionism.

The press — stationed at the perimeter — falls under the same logic of contagion. It doesn’t matter what it asks, only which drawer it can be filed into.

There’s a detail that captures the mechanism without raising its voice: a desk plaque reading WHO FCTC LEGAL. Low acrylic, black letters, firmly placed between slim microphones and paper cups. Here, law is not just a set of rules; it is a function. It marks. It halts speech when it threatens to cross the line. Legal doesn’t arbitrate plurality. It guards the boundary.

“It’s difficult,” admitted the same Latin American delegate. “You know this… When you try to protect a policy, you risk isolating it from the very reality it claims to protect.”

The sentence is simple. And so is the mechanism.

A public policy can shield itself to the point of losing contact with the very object it was built to serve.

When the premise of irreconcilable conflict becomes the only lens, everything is interpreted through origin rather than evidence. Scientific dialogue cools. Cooperation hardens. Any actor suspected of contamination is kept at arm’s length.

And the system begins to operate with a silent, repeated question: Where are you from? Instead of the one that should govern public health: What do your data show?

5.3 ceases to be a clause. It becomes a practice. A sorting routine. A way of seeing and filtering. At COP11, nearly one million dollars was allocated to expand its application, including national training, communication kits on “industry tactics,” codes of conduct, and manuals adaptable to other UN agencies.

It is no longer just a rule. It is a budget. It is a blueprint. It is replication.

The clause becomes infrastructure.

And infrastructure tends to feed on itself: the more you train to detect threats, the more threats you learn to see. And when threats appear everywhere, the response becomes automatic: Expand the bunker.

Conflict of Interest, Interest in Conflict

It wasn’t the first time. As at COP10 in Panama, Geneva repeated the gesture. Members of organizations linked to agriculture and the tobacco supply chain, as well as elected political authorities from Brazil’s main tobacco-growing region, were barred from participating in the conference. Even as observers.

The official justification came in a familiar form: potential conflicts of interest.

Among those directly connected to the political chain: Valmor Thesing (SindiTabaco), Romeu Schneider (Afubra, Tobacco Sector Chamber), Edimilson Alves (Abifumo), Rangel Marcon (Fentitabaco), Gilson Becker (Amprotabaco and mayor of Vera Cruz, RS), and Éder Rodrigues (Stifa). A list that needs no adjectives. The affiliations speak for themselves.

But as I witnessed, exclusion extended beyond industry and workers’ representatives. It reached state secretaries, mayors, federal and regional legislators — all elected, all excluded.

According to the delegation’s own report, officials from the governments of Rio Grande do Sul and Santa Catarina were also denied access: Edivilson Brum (Agriculture/RS), Vilson Covatti (Rural Development/RS), and Celles Regina de Matos (Cidasc/SC).

Mayors from key municipalities in Brazil’s tobacco heartland — Jarbas da Rosa (Venâncio Aires/RS), Emerson Maas (Mafra/SC) — were also blocked, along with municipal officials tied to local health and development agendas.

At this point, the term conflict of interest reveals itself as more than a technical filter. It becomes an instrument. And, not rarely, an obstacle to the public interest.

Seven federal deputies, Afonso Hamm, Heitor Schuch, Marcelo Moraes, Dilceu Sperafico, Rafael Pezenti, Zé Neto, and Zé Rocha, were also denied entry. So were several state legislators from Rio Grande do Sul: Marcus Vinícius, Silvana Covatti, Zé Nunes, Airton Artus, Dimas Costa, and Pedro Pereira.

The list, as reported, included more than thirty names, including Marco Antonio Dornelles, Marcos Augusto Souza, Joel Maraschin, Romano Scapin, and Ricardo Landim.

This episode exposes a tension the official text refuses to admit, yet which shapes the process from within: democratic legitimacy versus international technocracy.

When elected representatives are treated as inherently suspect, what’s at stake is no longer just tobacco control.
It’s the very criterion of legitimate representation, and the system’s ability to shield itself not only from industry but from anyone who brings friction, rootedness, or ambiguity and complexity to the debate. Including the territories most affected by its decisions.

And it’s here that the bunker shows what it truly protects: not just a policy, but a permissible field of questions. It doesn’t just bar actors. It bars questions. And without question, what remains is only form. Not thought.

Less than two kilometers from the official plenary, a parallel event unfolded: Good COP. Doctors, scientists, and users of vapes and heated tobacco products gathered to share experiences. Not doctrine.

They spoke of relative risk. Of relapse. Of failed attempts to quit. Of successes with lower-risk devices. They spoke a different language, shaped by individual histories, nuance, uncertainty, and scientific method. A language less concerned with purity and more attuned to process.

In the COP regime, that vocabulary had no voice. No nameplate. No microphone. It wasn’t counted. It didn’t exist.

“We knew they’d be here — same as in Panama, right?” said my source, standing up. “But since they have no formal status, they’re treated as noise. There’s very little space for contradiction.”

I asked whether institutional silence sometimes acts as a discreet form of censorship.

He paused.
Three, four seconds.
Then said: “COP’s structure is very closed. Not very permeable. You know that.”

He checked his watch.
Mentioned a meeting in five minutes.
And closed with a polite:

“Good work to you.”

In the language of the bunker, that’s not an opinion.
It’s a rule, spoken softly.

Next: From structure to scripture. Part 3 explores how technique becomes doctrine and how purity, once a principle of caution, turns into a practice of exclusion.

The quieter the treaty, the farther it reaches. The more technical its language, the more deeply it embeds itself in daily life, not as law, but as a condition.

The Eleventh Conference of the Parties to the Framework Convention on Tobacco Control revealed how a regime can grow without ever changing its name. How it expands without confession. How it silences dissent not through force, but through structure, ensuring it never truly enters the room.

The title remains. The substance does not.

I was in Geneva during those days. I watched doors close with choreographed precision, heard the breathless pause between simultaneous translations, and walked corridors where delegates kept their eyes low and their voices lower, speaking only through their paper cups, their shoes, their fatigue.

Outside, in the cold, among cigarette butts no one had swept away, I encountered a form of power that no longer needs to be written to rule. It governs in silence. It survives by habit. And it endures, unnoticed, in the grain of everyday life.

At first glance, COP11 appears to be a technical gathering: neutral, objective, functional. But its rituals betray another nature: a form of power that moves through repetition and gesture, not proclamation. In this first part, we follow the path where protocol becomes performance; where doors close in synchrony, and decisions seep into daily life as if they had always been there. The liturgy of control begins, as most liturgies do: in silence.

The Fading Glow and the Ending That Feels Routine

When the final session ends, the interpreters remove their headsets like someone unplugging a life-support machine. The delegates shut their metallic laptops. The conference logo disappears from the big screens. There is no applause. Only the dimming of the lights.

