by Carl V Phillips
The tobacco control industry’s house organ pseudo-journal, Tobacco Control, just released a special issue about what they call the “endgame”, which is their code word for the elimination of all of tobacco/nicotine use.
It is kind of a funny choice of words, since the word derives from the phase of a chess match where there are few pieces left on the board and a decent player can analyze every possible set of moves with greater certainty than earlier in the game. This is rather unlike the situation with tobacco/nicotine today where there are more options, more companies, more tobacco control activists, more real public health and consumer advocates (those of us supporting harm reduction and such), and — most notably — more smokers than there have been ever before, and where there is far less certainty about what will happen next. Most of those who use the term seem to be looking for a something more like the military concept of “mop up”, where victory is assured but some final actions are required.
On the other hand, the more I think about it, the clearer it becomes that they accidentally got something right in this case: When a chess match between serious players has an endgame (rather than one player resigning), it means that a balance still exists and the outcome is yet to be determined. If someone’s victory is already assured, there will be no endgame. Moreover, the endgame is (roughly) defined as the time when the removal of other pieces makes the pawns particularly important and the kings become active fighters rather than just hiding from the action. This seems like a pretty good metaphor for the rise of grassroots activism against the power brokers and for the emergence of active involvement of the primary stakeholders, the consumers. The more I think about it, the more I really like that. Bring on the endgame!
Anyway, I am not sure I have the stomach to read through most of the articles in that issue, though there is probably a month’s worth of the typical tired anti-THR lies to be found in them. I will count on some of you to highlight any high points (which probably really means low points). But I did read the short introduction by Kenneth E Warner, the Michigan professor who organized the conference that led to this collection of papers, and his anti-THR lies probably pretty much sum up what else is to be found there.
Ken is a smart and generally honest researcher, and was one of my mentors during my postdoc about 17 years ago. For quite a while in the 2000s, some of us working on THR thought that he was the most likely candidate among the card-carrying respected insiders of tobacco control to seriously embrace harm reduction and say “be damned” to the ANTZ special interests. I also remember that for a few years, he repeated something I told him during my postdoc: I had thought about doing more work on smoking-related policy and science, but with people like him already in the space, there seemed like there was not much more to contribute that would be useful. When I said that, I was half right: Brad Rodu had already released his groundbreaking work on THR, though most of us in public health did not have the slightest idea about it, which made clear that there was a lot of new, interesting, innovative, and helpful work to be done. However, I was right in my assessment that every other avenue of legitimate science about smoking was pretty much done by then; there has been approximately zero legitimate analysis any consequence since that time.
Alas, Warner never came out in favor of harm reduction, which brings us back to his recent paper, which asserts:
The continuing scourge of tobacco-produced disease is unlikely to yield to today’s evidence-based interventions. Several public health visionaries have introduced tobacco endgame proposals with the goal of substantially reducing, and perhaps entirely eliminating, the toll of tobacco.
He uses the anti-THR lie that “tobacco”, rather than smoking, is a major cause of disease. More importantly, he implicitly claims (several times) that THR is not evidenced-based, one of the two or three biggest anti-THR lies. The reality, of course, is that the evidence does not support the claim that current tobacco control tactics — more aggressive use of drugs, manipulation of packaging, and various other restrictions — do much more than torture smokers. The evidence is pretty sketchy about whether further education (in already educated populations) makes any difference or what the effects of even higher taxes and similar quasi-bans will do (there cannot be much evidence about something that has never been tried, after all). But, but contrast, the evidence that THR can reduce smoking and thus disease is overwhelming, at both the individual and population levels.
As for that last quoted sentence, the terms “visionary” and “public health” give far too much credit for the authors of the other papers in the issue and what appear — based on a quick review — to be the same tired old useless welfare-lowering and/or prohibitionist policies. Even the paper by Lynn Kozlowski, long the tobacco control industry’s pet harm reduction advocate (i.e., the guy they brought in for their staged “debates” about harm reduction rather than dare hear from those of us who were the real advocates for THR), barely mentions harm reduction and does not acknowledge its potential.
Interestingly, Warner fails entirely to even mention THR, let alone point out that it is the most important phenomenon in the area today, something that he surely realizes. Perhaps he did not want to risk offending his friends and patrons by even acknowledging it (very much like the last time I ran into him, at a Society for Research on Nicotine and Tobacco conference nine or ten years ago — after I had become a visible proponent of THR but before the U.S. SRNT stopped allowing us proponents to present — where he literally distanced himself from me, practically running away to avoid being seen talking to me). Yet at the same time, he acknowledges that “something new, bold and fundamentally different from the tried-and-true” is needed. Funny that.
Fortunately, as with actual endgames, one player does not get to just decide how it will play out. And unlike with the opening in chess, where following memorized long-established sequences is the norm, or the middle game where most players make use of general heuristics about what positions are better, in the endgame the exact ramifications of each move are thought out precisely. It is pretty clear that the ANTZ have little idea how to play in that world.