China’s ambition to collect a staggering amount of personal data from everyday citizens is more expansive than previously known, a Times investigation has found. Phone-tracking devices are now everywhere. The police are creating some of the largest DNA databases in the world. And the authorities are building upon facial recognition technology to collect voice prints from the general public.
The Times’s Visual Investigations team and reporters in Asia spent over a year analyzing more than a hundred thousand government bidding documents. They call for companies to bid on the contracts to provide surveillance technology, and include product requirements and budget size, and sometimes describe at length the strategic thinking behind the purchases. Chinese laws stipulate that agencies must keep records of bids and make them public, but in reality the documents are scattered across hard-to-search web pages that are often taken down quickly without notice. ChinaFile, a digital magazine published by the Asia Society, collected the bids and shared them exclusively with The Times.
This unprecedented access allowed The Times to study China’s surveillance capabilities. The Chinese government’s goal is clear: designing a system to maximize what the state can find out about a person’s identity, activities and social connections, which could ultimately help the government maintain its authoritarian rule.
Here are the investigation’s major revelations.
Chinese police analyze human behaviors to ensure facial recognition cameras capture as much activity as possible.
Analysts estimate that more than half of the world’s nearly one billion surveillance cameras are in China, but it had been difficult to gauge how they were being used, what they captured and how much data they generated. The Times analysis found that the police strategically chose locations to maximize the amount of data their facial recognition cameras could collect.
In a number of the bidding documents, the police said that they wanted to place cameras where people go to fulfill their common needs — like eating, traveling, shopping and entertainment. The police also wanted to install facial recognition cameras inside private spaces, like residential buildings, karaoke lounges and hotels. In one instance, the investigation found that the police in the city of Fuzhou in the southeast province of Fujian wanted to install a camera inside the lobby of a franchise location of the American hotel brand Days Inn. The hotel’s front desk manager told The Times that the camera did not have facial recognition capabilities and was not feeding videos into the police network.
A document shows that the police in Fuzhou also demanded access to cameras inside a Sheraton hotel. In an email to The Times, Tricia Primrose, a spokeswoman for the hotel’s parent company, Marriott International, said that in 2019 the local government requested surveillance footage, and that the company adheres to local regulations, including those that govern cooperation with law enforcement.
These cameras also feed data to powerful analytical software that can tell someone’s race, gender and whether they are wearing glasses or masks. All of this data is aggregated and stored on government servers. One bidding document from Fujian Province gives an idea of the sheer size: The police estimated that there were 2.5 billion facial images stored at any given time. In the police’s own words, the strategy to upgrade their video surveillance system was to achieve the ultimate goal of “controlling and managing people.”
Authorities are using phone trackers to link people’s digital lives to their physical movements.
Devices known as WiFi sniffers and IMSI catchers can glean information from phones in their vicinity, which allow the police to track a target’s movements. It’s a powerful tool to connect one’s digital footprint, real-life identity and physical whereabouts.
The phone trackers can sometimes take advantage of weak security practices to extract private information. In a 2017 bidding document from Beijing, the police wrote that they wanted the trackers to collect phone owners’ usernames on popular Chinese social media apps. In one case, the bidding documents revealed that the police from a county in Guangdong bought phone trackers with the hope of detecting a Uyghur-to-Chinese dictionary app on phones. This information would indicate that the phone most likely belonged to someone who is a part of the heavily surveilled and oppressed Uyghur ethnic minority. The Times found a dramatic expansion of this technology by Chinese authorities over the past seven years. As of today, all 31 of mainland China’s provinces and regions use phone trackers.
DNA, iris scan samples and voice prints are being collected indiscriminately from people with no connection to crime.
The police in China are starting to collect voice prints using sound recorders attached to their facial recognition cameras. In the southeast city of Zhongshan, the police wrote in a bidding document that they wanted devices that could record audio from at least a 300-foot radius around cameras. Software would then analyze the voice prints and add them to a database. Police boasted that when combined with facial analysis, they could help pinpoint suspects faster.