Outside, the wind sweeps across an almost empty parking lot. In the distance, the white mass of Mont Blanc stands where it always has. Colossal. Indifferent to the fate of a comma, to the semantics of clauses, to the choreography of draft texts. Indifferent to the language that seals, by consensus, an opacity no one dares name — not even in a whisper.

The building empties with the expected precision of Swiss efficiency. Trash bins are replaced. Side doors opened with care. Badges still sway on the chests of those who agreed out of faith, fatigue, or the quiet sense that it was already too late to disagree. Out of conviction, convenience, or exhaustion, even the architecture seems to comply. In the cracks, the wind whistles like a rule, marking the beginning of winter.

The concrete of the Centre International de Conférences Genève carries no trace of grandeur. It shows wear. Straight lines. A canopy far too wide for the modest flow of people.

Above it, the name stretches in cold lettering — CIG. Above that, a colorful COP11 banner attempts to manufacture celebration, where everything insists on protocol.

The regime does not announce itself with grandeur. It announces itself with normalcy.

It was there, between the faded screen and the canopy, that something less modest took place. Something the translucent badges and the sobriety of blue, white, and gray folders never quite disclosed.

Delegates passed in silence, in trios, in pairs — steps short, measured, almost solemn. Golden pins placed with geometric precision on lapels. Hair buns pulled tight enough to stretch skin. Ties centered with bureaucratic vanity, to the millimeter. Polished leather shoes with discreet soles glided over thick carpet, muffling the sound of everything.

An aide adjusted his headset even outside the room. A staff member folded papers as if folding a flag. In the background, a technician powered down the conference totem, switching off one light at a time, until only the blank screen remained, as if erasing a name with tweezers, letter by letter, leaving no trace.

Everything looked provisional. Nothing was.

Millions of deaths; billions of dollars

Between November 17 and 22, 2025, Geneva hosted the Conference of the Parties to the World Health Organization’s global treaty, a legal instrument that, for over two decades, has shaped fiscal, health, and regulatory policies on everything related to tobacco and, more recently, nicotine.

A conference that reads as technical. But one that regulates gestures, rhythms, and routines, even before it is understood.

Almost every country in the world has joined the Convention. Together, at least on paper, they manage an epidemic that kills around eight million people a year and circulates hundreds of billions of dollars in taxes, profits, and illicit trade.

In theory, the COPs present themselves as technical meetings: delegates lined behind color-coded nameplates, interpreters enclosed in glass booths, decisions sealed by consensus and crystallized into discreet documents titled in legal English.

On the stage of neutrality, the paper is clean and clear. The bodies backstage are not.

It’s enough to watch the subtext of restrained gestures. The weight of the headset on the ears, the way the body learns not to react in public, to sense what’s at stake: the daily future of countless lives, and what may be sold, smoked, vaped, taxed, or banned across much of the planet.

The COP is not merely a forum. It is the apex of treaty decision-making that cuts through multibillion-dollar economic chains and regulates habits inscribed in billions of bodies.

The path to the entrance offers no spectacle. It offers sidewalk.

Between the body and the canopy, there is a corridor of asphalt and dry leaves, a passage where the body crosses from the common world into the space of governance, standardization, and control. Yellow scattered across the ground. Nearly bare branches. The building ahead rises like a concrete block, heavy, slow, unwelcoming.

To the right, cars aligned with the discipline of the curb. To the left, vegetation already bowed to winter.

The event begins there, before the door. The world narrows, grows straighter, grayer, more administrative.

Life is being arranged into a path. One foot after the other. One badge after the other.

As I reach one of the side exits, I think of the precise choreography of the final documents; decisions recorded as unanimously approved, with no trace of dissent, no mention of internal tension.

I think of a policy refined in a lab. And then I remember the delegate who had crossed my path just minutes earlier, wearing the blank stare of someone who has spent hours in closed sessions. He paused, just for a second, as if calculating the presence of an invisible camera, and said, in a low voice:

“I’m forbidden to speak to the press.”
Forbidden.
The word clung to his coat.

Outside is the Farthest Place in the World

I walk beyond the perimeter of the badges. And the world reappears in simpler signs, less ambitious, more honest: tracks, timetables, signals. People meeting. People returning from the week’s shopping.

The tram stop remains in the exact location. Indifferent.

An orange train pulls in and departs with the regularity of something that doesn’t need a plenary to function. On the asphalt, the imprint of a bicycle. On a pole, a blue sign with the figure of an adult and a child, a pictogram of care that requires no consensus, produces no report, and becomes no directive. It simply signals what already exists. And keeps existing.

Out here, politics becomes this again: movement, fares, hurried steps, shopping bags over the forearm, cold hands, time measured in minutes. Inside, they debate “emission,” “product,” “regulation,” and “prohibition.” Out here, the body just wants to arrive.

Less than three hundred meters from the main entrance, already beyond the event’s geometry, another building displays its mission with no subtext: UNHCR, in large blue letters on a curved façade. United Nations High Commissioner for Refugees, written at the top. Physical proximity only shortens the moral distance. So it can be exposed. Institutions can be neighbors and still inhabit ethically separate worlds.

The wind doesn’t know the difference.

Henri Smokes and Doesn’t Read Resolutions

It’s in this stretch of the city, between signs and institutional facades, that I meet Henri. No badge on his chest. Just a body exposed to the cold and to the rules. An invisible part. A French-Maghrebi worker in a cheap jacket, a lit cigarette between his fingers, waiting for the tram. The pack appears and disappears in his left hand like an informal document.

I strike up a conversation at the stop. He answers kindly, without the trained reflex of no comment.

I say — more out of habit than necessity — that I’m heading to Cornavin. I mentioned that I had just come from a conference organized by the WHO. Henri has never heard of the FCTC. When I say COP11 and gesture toward the cigarette between his fingers, he looks at me with mild curiosity, like someone watching an aquarium.

But he smiles when I say I’m from Brazil, more precisely, from the deep south, the same city as Ronaldinho Gaúcho.

Then he shows his teeth and bursts out:
— Ronaldinhooo… ufff… il est ouf!

Diplomacy, for a moment, becomes a joyful caricature.
It doesn’t last.
The cold returns.

The pack Henri holds no longer costs what it once did. Prices have climbed — along with taxes, illness rates, warnings, and the quiet cost of habit. Charts follow, filled with numbers no one reads aloud. He knows, with the indifferent lucidity of someone with little room to choose, that smoking is harmful. He shrugs. Inhales deeply. Exhales into the frozen air.

Four dark-tinted vans cross our field of vision in the opposite direction, perhaps en route to some diplomatic mission. They pass without the sound of voices, as if the city had opened a corridor.

Henri stubs out his cigarette with the sole of his shoe. I, instinctively, keep my vape hidden between my phone and the palm of my hand. A small act of concealment. A small piece of theater.

