What's the Harm in Smoking Harm Reduction?

Smoking ‘harm reduction’ advocates seem to be working from the premise that some degree of harm is inevitable or unavoidable in relation to smoking. But this is manifestly untrue. The harm from smoking could be eliminated rather than just reduced – if there were the political will to ban tobacco products.

In the meantime the prevailing view seems to be that since some people will never want or be able to stop using nicotine, commercial interests should be allowed to supply it in the allegedly safer form of e-cigarettes. This line of reasoning supposes that smokers can be influenced through logic and common sense to switch to a less harmful way of absorbing nicotine into their bodies, but if this were true, why haven’t smokers abandoned cigarettes en masse in favour of e-cigarettes? Although many have, there are still 9.6 million smokers in the UK and 36.5 million in the US, for example.

A different picture presents itself if one looks at the question of whether anyone needs to use nicotine at all. The word ‘use’ in this context is the clue to what we are dealing with: drug addiction. The question, then, is whether it is or should be public policy for there to be millions of people walking around addicted to nicotine – in any form.

Many governments are working towards reducing smoking through what is called tobacco control, though this will be too little, too late for the nearly 6,000,000 smokers worldwide who die each year from smoking related diseases. (Source: the US Centers for Disease Control and Prevention.)

The dilemma is well put by Robert Proctor in his magisterial treatise on Big Tobacco, Golden Holocaust (2011):

Surveys show that most smokers want to quit and regret having ever started: tobacco is not a recreational drug, which makes it different from alcohol or even marijuana in this respect…smokers usually dislike their habit and wish they could escape it. (Emphasis in original.)

I would modify these statements slightly by pointing out that smokers may say they want to quit, but in practice they don’t really want to quit – not because they don’t dislike their ‘habit’ – but because they are addicted to the nicotine in tobacco smoke. And the reason they don’t really want to quit is because they have a fear of not smoking. Such inconsistencies are characteristic of addictive behaviour.

If smoking is seen for what it is – drug addiction – the question then becomes: why is the orthodox approach to the smoking problem only aimed at harm reduction rather than harm abolition? The former approach implies that nicotine use is here to stay, partly because there are benefits (pleasure, stress relief) people believe they gain from nicotine, of which it would be unfair to deprive them.

Part of this belief comes from the failure to appreciate that for practical purposes the only reason smokers smoke, or vapers vape, is to obtain relief from the discomfort of nicotine withdrawal; the alleged benefits are illusory. Unfortunately these simple facts tend to be obscured by doctors and others paying too much attention to research which seems to indicate that while smokers may indeed smoke to relieve the discomfort of nicotine withdrawal, they also smoke because of ‘triggers’ or ‘cues’ to smoke and because of the alleged release of dopamine stimulating the brain’s pleasure centre, etc. This kind of thinking, derived from laboratory studies or tick-box surveys, tends to support the erroneous idea that there are positive aspects of nicotine use. And this is one misguided reason why there is such an emphasis on tobacco harm reduction rather than abolition.

It’s also clear that the push to get smokers to change to e-cigarettes is largely commercially driven. For example, the ‘Third Vape Expo’ is scheduled to be held in Poland in March 2017. This is billed as:

The foremost professional vaping trade show. It is where industry players and experts showcase, share and incubate ideas. It is also where influencers and decision-makers seek and find solutions to propel their businesses…The Third Vape Expo Poland network now includes more than 2000 suppliers and buyers of vaping products from 15 countries worldwide.

There’s an interesting promotional video for this event featuring scenes from the September 2016 Expo: with catchy synthetic music in the background there’s no text or dialogue but the film shows hundreds of young people exploring the venue and visiting the different stands where vaping products are on sale. Many of them are merrily vaping away. It’s only too obvious that the purpose of this trade show is to entice young people to become long-term nicotine addicts.

Is this really the best way to deal with the smoking problem?