by Carl V Phillips
In a discussion group of scientists, policy-influencers, and other players in the world of THR (mostly e-cigarette) policy that I am a part of, there was a long discussion of mandatory “denicotinization” of cigarettes. As the discussion progressed, I ended up contributing an overview analysis of the whole matter that I think warrants a wider airing here. What appears below is the post I made there, though to protect the confidentiality of other contributors I referenced in the original I have deidentified them (following the Chatham House rule) and replaced their names with letters (W,X,Y); I am posting a note to the discussion group that those who want to claim credit for their contributions or to continue the debate here should jump in.
For those who may not know, the idea of forcing manufacturers to lower the nicotine content of cigarettes to make them less “addictive” has been kicking around from before the time there was much serious discussion about THR. The proponents of this arranged to have written into the Tobacco Control Act the provision that FDA can impose such mandatory reductions or ceilings, with the only limit being they cannot mandate complete removal of nicotine (which is really a meaningless caveat, since there is no practical difference between that and mandating a ceiling of a miniscule quantity nicotine — hey, it is not zero!).
The arguments in favor of such action are basically entirely captured in the sentence I used to describe it above: the assertion (based on no evidence or even a definition of addiction) that this will cause smokers to not be addicted, and thus reduce smoking. The main arguments against it include: 1. The response to lowered nicotine will be smokers consuming more cigarettes — and thus the constituents that actually make it harmful — in order to get the desired level of nicotine; this makes it the diametric opposite of real THR methods. 2. If regulated cigarettes are not satisfying, people will just turn to the black market for higher-quality (i.e., more desirable, though probably dirtier) products. Moreover, thanks to e-cigarettes making nicotine solutions widely available, smokers could just add the nicotine back in. 3. What right do those in power have to impose this illiberal prohibition (because that is clearly what it is, a prohibition of the variety of products people prefer, regardless of whether some somewhat-similar product remains legal) on people who choose to smoke? 4. There is no evidence whatsoever that this will accomplish its goal. The claims along the lines of “cigarettes will not be addictive if nicotine content is below…” can all be traced back to someone just making up that number from whole cloth.
In response to this last point, there has now actually been some research (which was the starting point for the discussion thread). The results were failure. Even in an artificial force-switching situation with volunteers who knew what they were getting into, subjects assigned to cigarettes with diminishing (over calendar time) nicotine content did not quit smoking. Indeed, as the nicotine content got lower many started cheating and using regular cigarettes. Another 21 comments followed in the thread, including from strong supporters of such a policy, strong opponents, and others, before I responded with the following:
The discussion of this topic never fails to captivate and astonish me — not in good ways. I am not sure how I could even catalogue my thoughts about it, but I wanted to at least throw out a few.
1. If someone were to mock-up a fake policy proposal to suggest that tobacco control is remarkably under-educated about ethics, human preferences and choices, social responsibility, history, and economics, I am not sure they could do a better job. This is the reason I bother to think about this train wreck in spite of the sentiment expressed previously about this mostly just being a dead-end waste of resources. These observations should be of as much interest to those in tobacco control as its critics, though the very characteristics that are illustrated here tend to be self-immunizing against such observations.
2. Though about 99% of the time someone says “precautionary principle”, they are talking about a policy or action to which it is not relevant, this is one of the rare cases where it applies. Someone is proposing a highly non-incremental change to the world; they are focused entirely on their own agenda, even though the intended social impacts — to say nothing of the possible unintended results — are huge; and there are very plausible arguments that it will create irreversible harms. The same people who have screamed “precaution!” about incremental and easily adjustable (even if not fully reversible) changes, such as the development of e-cigarettes, seem to not be at all bothered by proposing a radical untested policy that could have major irreversible negative consequences.
This is almost a picture-perfect precautionary principle application: The proponents’ position is basically “this is physically possible” + “this is not against the law” + “we predict that it could have some beneficial (for us) effect” + “those who warn about its major negative consequences cannot prove they will happen and we can tell stories in which no such harms happen” + “some people say this is unethical but we, personally, do not agree”. This is amazingly similar to the canonical precautionary principle applications like releasing a new organism into an ecosystem, damming a river, or opening the rainforest for resource extraction. Obviously any such principle is an ethical guideline — not universally accepted, and not a decision rule — but it is a pretty compelling about burden of proof: Before someone is allowed to blithely take the world down such a path, they should be forced to make a very compelling case that the benefits will happen and the bad-case consequences will not.
3. But it does not seem to even occur to tobacco controllers that they owe the world anything close to compelling evidence. This is a much more serious problem than the weakness of their evidence itself. As W noted, much of the “evidence” in support of this policy was just made-up from whole cloth. That says something bad about this policy proposal, but something even worse about the tobacco control enterprise.
Their research on the economics side of this consists of artificial studies of a handful of volunteers who are commanded to engage in a particular behavior. (And even though they have far more incentive to behave as dictated than do people in real life, apparently they did not do so — but we can even set that aside.) It somehow never occurs to them that no results of such studies can convincingly respond to such critical questions as, to take just one example of the many, “exactly why would anyone choose to smoke a cigarette that is designed to be unsatisfying in the first place?”
As for the prohibition being effective, we see tobacco prohibitionists worldwide responding to increasingly leaky prohibitions [e.g., smuggling to avoid taxes or “plain” packs, or the EU snus ban] by simply declaring that the black market does not exist. Not exactly the behavior of responsible people. (Hmm, lying about obvious facts in order to trick people into buying what you are selling for a few more years? It seems possible an enterprise would be vilified for the next half century if it were caught doing that.)
