Even professional harm reduction workers have issues with tobacco harm reduction

Ask any doctor what they would recommend if a patient of theirs who felt compelled to use a drug with proven health risks asked whether it would be better to take another drug which made them feel exactly the same but was a lot safer. Odds are the doctor would suggest switching.

Now ask them about smoking and e-cigarettes and the answer might change.

Though many doctors are coming around the health community as a whole is still experiencing a bizarre disconnect when it comes to nicotine. You can’t even call it cognitive dissonance because they don’t seem to experience any anxiety from endorsing harm reduction in general while rejecting it when it applies to smokers.

A few years ago at a small meeting held at one of the conferences of what used to be called the International Harm Reduction Association I witnessed a similar occurrence which given the context was even more disturbing. The meeting had arisen due to certain influential elements within the organization who wanted to eliminate tobacco harm reduction from their community.

It was very strange to see individuals who had supported safer sex, safer drug injection practices, and safe injection sites, practically foaming at the mouth at the thought of promoting tobacco harm reduction. One of the central objections was that one avenue of harm reduction, smokeless tobacco, was produced by tobacco companies, and these same people who would, if it improved the likelihood of safer practices, collaborate with drug producers and dealers, with difficult anti-democratic bureaucracies, and with pimps, would rather cut off their own hands than join with tobacco companies to find a solution.

When the people who are on the front lines of the battle reject what should be contiguous with their own goals (reducing the harm in risky practices) you have to be concerned about the average public health official.

I don’t want to be entirely negative here. I believe the tide is turning and to a great degree because e-cigarettes arose independently of the tobacco companies. However the companies are buying into the e-cigarette market and you can expect the objections to increase in number.

Most of these objections will be of the “just a way of maintaining nicotine addiction” nature. But guess what – along with the independent e-cigarette companies these “evil” folks are taking pretty well all the harm out of using nicotine. The addiction was never really the issue.

The anti-nicotine forces like to promote the idea that there is something special about smoking, nicotine and tobacco companies.

Not so.

Smoking is just another popular behavior with some safer satisfying alternatives available. Nicotine is just another drug like caffeine that feels good enough to make a difference but not so good that it disrupts the rest of your life. And tobacco companies are no different from any other large corporations that will do anything to keep customers.

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Comments

  • Michael J. McFadden  On February 18, 2013 at 11:02 pm

    “And tobacco companies are no different from any other large corporations that will do anything to keep customers.”

    Very true. And very true as well in their behavior over the years regarding their statements and research about health effects of smoking. You can bet your bippy that the McWhopperies have investigated health aspects of their various offerings and have kept the negative results quiet as a churchmouse. And you can bet your boppy that Big Auto engaged in similar activities back when seat belts were first being pushed etc.

    To some extent you can *almost* say “It’s not their fault.” Why? Because legally, I believe, they’re somewhat restricted in what they can say or do that will harm the profits of their companies. Shareholders can probably sue them within an inch of their lives if they start publicizing information that makes share prices take a big hit… even if such information was both true AND in the interest of public safety.

    Not a lawyer here, so not sure about that, but I *think* I read a detailed discussion once that pointed in that direction. It it IS true, then it’s something that should be changed… maybe some sort of corporate whistleblower law?

    – MJM

    • Paul L. Bergen  On February 18, 2013 at 11:34 pm

      Michael,
      I think you are right regarding that shareholders might if not sue be able to stop information that would be publicly useful if it interfered with profitability. Though not exactly the same, countries have been cautioned for having domestic restrictions (like public health care) which could interfere with a foreign company’s profits (Canada and U.S.A and the FTA).
      The point I was getting at was that the historical behavior of tobacco corporations was no different than other corporations. Yes they lied but what company didn’t? They are presented as an anomaly but what is getting more an more apparent is that they are typical and that we are just realizing that about other companies (now we hear about Big Pharma and Big Oil, etc).

  • Jim Rothenberger  On February 19, 2013 at 10:51 am

    I don’t believe you need to go as far off topic as to use Mickey D and the auto industry. The pharmaceutical industry itself will minimize risk, drop clinical trials that don’t provide the profile required and leave a product on the market when serious adverse events are uncovered. Many times you see the black box added after serious morbidity and mortality is uncovered rather than removing the product from market.

    There’s always a cost/benefit analysis done and it’s not always based on health. A product that is analyzed to remain profitable after the cost of litigation may be determined to remain a viable product. Chantix may be just that type of product. From a corporate view, there are huge profits with limited liability (thus far) from adverse events. That doesn’t help the health of the person that kills himself or others. From a health standpoint, is the product really a good choice for individuals that wish to quit smoking. What is the long term success rate, the adverse event rate and the cost compared to other alternatives. Pfizer and the FDA would like you to believe so.

    Until there is an objective continuum of risk/benefit established for the various products, both Pharma and consumer, the rest is just corporate positioning. Blaming an entire industry for the failures decades ago is ludicrous. Lying about the dangers of products, e cigarettes and smokeless for example, for decades, is criminal.

  • Lisa Belle  On February 20, 2013 at 11:09 am

    In the doctor’s office a few feet from the exam table I sat on a week ago was a poster of lungs with normal areola, or the little oxygen uptake cells, then a pic or COPD microscopic view, the opening was squeezed but still slightly open, the third image was, Emphysema and the airways and blood transmitters were almost completely shut. I had a pat on the back from him a year before during a visit, but this time, I handed him a card for casaa.org and asked him, if any other patients, who are suffering as the poster proves they will by smoking, would you be willing to hand them this card? “….. very evasive…. probably thought, this patient doesn’t have the credentials of my pharmaceutical buddies……hm!

    • Michael J. McFadden  On February 20, 2013 at 11:13 am

      Docs are in a bit of a bind. If they so much as HINT at some form of treatment or therapy that’s not 100% in the “fully approved guidebook” then they can bet their life they’re going to eventually get sued by some money-hungry patient who’ll blame them for malpractice. My guess is that SOME docs take the risk with patients who they trust… but they’re placing their futures in those patients’ hands when they do so.

      Sad.

      :/
      Michael

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