There has been a subtle yet crucial shift in ideology which has led tobacco policies astray.
Consider that the statement using tobacco can result in disease is markedly different from the statement using tobacco results in disease. The first recognizes that tobacco use is a risk factor and the second is a gross generalization. The second position might be more effective in countering initiation but it also ends up supporting a strong anti-harm reduction stance.
Stating simply that using tobacco leads to disease ceases to distinguish between the two and therefore the only reasonable action for removing the disease is to remove tobacco use. Saying it might result in disease leaves open the option for substitutions that have much lower risks.
We have come to a place where we expect smokers to get sick and die as a result. Those who don’t are considered anomalies and while many smokers do get sick as a result many who do not. The overwhelming “these things will kill me” characterization is more ideological and a mirror of the times than it is a statement of fact.
Once tobacco use is characterized as inexorably leading to disease you are left with the position that all tobacco use as immediately harmful, any level of exposure to that use (second hand and third had smoke) as harmful, all communing of smokers in public as harmful, all smoking in public as harmful, and also any use of any tobacco product of any kind as harmful and therefore tobacco harm reduction no longer has any place in the discussion.
Recently at SpikedOnline, Frank Furedi wrote about the shift in public thought to instead of using as worst case thinking as just one of many future scenarios using it as the prime policy driver.
Frequently, worst-case thinking displaces any genuine risk-assessment process. Risk assessment is based on an attempt to calculate the probability of different outcomes. Worst-case thinking – these days known as precautionary thinking – is based on an act of imagination. It imagines the worst-case scenario and demands that we take action on that basis. For example, earlier this year, the fear that particles in the ash cloud from the volcanic eruption in Iceland could cause aeroplane engines to shut down automatically mutated into the conclusion that they would. It was the fantasy of the worst case, rather than risk assessment, which led to the panicky official ban on air travel.
Implicitly, and sometimes explicitly, advocates of worst-case thinking argue that society should stop looking at risk in terms of a balance of probabilities. These critics of probabilistic thinking are calling for a radical break with past practices, on the grounds that today we simply lack the information to calculate probabilities effectively. Their rejection of the practice of calculating probabilities is motivated by a belief that the dangers we face are so overwhelming and catastrophic – the Millennium Bug, international terrorism, swine flu, climate change – that we cannot wait until we have all the information before we calculate their destructive effects. ‘Shut it down!’ is the default response. One of the many regrettable consequences of this outlook is that policies designed to deal with threats are increasingly based on feelings and intuition rather than on evidence or facts.
Human beings have always exercised caution when dealing with uncertainty. Today, however, caution has become politicised and has been turned into a dominant cultural norm.
The Furedi article helps to explain why tobacco use policy is fear driven rather than a process of finding the most reasonable solution to a problem. Can there be any other explanation of why a future possibility of all snus and e-cigarette users gravitating to smoking (without any evidence for this) carries more weight than the potential of reducing the risks for smokers now?
Take fear out of the equation and you are left with simply dealing with a behavior with existing and available safer alternatives which if adopted would remove virtually all of the associated health risks.
Tobacco harm reduction is already at work. Smokers are switching over despite the impediments erected by the anti-tobacco and anti-smoking organizations that lie about being concerned about the annual death toll.
-Paul L. Bergen