X cites the partial success in enforcing alcohol Prohibition as proof of concept, but things have changed a bit in the last hundred years: Since then humanity has invented big trucks, cargo planes, container shipping, and global organized crime networks with a lot of experience at smuggling. The latter received a huge boost thanks to Prohibition. (Tangential aside: This never occurred to me before, but perhaps a reason the limousine liberal politicos are so supportive of prohibitions is as an homage to the Kennedys.) Also, recipes for DIY renicotinization (un-de-nicotinization?) will be universally available in about five minutes, requiring only a solution of nicotine in propylene glycol (hmm, where are we going to find that?). The decriminalization of cannabis in a few jurisdictions is producing data that suggest the quantity of this other easily-shipped product was not hugely affected by criminalization. Oh, and there is the matter of alcohol Prohibition violations being easy to detect at the consumer and retail level, but detecting it for prohibition of normal cigarettes requires a lab test every time.
Or maybe the prohibition would simply inspire such a political backlash that Congress would just defund CTP as a result. There are countless plausible outcomes of doing something this.
But my point is not to present the list of all the practical considerations that need to be addressed; there are many more. Rather, I want to emphasize that in spite of the enormity of these points, tobacco controllers think it is sufficient to gather a bit of data that kinda sorta points in the direction of the hypothesis they would like to believe, and then declare it to be a fact that is sufficient for imposing radical policy. There are numerous important considerations that proponents of the policy would study and hash out in public if they were responsible and serious people. The lack of interest in serious concerns is a fundamental ethical failure, quite apart from all questions of the ethics of political philosophy.
4. The political philosophy is a separate and equally serious ethical problem. Y sketched the basics of why policies like this are generally not considered ethical in our society. But tobacco controllers generally dismiss such arguments as merely being a personal opinion, with the response, “and my personal opinion is different”. But while it is his personal view (and that of a large fraction of those who have ever given such matters serious thought), Y invoked by reference the many enshrined, accepted, established philosophical, legal, and constitutional bases for such a view [this included principles of autonomy, the work of J.S. Mill, and analogies to other behaviors that would be prohibited under such an ethic]. Tobacco controllers ignore this and consistently act as if “I personally think this is fine” is a valid ethical argument.
The infrequent but steady stream of tobacco controller writings on ethics, political philosophy, and the broader implications of their enterprise, generally leave me feeling like I am grading a freshman essays: “look at the really deep thoughts I have accumulated in my 17 years in the world, and notice that I am quoting from not one, but two, bits of intellectual writing that were not assigned reading, thus proving that I have thought of everything.”
X took the very rare step of offering an ethical argument with some substance rather than just saying something that translates into “I personally think this is ethical.” But what he argued [basically the standard argument that — my paraphrase — someone becomes more free, rather than less, if government force is used to prevent making a choice that is caused by some despicable thrall, instead mandating the “choice” of what everyone should really prefer] was a remarkably close paraphrase of “freedom is slavery.” Y also characterized it as Orwellian, though you could attribute that sentiment directly to Mao, Trotsky, Mussolini, and the various other authoritarian idealists Orwell was writing about. That does not make the sentiment wrong, of course. Every now and then, there is a situation where we agree that a bit of slavery actually improves people’s freedom, and it is accepted as ethical, and the immediate benefits are enough that it is worth the harms from making our society more Orwellian. But if that is the position you are arguing, you need to take it a lot more seriously than just declaring “this is one of those cases” and walking away. If your argument can also justify all manner of forced eugenics, you might still have a valid case to make, but it should be a clue that you have not given it sufficiently serious consideration. Consider the difficult ethical discussion that surrounds incarcerating people with truly serious psychological problems, something that is far easier to justify than the present proposal but that is still the subject of legitimate consternation and concern; keep in mind also how that power is inevitably abused.
If you want to invoke a relevant lesson from the 1920s, it is not the story of Prohibition, given the enormous physical changes to the world. It is the widespread embrace, by many in the same Western academic/intellectual circles that are behind tobacco control, of authoritarian utopias. This embrace continued until the lessons of c.1940 suggested that maybe it does not work out so well to replace liberty with the benevolent guiding hands of Homo superioris who just know how to make the proles better off. At least those ivory tower advocates for communism and fascism actually wrote about the big picture and tried to craft an argument for their position, rather than acting as if they were so clearly right that they did not have to.
5. Those who are just skimming this for nouns might think that I have descended into Godwin hyperbole. But this is serious analysis, not snark or chat room babbling that is the equivalent of those freshman essays. There is something wrong to the core about tobacco control’s relationship with scientific epistemology; this is not limited to cases where they are trying to lie about ecigs and such, but shows up throughout the enterprise. There is something wrong to the core about tobacco control’s relationship with political philosophy; they basically do not even seem aware that there is more to ethics than personal opinion about what ends justify what means. There is also a remarkable lack of understanding of history, real-world human behavior, and what people actually care about; this would unimportant if they were just practicing medicine, but a huge failure given that they are practicing social engineering.
These problems seem so core and so irreversible that I cannot see any room for someone to consider themselves part of tobacco control without implicitly endorsing them. When the core of an enterprise is this bad, there is really no room for a reformist wing. You can scoff at the denicotinizaton policy as if it were some wild outlier, but it seems to actually cut to the core of what tobacco control really is.