The scene ends with a detail COP would ever record in their minutes, but that explains everything. At the entrance, a metal ashtray overflows with crushed cigarette butts: flattened filters, damp paper, accumulated ash. In the background, blurred, the colorful “COP11” logo floats like a clean seal over a dirty remainder. The image is indecent and simple: the regime debates public health in abstraction; the body leaves residue on concrete.

Silently, I send a nod to Edoxie Allier — for the photo.
Henri boards the number 8. I wait for the 5.
The bus comes. Mont Blanc remains.
We inhabit dead zones, dissolved into data packets.

And the question before the dinner now is not metaphysical, it’s logistical: What does normative language actually reach, once the substance is already on the ground?

Next: When gesture ends, structure begins. Part 2 examines how language hardens into architecture and how, behind ritual, a system builds its walls.

The cell reacts. But to what, exactly? In a critical review, two researchers propose that a portion of preclinical studies may have tested not human use, but a state of overheating: an aerosol generated when the device exits its stable operation, something users describe as unpleasant and tend to avoid, but which, in standardized protocols, may end up being treated as representative of the habit.

A high-powered vaporizer (the sub-ohm kind, used in direct-to-lung mode) should not be mistaken for a generic “e-cigarette.” It’s a small, high-precision machine sensitive to two variables that determine its fate: whether to evaporate or degrade. Air and liquid, or the unstable balance between them, decide everything.

A coil heats a cotton wick soaked in e-liquid. The aerosol, in turn, doesn’t arise automatically. It’s the result of a continuous negotiation between heat and moisture replenishment. A kind of precise pact, balancing the avoidance of overheating with the preservation of equilibrium.

The agreement is simple: enough airflow to dissipate heat; enough wicking to keep the cotton moist. But when either condition fails due to misadjusted power or airflow, delayed liquid replenishment, or a protocol that imposes low flow rates on a device built for voluminous draws, the nature of the “vapor” shifts.

Instead of efficient evaporation, the system begins to operate at the edge of overheating. The aerosol ceases to be a mere proxy for use and, however unintentionally, begins to undergo thermal degradation.

Airflow passes through the coil assembly during the puff and prevents heat from accumulating like a fever with no escape valve. Wicking is the other half of the thermodynamic pact: the cotton’s ability to reabsorb e-liquid quickly enough to avoid drying out.

But this balance is fragile, always near collapse. Increase the power and restrict the airflow, or, in the lab, keep flow rates below what these devices require, and the “optimal” operating point shrinks dangerously. The cotton dries out, the coil begins to boil abnormally, and the chemistry reconfigures. Carbonyl compounds, including aldehydes, tend to emerge signaling that the transformation has shifted from the physical to the molecularly suspicious.

Users have a name for the moment taste exposes failure: dry puff. A burnt-tasting draw described as repulsive and invasive, and consistently avoided. But what the body rejects, the protocol accepts: in the lab, the puff is imposed, uninterrupted, immune to discomfort.

It’s in this dissonance between engineering and sensation that a device pushed out of stable operation, generating a failure-mode aerosol, that Sébastien Soulet and Roberto A. Sussman ground their critique of experimental literature. It’s not just a question of technical parameters; it’s a matter of listening to what taste is trying to say.

In their article, Critical Appraisal of Exposure Studies of E-Cigarette Aerosol Generated by High-Powered Devices, published in Contributions to Tobacco & Nicotine Research in December 2025, Soulet and Sussman don’t attempt to answer the question that usually dominates public debate: “Is it harmful?”

They don’t track people, build cohorts, or estimate population-level risk. What they do is more modest and, for that reason, more unsettling: they examine the method.

They treat the aerosol as what it truly is in preclinical studies: the experimental agent. And they ask the essential question: Does what some labs generate to expose cells or rodents physically correspond to what a human user would plausibly inhale? Or is it just a protocol artifact produced by pushing a device beyond its stable regime?

If they’re right, the consequence isn’t a moral verdict, it’s a validity problem. A hypothesis haunts the literature: what if part of what’s being measured isn’t human behavior, but the collapse of a machine?

Soulet and Sussman show consistent evidence suggesting that some of the literature may be measuring machine failure and interpreting it as human behavior.

Their target is deliberately narrow: preclinical exposure studies with recurring experimental setups and specific mechanical limitations. They’re not “re-evaluating vaping” as a population phenomenon. They’re asking, with surgical precision, whether the experimental agent as produced in specific protocols still deserves that name.

The question that frames the article is simple, technical, and almost bureaucratic. But it carries, quietly, a shock: what, exactly, enters the exposure chamber when a study claims to be testing “vape”?

The answer Soulet and Sussman suggest shifts the debate from the moral to the mechanical. In the article, they observe that although consumer use has “overwhelmingly” shifted to low-powered pods and disposable devices, high-powered sub-ohm models remain common in preclinical studies.

Many of these studies employ protocols derived from CORESTA RM81—or close variants—that operate at flow rates of approximately 1 L/min. For a pod, that may be a defensible starting point. For a high-powered sub-ohm device, it may be something else entirely: a setting that narrows the stable operating window and nudges the system toward overheating.

This doesn’t make testing extremes invalid. But it makes it untenable to treat them as normative, or to describe them without making clear the physical regime under which the aerosol was generated. At that point, the error is not merely technical. It’s interpretive.

One Liter per Minute

The article’s technical target is a structural flaw in standardization: when a ruler designed for one type of device becomes a universal rule. In practice, the CORESTA RM81 protocol specifies three-second puffs of 55 milliliters, spaced thirty seconds apart, under constant airflow.

Soulet and Sussman’s critique starts with a detail that seems minor, until it becomes physics: fifty-five milliliters over three seconds equals roughly eighteen milliliters per second, or just over one liter per minute.

For some devices, that’s just the norm. For others, especially high-powered sub-ohm systems, that rate acts as a choke point: it reduces thermal dissipation, narrows the stable operating window, and pushes the system toward the edge of overheating.

At that point, the ruler stops measuring. It starts distorting.

This is why the authors avoid talking “about vaping” in the abstract. Their scope is deliberately narrow, and precisely for that reason, interpretable. The paper focuses on a recurring experimental ecosystem: the InExpose/SCIREQ automated system, repeatedly paired with a single mod—the JoyeTech E-Vic Mini, often running a 0.15 Ω sub-ohm coil.

This isn’t a survey of e-cigarette toxicology writ large. It’s an audit of a specific subset, where the repetition of experimental setups allows for one straightforward question: what kind of aerosol does this method tend to produce?

It’s in that plumbing, not in some abstraction about “vaping”, that the authors locate the critical bottleneck.

The InExpose system, they argue, has a physical ceiling: an instantaneous peak of 1.675 liters per minute, which, over two- to four-second puffs, translates into practical flows between 1 and 2 L/min.

