Dr. Joe Kosterich first took an interest in nicotine vapes when patients who struggled to quit smoking quit thanks to vaping. Then Australia made the products they relied on nearly impossible to buy legally. Shot on location at GFN 2026 in Warsaw, the Australian GP explains how restrictions drove vape sales into the black market, where consumers face unregulated products and criminal gangs fight for control. Kosterich argues that public health’s war on nicotine has lost sight of the people it was meant to help.
Featuring:
DR. JOE KOSTERICH
Physician, Health Industry Consultant
@drjoesDIYhealth
drjoetoday.com
Transcription:
GFN interview — Joe Kosterich on Australia's vaping policy
Global Forum on Nicotine 2026
Brent Stafford 0:00:05
So Joe, you're a physician from Australia. Tell us a little bit about yourself.
Joe Kosterich 0:00:11
So I'm a GP, a general practitioner. I think in North America it's called family physician, which essentially means you see people from zero to 100 and for pretty much any issue that they come in with. And I've been doing that for close to 40 years.
I've been fortunate to have involvement in a number of health businesses over the years, and that includes organisation and management of medical centres.
in some online businesses, in a business in the 2000s that developed and implemented health programmes on mine sites and more recently in the medicinal cannabis space as advisor to a little green farmer which is an Australian listed medicinal cannabis producer.
Brent Stafford 0:00:58
You're, as we call on this show, a doctor doctor. A real doctor.
Joe Kosterich 0:01:04
Actually see people, yes, as against academic studies. Yeah, fair.
Brent Stafford 0:01:09
So when somebody walks into your practice and they're a smoker and they're looking for help, what have you done in the past?
Joe Kosterich 0:01:17
Well, this is where I suppose my entrance into the vape space came when, and I think it was around about 2011, 12, 13. I can't remember exactly. And over a period of some months, I had a few people come into the surgery saying, oh, I've managed to quit smoking by vaping. And I'd not heard of it at this stage. You quit smoking by what?
And by the time you hear this, and these are people who'd struggled to give up smoking and had tried all the usual methods. And that sort of got me interested. Well, what is this and why haven't I heard about it?
And it was around about the same time that the state government, again, I think in Canada they call it provinces, but states like in the US, was launching action against a retailer for selling these vapes. And the maximum fine was $45,000.
And I had a regular radio guest segment with a gentleman named Paul Murray who was on the talkback station and he also took an interest in this and we started talking about it on air and he also regarded this as a ridiculous approach. that they were finding a business $45,000 for selling a product that could actually help people stop smoking. But you know, there it was.
And that sort of sparked my interest. And I looked into it further. And then through Tim Andrews, who's actually at the conference this week, I was introduced to a couple of doctors from the east coast of Australia, Alex Wodak, who gave the oration on Wednesday and Colin Mendelsohn, who's given a narration here previously.
And together we formed what was called Australian Tobacco Harm Reduction Association, which was a small not-for-profit, basically to lobby for legal change in Australia. We didn't achieve that.
Brent Stafford 0:03:02
I was going to ask you, how did it go?
Joe Kosterich 0:03:04
No, that didn't go well. What we were able to do...
was punch above our weight in as much as we would get contacted by media quite often for comment and we were able to at least put some ideas into the public domain no we didn't get the laws changed we did in 2020 and it's not i don't think we can take the the entire if you like credit for this But in 2020, the then Minister for Health, Greg Hunt, wanted to essentially introduce the laws that were introduced in 2024 by his successor, Mark Butler.
And through a combination of, I suppose, some public pressure, we did get active in the media. And remember, this is in the first year of the pandemic response. But a couple of politicians, including Senator Matt Canavan, who's now the leader of the Nationals Party in Australia, which is a junior partner in the coalition.
And there was enough arcing up that what Hunt wanted to do was knocked out. The end result was not perfect, but it was better than what he planned. And then Butler obviously came and finished the job and created the mess that we see today. Yeah, you can put it on him, can't you? Look, absolutely. For reasons that, look, I've never spoken to the man. I don't understand.
