In search of an honest tobacco harm reduction (THR) skeptic

by Carl V Phillips

This is a serious question. I am genuinely trying to determine if anyone has an answer.

For many, if not most, polarized controversial political issues, it is possible to find decent human beings on both poles of the debate. I am talking about people who:

  • understand the fundamental facts of the matter and are not just dogmatically supporting a political position out of ignorance (a lie in itself, of course),
  • tell the truth, including:
    • acknowledging what is clearly correct among the arguments by the other side,
    • correcting themselves when they discover they have said something incorrect,
    • not acting as marketers under the guise of being analysts (i.e., grossly exaggerating the case for their position to sell it)
  • acknowledge and show proper respect for the gravity of what they are arguing, particularly the costs their position would impose on people.

In other words, there are people who are not overgrown children making adamant declarations about important matters they do not understand, who apparently legitimately believe their position is valid and thus that others might be persuaded to their position by the truth, and who seem to have a moral compass. Put another way, we are talking about people who do not appear — even to reasonable people who adamantly oppose their conclusions — to be evil, sociopathic, or a useful-idiot tool of those who are evil or sociopathic.

Theoretically, a non-sociopath can be an aggressive liar, genuinely feeling bad about the lies but having reached the studied conclusion that a greater good is served through those immoral acts. However, I would contend that in matters of political controversy (as opposed to, say, running a military campaign or trying to outmaneuver your market competitors), there is no legitimate role for lying. If you are trying to persuade the public of something and discover that you cannot do it by telling the truth, it is difficult to see how lying is ethically defensible. Thus there may be no such people, but if someone wants to try to make the case — that there are decent human beings who aggressively lie about THR but whose behavior is ethically defensible — I am listening.

I suspect we agree that there are decent people fitting the bulleted conditions on the different sides of the debates about abortion, climate change, redistributing wealth, animal rights, publishing pictures of Muhammad, and many others (assuming you do not feel so strongly about the issue that you cannot consider anyone who disagrees to be a decent person, but that is a different story — we are talking meta-characteristics of their position). There are also, of course, people who violate every one of the conditions in the above list on both sides of all those issues, but that does not change the fact that there are decent honest people making the arguments too.

Now consider an example that strikes me as similar to anti-THR: opposition to granting same-sex marriage rights. You could imagine someone making an honest argument along the following lines:

I realize that banning same-sex marriage causes some people to suffer material harm, as well as being treated like second-class citizens. Though I personally cannot empathize with wanting to do it myself, I recognize that many people do. I also realize there is no evidence of material harm to the rest of society from same-sex marriage (other than it making taxes and other finances more fair, and thus taking away some of the extra burden on gay people), no evidence that gay couples are worse parents, nor any other material motivation. However, I simply believe that homosexuality is per se wrong, and therefore I oppose any action by the state to normalize it.

A few minor word substitutions and you could get the argument of an honest ANTZ. The thing is, I do not recall ever seeing such arguments in either case. It seems like there must be someone out there in the wide world of anti-same-sex-marriage that actually owns up to this, though I am not sure because I have only cursory knowledge of the fight. By contrast, given my knowledge of the THR and anti-THR world, I think I would know if there was an honest, decent THR skeptic who admits the truths — that there is overwhelming evidence that low-risk tobacco products are indeed low risk; that THR has been shown to work; that many people like to use low-risk tobacco products; that various lies about risks and bad outcomes are, indeed, lies; that there is no material evidence of a downside — but who still expresses skepticism. I am not even talking about someone who admits the truth but is still is full-on anti. I cannot think of anyone who indicates even mild doubt about the wisdom of THR who does not also attempt to deny the truth.

Indeed, to relax the conditions one step further, perhaps there is someone who is a THR skeptic who disputes, based on some serious argument, some of what most of us think of as facts. I am not talking about just ignoring the facts or randomly asserting they are “not proven”, nor making patently dishonest junk “arguments”. I am talking something roughly analogous to disputing the worries about climate change, not by claiming there is some conspiracy to fake the warming data, but who rather, perhaps, offers a scientific argument as to why it might soon stabilize or why it would be easier to do something about it later rather than now. Is there anyone like that in tobacco control?

Again, this is a serious question. Is there anyone reading this whose self-perception is, “I am someone who openly acknowledges the facts about THR, even as I argue that actions should be taken that interfere with it”? Or is there anyone reading this who would say that about someone else.

A tangential follow-up question, then, for those who are not THR skeptics but self-identify as being in tobacco control: Given that the tobacco control establishment has evolved into being more anti-THR than anti-smoking over the last decade (and assuming you were not able to offer up a case that this was being done honestly), how can you stand to consider yourself a part of that?

