Paradoxes of harm reduction

Michael Siegel has attacked robustly and deservedly a paper from the World Health Organization that recommends the banning of e-cigarettes (which it describes pompously as ENDS (electronic nicotine delivery systems, even though some are used without nicotine). The ground for banning them is that they 'resemble' smoking and so hinder the 'denormalisation' of smoking. Believers in tobacco harm reduction, including Michael Siegel, consider that e-cigarettes provide an alternative to smokers that gives them nicotine less hazardously, and that banning e-cigarettes will seriously hamper many people's efforts to stop smoking.

I share this position to the extent that clearly banning cigarettes will make it harder for many people to quit smoking if that is what they want to do. I can't get excited personally about quitting smoking as an objective. I smoke very occasionally, have never smoked heavily and never succeeded in getting addicted (seriously, an anti-smoker told me that I wasn't trying hard enough!). I feel that enough people do give up smoking to demonstrate that it is possible given the willpower and the right circumstances (hence am sceptical about the addiction narrative), but don't share the idea that everyone has to give up.

But for those people who do have this conviction that smokers must give up, it makes absolutely no sense to ban e-cigarettes, simply because of their physical resemblance to the 'real thing'. It leaves medicinal nicotine the only alternative available, and this is a choice that many people simply will not make. There is also abundant evidence of its abysmal success rate.

E-cigarettes are a new kid on the block, and represent unexpected competition in the nicotine market. The power and influence of pharmaceutical companies in supporting tobacco control could be a strong factor in the reluctance of groups like Action on Smoking and Health to embrace Tobacco Harm Reduction.

ASH Scotland appears to be sitting on the fence. But Deborah Arnott sees some of the merits of e-cigarettes, as she explains here. She warns that the end game of tobacco will not be possible unless smokers have a real alternative – and, in my view, she presents e-cigarettes as the only potential subtitute for smoked tobacco that can satisfy smokers. Her tone is: 'Like it or not, smokers will only take what they want'.

Her concerns are that e-cigarettes are not made by the right people. She fears that tobacco companies will buy them up only to stop making them. Those dastardly Chinese make sofas that burn you so they clearly can't be trusted. They have to be regulated to the hilt (and preferably made by someone who won't just phase them out). But they must be available.

It may not occur to Deborah Arnott that she has a conflict of interest to contend with:

Source (h/tip Jay)

I am not sure that aiming to destroy an industry sits well with an aim to reduce the harms from smoking. It is absurdly ambitious, with profound economic implications. Apart from anything else it is stretching a point to call this a charitable objective.

Ending nicotine addiction at all costs is also stupendously ambitious and may also not be beneficial to health (for instance a person may substitute a far more harmful addiction).

The whole crusade, ridiculously, specialises in a very limited area of health interest, and holds tobacco responsible for virtually everything that can go wrong with someone's health.

Unaccountably this anti-tobacco project has become a global monstrosity, with the result that the World Health Organisation creates its first (only?) multilateral global treaty around similar goals. So confused is the World Health Organisation about its myriad goals that it cannot bring itself to bless e-cigarettes, the most successful smoking cessation method to date, because they look so much like smoking cigarettes that they fear that the wrong message will go out to the public.