In the name of tracking criminals — which are often loosely defined by Chinese authorities and can include political dissidents — the Chinese police are purchasing equipment to build large-scale iris-scan and DNA databases.
The first regionwide iris database — which has the capacity to hold iris samples of up to 30 million people — was built around 2017 in Xinjiang, home to the Uyghur ethnic minority. Online news reports show that the same contractor later won other government contracts to build large databases across the country. The company did not respond to The Times’s request for comment.
The Chinese police are also widely collecting DNA samples from men. Because the Y chromosome is passed down with few mutations, when the police have the y-DNA profile of one man, they also have that of a few generations along the paternal lines in his family. Experts said that while many other countries use this trait to aid criminal investigations, China’s approach stands out with its singular focus on collecting as many samples as possible.
We traced the earliest effort to build large male DNA databases to Henan Province in 2014. By 2022, bidding documents analyzed by The Times showed that at least 25 out of 31 provinces and regions had built such databases.
The government wants to connect all of these data points to build comprehensive profiles for citizens — which are accessible throughout the government.
The Chinese authorities are realistic about their technological limitations. According to one bidding document, the Ministry of Public Security, China’s top police agency, believed the country’s video surveillance systems still lacked analytical capabilities. One of the biggest problems they identified was that the data had not been centralized.
The bidding documents reveal that the government actively seeks products and services to improve consolidation. The Times obtained an internal product presentation from Megvii, one of the largest surveillance contractors in China. The presentation shows software that takes various pieces of data collected about a person and displays their movements, clothing, vehicles, mobile device information and social connections.
In a statement to The Times, Megvii said it was concerned about making communities safer and “not about monitoring any particular group or individual.” But the Times investigation found that this product was already being used by Chinese police. It creates the type of personal dossier authorities could generate for anyone, that could be made accessible to officials across the country.
China’s Ministry of Public Security did not respond to faxed requests for comment sent to its headquarters in Beijing, nor did five local police departments or a local government office named in the investigation.
Randolph Health, a 145-bed community hospital in central North Carolina, declared bankruptcy in March 2020 and might have closed for good if it had not received $14.5 million in federal emergencypandemic grants. The cash didn’t cover all its covid-related losses, but at least Randolph could make payroll.
“Every penny of that was critical and we were just thankful,” said Reynolds Lisk, a former Randolph board member who was born in the hospital in 1957 and fought to save it. “It literally enabled us to continue to operate.”
The money flowing from Washington was barely enough to keep Randolph afloat — but those funds proved to be a windfall for Atrium Health, a regional nonprofit hospital chain headquartered in Charlotte. Atrium got$617 million in government relief from April 2020 to December 2021.The money, along with a soaring stock market and surging payments for patient care, helpedit reap more than a billion dollars in surplus revenue last year. Atriumbulked up with two mergers and announced plans for a third during the pandemic. It boosted its CEO’s compensation by 24 percent, to $9.8 million.
The vastly different experiences illustrate the unintended consequences of a $178 billion bailout that Congress dumped into the national health-care system at the start of the pandemicin an urgent attempt to keep hospitals and doctors afloat. Two years later, data show that the money indeed served as a lifeline for many hospitals that might not have withstood the onslaught of the coronavirus — but the funds also exacerbated the gap between the industry’s haves and have-nots, disproportionately rewarding wealthy hospitals that did not need the money as urgently. Many institutions reported strong profits and pursued growth strategies without pause.
Rhen Clark, a registered nurse, walks out of a patient's room in the intensive care unit at Randolph Health. (Allison Lee Isley for The Washington Post)
“The rich got richer,” said North Carolina State Treasurer Dale Folwell, a Republican who is a critic of the business practices of Atrium and other hospital chains in the state. “It’s a transfer of wealth to them from taxpayers.”
