Is it safe?

Sometimes I feel like Dustin Hoffman in Marathon Man where Laurence Olivier who plays the demented Nazi dentist keeps asking him “is it safe?”

Tobacco harm reduction, and harm reduction in general operates on the principle of whether an action or substance is safer than another, not so much their absolute safety. One of the most prominent anti-tobacco harm reduction strategies is to ask the question of “is it safe” in order to avoid the comparison (For example.). Other factors being equal, once you accept that nothing is absolutely safe but that some things are safer than others, only a moron would not see the advantage in going with the safer activity.

Today, Michael Siegel had a good post on the FDA forging forward under their new tobacco mandate and pledging time and money to determine the toxic elements in tobacco smoke. As he points out, we have plenty of evidence about it being pretty harmful and a better use of these resources, if health is the issue, would be to concentrate not on further determining how dangerous smoking is, but to finding and promoting safer alternatives.

On the other hand, we have anti-e-cigarette articles coming out daily on how e-smoking is or might not be absolutely safe. (See this BBC article.)

You could easily have made the same arguments against airbags and seatbelts. Those items, which have saved the lives of thousands to date, have on occasion caused death when otherwise it might not have happened. They are not absolutely safe. But they are safer, and that is why they are now standard equipment in automobiles.

-PLB

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Comments

  • Carl V Phillips  On January 23, 2010 at 1:54 pm

    Just to help people avoid misinterpreting one thing that Paul wrote, it is indeed completely inexcusable to not recognize the advantage of lower risk. This does not mean that there may not be disadvantages of the low-risk alternative that are orthogonal to the risk question. Or, as I teach my students, just because something has an advantage does not mean it is better. (And, similarly, just because something has a disadvantage does not mean it is bad. It sure would be nice if people in public health would all understand that simple point.)

    Thus, it can be perfectly rational for someone to say “I know that smokeless tobacco is much lower risk than smoking, but I like smoking so much that it is worth it.” Someone who says such a thing is *not* a moron. The people who Paul was referring to are those who think that something being low risk is no advantage compared to an alternative that is high risk.

    Of course, many people making such claims are not morons either. They are something worse: They know very well what they are saying, but presume to themselves the right to lie to people about their health risks, violating people’s human rights and damaging their welfare in order to support some political goal.

    I just wanted to clarify because sometimes people read things too fast.

    –Carl Phillips

  • Paul  On January 23, 2010 at 3:08 pm

    Which is why I prefaced that statement with “other things being equal”. But perhaps my desire for brevity increased the likelihood of misinterpretation, so thanks for adding the detail, Carl.

    We tend to operate with our individual hierarchies of need; in other words, my need for feeling free of anxiety might outweigh the desire for a safer version of my drug of choice. And that is a rational educated choice, which is what harm reduction is ultimately about -knowing the risks and options and then making your own choice.

  • James Dunworth  On January 25, 2010 at 12:29 am

    I think those comments are probably worth expanding into another blog post on harm reduction.

    Regarding the BBC article, I didn’t think it was that bad. They did at least quote ASH UK as saying that electronic cigarettes couldn’t possible be as bad as regular cigarettes.

  • Paul  On January 25, 2010 at 10:24 am

    You are quite correct James. The BBC coverage was better than most. I meant my remarks to refer to the original source, the researchers’ article. Unfortunately that article is not open source at this time. (For those interested, the BBC did reiterate the pith of the article quite adequately).

    And yes, a followup post might be up later today.

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