A quotation commonly attributed to Albert Einstein defines insanity as repeating the same thing multiple times while expecting a different outcome.
Milton Friedman observed that, every so often, we should examine the results of policies, regardless of the good intentions behind them.
Regular listeners to the podcast may already be guessing where I am going with this. Thank you for your continued support. To our new listeners, welcome aboard. You are about to find out.
In June, I had the great privilege of attending and presenting at the Global Forum on Nicotine, an annual conference held in Warsaw. The conference focuses on helping people quit smoking.
Cigarette smoking remains the leading cause of premature death and potentially preventable illness worldwide. Approximately eight million people die each year from smoking-related illnesses.
It is important to acknowledge that there are no absolutes when it comes to the human body. Smoking is a major risk factor for heart disease, but people who do not smoke can still have and die from heart attacks. Similarly, people who do not smoke may still develop lung cancer.
However, we can increase or reduce our likelihood of developing certain conditions. Not smoking significantly reduces the risk of a considerable number of illnesses. This is why reducing smoking rates is such an important public health objective.
Government policies are generally introduced with that goal in mind. Smoking rates have fallen significantly since the 1960s, when it was estimated that as many as 70 percent of adults may have smoked. In many countries, that figure is now substantially lower.
During the 1980s and into the 1990s, Australia was highly successful in reducing cigarette-smoking rates. Australia was also an early adopter of policies such as prohibiting smoking in indoor venues and workplaces. Other countries subsequently followed suit.
As an aside, after the conference in Warsaw, I was fortunate enough to visit several other European countries for a holiday. In Greece, I saw something I had not encountered for many years: ashtrays on café tables. For obvious reasons, you simply do not see that in Australia anymore.
As I mentioned, Australian smoking rates had been declining. That is no longer the case, and the situation has become worse.
If the objective of government policy is to reduce smoking, we must acknowledge that smoking rates have now increased. Data from wastewater surveys and studies by the Australian Bureau of Statistics indicate that total nicotine use has also risen. This includes cigarettes and other nicotine products, such as e-cigarettes and vapes.
The situation becomes even more concerning. In 2025, an estimated 80 percent of the tobacco consumed in Australia was illegal, compared with 12 percent in 2017. That represents a nearly sevenfold increase in eight years.
The price of legal tobacco products has almost tripled since December 2016, largely because of tax increases. Tobacco taxes continue to rise every year.
There can be a role for what are sometimes called “sin taxes.” We also see these taxes applied to alcohol and gambling. However, there comes a point when the policy goes too far.
Australian Treasury figures reportedly show that the tobacco excise collected by the government is on track to fall substantially. Around the 2019–20 financial year, tobacco excise revenue was approaching $16 billion to $17 billion. In the most recent year, it was estimated to be approximately $9 billion, with projections suggesting that it could fall to $4 billion.
When the tax rate continues to increase while the amount of tax collected falls by approximately 75 percent, something is clearly not working.
When an estimated 80 percent of the market is illegal and illegal cigarettes cost roughly one-quarter of the price of legal cigarettes, it is hardly surprising that people turn to the black market.
Most people do not want to break the law if they can avoid it. We saw a similar pattern years ago with online piracy involving films and television programs.
Piracy declined significantly when streaming services became affordable and people could watch films and television programs at what they considered a reasonable price. As access became easier and more affordable, illegal downloading declined. It simply made sense.
There is a third aspect to consider.
First, smoking has increased. Second, government revenue has decreased significantly. This is occurring while the Australian government has increased taxes on productive Australians, and Australia now reportedly has one of the highest capital gains tax burdens in the world.
Despite this, the government appears willing to forgo more than $10 billion in annual revenue.
Meanwhile, the profits available to organised crime have become enormous, resulting in criminal turf wars. In many respects, Australia in the 2020s is beginning to resemble America during Prohibition in the 1920s.
We have seen firebombings, with the number reportedly approaching 200. These incidents have occurred primarily, although not exclusively, in Melbourne. There have also been incidents in Sydney, Adelaide, Perth, and possibly Brisbane.
These events have reportedly resulted in deaths. Neighbouring businesses also suffer the consequences, including property damage and difficulty obtaining insurance.
It would be difficult to design a worse system. The current approach has simultaneously contributed to increased smoking, reduced government revenue, and increased criminal activity.
Yet those with influence in major public health institutions appear to believe that everything is fine and that Australia is leading the world.
