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.
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I like this bit: “The continuing scourge of tobacco-produced disease is unlikely to yield to today’s evidence-based interventions.” To us non-scientists, this appears to be a contradiction in terms: “We can’t reduce disease with methods that are shown to work”.
There must be hidden layers of meaning in Warner’s material, because to the non-tobacco control person, it looks like an exercise in perfect irony – everything the exact opposite of the truth. But I suppose that is what you are saying, Carl :)
You know, Chris, something about that sentence was ringing an alarm in my mind, but I did not stop to think long enough about it while writing this. You are spot-on with that observation. To dig a little deeper into codewords, when tobacco control industry people say “evidence-based interventions” they do not actually mean what a scientist means with such a phrase. Instead, it seems to mean something like “has been studied by The Right People”. It does not relate to the *results* of those studies, which very often do not support the claim that it works (if you look at the actual analytics rather than just reading the conclusions), but merely the fact that they were done. It does not even relate to the methods of the studies — often they favor clinical interventions which are not appropriate for understanding social science, but not exclusively; sometimes their “evidence” uses similar methods to what the real science of THR uses.
So, if take this incredibly convoluted method for assessing what “counts” to them, but then trANTZlate it into the phrase “evidenced-based”, then you indeed get statements like the one you quoted which, when read without a trANTZlator, are indeed internally contradictory. Thanks for pointing it out. Might be worth a post in itself.
A trantzlator. Very funny. True though.
Indeed, the more I thought about this observation, the more I liked it. I added it to the sidebar and might write a bit about it.
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Re my expectation that someone would read the articles so I did not have to, my old THRo colleague Paul Bergen has a sentence or two about several of them. http://canadianvapers.wordpress.com/2013/04/17/the-desire-for-nicotine-is-more-likely-to-lower-smoker-related-disease-than-the-desire-to-quit/
I have never commented on this subject before, but I do not understand this obsession with wanting to control other peoples’ lives. Do any of these experts ever have a drink? Alcohol is addictive, a drug, and kills users and innocent bystanders alike, but I don’t hear the cry to ban it completely. And every time I read one of these articles I have to wonder who they are asking that they absolutely know the effectiveness (or ineffectiveness) of electronic cigarettes?? After being told for 30 years to quit smoking (my mother for 60!), and trying every other method out there from cold turkey to medication to pharmaceutical nicotine replacements, my mother and I received our electronic cigarettes last May and never had to touch another tobacco cigarette, from two packs a day to zero THAT DAY. No one has EVER asked us, the people who are helped by this method, how effective they are, they just keep telling us they’re not! For desperate people who have finally found a solution (continual reduction of nicotine levels down to 0 while still having the psychological comfort of relaxing with a hand-to-mouth device WORKS to eliminate smoking completely!) why would a stranger want to take that opportunity away from us? Something just does not seem “right” here.
My favourite part of this whole thing is that pharma only funds these people because they are incompetent.
Pharma not only needs smoking to continue at current levels, but it is a crucial issue for them. Never in a million years would they fund tobacco control, especially to the extent they do, if there was any chance that smoking prevalence would be reduced to an inconsequential figure; never mind if there was any prospect of an ‘endgame’.
Pharma has talented management who are expert at controlling the markets; the very concept that they would allow smoking to be eliminated, when it earns them at least $100bn a year, is farcical.
They employ the dumb and naive because these people are easily convinced their work is worthwhile, and because they will also repel any significant threats on behalf of pharma (because they are even dumber than they appear to be).
Anyone who comes along with something that has a realistic chance of killing off smoking (aka the goose that lays the golden egg) is immediately taken care of; their greatest success so far has been to stop the spread of the Swedish scenario. This was principally achieved because they were able to immediately stop the spread of Snus consumption, therefore there was no prospect of support from outside Sweden (those inside Sweden don’t need to support something that is a given). It seems the clever people have left TC, as they have dropped the ball subsequently.
They have been less successful with the removal of e-cigarettes because at first they didn’t take the ecig threat seriously, and then they underestimated the power of the community. I remember when we first met with the MHRA in 2010, I told them that they had no idea of the scale of the hot potato they had picked up (since even then, we could see that a powerful movement was being born). It was clear they had no concept of exactly what a citizen’s movement meant. They assumed it would be easy to steamroller their bans through without any meaningful opposition. They were entirely wrong.
However it is equally wrong to say they achieved nothing: the work they did was useful up until about four years ago, at which time it ceased to have any measurable effect, as the 20% barrier was reached. They, and others with a more educational agenda, reduced smoking to about half its prevalence in many countries. It is an important achievement, though of less overall significance than they might like to think; you might call it a step on the graph, rather than a gain of massive proportions: because in the long term it has a great deal less importance, since 20% of the population will always smoke (barring any THR influence), and in a few decades’ time the gains to date would not be significant overall. Preventing the continuing 20% smoking prevalence from existing in perpetuity would be a massive gain, in contrast, and that is beyond any possibility for tobacco control. Their proposed endgame moves all seem to revolve around bans of one kind or another; and bans don’t work.
The tobacco control industry now see the problem they face: that bans don’t work – although since that is heresy, they can’t actually speak it aloud; it will be impossible to prevent THR taking over; it will be impossible to prevent the reduction of smoking by others outside their sphere; it will be impossible to maintain their control of the issue; and one day it will be impossible to prevent their industry shrinking along with pharma’s receipts.
They are mostly too dumb to see that they need to get off the sinking ship. The honest ones already left, recognising that saving life is the goal, not saving tobacco control and its paymaster.
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