That limit is not an engineering footnote. It’s the line dividing two operational regimes.

With sufficient air, the device behaves as designed: it dissipates heat, maintains thermal stability, and produces consistent vaporization. With insufficient air, it enters a failure mode. The aerosol no longer carries the signature of use; it bears the thermal mark of a system in overheat.

The critique hinges on a point that the authors emphasize: for certain high-powered sub-ohm devices, airflow levels typical of protocols such as RM81 are not merely “low”. They are physically insufficient.

In earlier work, now revisited, they argue that much higher flow rates—on the order of 10 L/min—are required to generate aerosols without inducing device overheating or spiking carbonyl emissions. In this article, that figure isn’t offered as a preference or opinion. It’s framed as an operational threshold, a minimum condition for thermal stability and experimental validity.

When comparing calibrations at 1.1 L/min and 10 L/min, the critique stops being abstract. With more airflow, they argue, thermal efficiency improves, the device stabilizes, and its behavior becomes more predictable.

Even the numbers shown on the mod’s display (voltage, wattage) start to more accurately reflect what’s actually happening at the coil. That level of airflow also aligns with direct-to-lung design: a usage style built on large-volume puffs and low inhalation resistance.

The appeal of the argument lies precisely in its polarization resistance: it’s not moral, it’s mechanical. Too little air, too much power, and low resistance, and the stable operating window shrinks.

In the article’s own vocabulary, the “optimal regime” is one where the mass of vaporized e-liquid increases roughly linearly with power. When that curve breaks its linearity, a low-efficiency thermal regime begins. And that’s when, they claim, carbonyl compounds—like aldehydes—tend to spike sharply.

What the Cell Sees

If the aerosol is the experimental agent, then it, not the study’s title, is what biology responds to. And that shifts the question entirely.

Before discussing “toxicity,” the authors argue, we must ask: what, exactly, was generated to provoke that cellular or animal response?

In the paper, Soulet and Sussman state that, in addition to ten studies they consider virtually irreproducible, at least 31 of the 41 analyzed show signs, direct or indirect, that organisms were exposed to overheated aerosols rich in aldehydes.

A profile not born of randomness, but of a technical pattern: high power, low airflow, low resistance: the triad that steers the experiment into failure mode.

They identify two additional issues that, on paper, may appear to be minor adjustments but critically alter both the dose and experimental realism.

In three studies, aerosols were generated using e-liquids with 30, 36, and 50 mg/mL of nicotine. A choice which, according to the authors, distorts the usage profile: such high concentrations are typical of low-powered devices, not mods running at high wattage.

The result, they claim, is an unrealistic overexposure, both in vitro and in vivo.

The second red flag is the detection of carbon monoxide in the exposure chamber. For the authors, this is unequivocal evidence of advanced overheating, with pyrolysis and oxidation affecting the cotton wick.

This not only compromises the experiment’s thermal profile but also suggests the release of additional byproducts from the cotton, polluting the aerosol and contaminating the experimental agent with residues not present in typical use.

The most delicate move is how Soulet and Sussman link scattered studies to a single conclusion, even when methodologies are poorly described. They built that bridge using two tools: operating curves and calibration curves.

In the operating curves, they argue that under 1.1 L/min airflow (the CORESTA regime), the “optimal regime” for the E-Vic Mini with a 0.15 Ω coil compresses into a narrow range: between 15 and 30 watts.

According to the authors, 30 watts delivered (approximately 35 W on-screen) marks the upper operational limit of that regime. Beyond that point, the device overheats, with signs of film boiling and an exponential increase in aldehyde emissions.

They add a detail that acts as both a sensory anchor and narrative pivot: this transition, they say, would be felt by users as an aversive sensation, something the body learns to avoid, but which the protocol fails to detect.

It’s in the second piece, calibration, where the blow to screen-read trust lands hardest. The paper reports significant discrepancies between the power displayed by the mod and what actually reaches the coil.

In one example, 4.2 volts on-screen corresponds to just 2.85 V measured, yielding 41 W of actual delivered power.

When examining the range of conditions reported across the reviewed literature, the authors observe that real power tends to “touch the ceiling” between 40 and 46 W.

In studies conducted under temperature-control mode, that range is associated with relatively stable, but high temperatures: near and sometimes above 300 °C.

It’s in this overlap, 40 to 46 W, under airflow deemed insufficient, that their critique crystallizes: part of what has been labeled “vape aerosol exposure” may, in practice, be exposure to aerosol generated outside the optimal regime already in the overheating zone.

The Method That Leaves No Trace

The “failure-mode aerosol” thesis makes for a strong headline. But the argument that lingers, and is harder to dismiss, is drier. In many of these studies, the method leaves too little behind for another lab to reproduce what was actually generated.

Soulet and Sussman organize the 41 reviewed articles around a fundamental criterion: can we determine which device was used, which coil, and what power or voltage was applied?

In their taxonomy, “unknown” denotes that the parameters are entirely missing; the conditions are literally unknown. Such studies, they argue, are “completely irreproducible.” Looking at their table, they identify 14 studies at the top of the scale, labeled “Certain,” “Almost certain,” and “Suspicious”, that provide at least minimal information.

Of the remaining 27, 16 offer partial clues that allow for some inference. The final 10 offer nothing at all. To the authors, these are “completely unreproducible”: a “serious methodological problem.” At that point, the issue isn’t whether the aerosol was plausible. It’s whether, in a significant share of the literature, the experimental agent can even be reconstructed.

The article pushes the critique a step further, into a more sensitive terrain: the scientific validation system itself. Soulet and Sussman call this informational void a serious flaw, one that renders a study “essentially unreproducible or impossible to replicate.” But their diagnosis goes beyond what’s missing in the papers. It reaches those who greenlight them.

To the authors, this recurring technical omission reveals a failure in peer review, with reviewers and editors “not attuned” to the physical detail that actually determines what kind of aerosol is being produced.

What’s at stake, they suggest, isn’t just an imprecise data point; it’s an error that shapes the experiment and passes undetected through validation.

There is, however, a significant concession, and here the narrative demands utmost rigor. The authors acknowledge they cannot state with “full certainty” what the operating conditions were in the 27 studies that fail to report minimal parameters. Instead, they speak of a “high probability” that the critique applied to the 14 better-documented studies also applies to the rest.

That inference rests on two elements: the similarity of the experimental setups and the fact that operating the InExpose system requires training, which leads researchers to replicate established procedures.

That fragility, that inference is not fact, becomes part of the argument itself: when the method is opaque, the literature becomes, by definition, difficult to audit. And uncertainty ceases to be an objection. It becomes the most reliable data point left.

The authors’ point is not that “standardization is bad.” It’s simpler, and more demanding: testing extremes is legitimate, even desirable in public health, so long as the paper calls them extremes.

