Smokers are going to smoke, they should at least be given a choice to opt for harm reduction

There are various reasons why millions upon millions of people still smoke in spite of all the anti-smoking efforts across the globe, which are increasingly ramping up. Whether it’s due to an individual’s addiction to nicotine or their choice to keep one last vice, harm reduction alternatives such as vaping should be available to provide smokers with the option to reduce the harmful effects of smoking. This, however, is not the attitude of the “moralists”, writes Chris Bateman in this article looking at “the tension between people who do pragmatic science-based things and those who see these things in moralistic terms”. This article first appeared on MedBrief Africa. – Nadya Swart

Dogma beats science

By Chris Bateman

Anti-tobacco ‘moralists’ ignore science – harm reduction experts

One of the biggest public health barriers to reducing the eight million smoking-related annual deaths globally is the tension between “people who do pragmatic science-based things and those who see these things in moralistic terms”.

This means the “moralists” see only Big Tobacco’s devastating record and ignore the major technological advances in tobacco harm reduction and in non-combustible products.

That’s according to two veteran harm reduction experts, Canadian lawyer and public health advocate, Professor David Sweanor 1, and Professor Peter Harper 2, a leading UK oncologist and consultant to Philip Morris International. They were speaking to Medbrief Africa on the sidelines of the Fifth Scientific Summit on Tobacco Harm Reduction, Novel Products, Research and Policy, held in Athens on September 21 and 22 this year.

Professor Harper says no-one is listening to the (tobacco harm reduction) data.

“There’s no other subject I know in medicine where data is ignored. Nobody questions the validity of the data in tobacco harm reduction, they’re just saying they don’t believe it – without looking at it.”

He says that in the food industry people are ‘clearly questioning sugar content and sugar substitutes,’ while in the meat industry, meat itself is being questioned.

“They could target craft foods or food companies, but they don’t. To be honest you don’t see global leadership to the extent of tobacco industry where they’ve conglomerated into these few organisations which largely, though the Western World, sell tobacco. So, they (the food and meat industries) are less easily targeted. You could target craft foods or food companies, but they’re not (targeted). Maybe we didn’t see the persuasion they put in via confectionaries,” he posits dryly.

Professor Sweanor, who’s won millions of dollars in class action suits against global tobacco companies, says proponents of tobacco harm reduction run headlong into historical puritanical and moralistic barriers very similar to those encountered with alcohol, illicit drugs, or venereal disease – all of which proved to be public health disasters, “yet we keep on doing it”.

“They see it as a sin rather than a public health issue. So, if you see the use of nicotine as just being bad and sinful, then people should stop this. It’s like the people who say the only sort of sex education that should be available is abstinence, that the only approach we should have to narcotics is the war on drugs, that the only approach to alcohol is prohibition. We have this long history of people who try to use the power of the State to impose their moral views on the behaviour of others.

“Because we keep coming back to this moralistic approach, and there’s the constant tension in public health between people who’re trying to do pragmatic science-based things to improve health and those who see these things in moralistic terms. So that if you see the use of nicotine as a sin, to say we can do it in a less hazardous way, is to many people like saying, ‘I can agree not to murder people I don’t like – if you give me permission to sleep with somebody else’s wife’.”

“That’s a sin too, so you just must stop sinning. It isn’t a matter of a lesser sin, it’s just no sin. I think that’s what we run into. Plus of course the Thomas Kuhn ‘Structure of Scientific Revolution’3 stuff that when paradigms start to change, people are threatened. And if your academic, political, or business career has been based on the status quo, things are a threat. You know, you lose your position because suddenly the sorts of things you spent your life doing are no longer that important, they’ve solved the problem that you’ve spent your career working on!” he adds.

Asked what would shift these attitudes sufficiently to change population level-thinking and behaviour, Sweanor was unequivocal.

“The one mind that if we change, will completely change the world – in Michael Bloomberg. The multi billionaire philanthropist has spent hundreds of millions of dollars globally funding the abstinence-only view at the World Health Organisation – which is appalling given what they (the WHO) do on other issues. He funds campaigns for Tobacco Free Kids and other ‘abstinence only’ groups to work world-wide to attack alternatives to cigarettes.

When MedBrief Africa put it to him that Bloomberg was just one person, he responded, “You look at the various people he funds and the various positions they take. It’s striking how people will adjust their views to coincide with the potential funds they think they’re going to get. So, the WHO is taking an abstinence only view. The head of their tobacco section, when asked about harm reduction at a recent conference, said the following, “I’m not interested in risk reduction. I’m interested only in risk elimination”.