The hospital aid was part of nearly $6 trillion that Congress approved in three bills over the past two years as Washington scrambled to keep up with the pandemic. The loans, grants, direct checks and other emergency assistance added up to more than the entire federal budget in the fiscal year before the coronavirus arrived, creating a unique and lasting strain on policymakers to ensure that the funds have been put to good use. The investments helped respond to the virus and pull the economy out of its worst crisis since the Great Depression — but tracking it all down to figure out how it was used has emerged as a major problem.
Folwell’s office released a report Wednesday documenting hundreds of millions of dollars that North Carolina’s largest hospital systems accepted from the federalgovernment’s Provider Relief Fund, contrasting it with their strong financial performance during the crisis. Folwell said in an interview with The Washington Post that the hospitals should have plowed the windfall into more charity care, lowered prices or dipped into reserves to cover pandemic costs and sent the money back to the government.
Atrium said the money it received from the Pandemic Relief Fund was crucial to providing covid care, plugging holes in its operating budget and avoiding furloughs of medical staff at the peak of the crisis. Atrium used the money in innovative ways, it said, by creating a “hospital at home” program to care for covid patients remotely, and sending roving clinics into disadvantaged neighborhoods of Charlotte to provide tests and vaccines. It provided care to large numbers of low-income Medicaid patients, it said, even while experiencing sharp declines in revenue.
Atrium Health’s flagship campus in Charlotte. (Atrium Health)
“We turned off the tap on the revenue, and so those funds were what helped us to continue to deliver care to our patients,” said Christine Sibley, assistant vice president of reimbursement. “We were very fortunate that we were strategic enough to respond to the pandemic without affecting the quality of care.”
Hospitals were required to use the federal money for covid-related costs. But receipt of the money had a beneficial effect across their balance sheets, permitting hospitals across the country to log stronger profits and avoid serious damage to reserves of cash and investments, said Ge Bai, a professor of accounting and health policy and management at Johns Hopkins University who advised the North Carolina treasurer’s office in preparation of its report.
“Now that the dust settles, we realize many hospitals got more than what they needed,” she said.
North Carolina captures the effects in microcosm. Seven hospital systems in the state accepted a total of $1.5 billion in federal emergency aid, while collectively boosting their cash and investment reserves by an additional $7.1 billion, the state treasurer’s report said. Atrium had the largest reserve in the state by the end of last year, the report said, with a $9.3 billion stockpile. Relief fund rules prohibited using the money to pay executives earning more than $197,300 a year; Atrium paid its chief executive, Eugene A. Woods, with other revenue, the company said in a statement to The Post.
There’s little dispute that the$178 billion Pandemic Relief Fund, authorized by Congress in the CARES Act at the beginning of the health crisis in late March 2020, helped keep thousands of hospitals and physician practices across the country solvent in a time of extreme fiscal duress.
Enriquetta Clark, a certified registered nurse, uses a telemetry system to monitor the heart rates and rhythms of patients in the progressive care unit at Randolph Health. (Allison Lee Isley for The Washington Post)
The pandemic slammed hospitals financially by forcing a hiatus in surgical procedures and causing spikes in the prices of scarce supplies like personal protective equipment and ventilators. Hospitals worked around the clock on innovative but costly ways to deliver care in their communities, such as erecting tents for tests and vaccine sites in parking lots. Staff shortages added extraordinary labor costs, including overtime spending and paying expensive contract nurses.
Looking back, though, some hospital systems could have survived the pandemic by tapping into their deep reserves.
The initial federal bailout formula, hastily put in place by the Trump administration to help hospitals cope with these burdens, bestowed a disproportionate share on wealthier hospitals. Distribution of the first $50 billion was calculated based on each hospital’s 2019 Medicare billings and 2018 overall patient revenue, including payments from private-insurance companies, which pay the highest rates.
That put weaker safety-net hospitals, which serve higher numbers of uninsured people and low-income Medicaid patients, at a disadvantage. Medicaid typically pays hospitals less than Medicare and private insurance.
