When I was in Australia, my very good friend Dr Alex Wodak took me to one side and, in his typically low key, gentle manner, berated me for my attack on public health prompted by Ron Dworkin’s article on how public health messaging has taken on the mantle of moral crusading (see Blog 83). Alex pointed out all the good that public health has done in improving health in many different areas, not least in tobacco control.
And he is right; just using the UK as a small example, the public smoking ban in pubs, restaurants and on public transport has made a night out much more comfortable and safer; advertising (backed by legislation) has reduced road deaths through anti-drink driving and seat belt campaigns and on the global stage, public health has helped make huge strides in tackling some of the world’s deadliest diseases. Public health messaging though can result in much confusion among the public, especially when the messages wax and wane and/or have no real basis in science. For example, UK advice on whether it is OK for pregnant women to have the odd drink seems to change with the seasons. And it’s no good just telling people to eat more fruit and veg because the response is, ‘Well, how much more?’. So, it’s five a day or maybe ten a day or just binge on broccoli. Who knows? Even some of the classic anti-drug messaging like ‘Just Say No’ or ‘This is your brain on drugs’ (cue fried eggs in a pan) is not that damaging because at best it is ‘aspirational’ or at worst just laughable.
But what is totally unacceptable, is for public health to simply propagate misinformation aimed at confusing the very people who would benefit from accurate information, and this to seems to be a growing epidemic across the world when it comes to tobacco harm reduction as it applies to e-cigarettes and similar tobacco harm reduction options. Dr Michael Siegal makes this very point in his recent blog post where he berates the US authorities for acting against the public health interests of the millions of US vapers looking to improve their health and the millions of those still smoking who are looking for a way out while still enjoying nicotine. And as he says, what anti-smoking campaigners cannot stand is that unlike smoking, with its huge associated risk of death and disease, there is no obvious neat puritanical payback for the ‘vice’ or ‘disease’ of vaping. This is why they bang on about not knowing all the long-term effects in the desperate hope that down the line there is some serious bad news they can trumpet about.
And how about this from the head of the so-called World ‘Health’ Organisation – who claims that nothing has changed since the advent of safer nicotine products coming onto the market, and that it’s just business as usual for the tobacco companies and naturally trots out the same tired narratives about youth and vaping while refusing to acknowledge where the real public health epidemic lies. Let’s see, among American youth who experiment with vaping and actually don’t smoke and may never smoke – or the six million people around the world who right now do smoke and die? Answers on a very small stamp please.
As part of the general anti-vaping campaign, it has become fashionable (cf the current line taken by the Hong Kong Government to push on with a total ban on safer nicotine products) to try and discredit the oft-quoted conclusions of PHE that e-cigarettes are 95% safer than smoking by citing the infamous editorial from The Lancet which went so far as to suggest there were conflict of interest issues in this conclusion. Of course, few readers of such criticism outside the UK would know that the editorial was written by two ardent anti-vaping activists whose views could hardly be deemed ‘objective’ even if appearing in the pages of The Lancet.
The problem for public health is the risk that the messages will simply not be believed, that public health will not be credible messengers. At one extreme is the growing and influential movement in the USA which is campaigning against children being vaccinated in the face of all the medical evidence. More germane to the interests of tobacco control is some recent research by the US National Bureau of Economic Research which published a hefty paper on the ‘messenger effect’ as it relates to e-cigarettes, funded incidentally by the FDA and National Institute on Drug Abuse.
Of a sample of nearly 3000 smokers engaged in an online survey, the ‘messengers’ presented were the FDA (government), doctors and a fictitious e-cigarette company. What was interesting was that the e- cig company carried more weight than either the FDA or doctors, “We observe that information from the fictitious e-cigarette company increase the probability of reporting an intention to use e-cigarettes in the next 30 days”. In the survey, 62% agreed that e-cigarettes are healthier than cigarettes; 58% agreed that switching to e-cigarettes would improve health while 47% agreed that the government should promote switching to e-cigarettes. All this in the context of receiving messages from an e-cig company which at the very least suggests that more adult smokers would switch to e-cigarettes if only governments would allow very specific targeting of smokers, (like packet inserts) instead of doing their level best to ban them.
I will end this blog with a warning. Most tobacco harm reduction advocates I know are only too happy to engage in sensible and mature debates with those holding opposing views. Opponents have been invited to GFN to debate the issues, but don’t come – presumably scared of being infected with TIV (Tobacco Industry Virus).
The team at K•A•C recently embarked on a very successful trip to Africa to help spread the message of tobacco harm reduction through promotion of the Global State of Tobacco Harm Reduction report. The success of this mission was a huge tribute to the enthusiasm and abilities of our local hosts who were then the subject of libellous attacks in regional press. We are more than happy to debate the issues in open forums but will not tolerate those working for and on behalf of K•A•C to be the subject of smears, lies and innuendo without a response from us which in some cases may be legal. As Dr Joe Kosterich memorably said at last year’s GFN conference: “Run your own race”. But if anybody thinks they can trip us up, think again.