He seems to think that a policy that has simultaneously increased smoking rates, and it's interesting we're having this discussion today because just in the last 48 hours, Australian Bureau of Statistics data has shown that nicotine use has increased potentially 40% in the last eight years or so.
So we've got, and we know that smoking rates have increased 80%, eight zero percent of the nicotine market in Australia is now illicit. And just to put the, if you like, icing on the cake, the revenue from tobacco excise for the federal budget is down in excess of $10 billion, $10 billion.
And this was estimated to be comparable to what the federal government spends on education, double what it spends on housing. And that's just what they're losing. And that is going down year on year. So the tax, the excise rate is increasing And I think John F.
Kennedy once said this, and look, if it was somebody else, apologies, that typically when you reduce the tax rate, you increase the tax take and suspect the reverse applies. And I'm not going to say that there isn't some role in inverted commas syntaxes.
But what's sometimes called the Laffer curve, and now I'm not an economist, shows that there's a point where it becomes counterproductive and the tax amount becomes such that people are prepared to break the law.
Most people probably prefer not to break the law if they don't have to, and I think we saw Previously with the piracy with movies, when people thought the cost was too much, they'd risk downloading and viruses and everything that went with the illegal downloading of movies.
Once we had streaming services that charged what the public perceived as a reasonable price, then the demand for pirating dropped considerably. So, yes, we've got an absolute failure of policy on all levels.
And this is also now this massive hole in the budget in excess of $10 billion also comes just on the heels of a government that's now introduced very unpopular taxes where it's penalising young entrepreneurs who are running start-up businesses by increasing the capital gains tax.
I know, it's like people overseas must think what is this country doing and it's a good question and I wish I had an answer but I think we're run by people who have no idea what they're doing.
Brent Stafford 0:06:51
We had Rohan Pike on the show about a month and a half ago and he was saying that 95% of nicotine vape purchases, essentially all of it, is black market now.
Joe Kosterich 0:07:05
Well, after Greg Hunt introduced the requirements for there to be a prescription for vapes, and there were two, the options was to get a prescription and then you could import vapes. And typically people did this from New Zealand.
And I was one of the few, and you had to be what was called an authorised prescriber, and I was one of the few of those in Western Australia, and I would see very few people coming in for prescriptions. And look, maybe they're going elsewhere, wouldn't swear to it, but the numbers suggest that even in those days, people were going to the black market.
Once the rules were changed again such that you needed a prescription and go to a local chemist so you could no longer import from typically, not only, but typically New Zealand, the number of people who are seeking a prescription is negligible. WA and Tasmania are the two states in Australia where an actual prescription is required for any vape.
In the other states, people can buy it from the chemist without a prescription up to a certain milligram. I think it's 20 milligrams per mil is the cutoff. But they're not doing it because they don't want those products. And the black market is absolutely booming. It's absolutely booming. I mean, obviously, we're in the 2020s.
In the 1920s, we saw this play out in America with the banning of alcohol. And the exact same result occurred. Didn't affect usage. In fact, if anything, there's an argument that alcohol use went up. And obviously the mafia got its start through that way. In fact, I saw a documentary that said during prohibition, people could get alcohol almost anywhere, anytime.
It wasn't like opening hours and closing hours. So it was actually easier to get hold of than when prohibition ended and you had licensed venues and they were open certain hours. Again, the proverbial visitor from Mars would look and think, if the aim of public policy is to reduce smoking rates, then it's an abject fail.
And if part of that public policy is to raise revenue on the understandable basis that yes, there is some health costs of smoking, although I know there's a counter argument that says, and this is terrible, but it's economics, But smokers do die prematurely, so therefore their health costs may actually be less rather than more.
I'm sure there's arguments on both sides and you can look at the numbers. But if part of that is to raise revenue and it is to reduce smoking rates, it's an F minus.
Brent Stafford 0:09:48
Well, they could obviously just, you know, affix an appropriate excise tax to nicotine vaping products and make them freely available. And I'm sure they'd probably bring in a few dollars, enough to make a difference.
