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s2smodern

I had in mind to do a reflective piece when I reached blog 100, not imagining that by the time I arrived here, millions of people across the world would have more time for reflection than they can cope with.

Professor Alex Stevens from Kent University has written an article on the proposition that it is naïve to imagine the scientific and medical advice, given to politicians about COVID-19, is simply adopted and implemented. Of course not – government advisors on any policy issue often feed politicians what they want to hear or have their advice bent to the will of political expediency. And there is a problem with the ‘science’ of COVID-19: there is no one ‘science’, no single template of agreed medical advice adopted around the world. Clearly different governments are getting different advice.

In such a febrile and uncertain environment this is to be expected; the whole history of scientific discovery is one of competitive research, testing out theories, debating and arguing with peers through journals and meetings which hopefully – through study replication – progress the sum of human knowledge to a point where a level of consensus is reached. Currently COVID-19 publishing is growing exponentially without, one assumes, much attention being paid to the peer reviewing process – flawed though that is. I heard a London research doctor say that after a day’s work now staffing the hospital front line, he goes home to find three or four new and important papers on COVID-19 have been published. He is finding it almost impossible to keep up. It is not quite as bad as Hollywood screenwriter William Goldman’s view on tinsel town’s ability to predict which films would be successful, “Nobody knows anything” – but many basic questions about this virus remain unanswered. Professor Stevens wrote that politicians cherry-pick the research or advice that suits; but it seems to me the situation regarding tobacco harm reduction (THR) is much worse than that.

I have worked all my professional life for drug NGOs whose raison d’être was to promote information and policy driven by a reasonable assessment of the evidence base, absent of any ideological motives. This is critically important in such an emotional and volatile environment as illegal drugs. When dealing with risky behaviours where people find abstinence impossible, the logical and humane response is to try your utmost to help people survive and ‘live better’ even if they don’t necessarily ‘get better’ either in the short or even longer term.

But since moving into the world of THR back in 2016, I have been appalled to find a situation in which ostensibly reputable medical and public health organisations do more than cherry-pick the evidence they like. They just trash the evidence they don’t like without providing any credible data of their own to back up their opposition. They deliberately conflate smoking, vaping and nicotine, then swerve around the whole evidence base by claiming that THR is just another Big Tobacco ploy, and at the same time accusing THR advocates of misleading the public about relative safety. Cue hollow laughter. Relative to its global influence, the worst culprit is the WHO. Its recently published Q/A on the topic was simply riddled with wrong information. One of their top officials told a meeting of politicians that vaping had been killing people since 2012 and vaping led to cannabis use. Misleading? Or is there some definition of the word I’m missing here? But the WHO is not alone. Equally influential bodies such as the US Center for Disease Control and the Federal Drug Administration are equally culpable.

There are many examples of so-called experts commanding the attention of the media and politicians because they are playing on the fact that most people hearing this farrago of nonsense will not bother to check the information for themselves. Instead they rely both on the credentials of the messenger and their own gut reaction as to what they believe to be true – that given its track record, the tobacco industry is trying to create a new generation of nicotine addicts and that vaping and smoking are equally dangerous. COVID-19 is being used as a golden opportunity by the WHO and other national public health bodies to underline the message of equal risk without any sound evidence. The end result will be more current smokers deciding not to switch and carry on smoking, with the inevitable outcome for half of them.

With all the caveats, nonetheless we are living in times where trusting medical and scientific advice has never been more important. Therefore, it is not acceptable to have national or international public servants lying to the very public who pay their not inconsiderable salaries in pursuit of their own moral – rather than a public – health agenda. Many of these misinformants have medical qualifications and presumably signed up to ‘First do no harm’. But when it comes to public communication in a time of high anxiety - they should also add - ‘And tell the truth’. One hand should be washing the other.

https://www.nature.com/articles/s41562-020-0894-x