In an article published this week in The International Journal of Drug Policy, David Sweanor and Lynn Kozlowski accused American public health organizations of instituting an “information quarantine” on the truth about low-risk nicotine products like e-cigarettes and smokeless tobacco. Sweanor, an attorney and adjunct law professor at the University of Ottawa, is a respected tobacco control leader in Canada. Kozlowski is a public health professor at the State University of New York-Buffalo, and a well-known tobacco researcher.
They looked at the information available on the websites of various US government agencies and private health organizations, and found there were almost no honest comparisons of relative risk between various tobacco products. The fact that smokeless products are widely known to be far less dangerous than combustible cigarettes is consistently ignored or underplayed.
The Public Is Getting the (Wrong) Message
And the “quarantine” is working. The public believes what it’s told by institutions like the US Centers for Disease Control and Prevention (CDC) and American Cancer Society.
According to a survey by the National Cancer Institute, only 13 percent of Americans understand that smokeless tobacco products are less dangerous than smoking. And an Ipsos/Thomson Reuters poll in 2015 showed that just 11 percent of American adults strongly agree that vaping is healthier than smoking.
In addition to slamming health organizations for lying to the public, Sweanor and Kozlowski also discuss the law that prevents manufacturers from telling the truth about smokeless products to consumers. The 2009 Tobacco Control Act “forbids marketing by manufacturers of any reduced-harm product information unless it has been proven before marketing that such marketing will not have an adverse effect on population health, a near-impossible task, a barrier that no product has yet surmounted, and one not imposed on other FDA-regulated product categories.”
Like Selling Heroin In Dirty Syringes
Once the imminent “deeming regulations” are in place, the same rules will apply to all e-cigs and vapor products. The consequences of preventing manufacturers and sellers of vapor products to honestly communicate lower risk to consumers are grim. Cigarettes are still widely available. More people will continue to smoke, and many will continue to die from smoking-related illnesses.
“It is as if needle-exchange programs had to prove no negative public health effects before being implemented,” they write, “while heroin given via dirty syringes was sold over the counter.”
In an interview on a Snubie.com podcast, Sweanor summed up the harm reduction approach he advocates. “Many of the biggest breakthroughs we’ve ever had in public health come down to two really, really simple concepts: you give people the information they need to make an informed decision, and you give them the ability to act on that.” Restricting the sale and marketing of products that are clearly less risky than cigarettes — making them less attractive and more difficult to acquire — turns that on its head.
Meanwhile, In England…
Harm reduction and vaping is the theme of another academic paper published this week in the New England Journal of Medicine (NEJM). In this one, three authors from the Mailman School of Public Health at Columbia University contrast the harm reduction approach in England and the prohibitionist bent of American tobacco control and public health groups.
Referring to last year’s groundbreaking report from Public Health England — which urged doctors to recommend e-cigs to patients who are unable or unwilling to quit smoking — the NEJM authors note that, “As dramatic as the report’s recommendations appear to be, they built on the United Kingdom’s long-standing commitment to harm reduction.”
They go on to detail many examples of the British health establishment supporting harm reduction approaches, and then compare those to public health attitudes in the United States. “In England, where leading medical organizations regard nicotine alone as relatively benign, the pressing need to reduce the risks for current smokers frames the debate. The overwhelming focus in the United States is abstinence.”
Powerful Voices Supporting Vaping
Two of the authors, Amy Fairchild (listen to an interview with her on this topic here) and Ronald Bayer, collaborated on a similar paper for the same publication in 2014. They staked out their position in no uncertain terms. “We may not be able to rid the public sphere of ‘vaping,’ but given the magnitude of tobacco-related deaths — some 6 million globally every year and 400,000 in the United States, disproportionately among people at the lower end of the socioeconomic spectrum — an unwillingness to consider e-cigarette use until all risks or uncertainties are eliminated strays dangerously close to dogmatism”
Clearly, Fairchild and Bayer are powerful voices for the adoption of a moderate, harm reduction-based approach to e-cig regulation in puritanical America. The question is, will American public health officials and regulators ever get past their quit-or-die dogma and allow themselves to listen?