Randolph Health is surrounded by a mostly rural population in Randolph County that is poorer and sicker than the rest of the state, with high rates of diabetes and opioid addiction, and a higher-than-average percentage of Medicaid patients.
“The big boys got most of the money. Do you think these guys need more money? Come on,” said Michael Sarian, the hospital executive whose company, American Healthcare Systems, paid $10 million for Randolph Health last year in a bankruptcy auction. “They have all these excess funds. What are they going to do with them?”
Randolph Health in Asheboro, North Carolina. (Allison Lee Isley for The Washington Post)
The North Carolina Hospital Association said it would have been imprudent for its member hospitals to pay for emergency costs by dipping into reserves, which are important to maintaining high bond ratings that keeps the cost of borrowing low.
“I realize its politically sexy to talk about reserves, but the reality is that to do what the treasurer has asked would put that entire state bond rating in jeopardy,” said Cody Hand, senior vice president and deputy general counsel at the association.
Large, urban areas also saw disparities in the distribution of covid money. In New York, for instance, the gap between two large hospitals in the same Lower Manhattan neighborhood stand out, according to academic researchers at the University of Chicago, Rutgers University and Taipei University who published a study about the differences.
NYU Langone Medical Center — the flagship hospital of a health systemwith high numbers of private-insurance and Medicare patients — received $413,000 in Provider Relief Fund money per bed for its 1,468 beds, according to data the researchers supplied to The Post. Bellevue Hospital, which is run by the city and has a high Medicaid patient population, received $259,000 in relief money per bed for its 527 beds, the researchers found.
The government made the lopsided distribution even though NYU Langone is far wealthier. Using a common measure to compare hospitals’ relative financial health, the researchers found that NYU Langone had 118 days cash on hand, compared to Bellevue’s days cash on hand of less than one.
Other researchers have made similar findings. “Those that treated majority white, majority private-insured got more financial assistance than those that didn’t,” said Christopher Whaley, a policy researcher at the RAND Corporation and professor at the RAND Pardee Graduate School. The Trump administration in 2020 used a broad brush to distribute the cash rapidly, he added.
Some hospitals returned the money, notably, the for-profit chain HCA, which sent back $1.6 billion in Provider Relief Fund payments.
Later distributions were tailored to favor hospitals hit with the most covid patients, as well as those in rural communities and with large Medicaid populations. But those rounds of assistance were each smaller than the initial $50 billion, which automatically arrived in the bank accounts of hospitals and physician practices without even requiring an application.
“We knew the providers were experiencing dire circumstances and higher costs and losing revenue as a result of the pandemic, and this was a lifeboat to get them through this time period,” said Thomas Engels, the former Trump administration official who ran the agency within the Department of Health and Human Services that was in charge of coming up with a formula to distribute the money.
“Congress wanted us to get those funds out. The president wanted us to get those out right away,” Engels said. The agency that Engels ran, the Health Resources and Services Administration, consulted with the American Hospital Association and other prominent industry groups to devise its formula, he said.
The American Hospital Association, the Washington lobbying group for U.S. hospitals, responded to complaints about the Provider Relief Fund by noting that hospitals incurred extraordinary costs during the pandemic. The AHA has asked Congress this year to extend the deadlines for repayment of another form of aid hospitals received, advanced Medicare payments.
“Each hospital and health system came into the pandemic with their own unique financial situation. Moreover, each and every one of them played an integral role in caring for patients and protecting their communities,” the association’s president and CEO, Rick Pollack, said in a written statement.
“Cherry-picking financial data is not reflective of the many immense struggles and challenges facing the hospital field,” he said, “including a workforce shortage crisis, along with skyrocketing input costs for supplies, equipment, drugs and labor, and near-historic levels of inflation.”
Critics say the result was a bailout that helped large systems the most, enabling further consolidation.