12 responses to “In search of an honest tobacco harm reduction (THR) skeptic

  1. Carl V Phillips

    As a random point of amusement, the WordPress software did not like the fact that I had no tags for this (it really did not fit anything I try to keep tagged). So after I posted it, it suggested I go back and add the new tag “decent human beings”. I liked the suggestion.

  2. What about people that took jobs in Tobacco Control to stop the deaths from smoking, are not against THR, but are aware they’ll be fired if they buck their bosses?

    • Carl V Phillips

      That is a bit different. I am looking for people who are genuinely skeptical but not liars etc., but these are people who are cogs in the anti-THR machine without actually being skeptical.

      I suppose I should have specified that it (the honest skepticism) needs to be a public position. I guess there could be someone who fits the description but keeps it secret, but how would we know who it was?

  3. There are a bunch of UK academics who are what you might call middle-ground, at least in comparison to the raving crackpots. Some of them might be anti-THR but prepared to admit it’s due to overall policy as against any specific failings of any THR product or policy. And there are plenty who seem to have changed position in the last couple of years as the evidence for THR has become harder to obscure, to support THR at least as a concept; and at least that is honest (or moving toward honesty, in PH terms).

    A bigger issue in the UK than the one you pose is the number of PH staff who claim to support THR but also support regulations that ban it. The concept of a consumer-driven move away from smoking that is only possible with free access to a full range of alternatives unhampered by irrelevant regulations seems completely alien to them. It’s as if they can’t see Sweden on the map, it’s a blank area where there are dragons. If pharma doesn’t supply it then apparently it can’t be supported. This is a common position here even though it makes as much sense as supporting free laptops for residents of the jungles of Papua New Guinea.

    Perhaps that’s the idea: appear to support it but make it impossible to happen. It’s hard to work out which is worse: argue against THR but admit there are no science-based reasons for doing so; or support THR while simultaneously asking for meaningless regulations that prevent THR. There seem to be a lot more in the second category.

    • Carl V Phillips

      Ok, who. Name names.

      For many purposes, it could be fine to identify someone who actually is pro-THR but pretends to be anti because he has been bought off by tobacco control money. Whatever he came up with as the excuse for the position might well be the legitimate arguments of an honest person. (Of course, given that his opinions are for sale, it is also quite possible that he is not actually a decent human being and his position is all lies.)

      Also, I believe there are dragons in Sweden. I read it in a peer-reviewed journal, so it must be true.

  4. I hear tell that there are people in smoking cessation clinics in the UK who are unreservedly (well, almost) supportive of ecigs. However, the higher you go in the structure of these organisations, the more often the support is tepid. There is very often the hidden mental reservation, “provided that they are classed as medicines” At the very top come the ‘deniers’, who want ecigs banned ‘until more in known about their long-term effects’ (which, effectively, means never since, if they are not used by many people, then there will never be any long term effects to know). Reading comments from these ‘top people’ (which are always edged around with ‘ifs and buts’), one cannot help but feel that the problem is structural, especially in organisations such as the WHO and the EU.

    • Carl V Phillips

      Seem my response to Chris re part of this. It is definitely true that the extremists are concentrated at the top of organizations and networks. That does not in itself mean that they could not offer an honest argument. But they do not do so.

      One possibility that you implicitly bring up is that a lot of those people are anti-ecig because they really do not know what they are doing. Thus they are not able to assess anything for themselves and are forced to just follow childish recipes like “anything that is medicine is good; anything else is bad”.

  5. Carl Hi
    “a lot of those people are anti-ecig because they really do not know what they are doing. ” may well be the truth. In much of the academic sector (and related fields)- the higher up you go, the more the numbers are dominated by ‘professional administrators’ rather than people with real expertise.

    • Carl V Phillips

      I agree that when you get a lot of those types making statements about something, watch out, because they do not know much. But it is not like Jonathan Samet was not a decent (not great, but ok) researcher before become an administrator. Also there are plenty of non-moribund academics leading the charge here, people who should be expert. Part of the problem there is that “public health” tends to train students who are even worse than their professors (who at least mostly trained in other fields).

  6. “Also, I believe there are dragons in Sweden. I read it in a peer-reviewed journal, so it must be true.”

    This made my day :0)

    It also underscores the biggest problem.

    I discovered this blog today and will be sharing many of your posts with our customers over the next few weeks. I will have to seep it out to them slowly so brains don’t melt.

    • Carl V Phillips

      Thanks. If you care to, keep me posted on what you decide is worth highlighting via twitter or email. I need to do some archive reminder tweets myself and that will motivate me.

  7. Honestly, I’ve read so much today that I have to let some of it soak in myself. I need to filter some of it with what’s relevant to the average vape shop / e-liquid customer and what will only be seen as gobbily gook by the less technically minded. No offense intended, I for one appreciate the scientific approach even if I must translate it to simple speak.

    Some truly WONDERFUL information here and I’m looking forward to going back through your rebuttals as time allows. Thank you for the incredible effort.

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