Tobacco Harm Reduction and the right to health

18 groups has had a very real impact on many thousands of lives. Myth and misinformation about the measles vaccine has seen increases in outbreaks in both high- and low- income countries, reversing the trends towards eradication in higher income countries. Anti-tobacco harm reduction information, on the other hand, has come from official government, medical and public health sources in many countries and from within the WHO itself. There is an underlying philosophical problem here. Aside from misguided activists, few could argue that everything should be done to eradicate a communicable and infectious killer disease. But when it comes to non-communicable diseases, which are often seen in public health ranks as the result of lifestyle choices, then the battle can be framed in moral terms rather than health pragmatism. For some in public health, the pleasurable aspects of nicotine consumption for consumers can be hard to embrace. People who use nicotine in properly regulated safer nicotine products do so without causing themselves or society significant harm. The response to the global public health crisis of tobacco-related illness could be transformed if policymakers separated ‘nicotine use’ from ‘tobacco consumption’. “I was surprised how the desire to vape or smoke disappeared completely as soon as I switched to snus. It's much more enjoyable and the nicotine lasts much longer. I can trail run without getting out of breath and cigarettes smell like hell now.” Snus user 57 Medical myth, misinformation and media muddle The tobacco industry has a long history of egregious duplicity over the consequences of smoking. This history, combined with an underlying antipathy to the non-medical use of nicotine, has led to the creation of a broad coalition of academics, clinicians, anti-tobacco campaigners and government and medical agencies who unite to condemn tobacco harm reduction. Their campaigning is often well-funded by philanthropic and international bodies. Independent harm reduction evidence and its authors have been vilified, for example, with misrepresentation of evidence about the dangers of vaping compared to smoking, and disputes over the role of safer nicotine products in aiding smokers to switch from smoking or quit altogether. Much of the media, interested only in ‘bad news’ stories, often focuses its attention here. This causes confusion and mistrust among both smokers and health professionals. Deaths and illness linked to vaping in the US in 2019 – wrongly and consistently attributed solely to vaping nicotine liquid – are a case in point. Investigating agencies, and therefore mainstream media, took months to identify and communicate clearly that the majority of affected users were vaping THC liquids containing additives harmful to human health if inhaled, including thickening agent Vitamin E acetate. 58,59 Some surveys have shown that more current smokers now believe vaping is as dangerous as smoking – with the inevitable outcome that they continue smoking tobacco. 60 The inconvenient truth is that proponents of tobacco control who argue against access to safer nicotine products are paradoxically perpetuating the sale and use of the very thing they are trying to eradicate: the tobacco cigarette. They are supporting the industry they are focused on destroying, to the detriment of wider public health concerns. The inescapable truth is that antipathy to tobacco harm reduction protects and supports much higher risk cigarettes. 57 Reddit user BeatDukeAutomaton (December 2019), answering a thread comparing snus use to cigarette use https:// www.reddit.com/r/Snus/comments/ef3ssr/does_snus_help_relieve_stress_like_cigarettes_do/ 58 Blount, B., Karwowski, M., Shields, P. et al (2019) Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI New England Journal of Medicine (DOI: 10.1056/NEJMoa1916433) https://www.nejm.org/doi/full/10.1056/NEJMoa1916433#article_Abstract 59 Boyd, C. (2019) Vaping and lung disease: the CDC’s lesson in how not to handle an illness outbreak. Filter magazine . https://filtermag.org/vapes-and-lung-disease-the-cdcs-lesson-in-how-not-to-handle-an-illness-outbreak/ 60 Action on Smoking and Health (ASH) (2019) Use of e-cigarettes among adults in Great Britain . https://ash.org.uk/wp- content/uploads/2019/09/Use-of-e-cigarettes-among-adults-2019.pdf