“It increases the war chest to go buy up independent hospitals or provider groups … and the whole process gets even worse,” said Dale Owen, leader of a large physician group in Charlotte that broke away from being owned by Atrium and become independent.
Concentration of health care delivery in individual U.S. cities often fuels higher costs because it gives hospitals and their allied physicians greater negotiating clout; they can command bigger reimbursements from insurance companies, which is reflected in ever-rising insurance premiums, according to health care experts.
Atrium in 2020 completed a merger with Wake Forest Baptist to gain a coveted affiliation with a medical school and expand operations in North Carolina, South Carolina, Virginia and Georgia. In 2021, Atrium sealed its takeover of three community hospitals headquartered in Rome, Ga., agreeing to pump $650 million into the out-of-state facilities.
Registered nurse Charlotte Welborn administers intravenous antibiotics to a patient at Randolph Health. (Allison Lee Isley for The Washington Post)
Then last month, Atrium announced it intends to merge with Advocate Aurora Health, which operates hospitals in Illinois and Wisconsin, creating a national-caliber system that will serve 5.5 million patients at 67 hospitals.
Atrium calls these tie-ups “strategic combinations” rather than mergers, because Atrium is not taking ownership of the real estate and assets of its partners. It says the growth will improve the quality of patient care. Atrium helps the smaller hospitals in its system thrive by integrating care with its bigger flagship hospitals, it said.
“We are a backbone for those smaller organizations,” said Sibley, Atrium’s assistant vice president.
Similar dynamics played out across the country.
Yale New Haven Health System, which operates five hospitals in Connecticut and Rhode Island, reported in public-disclosure documents that it received $476 million from the Provider Relief Fund and federal emergency aid routed through the state. Its investment holdings rose by a billion dollars to $4.5 billion by the end of its last fiscal year. In February, it announced it plans to acquire three hospitals, in Waterbury, Manchester and Vernon, Conn., for an as-yet-undisclosed amount.
The covid relief funds “did not fully cover the intense costs associated with caring for patients so dramatically impacted by this pandemic over more than two years,” spokeswoman Dana Marnane said in an email. The health system’s expansion, she added, “delivered real value back to the communities it serves.”
Intermountain Healthcare, based in Salt Lake City, grew from 24 hospitals to 33 in five states with a merger completed this year. It received $220 million from the Provider Relief Fund. And Georgia’s Piedmont Health, which received $239 million in federal pandemic money, acquired seven hospitals in the Peach State. Intermountain and Piedmont did not respond to a request for comment.
Cody, at the North Carolina Hospital Association, said mergers are part of long-term strategies that are unrelated to the short-term finances of covid care.
“These nonprofit systems are looking for ways to spread their risk,” he said. “We were trying to figure out how to survive past covid.” He added that growth strategies are oriented to business strategies looking ahead 10 to 20 years and said the timing of mergers as Provider Relief Fund money rolled in likely was a coincidence.
With the Provider Relief Fund winding down, and the declining stock market this year, hospitals experienced a financial downturn in the first quarter, he said.
Randolph Health is among a dwindling number of independent hospitals in North Carolina. Its financial struggles can be traced to the economic decline of Randolph County: Furniture manufacturing and textile production, the mainstays of the economy for decades, moved overseas in the last quarter-century. Well-paying jobs dried up.
“It was death by a thousand cuts, as our economy got more difficult. People who had health insurance didn’t have health insurance any more,” said Lisk, the former board member. “About 25 percent of our patients were fully insured. The rest were either Medicaid, Medicare or nothing.”
The hospital’s geography also posed problems. Larger hospitals with advanced surgical capabilities and ones designated as trauma centers sit less than an hour away in Winston-Salem, Greensboro and Raleigh-Durham. They siphoned away patients for the most lucrative procedures. Randolph poured money into a new emergency room and cancer center in the past 20 years, but the debt for those improvements put a heavy burden on the bottom line. More than two-thirds of its 145 beds were empty on average in recent years.
