Monthly Archives: July 2015

Why is there anti-THR? (4) Money, money, money

by Carl V Phillips

Continuing this series. Sorry about the cheesy title. But it never hurts to have a reminder that Sweden is the most important population in the annals of tobacco harm reduction. (Click here to get ABBA-rolled.)

The sale of cigarettes generates an enormous amount of net revenue. Truly enormous. A pack of cigarettes costs tens of cents to produce and sells for 5, 10, or even 20 dollars in places where most readers of this blog live. Manufacturers and merchants keep some of that. But the vast majority of those purchase prices are taxes. In the order of 90% of the net revenue accrues to governments. Few consumers realize this, perhaps because unlike most other sales, excise, and value-added taxes, these taxes are intentionally never broken out. Look at a the receipt from purchasing cigarettes, and it does not tell you that most of what you just paid was tax. Continue reading

Why is there anti-THR? (3) Anti-tobacco extremism

by Carl V Phillips

Continuing this series. In the previous post I made several references to the importance of anti-tobacco extremism among the anti-THR opinion leaders. It was impossible to avoid jumping ahead like that because extremism is the leading cause of anti-THR activism and lies, but I felt starting with it would distract from the origin story.

I coined “anti-tobacco extremist” as a technical term. Non-thinkers sometimes interpret it as name-calling, perhaps due to the degradation of the legitimate and descriptive word “extremist” (it  is most often used — inaccurately — as a derogatory description of holy warriors). But it means what it says: those whose position is the most extreme one can take on an issue (or in the neighborhood of that). The thought experiment I devised for defining it was the answer to the question: “If you could magically change the world such that either (a) people could continue to enjoy the benefits of tobacco product use with absolutely no health risks or (b) all tobacco product use was eliminated, which would you choose?” Anyone who actually cared about humanity would obviously choose (a) — after all, what kind of person would pass up the chance to offer benefits without costs? As it turns out, a large portion of tobacco control opinion leaders would choose (b), making them anti-tobacco extremists. They do not want people to stop using tobacco products because they are concerned about the people; they want them to stop because they consider tobacco itself to be evil and any use to be a sin. Continue reading

Why is there anti-THR? (2) “Not Invented Here” syndrome

by Carl V Phillips

Continuing this series from the previous post, I want to start with an explanation for why the opinion leaders genuinely oppose THR that may not make for good inflammatory rhetoric, but is a critical part of the narrative. Though it is not a dominant force anymore, I believe it represents the origin story for why anti-THR became established in the first place.

The one-sentence version that I often offer is: Those who spent their careers trying to get people to stop smoking, but accomplished almost nothing[*], resent the possibility of smoking being substantially reduced in spite of their efforts rather than because of them. Continue reading

Why is there anti-THR? (1) The importance of narrative and Opinion Leaders vs. Useful Idiots

by Carl V Phillips

[This series continues with:
(2) “Not Invented Here” syndrome
(3) Anti-tobacco extremism
(4) Money, money, money
…more to come…]

Prologue [update (Sept 2016)]: In retrospect, I realize the title of this series does not quite match the subject matter that evolved. To correct the ambiguity: In the title and most places in the text, I use THR as a shorthand for a single aspect of THR, the substitution of low-risk products for high-risk ones. I am not going down the paths of other aspects of the harm reduction approach in this series. I and others often employ this shorthand when the context is clearly about product substitution, but there is no such context here, and thus this was probably a mistake.

This matters because there is an unfortunate tendency to think of harm reduction as being only about technical fixes like product substitution, seat belts, and needle exchanges. These are usually the most tangible and discussed aspects of harm reduction, and thus tend to “capture” the term, but they are not at its core. The shorthand has the harmful effect of distracting from the bigger picture. The core principle of harm reduction empowering people (with information and rights) to make their own best choice. Technical fixes are not even the most important concrete step in harm reduction, which is ending caused-harms. I have discussed these points recently, here and here.


The average person, upon learning that there is violent opposition to tobacco harm reduction (THR), is quite reasonably baffled. It is difficult for them to fathom that an entire (taxpayer-funded) industry could be devoted discouraging smokers from switching to low-risk alternatives, or even to discouraging people from making the free choice to use a low-risk product rather than being abstinent. It is more difficult still to believe that their leading tactic is promulgating blatant and easily-refuted lies. To any caring and honest person — no, make that any caring or honest person — this seems to be either insanity or pure evil. Indeed, it seems so crazy, that most people just assume the blatant lies must be plausible claims. After all, if they were not, why would anyone oppose THR? Continue reading

The toxic combination of medical ignorance, arrogance, and police powers

by Carl V Phillips

After decades of working in this area, it takes a lot to cause me to say “they must be kidding.” A post in the NYT yesterday did it. It was about parents who exercise some judgment about treatment of rare or elusive diseases in their kids, specifically when they refuse a non-diagnosis and advice to not pursue further tests and treatment. Apparently there is a trend toward medics deciding to call this child abuse and the government sometimes agreeing to the point of taking children away from their parents as if they were actually abusing them. Obviously this is tangential to the topic of this blog, but it struck me as a remarkable example of some of what we are dealing with. (I will note that I generally have little patience for the barrage of tangential posts on message boards on the theme of “here is another example of those people doing the exact same thing!” Usually they are, um, not exactly enlightening. So please go ahead and stop reading now if you are getting that vibe now.) Continue reading

Public health (heart) lung cancer

by Carl V Phillips

Tobacco control and “public health” have the same attitude toward lung cancer as homophobes do toward AIDS. In both cases, they are motivated by “moral” objections to particular behaviors and are desperately frustrated that people fail to just stop doing what they personally consider sinful/disgusting/unappealing (those are fairly interchangeable concepts for this sort of person). Thus many of them are happy that there is a disease that disproportionately punishes the sinners. Of course gay bashers (as well as also those who object to all sexual promiscuity and the relatively smaller group who hate injection drug users) do not pretend to care about the physical health of the targets of their opprobrium, so they are merely vile; “public health” people are also hypocrites.

About ten years ago, I coined the term “anti-tobacco extremists” to refer to those who take the most extreme view of tobacco use. This was an attempt to push back against anti-THR activists being inaccurately referred to as public health, given that they actively seek to harm the public’s health. I have since given up on that, and recognize that “public health” is an unsalvageable rubric, which should just be relegated to being a pejorative. But the extremist concept remains useful. The test for anti-tobacco extremism is the answer to the following question: If you could magically change the world so that either (a) there was no use of tobacco products or (b) people could continue to enjoy using tobacco but there was a cheap magic pill that they could take to eliminate any excess disease risk it caused, which would you choose? Anyone who would choose (a) over (b) takes anti-tobacco to its logical extreme, making clear that they object to the behavior, not its effects. Continue reading

The @CDCTobaccoFree follies: propaganda, promotion of scientific illiteracy, and censorship

by Carl V Phillips

The twitter feed from the anti-tobacco liar branch of the U.S. Centers for Disease Control (CDC) is one of the more pathetic efforts of our government. I will circle back to its worst problems, but for now I will just observe that they rarely get 10 retweets of anything or positive comments, including from their own sympathizers. Mostly the CDC tweets just generate replies from the public, criticizing their stupid claims and lies. Those of you who follow me on twitter see my hacked MTs of their posts, translating them into what it really means.

So a funny thing happened yesterday: They were well on their way to getting 100 or more retweets of a post and numerous positive comments. We will never know how many they would have gotten because they deleted it, an act that is clearly inappropriate and pretty clearly a violation of government records and communications rules. Continue reading