This relatively new approach has as its primary goal the promotion of public health and would regulate products based on their risks, relative risks and intended uses – on a continuum of risk from the deadly highly toxic cigarette, to significantly lower risk non-combustible forms of tobacco, e-cigarettes, inhalers, and NRT products.
While many embrace the general idea of the continuum of risk and the concept of harm reduction, details on how we can implement such an approach continue to elude us and often we become tied up in public relations campaigns that involve emotional, unscientific, and even dogmatic rhetoric.
The question that many are having to consider is how can we move forward in an environment that has traditionally been plagued by distrust and animosity at many different levels but that now transcends the old tobacco wars of the 1980's and 1990's with both new players and a growing diversity of products?
The Importance of Civil Engagement and Dialogue - The 'Morven' Dialogues at the University of Virginia
"It is important to see the one across from you - who may be your enemy - and see him as a friend waiting to be made." Archbishop Desmond Tutu
One way to bring some civility and a better understanding to the discussions is to conduct 'dialogues' in what are often referred to as neutral safe havens. One such ongoing successful effort has been at the Institute for Environmental Negotiation at the University of Virginia, where a series referred to as the ‘Morven dialogues’ has been held to discuss issues related to tobacco, nicotine and alternative harm reduction products. These dialogues are a continuation of dialogues first held at University of Virginia in the late 1990's - The Southern Tobacco Communities Project - between the public health community and tobacco growers. In that instance both sets of stakeholders found common ground that allowed growers to support FDA regulation and the public health community to embrace a tobacco buyout.
The University of Virginia dialogues have been conducted under the auspices of professional facilitators and employ a variation of the Chatham House Rule that allows participants to safely express their views and ideas as well as being given the opportunity to listen and learn from others. In the most recent dialogues, all the participants retained a high level of respect not only for the process and format of the meeting but also for others participating. It is important to recognize that these dialogues are neither intended to be 'conferences' nor 'negotiating sessions' although in some instances agreement and common ground can be the outcome. In one of the dialogues, one participant reminded everyone that 'we are all leaders' and potential agents of change and as such have the responsibility to move the discussions of the issues forward in a transparent manner and on many different fronts.
In what was the culmination of a series of recent dialogues on 'harm reduction' held in 2011, 2012, and 2013, Core Principles were developed that are intended to be used in helping stakeholders move forward in addressing a series of interrelated issues on tobacco, nicotine and alternative harm reduction products. These Core Principles 'belong to no one' but can be used and 'embraced by all', and are a means for bringing both civility and focus to the debates and discussions. They include such topics as:
- definitions and terminologies
- the need for comprehensive regulatory oversight
- the need to support science and research
- ensuring consumer participation in decision making
- the need for the monitoring and surveillance of all products
- the need to encourage and promote innovation and market place competition, and
- the need to promote dialogue and engagement.
It is hoped that the on-going dialogues at Morven (and similar dialogues elsewhere such as at the FDA, and the Food and Drug Law Institute) will continue to offer and serve as a model for all stakeholders in the US, Europe and globally to focus on outcomes rather than in promoting on-going 'wars' that often yield few results. Legislative and regulatory bodies including the World Health Organization (WHO) need to give this approach the serious attention it deserves. Policy decisions should be informed and based on the most up to date information available. This will require that all stakeholders be given the opportunity to express their views and in many cases to be challenged. It is recognized that some will choose not to participate in this type of an approach, instead advocating and using the polarizing tactics of the past. But it has been my own experience, that for those who choose to sincerely engage in 'safe haven' discussions, there is great deal to gain and little to lose.
Scott D. Ballin, JD, is a Health Policy Consultant based in Washington DC