Reynolds Lisk, a former board member at Randolph Health, stands for a portrait near the hospital’s visitors center. Lisk, who was born in the hospital, played a role in fighting to keep the medical center’s doors open. (Allison Lee Isley for The Washington Post)
Randolph couldn’t woo any merger partners, said Lisk. “They didn’t need to take on something that was going to be a cash drain to their system.”
The pandemic hit in early March just as Randolph Health’s lawyers submitted its filings in U.S. Bankruptcy Court in Greensboro. The threat of infection forced the hospital to curtail operations, including surgeries that could be rescheduled, cutting another $13.5 million out of its revenue in 2020 and 2021. Increased costs for personal protective equipment, drugs and staff drained another $5.5 million.
Now the community is rooting for Sarian, the new owner who won the hospital with a $10 million bid in a bankruptcy auction. To fuel his turnaround plan, Sarian will be using a combination of his own money plus part of a $20 million state pool for distressed hospitals. Saving the hospital would be easier if the federal government had distributed covid money more equitably, Sarin said. As it is, the cash from Congress for Randolph fell $4.5 million short of total covid expenses.
“It could have been a lot fairer to inner-city hospitals and rural hospitals,” he said. “The big systems, they don’t need the money.”
Last week, in the month of Pride (formerly known as June), President Biden signed an executive order directing his health and education departments to do everything in their power to encourage transgenderism among children and “promote expanded access to gender-affirming care.”
To justify this intervention, Bidenwarned of the alleged alternative: “so-called ‘conversion therapy’ — a discredited and dangerous practice that seeks to suppress or change the sexual orientation or gender identity of LGBTQI+ people.”
Biden is confusing a couple of things to be deliberately misleading.
In the late 19th and early 20th centuries, homosexuals were subjected to scandalous medical malpractice. Gays and lesbians were given sexual depressants, testosterone, estrogen, and electroshock therapy, and subjected to castrations, vasectomies, hysterectomies, and even lobotomies. Over time, such interventions were abandoned. By the latter half of the 20th century, the medicalization of homosexuality had ceased altogether, culminating in the American Psychiatric Association’s removal of it from the Diagnostic and Statistical Manual of Mental Disorders in 1973.
No one wants a return to this so-called conversion therapy. But the term is also used to describe talk therapy designed to assist patients who wish to mitigate or redirect unwanted sexual desires. This form of therapy might be abused (and has long been viciously attacked by the Left), but it isn’t wrong as such. Regardless, conversations between therapists and patients are covered by the First Amendment, and the government has no compelling interest to intervene in this matter one way or another.
Finally, the phrase “conversion therapy” has now, for ideological purposes, been widened to include therapiesdesigned to help gender-distressed patients feel more comfortable with their sex. This repurposing of the term is especially concerning when it relates to children, for whom watchful waiting and therapy are the best approaches. Instead, the advocates are pushing “gender-affirming care,” i.e., moving quickly to help “transition” patients to new genders.
One argument critics have traditionally made against trying to change a person’s sexual orientation through therapy is that doing such a thing is impossible. But the same people won’t apply their own logic to sex. We know with certainty that people are either male or female, “born that way.” Indeed, the methods of “gender-affirmative care” resemble the old conversion therapy. Experimental drugs and surgeries? Check. Sterilization and sexual dysfunction? Check.
Biden’s intervention comes as elements of the mainstream are beginning to acknowledge that all this might be a mistake, or at least that there’s a debate over it. Even theNew York Times, after years of ignoring skeptics of transgender orthodoxy, has published a piece acknowledging that “gender affirmation” isn’t quite the medical consensus it was made out to be after all.
Rather than heed such doubts, Biden has doubled down. He promises to take “steps to address the barriers and exclusionary policies” throughout the states. He is referring to laws such as Florida’s move against medicalized gender transitions for minors and Governor Ron DeSantis’s ban of Medicaid coverage for transgender treatments such as cross-sex hormones, breast removal, and genital surgery. Never mind that the Obama-Biden administration concludedin 2016 that “the quality and strength of evidence [for gender-reassignment treatments] were low” and that “there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria.”