The problem starts when the edge becomes routine by inertia. Or when the method is described so incompletely that the reader assumes representativeness where there was only convention.

If the aerosol is the experimental agent, what’s needed isn’t an adjective, but a schematic: applied airflow, coil type, delivered power (measured, not just screen-reported), puff profile. Without that, a biological result doesn’t lose validity for being “alarmist.” It loses validity for being unrecoverable. There’s no way to reconstruct what, in the end, was actually tested.

The Reach of the Critique and the Data

It’s easy to see why this paper might become a tool in the hands of harm-reduction advocates: it offers a technical key to question studies in which the analyzed “aerosol” may not represent plausible use, but the behavior of a device operating outside its stable regime.

If the exposure was generated under overheating conditions, the biological signals observed may be inflated, and the public debate, unknowingly, ends up arguing over an experimental artifact as if it were a consumer habit.

But the paper’s usefulness hinges on one essential discipline: resisting the temptation to treat it as absolution. Soulet and Sussman do not claim vaping is “safe.” What they argue, within a specific scope, is that there are concrete reasons to doubt the validity of some exposures, and especially how they were described.

The scope is narrow and deliberately repetitive: InExpose/SCIREQ, E-Vic Mini, and often, sub-ohm coils. The authors themselves note that this device architecture no longer reflects typical use. The E-Vic Mini was released in 2015 and is now described as “hard to find” and of “marginal” use.

By 2019, high-powered mods already showed low prevalence (6.3% among youth, 9.5% among young adults), and, according to the authors, these numbers have likely declined further with the rise of pods and disposables.

That weakens any easy extrapolation, and also reminds us that niches exist. And may deserve study, as long as the study clearly states what it’s doing.

The paper forces a practical question, one that precedes any regulatory slogan: when public policy leans on exposure studies, those studies must clearly declare what is being tested.

Is it typical use? Extreme but plausible use? Or a failure mode induced by lab parameters?

It’s legitimate to explore the edges. What’s not legitimate is to call the edge the center by inertia, or to describe it so incompletely that the reader assumes representativeness where there was only convention.

If this study leaves a legacy, it will likely not be a verdict on human risk, but a minimum technical standard of honesty, presented as a guideline.

The authors recommend pre-calibrating devices; state that the E-Vic Mini operates more efficiently and displays more accurate readings at airflow rates below 10 L/min, consistent with its direct-to-lung design; and suggest that, if the system remains restricted to low flows, experiments should avoid configurations that push it outside the Optimal Regime.

The moral, for regulators and journalists alike, is less about values than about method: be wary of firm conclusions when it’s unclear how the aerosol was actually generated, or when the experimental setup itself seems designed to trigger overheating.

In science, the most critical data point isn’t always in the graph. Sometimes, it’s in the setting just before it, somewhere in the air, the method allows through.

The technical critique discussed throughout this article is developed in detail by Dr. Sébastien Soulet and Professor Roberto A. Sussman in their paper, Critical Appraisal of Exposure Studies of E-Cigarette Aerosol Generated by High-Powered Devices, published in Contributions to Tobacco & Nicotine Research (vol. 34, no. 5, December 2025, pp. 202–221). DOI: 10.2478/cttr-2025-0019.

by John Keene

Love everything
Love the sky and sea, trees and rivers,
mountains and abysses.
Love animals, and not just because you are one.
Love your parents and your children,
even if you have none.
Love your spouse or partner,
no matter what either word means to you.
Love until you create a cavern in your loving,
until it seethes like a volcano.
Love everytime.
Love your enemies.
Love the enemies of your enemies.
Love those whose very idea of love is hate.
Love the liars and the fakes.
Love the tattletales and the hypercrits, the hucksters and the traitors.
Love the thieves because everyone has thought
of stealing something at least once.
Love the rich who live only to empty
your purse or wallet.
Love the poverty of your empty coin purse or wallet.
Love your piss and sweat and shit.
Love your and others’ chatter and its proof of the expansiveness
of nothingness.
Love your shadows and their silent censure.
Love your fears, yesterday’s and tomorrow’s.
Love your yesterdays and tomorrows.
Love your beginning and your end.
Love the fact that your end is another beginning,
or could be, for someone else.
Love yourself, but not too much
that you cannot love everything and everyone else.
Love everywhere.
Love in the absence of love.
Love the monsters breeding
in every corner of the city and suburb,
all throughout the soil of the countryside.
Love the monster breeding inside you and slaughter him
with love.
Love the shipwreck of your body, your mind’s
salted garden.
Love love.

Sometimes, the only honest way to survive is to sing hard, “as hard as life itself.”

That is the pulse running through Punks: New & Selected Poems, by John Keene: a book that refuses neutrality, that chooses combustion over contemplation, that turns archive into movement. It doesn’t merely gather decades of writing: it restages them as a living, insurgent, plural body.

Keene had already signaled his power in Annotations and Counternarratives. But it is in Punks that his voice reaches a turning point: more than an author, he emerges here as an archivist of the unnamable, a cartographer of what official history chose to forget — and what poetry, when sharpened, dares to remember.

With each page, the language shifts, as if shedding skin.

Form here is not ornament; it is a tool, it is a blade, it is music.

And what does it cut?

Silencing. Erasure. The comfort of fixed categories.

Keene summons an unruly chorus of Black presences, intimate and historical: bodies in bars, in bedrooms, in emotional trenches. These are voices that sing mourning without losing the rhythm of joy, that traverse AIDS and oppression with the same breath that claims love and desire. They are lovers, friends, ghosts. And no one here asks permission to fit into a single narrative.

There is, in fact, something of the ethics of harm reduction in this book: a radical listening to forms of life that endure even when wounded, that create beauty even when marginalized. Lives not seeking moral cure, but dignity and continuity.

Poetry here becomes, in many ways, a form of care. Not a care that domesticates, but a care that acknowledges the wound without trying to erase it, violate it, or silence it; it directs love toward the wound that holds pain and desire as inseparable facets of survival.

This is not a book about identity. It is a work that acts upon identity. That unsettles it. That insists: poetry doesn’t need to explain itself, it needs to exist. With thickness. With contradiction. With desire.

Punks does not describe history. It keeps it raw. And in doing so, it transforms it, as if wrapping it in a skin that is both resistant and radiant.

If I could, this would be the Christmas gift I’d give each of you.

Merry Christmas.

Only later did the moment begin to feel more significant. That lunch now seems less like a break in policymaking and more like a portal. Beyond that threshold lies a broader transformation, one that no longer centers on nicotine.

From Austria to Mexico, from Norway to the Philippines, governments under radically different political systems are quietly reshaping nicotine public health. Not to compare risks or expand care for smokers, but to mold behavior, redesign markets, and shrink the space for autonomy, health education, and informed decision-making.