Joe Kosterich 0:10:02
Well, if we look at what we call in Australia, across the ditch to New Zealand, they've gone the completely opposite direction. not only have they not demonized, if you like, vaping, they've legalised it. There are stores where you can buy IQOs or heat not burn products, you can buy vapes.
They are typically, a lot of them are available at convenience stores and petrol stations. We were in New Zealand a few years ago and needed to fill up the rent-a-car and you can see there's one section for cigarettes and right next door to it is for vapes. So it's no more difficult to access the at least 95% less harmful option and people will do that.
And New Zealand smoking rates are falling and Australia's smoking rates are not falling. And it then perhaps goes, if you want to go one level deeper than that, in Australia, in the indigenous population, smoking rates are roughly three times that of the general population.
In New Zealand, the smoking rate in the Maori population I think is also somewhere between two to three times the rate of the general population. I'm not going to square to that exact number. But there's also been a focus on wanting to reduce smoking in that population.
So you go on to the New Zealand Ministry of Health website and there's a video, it's a mock-up video, of a doctor talking to a Maori patient about switching from smoking to vaping. And I'm like, you know, this is New Zealand, Australia. They're not the same. You know, they're better at us than rugby. We're better than them at cricket.
But, and look, they're not identical cultures, but they're very, they are similar. We've been to New Zealand a number of times over the years and look, the New Zealanders might not like me saying this, but sort of a little bit like the seventh state.
No, it's not exactly the same, but there are a lot of, I mean, there are a lot of similarities, but this just stands out as one country is doing what works and is persevering with it and getting the results and the community is benefiting and other countries doing the exact opposite. And obviously we've spoken about the consequences.
Brent Stafford 0:12:16
So in New Zealand, do they have a rash of fire bombings, arson, extortion and murder wrapped around safer nicotine products?
Joe Kosterich 0:12:29
No, obviously they don't. Again, because it's a legal regulated market as against an unregulated, illicit market where the criminal gangs fight for turf. And I think in Melbourne alone, they've been over 100 fire bombings. And it also has reached the stage where there are businesses that just happen to be next door to one of these shops and they can't get insurance.
You're running a florist and you just happen to be next door to a convenience store and all of a sudden you can't get insurance. And then that affects those people's business. So the ripples of damage go even further.
Brent Stafford 0:13:06
Yeah, so I mean, let's not let me paint that picture, you paint it for us, for our audience that doesn't yet really understand what's going on in Australia, help them.
Joe Kosterich 0:13:16
Well, I mean, essentially you've had, the best analogy I could give is think 1920s America, that you have a product that people want that has been banned. Now, banning it doesn't stop people wanting it. So demand doesn't go away. And nature, as I say, abhors a vacuum.
So therefore, there's enough money to be made by criminals who realise that their likelihood of getting caught, particularly the senior ones, is very, very low. Look, some low-level people might get pinged. And every so often, you'll get a minister doing a photo opportunity. Oh, look, we've seized 24 cigarettes. Aren't we great? 24, a few more than that.
But you get typically, oh, this is this massive haul. And it's sort of like three hours supply, something like that. So this is, so the criminal gangs are going to fight for territory. They don't respect the law, but also consumers suffer because there is no manufacturing standard.
So with, you know, like in New Zealand, you've got vapes that have to go through the quality control that any legalised product has to go through. There are some manufacturing standards. If it says X milligrams per mil, it's got X milligrams per mil. If it lists the ingredients, those are the ingredients. Black market doesn't do that.
And even the same with cigarettes, which are now roughly a quarter the price on the black market than the legal market. Look, I suspect it's substantially tobacco, but who knows what else might be in there? So it's actually damaging to the consumer because they don't know what they're getting. And then this is hailed by the powers that be.
Oh, look, these products are really dangerous. Well, if you allow the black market to dominate and there are no manufacturing standards and no quality or safety controls, yeah, that's what you get.
