The dual use lie

by Carl V Phillips

I’m back, after some holidays and then trying to catch up on research work.  I cleverly avoided the need to do some kind of new year’s deep reflection or retrospective, though I will mention that the your-year-in-review WordPress bot congratulated this blog for having so much content and readership for its short tenure.  I will start with a few easy ones for a few days, mostly taking advantage of what others have written about THR over the last few weeks.

But today I will start with an often unchallenged bit of THR lying that is related to my current work, the claim that dual use (a term which usually refers to someone who both smokes and uses a low-risk alternative product) is somehow more harmful than merely reducing smoking.  Today’s example comes from serial liar Stanton Glantz(*) who publicized his comments opposing honest labeling about the low risks of smokeless tobacco.  As you might know, RJR has petitioned the US FDA to change the health warning labels on smokeless tobacco so that they accurately point out that ST it is much less harmful than smoking, rather than implying that it is just as bad, as the current labels do.  Of course, the anti-harm-reduction forces, who prefer that people keep smoking if they are not going to obey and become abstinent, vehemently oppose this.

[*In keeping with an ongoing meta-theme of this blog, I will repeat my observation about Glanz that many of his claims appear so earnest and yet are so incredibly out of touch with the obvious reality, one might debate whether “liar” is the right term for him.  This contrasts with the many obviously cynical liars in the tobacco control industry who clearly know what they are communicating is false.  Arguably someone is not precisely a liar if they are so deluded that they actually believe what they are saying despite being well-read on a topic (the latter contrasting with many of the “public health” useful idiots who just repeat what they are told and are lying in claiming expertise).  Of course, “grossly incompetent and out of touch with reality” is not exactly better than “liar”.]

Glantz’s testimony includes this statement:

Altering the text of the warning label to unequivocally state that smokeless tobacco presents substantially lower risks to health than cigarettes neglects the effects of dual tobacco use and the effects of smokeless tobacco use on smoking cessation, and so is fundamentally misleading consumers to underestimate the true risks associated with smokeless tobacco use.

The last bit is the usual obvious lie, since it is almost impossible for someone to underestimate the true risks of ST, as low as they are, and any correction away from the current overestimates will clearly reduce how much consumers are “fundamentally misled”.  The first part is more interesting.

Those of you who have followed anti-THR over time will know the pattern of the anti-tobacco extremists drawing the same conclusion, year after year, but altering their claimed justification for the conclusion when last year’s rationalization falls apart.  The current vogue is to claim that the existence of dual use means that THR is not so low risk after all.  Of course, a major reason for the persistence of dual use is that the extremists have prevented consumers from getting the message “now that you are using a low-risk product some of the time, you will lower your risks a lot by switching completely.”  But setting that aside, is there any basis for claiming that dual use is bad?

Someone who replaces some of their smoking with a low-risk alternative is smoking less.  Smoking less reduces risk (though obviously not as much as smoking none at all).  The big implicit lie — never stated, because then they would have to try to defend it, which they cannot — is that reducing smoking due to dual use is not as beneficial as reducing smoking without substitution.  There is simply no evidence to support this claim and no reason to believe it is true (beyond a level that is so small as to be a rounding error).

Put simply, dual use is reduced smoking, and reduced smoking reduces risk.

Even the worst-case scenario, in which someone uses a low-risk product while still smoking just as much, any additional risk is so trivial as to be inconsequential.  But someone who is doing that is in a great position to start substituting, and thereby reduce their risk (if only they learned about the option), so they are still on average better off in the long run.

Of course, that worst case (as defined in terms of actually caring about health and people) is not really the worst case in the eyes of the extremists.  They are bothered by the possibility that dual users do not have to suffer the pain that anti-smoking restrictions inflict on people who exclusively smoke, and they want tobacco/nicotine users to suffer.

Besides, if they really cared about discouraging dual use — rather than just using it as their anti-THR rationalization du jour, they would be supportive of a new label on ST that said something like “Exclusive use of this product is far less risky than smoking”  (h/t to Gregory Conley for that observation).  But, of course, they do not really want to encourage dual users to shift entirely to low-risk product use, because that would ruin their entire business model.  Rather, they are just saying whatever they think will accomplish their cynical goals, without regard to whether they really believe it.