Harm reduction applied selectively

Observes Sweanor, “Well that is such an ignorant statement from somebody who should be doing public health. So, you mean you wouldn’t support ideas like auto safety, wearing three-point seatbelts, collapsing steering columns, airbags, crumple bars and the like -because those things are still dangerous?”

I think what we have is something we’ve seen for centuries. It’s the battle between the principles of the Enlightenment where you seek truth, you use science, you have a humanist approach, versus the values of the Inquisition, which is that we’re fighting evil and if you’re seen as being a heretic and I’m seen as talking to you therefore I must be a heretic and the only things you do with heretics is totally ostracise them. So rather than challenging them, rather than saying “I think you’re wrong and here is why”, I refuse to talk to you. I refuse to let anybody else talk to you,” he added.

Sweanor claims to have been personally targeted by the WHO after he criticised its approach to tobacco control.

He says the WHO refused to allow researchers affiliated, as he was to the University of Ottawa, to participate in a Cochrane review on lessons Covid-19 held for future pandemics. 

“If that’s not the inquisition then what is?” he asked.

Asked what he saw as the solution to an impasse in which one side seemed to accuse everybody attending events such as the Athens conference as being in the thrall of big tobacco while attending delegates seemed to believe that the dominant faction was in the thrall of the status quo, he replied:

“I’ve debated, regulated, and litigated against big tobacco companies for 40 years, I’ve cost them lots of money, but the bottom line is it’s about science. It’s about saving lives. Rather than finger pointing and silliness to say, ‘we don’t care if somebody (Big Tobacco) earlier in their career did something awful and stupid. If they’re doing something now that’s important, you know, if you happen to be the best swimmer we’ve got here right now and I see a child out drowning in the Aegean, do I say, ‘Well I’m not going to let him go out there and do that because I don’t like other things he’s done? The last thing I’m going to do is let him save a child’s life.’ I mean, that’s just stupid. 


We’re trying to deal with eight million (smoking-related)deaths a year by being pragmatic. If somebody has something to add to that conversation, let them. If somebody has a new idea, examine it. Look at the science, evaluate it, but to just try and dismiss anything, either because the funding comes from an abstinence-only person or because they’ve talked to somebody in the tobacco industry – that gets us nowhere. You want to have open dialogue,” he said.

Citations.

  1. Professor David Sweanor is an adjunct professor of law and chair of the advisory committee of the Centre for Health Law, Policy & Ethics at the University of Ottawa. He helped spearhead the development of world-leading tobacco control initiatives in Canada starting in the early 1980s, first as counsel to the Non-Smokers Rights Association and then as an independent consultant. His global work has included litigation against cigarette companies and assistance to the World Bank and World Health Organisation.
    He has been widely published in peer-reviewed scientific journals, including the New England Journal of Medicine and JAMA, testified before parliamentary committees in Canada and elsewhere, and before both Senate and House committees in the United States. He has received various awards for his work, including a ‘Public Health Hero’ lifetime achievement award from the Pan-American Health Organisation. His interest focused on the interaction of law and economics as a determinant of public health. He has worked on tax policy, contraband tobacco, litigation strategies, risk communication and the provision of less hazardous alternatives to existing products.
  2. Dr Peter Harper has been a leading consultant at Guy’s and St Thomas Hospital for over 25 years. He is both an accredited physician and a medical oncologist. One of the four founder partners of the London Oncology Clinic, he has authored more than four hundred papers and chapters in peer reviewed publications and is acknowledged globally for his work in researching new drugs and developing improved forms of cancer treatment. He has been the chair, or a member of many international executive committees investigating novel approaches to cancer treatment, editorial boards for professional publications and is currently a member of eight pharmaceutical company advisory boards and is a member of sixteen professional bodies globally, including serving on the board of a committee of the American Society of Clinical Oncologists (ASCO).
  3. According to Thomas Kuhn’s “The Structure of Scientific Revolutions,” (first published in 1962), the development of a science is not uniform but has alternating ‘normal’ and ‘revolutionary’ (or ‘extraordinary’) phases. The revolutionary phases are not merely periods of accelerated progress but differ qualitatively from normal science. His work is considered a landmark event in the history, philosophy, and sociology of science

Disclaimer: Chris Bateman, a freelance healthcare journalist and former News Editor of the SA Medical Journal, was sponsored by PMI to attend the 5th Global Conference on Tobacco Harm Reduction, in Athens, Greece. He was not in any way influenced on what stories to write or whom to interview.

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