Brent Stafford 0:15:12
Let's try to put this in perspective. On one hand, you've got combustible tobacco, which... kills, you know, after a certain amount of time, eventually half of the users will die. And then you've got safer nicotine products like nicotine vapes. They're not the same thing. No.
Joe Kosterich 0:15:30
And that I think is part of the problem. In fact, it could go to the, in my opinion, the nub of the problem in terms of big public health in Australia, that what started out as we want people to quit smoking, it's very laudable and we can all agree with that. morphed into a crusade against the tobacco industry.
And I'm not here to apologise for the tobacco industry, but a war against the tobacco industry is not the same as we're focused on people quitting smoking. But that then morphed into a war on nicotine. And nicotine, as Michael Russell stated in 1967, is not the problem. That's what people want for a variety of reasons. It's not my substance of choice.
I prefer a glass of red wine. But if people choose to use nicotine, that is not of itself carcinogenic. That is not of itself what causes heart disease. The combustion of tobacco is a risk factor and contributes to those conditions. If nicotine was dangerous, I couldn't go to a supermarket. So we're not talking about a prescription product from a doctor.
We're not even talking about a chemist. We're now talking about a supermarket where I can buy nicotine gums, nicotine sprays, nicotine patches. I can buy all of these at the supermarket, sometimes on special, And there's a lot of arguments about flavours in vapes, all sorts of flavours for nicotine chewing gums. It's the same nicotine.
So we can have it in all of these forms, put them into a liquid and suddenly it's dangerous. Now, that to anybody who isn't ideologically bound makes no sense. But again, we're back to the fact that this policy is not driven by evidence. It's not driven by science. I would go as far as to say it's not driven by the interests of the health of the public. It's driven by ideology.
Brent Stafford 0:17:23
You know, when you say that, I mean, can you put some specifics around that? Well, it's hard for me to ask this question because I'm not talking really a left or right issue, but what is it about public health in general, because it's probably the same in Canada and the US and UK, but what is it about public health that has them pushing these kinds of policies?
Joe Kosterich 0:17:52
That's a really good question and I necessarily don't have an answer but I have got an opinion and I think it's multi-pronged. One is this morphing from the wanting to get people to stop smoking for all the right reasons through to we are now at this war on nicotine. I think there also is a disconnect.
i will see people in you know the the medical center and talk to them about their experience if i'm sitting in some ivory tower i don't get that i don't get the feedback from people on the ground if i write a prescription for you for some treatment and it's not helping you you're going to come back and i'll see that so if i give you a prescription for a blood pressure medication, so your blood pressure's up, you come back a bit later, your blood pressure hasn't gone down, I can adjust the dose, I can do a few things, but this is based on what I'm recommending to you and its effect on you as a person.
But in public health, they're not dealing with you as a person, they're dealing with a population. you can't deal with a population other than in an abstract and a numerical sense. So there's this disconnect between what we advise as a public health bureaucracy and the feedback of which there is none.
Then I think there's an echo chamber and it's been highlighted at this conference that most of the papers that get funded are those that look to find a problem with alternative electronic nicotine delivery systems.
And if people are reliant on government for their funding and government doesn't want these products, again, for whatever reasons, and that's, again, that one is harder to explain, then they'll all toe the line and nod their heads. And the idea of science as a process of inquiry, and I think...
I think it's Albert Einstein who was attributed to have said that, but I'm not going to swear to it. 1,000 experiments can't prove me right, but one can prove me wrong. And the idea of scientific inquiry is my current ideas are wrong and need to be proved to be correct.
Whereas now we're in a situation where really a lot of scientific, in inverted commas, scientific studies are about proving what I already know just to show that I'm right. And by the way, all my mates agree with me, so we must all be correct. So it becomes this closed echo chamber. And anybody who questions that very quickly finds themselves out the door.
Either they've been ostracised or they're cancelled or they lose any access to funding. And so therefore it perpetuates itself. That's kind of Soviet to me. Yeah, well, and that goes deeper to this ideological view that I think there are people who think they know better what's best for everyone. First of all, I'd reject that entirely.
