Dr. Mark Tyndall’s Lucid and Urgent Gaze
Public Health, Harm Reduction, and the Imperative to Rethink It All
In his provocative essay Vaping: Behind the Smoke and Fears, Dr. Mark Tyndall dismantles myths, challenges dogmas, and offers a passionate — and rigorously documented — defense of harm reduction as a means to reshape the fight against smoking. More than a book, it is an invitation to shed ancestral fears and embrace a new public health paradigm — one where evidence prevails over stigma and compassion triumphs over condemnation.
For decades, the war against tobacco has been waged with an almost religious fervor, erecting public health monuments in a desperate attempt to mend the wounds cigarettes inflict on bodies and societies. Yet in this war, absences are not mourned, nor are the dead honored: they are lifeless bodies transformed into numbers, faceless data, orphaned statistics, footnotes stripped of the stories they once carried.
In our era, saturated with petrified certainties, impermeable dogmas, and fleeting complexities, Dr. Mark Tyndall emerges as an enlightened heretic. A Canadian physician specializing in internal medicine, infectious diseases, and public health, his career was shaped not merely in conferences or academic offices but at the margins, where HIV, addiction, and stigma weave invisible networks of exclusion.
Across the 204 pages of his newly published Vaping: Behind the Smoke and Fears (2025), Tyndall offers far more than a treatise on electronic cigarettes: he delivers a meticulous autopsy of the failures of contemporary public health — and with it, a legitimately bold proposal. Replace combustible cigarettes — the deadliest weapon in modern health history — with significantly less harmful nicotine alternatives. A manifesto for reason in an age of hysteria.
The Radical Ethics of Saving Lives
For three decades, Tyndall has witnessed the effectiveness of harm reduction: syringe exchange programs, methadone therapies, supervised injection sites. To him, vaping is neither a technological whim nor a passing trend, but the natural extension of this philosophy — a strategy that, far from condemning, accompanies and preserves lives.
With scientific rigor and humanist passion, his 204-page work unfolds an informed and nuanced defense of vaping as a public health tool. Tyndall neither glorifies vaping nor conceals its risks — he acknowledges that nicotine is addictive and that inhaling any substance carries costs — but he emphasizes that these risks are negligible compared to those of tobacco combustion, the root cause of the diseases that overwhelm cardiology, oncology, and pulmonology wards across the globe.
“We’ve created cardiac wards, stroke units, lung cancer centers, and specialized respiratory clinics largely to care for people who smoke cigarettes. The sad irony of these expensive facilities is that while they provide life-extending and sometimes life-saving interventions, they exist only because we’ve failed to eliminate smoking. They are proudly promoted and celebrated by governments, the medical profession, pharmaceutical companies, and the medical supplies industry while disease prevention is largely left to individuals, charities, and underfunded public health campaigns.”
One of the book’s most powerful threads is its dissection of the so-called “youth vaping epidemic.” Drawing on Stanley Cohen’s concept of moral panic, Tyndall dismantles the alarmist narrative that has colonized media, institutions, and political discourse since 2014. He recounts the specific case of a young Canadian — a bright student and athlete — suspended and ostracized for having vaped just once in his school’s bathroom. A brutal illustration of how zero-tolerance policies mete out disproportionate punishment, sowing fear where understanding should be cultivated.
Tyndall argues that the narrative of fear has had devastating consequences: it has obstructed adult smokers’ access to safer alternatives, perpetuating the cigarette’s dominance. Vaping, demonized as an alleged gateway to future addictions, has fallen victim to the same oversimplification that has clouded so many other debates in public health.
In chapters such as Public Health Leadership, Groupthink, and Apathy, Tyndall sharpens his most pointed critiques against his peers. He denounces the groupthink that, unable to distinguish between combustion and vaporization, mechanically replicates cigarette restrictions in the world of vaping.
“Vaping could reduce harm for the user and virtually eliminate risks for those around them,” he argues, refuting unfounded fears about secondhand vapor. Institutional negligence — fueled by political interests, fear of change, and pressure from large organizations — has not only delayed the acceptance of vaping as a legitimate harm reduction tool; it has condemned it to a regulatory limbo.
Tyndall draws a bridge between vaping’s present and the prohibitionist past. From the failed alcohol prohibition of the 1920s to today’s fentanyl crisis, he shows that prohibitionist policies do not eliminate risks — they multiply them. In the case of vaping, excessive bans not only restrict access to safer products but also fuel an unregulated black market, exposing users to liquids of uncertain composition and low-quality devices. The solution, he argues, lies not in repression but in smart regulation: controlled devices, guaranteed-quality e-liquids, and policies capable of striking a balance between protection and access.
A Matter of Survival
Perhaps Tyndall’s most provocative argument is framing access to vaping as a human right. Just as access to clean syringes or opioid substitution therapies extends the principles of dignity, autonomy, and effective public health, ensuring safer nicotine alternatives would do the same. “Promoting safer nicotine products can directly improve health outcomes that disproportionately affect disadvantaged populations,” he contends.
In what stands as his boldest prediction, Tyndall foresees that within less than twenty years, combustible cigarettes will become obsolete in high-income countries. He points to examples such as Sweden, Iceland, New Zealand, and Japan, where the combination of pragmatism, regulation, and harm reduction technologies has significantly reduced smoking rates.
Yet he warns that the future of vaping hangs by a thread, threatened by dogmatism, misinformation, and the stigma tied to its association with big tobacco. More gravely, he emphasizes that the prohibition of safer alternatives in much of the low- and middle-income world perpetuates a historic injustice: in societies where smoking remains entrenched, the most vulnerable are denied access to tools that could save lives. Thus, the fight against tobacco emerges not only as a public health challenge but as an urgent matter of social justice.
A Manifesto for Reason and Compassion
Critics have been generous with the book. Gerry Stimson, emeritus professor at Imperial College London, calls it “essential reading for anyone who wishes to see an end to the suffering caused by combustible cigarettes.” Professor Marewa Glover, from New Zealand, highlights its “urgency and scientific rigor,” while Clive Bates (photo) praises it as “a powerful chronicle of how a technological solution collided with a storm of misinformation.”
Indeed, it is hard not to praise this work for its rigor, urgency, and depth. But beyond the reviews, Vaping: Behind the Smoke and Fears stands as an urgent call to rethink the fight against smoking — to abandon punitive narratives and embrace real, human, evidence-based solutions.
In an age of viral misinformation, rigid dogmas, and simplistic certainties, Tyndall offers a nuanced defense of complexity — a hymn to compassion and a reaffirmation of science as a moral compass.
Perhaps, after all, the future of the fight against tobacco will not be written in the condemnation or isolation of those who smoke, but in the restoration of their dignity and the repair of a harm perpetuated by policies that chose to ignore and punish rather than understand.
More than a book, Vaping: Behind the Smoke and Fears is an urgent call to rethink public health through the lenses of human dignity, compassion, and evidence — an essential read for those unwilling to accept a future that merely repeats the mistakes of the past.
Vaping: Behind the Smoke and Fears by Dr. Mark Tyndall is a 204-page exploration of public health, harm reduction, and the urgent need to rethink traditional approaches to smoking cessation. Published on May 30, 2025, by Tellwell Talent (ISBN-10: 9781834182001), the book is available through major platforms such as Apple Books, Amazon, Barnes & Noble, and Booktopia.