Once the pattern becomes visible, prohibition reveals itself as only one instrument among many. Where bans fail, the state monopolizes. Where markets resist, they are engineered. Where products persist, information is withheld. And where uncertainty reigns, the future itself is legislated.

A deeper question, rarely raised in global media, haunts this transformation: whose interests are being protected, and at what cost?

Which classes and industries stand to gain?

Which forms of consumption remain tolerated, regulated, and profitable, and which are rendered invisible or criminalized?

« The vape is now viewed not as a risk to be managed, but as something to be eliminated.

On the afternoon of December 9, inside Mexico’s Chamber of Deputies, no specific product was under debate. There were no bottles, no devices, no brand names on the table. What was being approved was something more abstract. And far more ambitious. A new revision of the General Health Law would now ban technologies, mechanisms, and systems designed to vaporize or atomize inhalable substances, including those that do not yet exist.

That same week, thousands of kilometers away, the chairman of Tajikistan’s upper house of parliament posted a message on Telegram. In just a few lines, he announced he had issued “specific instructions” for parliamentary committees to prepare a total ban on the use, production, and circulation of electronic cigarettes. There was no bill. No study. No debate. The decision came before the text.

In Europe, the tone was different: more restrained and more technical.

In Spain, the national competition authority urged the government to consider “less restrictive alternatives” before banning disposable vapes. In Norway, a supranational body pointed to an uncomfortable fact: the country bans nicotine vapes, yet 6% of the population reported using them in 2024. If the ban has been in place for years, what exactly is it protecting?

The political regimes differ. So do the institutional languages.

But the movement is eerily similar.

From Vienna to Manila, from Hanoi to Cardiff, governments are redrawing their nicotine and alternative product policies not to reduce risk, but to redefine what may exist, what may be said, and who may choose.

Sometimes, through outright bans. Sometimes through state monopolies. Sometimes, through advertising restrictions. And sometimes, by legislating the future for generations to come.

The immediate object may appear to be the vape. But what’s at stake is something much larger. What is emerging globally is not a coordinated policy against vapor products, nor a uniform response to new scientific evidence. It is something quieter and more serious: the transformation of public health into a technique of governance.

Instead of focusing on comparing risks, identifying uses, and responding to genuine behaviors, many governments have begun using the language of public health to pursue other goals: moralization, market regulation, social discipline, discourse management, and the proactive governance of the future.

Harm reduction, pragmatic and imperfect, is giving way to symbolic solutions: legally expansive, politically comfortable. This is not merely about banning products. It’s about governing (the possibility of) choices.

It is this shift, from measurable risk to acceptable conduct, that connects countries as different as Mexico, Vietnam, Austria, the Philippines, Norway, Spain, Zambia, and Tajikistan.

The vape is merely the thread. What arises is a new repertoire of power, exercised in the name of health, but not always guided by it.

Mexico and Tajikistan

Prohibition as Erasure: The Ban Before the Object

Some prohibitions regulate behavior. Others do something more radical: they deny the object's very existence. It is in this second category that Mexico and Tajikistan, through very different paths, now find themselves.

In Mexico, prohibition arrives cloaked in legal density.

The reform of the General Health Law does not simply ban existing devices or liquids. It forbids technologies, mechanisms, and systems designed to heat, vaporize, or atomize inhalable substances, with or without nicotine, including hypothetical future formulations that do not yet exist.

Gels, salts, waxes, dry aerosols, resin extracts, oily compounds: the list functions less as a technical specification than as an authoritarian political gesture.

The legislator is attempting to shut down the future.

In doing so, the authorities avoid the uncomfortable task of explaining why products with significantly lower levels of toxic exposure than combustible cigarettes should not be regulated, but instead eradicated.

The law does not ask what the relative risk is, for whom, or compared to what. It begins with a prior assumption: that specific categories of technological practice do not even merit the status of a regulatable object.

That is why products with and without tobacco, and with and without combustion, appear side by side, treated as equivalent threats. The problem is not the substance. It’s the gesture. Not the measurable harm, but the possibility of existence.

This logic, ontological before it is sanitary, is rare even in classical prohibitionist policy. Alcohol, illicit drugs, pesticides, and high-risk pharmaceuticals are all regulated based on gradations, exceptions, and limits of use.

In the case of nicotine technologies, differentiation is discarded as a principle. The prohibition is not a response to a concrete problem. It preempts the very possibility of alternative solutions.

In Tajikistan, the same result is achieved through a shorter route.

There is no legal text, no parliamentary debate, no public justification.

There is only a directive.

In a Telegram post, the chairman of the upper house announced he had given “specific instructions” for committees to prepare a ban on the use, production, and circulation of electronic cigarettes.

Before the law comes the decision. Before the decision, nothing. Here, public policy is not born from data, nor from a choice between alternatives. It emerges as an act of authority.

The language is revealing: it does not speak of regulating, limiting, or controlling. But of eliminating from legitimate space. Public health operates as a command language. Not as a field of deliberation.

In both cases, through radically different degrees of institutional sophistication, the effect is the same. The vape is no longer treated as a dangerous object to be governed, but as something that should not exist.

The question of effectiveness, whether prohibition reduces consumption, shifts markets, or changes behavior, becomes irrelevant. The goal is not to manage risk. It is to declare moral boundaries.

When public policy operates in this register, evidence ceases to be central. What matters is the assertion of power. And once the state decides something cannot exist, any subsequent discussion of harm reduction, adult use, or comparison with smoking begins to sound like a technical heresy.

Vietnam

The Ban That Exports ‘Risk’

If in Mexico and Tajikistan the state decides that certain products should not exist, Vietnam offers a more precise, and perhaps more cynical, message. The products may exist. They just shouldn’t circulate among Vietnamese citizens.

Amendments to Vietnam’s Investment Law prohibit the manufacture, import, sale, and domestic use of vapor and heated tobacco products. So far, the script is familiar. What makes the Vietnamese case revealing is what follows: the same law explicitly authorizes production for export, provided that companies register within a specified administrative window.

The contradiction is not accidental. It is the key to interpreting the entire policy.

If the product were intrinsically unacceptable from a public health standpoint, exporting it would be unthinkable. If the concern were harm reduction, domestic regulation would be inevitable.

By permitting export and prohibiting internal use, the state implicitly acknowledges that the issue isn't the risk itself, but rather who assumes it and where.

Public health here does not function as a universal principle. It operates as a territorial instrument. The risk hypothesis used to justify non-regulation does not change when it crosses borders. Nicotine does not become less active abroad. What changes is the political calculus.

Vietnam protects its domestic narrative of health vigilance, avoids internal cultural friction, and simultaneously preserves revenue, industrial jobs, and foreign trade relationships.

This is not incoherence. It is political economy in its purest form.