These are the individual to decide what's best for them. And people may make decisions that others disagree with. And we could even say, look, I don't actually think that's in your best interest. But that absolutely goes against respect for the autonomy of the individual to make their own choices for better or for worse. And again, as long as you're not harming anybody else.
But if there are people who think they know what is best for everybody and they have an almost religious zeal for about this desire to impose upon people what is best for them, whether they like it or not, then we're no longer really talking about public policy in terms of here's the rationale, here's the logic, here's the data, here's the evidence.
We're almost talking religion. Almost talking religion, yes. And look, if we really want to go down the philosophical rabbit hole, if you look at how some things operate in society these days, again, nature abhors a vacuum. Look, religion of all forms has got its problems and historically terrible acts to atone for.
But as that's retreated from society, human beings are hardwired, they have to believe something. Again, whether we like that or not, I think that's fairly hardwired into human beings.
So we have this vacuum of there's nothing to believe in, so we now have all these secular beliefs, and they are, I suppose, pushed and promoted in similar ways to how religion was previously pushed and promoted, and they have their high priests. And our current high priests are, I suppose, in inverted commas, scientists.
And we saw this with Anthony Fauci in the early part of the decade. I am the science. Well, that's like, I am the Lord. If we don't have the Lord, then okay, you're the highest that we've got. Fantastic.
Brent Stafford 0:22:48
Yeah, if you take religion and remove the contents and look at it as a truth-making process, which is what it is, the myths around it, the way in which there's some usual original sin, its enforcement mechanisms and its way in which that it perpetuates itself through the generations, regardless of the contents, it's a process and it's a truth-making process.
And within public health, they almost have their own truth and they're perpetuating it.
Joe Kosterich 0:23:23
And a big part of that is getting rid of the heretics. So the heretics obviously were those who opposed the church. And interestingly, I mean, there's probably no, I mean, blasphemy is against God, but heresy is against the church. You could be a heretic and still believe in God in those days, but just not the teachings of the church.
So the heretics will question the ideology of the public health poo bars, but they find out that that is to their cost. They don't get reappointed. They don't get funding for any papers. And look, some people will go against the tide, but people have bills to pay. They may have families to look after. They need a roof over their heads.
Not everybody is in a position to or has the wherewithal, so I don't criticise people for doing this, to really to stand up to the herd.
Brent Stafford 0:24:17
You mentioned a couple of things I think are important to just kind of maybe touch back on. One is that They've lost the understanding of the null hypothesis. And that gets to the point where, you know, you're supposed to come up with a hypothesis. You're supposed to throw everything at it to disprove it.
And as long as it's not disproved, it can be held as some form of truthful knowledge at any moment, which could collapse based on the next experiment. But they've completely, totally abandoned that.
Joe Kosterich 0:24:49
Yeah, absolutely. It's almost in a lot of these bodies, and some of this, I suppose, starts with the World Health Organisation and how closely they're joined at the hip to the WEF. I really don't know, but you wonder. But the start point is this ideology that we have to eliminate nicotine. Well, why?
I mean, nicotine's been in human civilizations for hundreds, maybe thousands of years, you know, for better or for worse, similar to alcohol, similar to cannabis apparently has been found to be in human civilizations for 5,000 years. I heard a talk from a lecturer at the University of Western Sydney last year. So these substances are not new. They're not about to go away.
But what's possibly even worse is that history has shown us how this ends. History has shown us how this ends. And yet still, you probably have these people who maybe do have a bit of a God complex. And they're both, they're in politics and they're in the bureaucracy and they're in big public health who think, no, well, no, that was last time. This time it'll be different.
And the reason it'll be different is we know better. So again, there's this sort of, we are the God-like figure because there is no God. So therefore we are the top and we know best. And we certainly know better than you as an individual.
Brent Stafford 0:26:11
You mentioned that part of the issue might be that they don't see individuals. And I think that's very important because fundamentally public health is based on epidemiology, which is only about population level data, population level interventions. The interventions, which is the action part of public health, is all based on population level.
So how could they possibly even see or care about the individual and the damage that might be happening to people?