Biden has, once again, allied himself with his side’s radical culture warriors, in this case in the service of a trans fad that, if there’s any justice, will come to be regarded as just as foolish and unwarranted as the long-abandoned practices that Biden used as a foil last week.
Smoking contributes to more preventable death than any other cause. Nicotine in cigarettes is addictive, but it is the burning of tobacco that releases chemicals that worsen health. To wean smokers off cigarettes, all nicotine substitutes should be welcomed, even if they pose some risk. But many US organizations, public and private, discourage vaping because they’re concerned children might try it and it might have cardiovascular risks.
But many studies show that vaping and other products are more effective at lowering smoking rates than gums and patches. Smoking is a ritual, and alternative vaping and heat-not-burn products simulate the act of smoking, without the burning of tobacco.
Yet many U.S. health groups, like the American Cancer Society, will only tolerate abstinence and medically provided nicotine patches and gums, viewing vaping skeptically with a zero-tolerance or ultra-precautionary approach. Official U.S. health policy does not actively encourage these products. The Food and Drug Administration has approved very few vaping products, denying hundreds of applications. The Centers for Disease Control is equivocal about the role of vaping in smoking cessation.
Britain, on the other hand, has adopted a more holistic approach to risk by acknowledging the possible risks of vaping and clearly explaining that smoking is 95% more dangerous than vaping. Indeed, government bodies such as Public Health England and the National Health Service (NHS) encourage the use of vaping in smoking cessation, even providing vaping to the poor to stop them smoking. The UK bans vaping for kids but wants new products that can help current smokers quit.
The difference in the policy approach of U.S. and UK governments is followed by the physicians in those nations. I undertook a survey of British and American physicians. Only 1 out of 23 U.S. physicians (4%) thought vaping was a legitimate part of smoking cessation policy, whereas nearly half (44%) of the 25 British physicians surveyed thought vaping could be part of smoking cessation policy.
This difference in policy advice and physician opinion matters. Some cities in the U.S. have banned vaping products because they think they’re associated with youth vaping. While it is true that young people do try vaping products, those that vape often do so instead of smoking. One of the few academic studies of these recent policy changes found that in San Francisco, smoking rates had risen following the vaping ban. This is simply the worst possible outcome from a public health standpoint.
The great social anthropologist and risk expert Aaron Wildavsky understood the fear of new products. As he explained, experimentation generally produces better and often safer products. Cars produced in 2022 are safer than those produced 20 years ago, which were safer than those produced in the 1980s. Per mile traveled driving has never been safer. That doesn't mean new cars are safe. As Wildavsky famously wrote, it is better to have “trial and error,” allowing new and potentially risky but often safer products to come on the market, than “trial without error,” denying the new because it might carry risk. In many ways, vaping is on trial in the U.S. Most new products are not being allowed on the market, and existing ones are being restricted and even banned.
But it is smoking that is the real danger, and vaping is far safer than smoking and therefore should be encouraged. Under 18s should not smoke or vape, but many will nevertheless find ways to try alcohol, smoking, or illicit drugs. Seasoned anti-smoking advocates have explained that, when looking for the lesser of two evils, it is better for kids to vape than smoke. While children shouldn’t do either, to ignore the lure of forbidden fruit drives naive public policy.
Unfortunately, very well financed anti-vaping groups seem to dominate advice and influence public policy. Bloomberg Philanthropies is spending $160 million to push for vaping flavor bans, and it considers the San Francisco ban a success. While it and other groups are obviously well intentioned, current and future smokers are at risk because safer alternatives to cigarettes are not available.
Roger Bate is a Senior Fellow at the Pacific Research Institute and author of the paper 'Vaping on Trial', published this week by PRI.