Australia may be leading the world, but it appears to be doing so in the level of criminal activity within the tobacco market and in the percentage of tobacco and nicotine products supplied illegally. I am not sure that this is an achievement worth celebrating.
For whatever reason, the minister also appears oblivious to the complete failure of these policies.
You could not make this up. What makes the situation arguably worse is that the government was warned that this would happen.
Rowan Pike, a former Australian Federal Police detective and Australian Border Force official, has reportedly said:
“The violence is now an old-fashioned turf war, and criminal gangs attracted by the profits are fighting to control distribution.”
The situation is obvious to anyone willing to examine it. People can draw their own conclusions about whether certain decision-makers are prepared to do so.
At the same time, Australia remains an outlier in its approach to vaping.
According to research commissioned by the United Kingdom government, vaping is estimated to be at least 95 percent less harmful than smoking.
If you do not smoke, do not start vaping. Fresh air is the best substance for your lungs. However, vaping is considered substantially less harmful than smoking.
Nicotine itself is not the principal cause of smoking-related disease. If nicotine alone were the problem, people would not be able to purchase nicotine patches, gums, and sprays from supermarkets.
These products are sometimes available in several flavours, particularly nicotine gums and sprays.
Nicotine is the addictive component for some people, and it is often the substance they are seeking when they smoke. However, smoking also exposes people to numerous harmful chemicals. Those additional chemicals contribute to many smoking-related illnesses.
We already have less harmful methods of delivering nicotine. However, for reasons best known to the minister, the relevant government department, and the public health establishment, placing the same nicotine into a vaping device is treated very differently.
Nicotine in other approved forms appears to be accepted, but when it is delivered through a vaping device, it is suddenly regarded as unacceptable.
To quote Rowan Pike again:
“The government’s policy has basically meant that we’re putting our health in the hands of criminals.”
That statement summarises the problem quite neatly.
There are solutions. Australia only needs to look across the Tasman Sea to New Zealand, where smoking rates are continuing to fall without the same level of associated criminal activity.
In New Zealand, it is not significantly more difficult to access vaping, a substantially less harmful alternative, than it is to access cigarettes.
I will also quote from an article by R. E. Ibrahim published on Reason.com, which we will include in the description:
“Australia is yet another cautionary tale of what happens when the government polices the personal choices of adults and opens up a new front in the war on drugs.”
Prohibition did not work in America during the 1920s, and the current approach is not working in Australia during the 2020s.
The solution, which we have discussed previously, is to make vaping legally and practically accessible.
Some people will point out that vaping is technically legal in Australia. That is true, but accessing legal vaping products is extraordinarily difficult. People who want to obtain legal vaping products face significant barriers.
Public messaging about the dangers of vaping has also discouraged many people from considering it as an alternative to smoking. Some people now believe that vaping is as harmful as smoking, or even more harmful. The available evidence does not support that conclusion.
Research has repeatedly indicated that vaping is one of the world’s most popular and effective methods of quitting smoking.
As I said before, the solution is relatively simple, and it is already working in countries where smoking rates are declining.
In Sweden, fewer than 5 percent of adults reportedly smoke. One factor is the availability of an alternative nicotine product called snus. I will not go into the details of that product here, but most people will choose a less harmful option when it is easy to access and unnecessary barriers are not placed in their way.
If Australia is serious about reducing smoking rates, policymakers already know what can be done. Other jurisdictions have demonstrated workable alternatives, and the potential solution is remarkably straightforward.
This issue could be resolved if there were sufficient willingness to do so.
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Dr Joe Kosterich – Doctor, Health Industry Consultant and Author
Doctor, speaker, author, and health industry consultant, Joe is WA State Medical Director for IPN, Clinical editor of Medical Forum Magazine, Medical Advisor to Medicinal Cannabis company Little Green Pharma and Course Chair, and writer for Health Cert. He is often called to give opinions in medico-legal cases, has taught students at UWA and Curtin Medical schools and been involved in post graduate education for over 20 years.
A regular on radio and TV, Joe has a podcast – Dr Joe Unplugged, has self- published two books and maintains a website with health information. He has extensive experience in helping businesses maintain a healthy workforce.
Past Chairman of Australian Tobacco Harm Reduction Association, current Vice President of Arthritis and Osteoporosis WA, Joe previously held senior positions in the Australian Medical Association and has sat on numerous boards.