Joe Kosterich 0:26:47
At a population level, absolutely, you're not interested in the individual, which again feeds into, for example, into guidelines. So maybe to revisit the pandemic response, there are seeing people who had side effects from the vaccine. Some people were fine with it.
But those people who had side effects could just be ignored because statistically they were deemed to be a small number, so therefore they don't matter. If we have an edict that says a certain infection needs to be treated with penicillin, great, penicillin is a life-saving medication.
But if you're allergic to penicillin, it could actually kill you because you have a severe allergic reaction called an anaphylactic reaction. But public health will say, well, penicillin should be used for this infection, but it's not suitable for me. Oh, it doesn't matter.
And look, that's an extreme example, and no, it doesn't quite, no, it's not, for people listening, no, it's not quite as bad as that. But as soon as we have this one size fits all approach, we are diminishing, diminishing the individual as an individual who is autonomous and has every right to make decisions about what is best for them.
And again, my rider is that it is not harming other people.
Brent Stafford 0:28:06
You know as long as cigarettes are still legal, you think the government should have an obligation to provide access to safer alternatives.
Joe Kosterich 0:28:15
And the same people who rage against less harmful nicotine products are typically the same ones who argue for safe injecting rooms and other harm reduction in illicit drugs, and that includes pill testing at music festivals. Well, if we're going to do that, then why is it not the same with nicotine? And that, again, is a blind spot that I don't have any particular answer to.
Brent Stafford 0:28:45
Well, here's what's interesting about that is that those public health professionals who believe in harm reduction when it comes to, say, drugs, they often describe it as they must respect the autonomy of the drug user and the dignity protect the dignity of the drug user, except for when it comes to safer nicotine products, there's no autonomy, there's no dignity, there's only disgust and disdain.
Joe Kosterich 0:29:18
So immediately we have complete hypocrisy. Yes, what we apply over here doesn't apply over there. And I've not heard, I've missed it, what the rationale for that hypocrisy is. I'm sure they have some rationale for themselves because if they didn't, they probably wouldn't do it. But they do. But it's clearly, clearly hypocrisy.
hypocritical and yes, as he said, no respect for the dignity or the autonomy of the person who's smoking and wants to quit smoking using the world's most popular and effective quit smoking method.
Brent Stafford 0:29:54
So give us an idea of Dr. Joe's prescription for public health to make things better.
Joe Kosterich 0:30:03
Look, essentially, I think New Zealand has got it right. You make access to other products, and that includes vaping, it includes the heat not burn, and I'm not an expert on the snus, but clearly Sweden has got less than 5% smoking, so they're getting something right. So you make access to those products no more difficult than to access cigarettes.
People can access at any supermarket or any convenience store and obviously on the black market but even forgetting that for a moment. So you make those other products as easy to access.
Yes, they can be taxed to a level that's proportionate and proportionate to harm and I think it was the IMF a few months ago that again put out a statistic chart showing the relative risk and of harm and some comments on proportionate taxation. You reduce excise on cigarettes in Australia and tobacco down to levels to where we didn't have these current problems.
And those levels would be around about 2019, 2021. At those levels, we didn't have the black market in cigarettes that we have today. So not saying get rid of excise. Yes, we can have excise, but it needs to be proportionate. And with those two foundations in place, then yes, one can go after the black market with strategic law enforcement.
And that law enforcement can then really be targeted because we've dealt with both the supply and the demand side. So we're catering to the demand by enabling access to products. People then will be less inclined to go to the black market. Look, it's not going to disappear. I think there's still bootlegged alcohol in the United States to this day. But there's not a lot of it.
So if you reduce demand for the illicit product by providing a legal product that is at a reasonable price, like if the price differential is small, people will still say, look, I'd rather have this product. I'm going to know what's in it. I'm not breaking the law. If the price differential is too great, then they will do that.
So it's not particularly difficult and it's not as if the Australian government hasn't been told repeatedly. They've just chosen for whatever reason to ignore data, evidence, statistics, facts, the list goes on.