The Need for Nuance
It’s time for regulators to stop lumping all tobacco products together as being equally risky.
By George Gay
“It’s still difficult for me to understand how the European Commission can claim on the one hand that they want to do everything in their power to fight cancer, including revising tobacco policy, yet on the other hand completely reject the idea of liberalizing regulations for one of the very few products that has shown it can displace cigarettes.”
The above is a quote attributed to the Swedish member of the European Parliament, Sara Skyttedal, as part of a Snusforumet story published on Nov. 19. Skyttedal is clearly frustrated and angry with the commission, and, according to my interpretation of the story, her frustration comes down in part to the fact that while the commission says it wants to reduce the incidence of smoking throughout the EU to the low level at which it stands in Sweden, it is not willing to remove the ban on snus, the product that has largely displaced cigarettes in Sweden but that, for inexplicable reasons, is banned in the EU with the exception of Sweden.
I feel certain Skyttedal is merely making a point: She doesn’t really believe there is a logical conflict in the commission’s position. The apparent conflict is easily resolved by pointing out that while the commission might say it wants to do everything in its power to fight cancer, that is not the case. In fact, this becomes clear later in the story when, talking about the connection between Sweden’s low level of tobacco-related cancers relative to those in the rest of the EU and the fact that Sweden is the only country in the EU where snus is legally available, Skyttedal says the commission sees the connection but is not willing to act on it.
I hate to state the obvious, but I would guess that one of the commission’s hang-ups has to do with tobacco. It can tolerate the idea that nicotine in the form of nicotine-replacement therapy products or even vaping products should be allowed to replace tobacco products, but it cannot bear the idea that tobacco products might be allowed to substitute tobacco products. Tobacco has pariah status; nicotine is somewhere lower on the continuum of the unacceptable.
Let me provide an example. In November, my newspaper ran a story about how, because of the goods transport chaos afflicting the U.K. post-Brexit, there might be a shortage of alcohol this Christmas. This was seen as a negative because, apparently, we cannot celebrate this Christian festival without being off our heads, and despite the fact that such a shortage would probably result in fewer family fights, stomach-pumping hospital visits, drunk driving and all that entails, assaults on hospital accident and emergency staff and even deaths, since alcohol kills.
Imagine, however, if the story had been about a shortage of tobacco at Christmas. This would have been presented as a positive, though it would have caused a number of negative outcomes and almost no positive results, with the exception that a few people might have discovered they were able to quit their habit.
Language Matters
But I digress. Let me return to Skyttedal’s original complaint about the commission’s failure to follow through on its aim to do everything in its power. There are certain categories of phrases that immediately flash warning signs to the effect that what is being said should be taken with a pinch of salt, and one such category comprises those with superlatives. Just think of the phrases “nobody wants to see …” and “everyone agrees that ….” You hear and see such phrases used all the time, but it doesn’t take more than a second’s thought to realize they cannot be correct. It is almost impossible to imagine an instance when nobody or everybody was in favor of something. So when somebody tells you they are doing “everything in their power” to bring about a certain result, you know it’s time to look somewhere else for help.
Language matters, and, to my way of thinking, one of the problems that people who champion tobacco harm reduction have helped to create is down to the fact that they have been too willing to accept and parrot some of the extreme language and figures used by those people also involved in tobacco control but who are opposed to harm reduction. For instance, there has been a willingness to go along with claims of nicotine addictiveness that are clearly unsupportable, even though some health professionals keep this pot simmering by telling smokers they cannot give up nicotine without the support of … yup, there’s a surprise, health professionals.
Probably the ultimate superlative is “smoking kills,” which has become so ingrained that you are mocked if you say you don’t agree with it, but the truth of the matter is that a certain percentage of smokers die of smoking-related diseases, mostly after a long and possibly enjoyable history of smoking. The other smokers die of something else—perhaps of injuries caused by a drunk driver. And, I hate to be downbeat, nonsmokers die too, perhaps of “tobacco-related diseases,” though ones caused by pollution. If they didn’t die, the world would become full up, and the gene pool would lose its vigor.
OK, some will argue the smoking problem is not only about death but about the physical and economic costs of smokers living with medical conditions linked to their habit. But we are all prisoners of the choices we make. I doubt there are many people who reach the age of 50 without carrying some physical ailment linked to something they did when they were young. Some footballers die at relatively young ages having suffered from dementia attributable to their playing football, but few would claim playing football kills. Rather, we try to change the rules of the game and the equipment used to prevent brain damage—we employ harm reduction techniques.
Perhaps it’s time to reconsider what we mean by “smokeless.” After all, some tobaccos are cured using artificial heat—in some cases by burning wood fuel and contributing to deforestation. (Photo: phanasitti)
Distortion is a Problem
On the question of parroting figures, take the annual death toll attributed to tobacco-related diseases. Over the years, it has been increased a number of times, usually in lots of one million, so it now stands at the nicely rounded figure of 8 million. At the same time, the World Health Organization, which has ownership of this figure, has been claiming success in its efforts to prevent the deaths attributed to tobacco. But even given the world’s population has been increasing, it cannot be the case that the figure for tobacco-related deaths keeps leapfrogging this supposed success.
Why is this important? Because by exaggerating the problems caused by tobacco, some sections of tobacco control have been allowed to distort the picture to such an extent that it becomes difficult to sell the idea of tobacco harm reduction. When tobacco is depicted as being “deadly”—a superlative you often see applied to this product—and that depiction is not challenged, it becomes too counterintuitive even for the uncommitted to imagine that the problem caused by tobacco can be significantly reduced by another tobacco product such as snus. Additionally, because too many people have, for a quiet life, gone along with the U.S. Food and Drug Administration’s airy-fairy idea that e-cigarettes can be “deemed” “tobacco” products, the use of even vaping products as tobacco harm reduction agents can be challenged easily by those who wish to do so.
What we need is honesty. For instance, we need to stop lumping all combustibles together as if the consumption of cigarettes, cigars or pipe tobacco is equally risky. This cannot be the case, especially at a population level. And we have to do the same in respect of smokeless products. For instance, what do we mean by “smokeless”? Are we talking only of the consumption of the final product? Perhaps it’s time we checked out whether some of the tobaccos used in some “smokeless” products are cured using artificial heat—in some cases by burning wood fuel and contributing to deforestation.
It has become fashionable to talk of both individual and population risk, so, in this context, is it OK to reduce the harm caused to individuals by tobacco consumption if the production of the less risky items involves damaging the environment and, by extension, threatening the health of tobacco and nontobacco users alike?
This is a massively complex question, the answer to which would mean a descent into not altogether helpful relativities. One thing seems clear to me, however. If you drew up a continuum of environmental risk caused by tobacco and nicotine products, you would wind up with a picture somewhat different to the continuum of individual consumer risk caused by tobacco and nicotine products, which we are more used to seeing. But one thing would remain pretty much the same. Smokeless products, such as nicotine pouches, snus and chewing tobacco, would be the stand-out products when it comes to reduced environmental risks. What would change, I think, is that the divisions between combustibles in respect of environmental risks would widen appreciably, and vaping products, which are smokeless, while scoring well on the individual consumer risk continuum might well end up in free fall on the environmental risk continuum, something that needs to be addressed.
I’ve seen it said that there should be one set of rules for combustible products and another set of rules for noncombustible products. I think the rules need to be more nuanced than that.