This choice reveals something essential about the contemporary use of public health discourse: it need not be consistent. It needs to be functional.

By separating internal consumption from external production, the state signals virtue at home and pragmatism abroad. Health becomes a moral shield; trade, the real architecture.

There is also a revealing institutional detail.

Rather than operating primarily through health legislation, the government amends the Investment Law. In doing so, it shifts the debate from individual behavior to production structure. The product is not regulated. Investment is blocked.

It is a particularly effective form of prohibition: it acts before a regulated market can emerge and before domestic actors can gain enough political strength to contest it.

The timeline reinforces this reading.

The requirement for prior registration, coupled with an effective date only in 2026, creates a controlled transition window. This is not a response to a crisis. It is a planned reorganization. Here, time itself becomes political language. The result is undeniable: domestic consumption is undesirable, invisible, forbidden. Export production is tolerable, profitable, and manageable.

And when public policy explicitly accepts that a risk is unacceptable for its own citizens but acceptable for foreigners, the health argument ceases to be an analytical criterion. It becomes convenient rhetoric.

Wales

The Future, Legislated Without Evidence

In Wales, prohibition neither denies the product’s existence nor exports the risk elsewhere. It does something more ambitious and more challenging: it legislates the future.

By approving the UK government’s Tobacco and Vapes Bill, the Welsh Parliament endorsed a legal innovation with no empirical precedent. Anyone born after January 1, 2009, will never be allowed to purchase tobacco products, including heated ones, legally.

It doesn’t matter how old they become. It doesn’t matter the context.

The ban is permanent, based not on behavior but on date of birth. It is the so-called generational ban, a long-term political and legal experiment that cannot be tested, corrected, or evaluated in the present.

The state is wagering today on outcomes that will only become visible decades from now, by which point reversing course would require admitting political failure.

This marks a profound shift in the logic of public health.

Historically, health policies regulate actions: smoking indoors, selling to minors, and advertising harmful products. Here, the unit of regulation is the person, classified by birth cohort.

Two adults with the same habits and risk profile will be treated differently simply because they were born on opposite sides of an arbitrary calendar line.

Beyond being normative, the problem is also methodological. There is no current evidence capable of demonstrating that a permanent generational ban reduces long-term consumption, avoids selective illicit markets, prevents unequal enforcement, or does not push users toward more harmful alternatives.

Public policy abandons observable data and begins to function as a form of regulatory faith.

And the bill goes further.

It grants the Executive broad, open-ended powers to restrict content, design, packaging, and sale of tobacco, nicotine, and vapor products, including devices and substances not yet on the market.

These powers are not accompanied by clear standards of proportionality or by explicit requirements for evidence-based review.

Public health policy shifts, quietly, from Parliament to government, from ongoing debate to administrative decree.

Another revealing element is the treatment of nicotine.

Nicotine pouches are rightly restricted when it comes to sales to minors. But the broader legal framing treats all nicotine as an undifferentiated problem regardless of delivery method or risk profile.

By automatically extending rules for nicotine vapes to non-nicotine ones, the bill makes clear that the real target is not the compound itself.

As we’ve seen throughout this series (Global Dispatches), the global target is not nicotine itself, nor the combustible cigarette, but the symbolic gesture historically associated with tobacco.

Curiously, it is not the most lethal form of nicotine that draws the harshest policy response, but its lower-risk alternatives. The cigarette endures not despite the crackdown, but often because it is familiar, taxable, and symbolically domesticated.

What unsettles regulators is not only the product, but the possibility of pleasure outside sanctioned frameworks. People enjoy nicotine, and that, too, is part of what is being governed.

But the most eloquent silence is elsewhere.

For years, the UK was a global reference for its pragmatic use of vaping as a smoking cessation tool, with explicit support from the public health system. That tradition has simply vanished from the current political framework.

The adult smoker, present, measurable, persistent, has ceased to be a subject of public health policy. He becomes an acceptable externality.

The exclusive focus on the “next generation” functions as a perfect rhetorical shield. Any questioning can be framed as indifference toward children. Moralization of the future replaces management of the present.

What Wales ultimately approves is not just an anti-tobacco policy. It is a model of public health that abandons risk comparison and bets on fixed moral categories. It transfers enduring power to the Executive and its transient agendas, all in the name of an idealized future that does not yet exist and therefore cannot answer back.

Austria

The State That Captures the Market

In Austria, public health manifests less through outright prohibition and more through the reorganization of the market under state control. It is a gesture that is less moralistic, more administrative, and, precisely for that reason, potentially more enduring.

In December, Parliament approved, as part of the 2026 budget law, the extension of the tobacco monopoly to nicotine pouches and e-liquids, while simultaneously launching a public consultation to ban disposables and impose strict technical limits on non-tobacco nicotine products.

These are not isolated moves, but elements of a single strategy.

By embedding the monopoly into budget legislation, a technical, low-visibility domain with no clear mechanisms for public oversight, the state produces a structural effect: Pouches and e-liquids are subject to the same administrative regime as cigarettes and are permitted for sale only through licensed tobacconists or authorized vendors.

Critics in the press have noted that this decision does not stem from new toxicological evidence, but from an older, more effective logic: If something cannot be eliminated, it can be captured. Consumption persists, but channeled through predictable circuits: fiscally traceable and institutionally controllable.

This kind of monopoly is not inherently illegitimate. In other contexts, it has been used to reduce harm and limit private abuse. It can be beneficial if accompanied by broad access, fair pricing, transparency, and fundamental mechanisms for social oversight.

Austria’s problem is not the existence of the monopoly, but its design: It emerges without robust public debate, without explicit health objectives, and without meaningful participatory channels.

In this arrangement, capture ceases to be a deliberate public health tool and becomes a form of opaque state curation.

The state not only regulates who sells, but also decides which products survive, in what formats, and at what cost, replacing market competition not with democratic governance, but with centralized administration: more fiscally predictable than rational from a health perspective.

The second move, the detailed technical regulation, completes the first.

The public consultation proposes a ban on disposables and the creation of a new legal category of “non-tobacco nicotine products,” subject to a specific set of restrictions: Maximum weight per unit, nicotine ceilings per gram, a closed list of flavor descriptors, and bans on ingredients like vitamins, caffeine, and taurine.

This goes beyond protecting against unknown risks. It is the microengineering of consumption. The state begins to define not just what can be sold, but how the body may absorb nicotine, in what amounts, under which sensory stimuli, and with what symbolic limits. Acceptable adult use ceases to be an informed choice and becomes a disciplined behavior.

But the central contradiction, rarely made explicit, is this: These measures primarily affect non-tobacco products, whose risk profiles are substantially lower than that of combustible cigarettes, which remain legal, widely available, and integrated into the same state monopoly.

