Snowdon on the prohibitionist’s dilemma

Christopher Snowdon blogs:

There’s a very revealing quote from the ‘policy and advocacy director’ (ie. chief lobbyist) at Queensland’s Cancer Council in this story that Dick Puddlecote picked up. He’s talking about e-cigarettes:

“This was a problem we didn’t have a number of years ago. It’s a real frustration for those of us working in public health because it wasn’t even on the horizon a number of years back.

“It’s something we’re just better off without.”

This tells you a lot about the mentality of the anti-smoking crusade. Consider the following scenario.

You are deeply concerned about the effect of smoking on health. You’ve spent your whole career trying to help people give up smoking. You dream of a ‘smoke-free world’.

But it’s a struggle. Smoking rates tend to be on the decline in wealthy countries, but they are falling very slowly. Globally, there are more people smoking than ever before and there will be more people smoking tomorrow.

No matter how many bans you introduce, a large minority of adults continues to smoke. Tax rises have had some effect on smoking prevalence but—although you would never say so openly—you are aware that these taxes are a major burden on the poor and are fueling a large and growing black market.

What’s more, nearly everything has been tried. All the reasonable stuff—health warnings, anti-smoking ads, banning sales to minors—was introduced before you were born. Even the more extreme measures on the list have mostly been ticked off, which is why you’ve had to spend the last few years scraping the bottom of the barrel with this silly plain packaging campaign. But what comes next? It has to be prohibition of some sort, and you know that won’t work.

At one time, many years ago, it seemed that nicotine patches and gum might offer a solution, but it has become clear that smokers don’t really like them and their efficacy as stop-smoking aids is pretty negligible.

And then, out of nowhere, a product falls into your lap that smokers actually like and which helps smokers quit. Incredibly, even smokers who had no intention of quitting find themselves switching to it. There is no evidence that it causes cancer, heart disease or COPD and it doesn’t create an odour that non-smokers would find objectionable.

You can’t believe your luck. This is the kind of thing that people like Michael Russell hoped to discover in the 1980s: a device that delivers nicotine in a satisfying way without delivering the smoke and the toxins. At last! This changes everything! What anopportunity!

That’s scenario number one.

And there have been some (a minority) who react like that.

In scenario number two, you are a journeyman public health advocate picking up a nice, steady wage from the government every month. You hold lots of meetings and you go to lots of conferences. You and your colleagues developed a plan of incremental prohibition in the early 1980s and you have it all mapped out.

The Plan was to ban tobacco advertising and then ban smoking in as many places as possible. You were going to raise taxes on tobacco until it became unaffordable for people on low and median incomes. Other ideas—display bans, graphic warnings, banning menthol cigarettes—could be incorporated if you could convince politicians that something should be done and these policies were something.

You would attack what you considered to be the source of problem—the tobacco industry—with plain packaging, windfall taxes, standardised cigarettes or whatever. Gradually, you would beat smokers and the industry down until both were so unpopular that you could push for the final goal of prohibition. Within twenty years (it was always twenty years away) the tobacco industry would be outlawed and there would be no more smoking. In the meantime, there was good money to be made getting research grants to prove that the various policies in The Plan would work.

And then something comes along that you didn’t expect. A new product that gives smokers a way to enjoy nicotine without the health risks of smoking cigarettes. You didn’t come up with the idea. The government didn’t come up with the idea. It came from the private sector, and private businesses are making money out of it. Worse still, after a few years of monitoring the market, the tobacco industry buys up a few companies and now they’re making money out of it.

Sure, lots of people are giving up smoking as a result, but not in a way that was part of The Plan. Where does this leave you? What will become of the public health professionals and all their peer-reviewed studies? What about the ‘endgame’? What a problem!

So you bite your nails and say to yourself…

“This was a problem we didn’t have a number of years ago. It’s a real frustration for those of us working in public health because it wasn’t even on the horizon a number of years back.”

And then you pour yourself a glass of skimmed milk, slump into your armchair and say…

“It’s something we’re just better off without.”

There are public health lobbyists who hate the effect of smoking, and there are public health lobbyists who just hate tobacco companies. The former tend to be rational about reducing harm.

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