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s2smodern

From reading the esteemed work of Professors Wayne Hall and Lynn Kozlowski, I have been led into the world of moral psychology as it applies to harm reduction and the attempt to explain the root of passionately held views. The modern day moral psychology guru Jonathan Haidt argues that trying to reconcile opposing moral positions will never work if neither side is prepared to acknowledge where the other side is ‘coming from’.

This is mirrored by a recent exchange among tobacco academics and analysts about how a totally independently review of the evidence for tobacco harm reduction (THR) might somehow build bridges between opposition camps. I’ll come back to that in a future blog.

Haidt has written a whole book on this called The Righteous Mind: Why Good People are Divided by Politics and Religion, so what follows is a very brief and overly-simplistic summary. There are three basic moral concepts, with five associated moral foundations, which result in three emotional responses:

Moral concept

Associated moral foundations

Emotions if violated

Autonomy (justice, rights)

Harm/care

Fairness/reciprocity

Anger

Community (hierarchy, duty, social roles)

In-group/loyalty

Authority/respect

Contempt

Divinity (pollution, sin)

Purity/sanctity

Disgust

As a sweeping generalisation and conflating the three points, those on the political liberal left are more likely to favour harm reduction because of their stance on justice, fairness and rights while those on the conservative right are more likely to favour positions which highlight loyalty, authority and respect – and arguably moving further to the political edges, you have those whose views are underpinned by religious notions of purity and sin. These moral standpoints, Haidt says, are first response gut instincts, entirely detached from any ‘evidence-base’ and will elicit an outburst of anger, contempt or disgust, depending on which moral position has been attacked or questioned. For example, academics who support THR will often be held in contempt by opponents who will accuse them of being industry stooges because they are viewed as violators of the supposed ‘group loyalty’ of their peers. Only later will there (possibly) be a search for external rationalisations, say in science, for these emotional responses. For now, I just want briefly to reflect on how this moral framework applies to gateway theory.

According to the tenets of moral psychology, it is not possible for an opponent of tobacco harm reduction to contemplate anything that compromises an all-out attack on what is clearly a very serious health issue. Therefore, they will not engage in any ideas about communicating truthful information or trying to find ways of reducing harm. Instead, the argument is framed around protecting children and attacking the tobacco industry. There also appears to be a streak of divinity running through gateway arguments which is all about combatting sin and preserving purity, in other words, preserving the ‘innocence’ of children and protecting them from the evils of sinful behaviour. So you get all kinds of campaigns warning teenagers about the dangers of vaping, actually aimed at the ‘good’ kids, the ones who probably wouldn’t vape anyway, whilst the ‘bad’ kids who have probably started smoking or contemplate doing so, are effectively ignored as presumably ‘beyond saving’ and who, in turn, will ignore the warnings. To not focus on those young people most at risk of smoking and instead going for a ‘feel good’ counsel of perfection seems a serious dereliction of public health duty, but I wouldn’t get far with that argument, would I?

So what do you do? Whatever the ideal situation might be, trying to deliver school-based truthful information about any substance use is fraught with danger, not least the parent/governor lynching party that will be coming at you. But young people operate in the real world and can just as easily absorb truthful public health messaging aimed at adults. After all, tobacco companies have (to the best of my knowledge) never actively targeted ads at young people; they didn’t have to when cigarette ads were everywhere you turned. (However, I’m no tobacco historian, so I bow to superior knowledge on that one). But you can’t do much on the advertising front about any safer nicotine product. Paraphrasing one academic, there is good news about risk reduction, but you are only allowed to whisper it. Then again, the viral nature of communications these days can quickly outrun any considerations of public messaging as the seemingly explosive popularity of JUUL can testify. Everybody is now playing catch-up on that one. I don’t know how many younger JUUL users are already smokers, but should young people be seriously denied access to this product by whatever means, if would be interesting (and potentially tragic) to see how many take up (or go back to) smoking instead.

And in other news…

At the recent inaugural forum of the UK Vaping Industry Association, one session was chaired by Norman Lamb MP, who also chairs the current Parliamentary inquiry into e-cigarettes. Lamb was asked why representatives from the major tobacco companies were invited to give oral evidence, but not the vaping industry, nor advocacy groups. As if by magic, an invitation has now been extended to both, so on 9th May around 5pm, the UKVIA and the New Nicotine Alliance will be giving evidence. There will be a live stream of the proceedings at:

https://www.parliament.uk/business/committees/committees-a-z/commons-select/science-and-technology-committee/inquiries/parliament-2017/e-cigarettes-17-19/

At the same enquiry, neither Dr Tim Baxter from the Department Health, nor Public Health Minister Steve Brine ruled out the possibility of reviewing the Tobacco Products Directive post-Brexit, including lifting the ban on snus. Dr Baxter said;

“Page 27 of the tobacco control plan is headed ‘Leaving the European Union’. It sets out a commitment, and we have to review the tobacco and related products regulations within five years anyway. That is in the regulations. In the context of Brexit, we will be reviewing the legislation to see where changes might be made. There will be that review. The challenge will be to identify where changes might be made that would continue to protect public health but that might simplify, deregulate and so on. The plan says: ‘In particular, the government will assess recent legislation such as the Tobacco Products Directive, including as it applies to e-cigarettes, and consider where the UK’s exit provides opportunity to alter the legislative provisions to provide for improved health outcomes within the UK context.’ ”

A new study claims that when viewing advertisements for flavoured e-cigarettes, brain scans showed that a cohort of 18-25-year-olds responded more positively to what they saw “than when [viewing] only images of tobacco on e-cigarette advertisements” said the lead researcher. Given that e-cigarettes do not contain tobacco, I don’t understand exactly what the subjects were looking at, but apparently the results confirmed the researchers resolve to find ways of preventing young people from trying e-cigarettes. From brain scan to major policy recommendation in one unconvincing leap, but which led me to wonder what the brain scan of a ‘young person’ would have looked like on exposure to the advertising of Death (and Death Light!) cigarettes on sale in the UK and elsewhere in the 1990s.

This new vaping education video and website from Canada is worth a look:

https://www.youtube.com/watch?v=2Tzqh7ghG6M&feature=youtu.be (www.vaepworld.com)

And finally, an amusing little tweet from Judy Gibson:

“Prof Glantz ‘discovers’ yet another vaping ‘gateway’. Let’s predict links to alcohol misuse, petty theft, unsafe sex, tattoos, untidy bedrooms, flunking exams, heavy metal & hang-gliding to avoid wasting funds on any further research”.

Amen to that.