by Carl V Phillips and Elaine Keller
In honor of the birthday of one of us (EK), we are using the great title that the other of us wishes he had thought to use for his 2009 paper. In acknowledgement of her birthday, Elaine posted this yesterday on the Facebook CASAA members group:
Today is my birthday. My birthday wish is that e-cigarettes had been invented in 1983 instead of 2003. I was reluctant to share with the world that I was diagnosed with lung cancer last summer. I was afraid that some tobacco control liars might use that information to falsely accuse e-cigarettes of causing cancer. But an important fact is that for ex-smokers, the excess risk for lung cancer doesn’t go away the day you quit. In fact, it hangs around for a good TWENTY YEARS after you quit smoking.
So if I had been able to quit smoking in 1989 instead of 2009, perhaps I would not have needed to have the lower left lobe of my lung removed in July, and to go through chemotherapy. I’m happy to share with you all that my follow-up CT scan on December 4, showed no evidence of cancer. So I am officially in remission. To those who want smokers to wait around for 10 or 20 years for scientific proof that e-cigarettes are 100% safe, I say this, smokers don’t have that luxury.
Dr. Carl Phillips, CASAA’s Chief Scientific Officer, brilliantly analyzed the difference between being able to quit smoking immediately via switching to a reduced risk alternative source of nicotine (Tobacco Harm Reduction – THR) and postponing quitting until ready to “quit completely” (e.g., not needing to earn a paycheck after reaching the age of retirement) in “Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments.”http://www.harmreductionjournal.com/content/6/1/29
Most lung cancers are not diagnosed until Stage 4, when survival rates are grim. I thank God, and credit e-cigarettes, for the fact that mine was caught at Stage 1.
Sure quitting tobacco products entirely was theoretically an option for every smoker in 1989, but how many did it? (Hint: not many.) E-cigarettes had already been manufactured starting in the 1960s (and even designed on paper in the 1930s, though we are aware of no evidence a device was ever constructed). Quitting tobacco products entirely was still an option in 1999, but how many did that? (Hint: more, but still not many.) That was about the time that a major tobacco company tried to bring a more modern e-cigarette to market, but, again, they were quashed by regulators. What would have happened if those options had not been banned? Some of the answer can be found in Elaine’s story and some in Carl’s New Year post here. Of course, low-risk tobacco products were on the market. By 1989 it was adequately clear that smokeless tobacco was low risk, and by 1999 there was no legitimate doubt. But that fact was hidden from smokers by a concerted disinformation campaign which was almost as effective at preventing harm reduction as the repeated bans of e-cigarettes.
If smokers had been allowed access to e-cigarettes and knowledge of other low-risk alternatives decades ago, millions would have switched decades ago. It is not difficult to imagine that the majority of those now smoking would have quit via THR, or would have picked up a low-risk product instead. (It is particularly easy to imagine it when you observe that it actually occurred in Sweden.) The lowest risk alternative clearly was promoting THR in 1989, not pushing for total elimination of tobacco products.
Some of those behind the disinformation, bans, and attempted bans — both today and historically — are genuinely evil or at least sociopathic. They have a personal preference for a world that is free from all tobacco products (for some baffling reason that they never explain), and they lie and otherwise violate social norms, causing people to suffer and die, in pursuit of that goal. (Indeed, some of them clearly relish that suffering.) But they are a small minority of those responsible for this. They would not have the power without the much larger cadre of useful idiots. Most people who consider themselves to be “tobacco control” are not evil or sociopaths, but given the turn that the tobacco control industry has taken — in particular, that its defining characteristic today is being anti-harm-reduction — they have become the useful idiots serving the goals of the extremists. They typically actually believe that trying to dissuade people from THR is good for public health. Why? Because they believe that pursuing THR poses a higher risk to smokers than does pursuing complete cessation.
They are wrong. Badly wrong. This is obvious to anyone who actually thinks about this issue in even a slightly sophisticated manner.
Their naive notion seems to stem from the fact that, technically, from a purely medicinal standpoint, using a smoke-free tobacco product seems to pose some health risk (though we do not know that for sure) while abstinence poses none. Thus, they (mistakenly) conclude, THR must be the higher risk alternative. But this is only true if all else is equal — in particular if they would have both come to pass on the same day — and that is seldom the case. Someone who really would just quit on a given day in 1989 will have done so. Everyone else would have been safer had they switched, as emphasized by EK in her testimonial, as calculated in CVP’s cited paper, and as appears in the calculation for CVP’s New Year post.
In short, promoting abstinence is not a safe alternative to harm reduction.
Of course, anyone with an understanding of public health should know this already. Is demanding sexual abstinence a safe alternative to encouraging condom use? Is banning a popular drug a safe alternative to regulating it? Is mandating the use of an extremely awkward safety device, that technically offers slightly better protection to those using it than a pleasant alternative, a safer alternative? The empirical answer to the latter requires a bit of technical knowledge, but anyone familiar with occupational health or the use of safety gear more generally knows the answer: Offer only a highly unpleasant choice and people will just not comply, choosing the riskiest option of foregoing safety equipment entirely instead.
If non-sociopathic tobacco control people only understood the simplest 101-level lessons from their own field, public health, they would recognize this. But instead they are manipulated by the extremists into being useful idiots. They are tricked into not even thinking through what they are doing and saying.
One additional observation is necessary for fully understanding EK’s personal note and fully appreciating the preceding passages: Abstinence is a very unpleasant alternative for many. A few (like EK) can articulate this and openly explain that being able to function — to be happy, productive, employed — depends on continuing to consume nicotine. Given a choice of smoking, with all its costs and benefits, versus abstinence, smoking is better. Many other smokers basically get this, and do not seriously want to quit, even if they cannot quite articulate it. No observer has any excuse for not understanding this. It is simple social science or, for that matter, basic understanding of the behavior of sentient beings: Given only the two choices, if people choose smoking rather than abstinence, then they clearly like smoking (all costs considered) better than abstinence. Anyone who wants to dissuade people from smoking, then, who observes this — and who has even half a clue — will immediately figure out that he needs a third option.
And if he has a little human compassion, in addition to having a little clue, this will not just be because promoting THR lowers risk compared to promoting abstinence. It will be because THR gives smokers who benefit hugely from tobacco use (or just nicotine) a lot of benefit in addition to getting them off of smoking.
But even for those who do not care about people and only care about risks, the answer is the same. You have been duped by extremists who care neither about people nor even about people’s health, but are just bizarrely obsessed with the N. tabacum plant. Demanding the elimination of all tobacco product use is simply not the lowest risk alternative.
Smokers do not have the luxury of waiting for some perfect solution. Those who presume for themselves the right to control tobacco users do not have the luxury of pretending otherwise, pretending they are not killing people. Those who effectively prevented THR for decades are responsible for the lung cancers of Elaine Keller and tens of thousands of others.