The most lethal product stays accessible. Less harmful alternatives are captured, possibly restricted, made more expensive, and technically domesticated.

This is not incoherence. It is political coherence.

Cigarettes are known to be stable and predictable in terms of tax revenue. Alternative products are dynamic, technological, and challenging to fit into traditional control models.

The Austrian state appears to choose what it can administer, rather than what makes the most sense from a harm-reduction perspective.

This is where the Austrian model's sophistication lies. There is no war-on-drugs rhetoric, no explicit moral panic. There are precise numbers, elegant legal categories, public consultations, and budgetary instruments.

Public health functions as legitimizing language. Economic control becomes a permanent structure. Consumption is not eliminated. Risk may not be resolved.

What is decided, quietly, is who may sell, how they may sell, and what version of the adult user is deemed tolerable.

Philippines

Governing Speech, Managing Silence

In the Philippines, the state neither bans the product nor monopolizes the market. It does something subtler and potentially more effective: it subjects all to prior approval.

A proposed order from the Department of Trade and Industry requires that manufacturers of vapor products and so-called “novel tobacco products” obtain government authorization for any advertising or promotional activity at least 30 days in advance of its release.

At first glance, this appears to be a procedural adjustment. In practice, it marks a profound inversion of the regulatory paradigm. Until now, the logic was familiar: companies communicate; the state monitors, punishes abuses, corrects excesses.

The new rule reverses the axis. No communication can occur without government approval. All advertising is regarded with suspicion. The burden is no longer “not to deceive," but to convince the government to permit speech.

This is not just about regulating advertising but about establishing a system of prior approval for commercial speech, something that, in liberal democracies, is usually handled with great caution and implemented more subtly.

The requirement of advance submission creates a permanent mechanism of delay, uncertainty, and self-censorship. To inform becomes risky; to communicate, costly; to plan, a gamble. Decision-making power is concentrated in a “specialized office” within the ministry.

The draft, however, does not specify objective approval criteria, scientific standards, response timeframes, or appeal mechanisms.

This normative vacuum expands administrative discretion and enables decisions based not only on actual risk, but also on political mood, moral pressure, or institutional convenience.

The definition of “novel tobacco products” is deliberately broad: it includes any non-combustible substance, solid or liquid, that contains tobacco-derived nicotine or is used as a cigarette substitute.

This conceptual elasticity allows vastly different risk profiles, emerging technologies, and potentially useful cessation tools to be treated under the same bureaucratic filter.

There is no risk differentiation. No use differentiation. No audience differentiation. As in other countries in this series, the adult consumer disappears from the frame.

There is no mention of the right to information, the difference between persuasive and informative speech, or communication related to harm reduction.

By controlling advertising, the state determines which narratives may circulate, and thereby shapes which choices remain available.

The Filipino paradox is evident. In 2022, the country passed a specific law to regulate vapor products, with and without nicotine, implicitly recognizing that governing the market was preferable to banning it.

The new order does not revoke that logic, but it hollows it out.

Without formally banning anything, it creates an environment where existing in the public sphere depends on prior authorization.

It is a form of prohibition by attrition, a concept developed by Brazilian historian Henrique Carneiro to describe strategies that multiply practical barriers, administrative burdens, and daily frictions to disincentivize conduct without formally prohibiting it.

The product remains legal. But the conversation about it is monitored.

Public health no longer acts solely upon substances. It begins to govern silence.

Norway and Spain

When Some Law Still Resists

Amid the global expansion of prohibitions, monopolies, and discursive controls, some legal systems still generate friction.

Not because they promote harm reduction or reject public health discourse, but because they insist on what that discourse has increasingly avoided: proportionality, evidence, and comparison.

In Norway, this friction appears in almost clinical form.

The EFTA Surveillance Authority, which oversees compliance with European Economic Area rules, reviewed a proposal to maintain the ban on nicotine vapes and extend it to nicotine-free products.

The opinion acknowledges that states have leeway to adopt restrictive measures in the name of public health.

But it makes a devastatingly simple observation: Norway has banned the legal sale of these products for decades, and yet, 6% of the population reported using them in 2024. That amounts to around 150,000 people. The implicit question is unavoidable: If the ban has been in place for years, what exactly is it intended to protect?

In European law, good intentions are not enough. A restriction is only valid if it is necessary, proportionate, and effective in achieving its stated goal. By pointing out that use persists despite the ban, the authority shifts the burden of proof: prohibition is not evidence of protection.

A measure can coexist with the very behavior it seeks to eliminate and may even drive it underground.

The legal threshold becomes even stricter when the government proposes to ban nicotine-free products.

Without classical chemical dependence, the standard health rationale weakens.

The alleged risk becomes indirect, symbolic, or behavioral, the kind of justification that, within European legal frameworks, demands a concrete demonstration of necessity.

Invoking the protection of youth is no longer sufficient.

In Spain, dissent takes a different form. The National Commission on Markets and Competition does not block the government’s proposal to ban disposable vapes, nor does it defend vaping as a public health solution.

It simply recommends that the government assess whether “less restrictive alternatives” exist to a total ban.

The expression is bureaucratic, but its implications are profound. It reopens the space that the current debate seeks to close: policy comparison, impact evaluation, and risk differentiation.

Prohibition ceases to be a legitimate starting point and returns to what it should have always been: a last resort. The state is urged to demonstrate that regulation would be insufficient and that a ban is necessary.

The Commission also notes that many of these issues will soon be addressed at the European level, in the upcoming revision of the Tobacco Products Directive.

Banning now may entail later undoing, regulatory costs, legal uncertainty, and market distortions. European law, with its principles of coherence and proportionality, still imposes limits on prohibitionist enthusiasm.

The Architecture of Control

Seen together, these cases do not form an accidental mosaic. Countries with divergent political histories, legal systems, and regulatory traditions are nonetheless converging toward strikingly similar solutions.

Not because they share scientific evidence (it varies, is contested, or simply ignored), but because they share contemporary anxieties.

Anxiety about technologies that defy classical categories. Anxiety about dynamic markets, difficult to tax, and harder to control. Anxiety about adult behaviors that resist state, sanitary, and moral pedagogy. Anxiety about uncertainty itself: scientific, economic, social, political.

In response, a shift emerges in contemporary public health: It no longer operates as an empirical field for comparing risks, but as a legitimizing language for decisions already made.

The central question shifts: no longer “how to reduce real harm?” but rather, “how to render certain behaviors undesirable, invisible, or administrable?”

Responses vary across the globe, but they follow the same logic: to deny the object's existence, to externalize the risk, to legislate the future, to capture the market, to govern speech, or to displace debate beyond democratic reach.

What binds them is not vaping itself, but the replacement of imperfect, comparative, and revisable regulation with a moral management of risk: politically convenient, economically viable for select sectors, and empirically undemanding.