Smokeless Tobacco: Carl V Phillips Misleading Smokeless Info


The World

Carl V. Phillips

Dear Public Health: the public despises you, so you are probably doing it wrong
21 September 2014
By Carl V Phillips
A collection of disjointed, though related, thoughts I have had for days, months, and years have coalesced together in a very interesting way. The thesis here is a theory I have evolved based on experience and focused thought over a couple of decades, not some flight-of-fancy. Still, I grant that this story is necessarily simplified and certainly there is room for debate. Also, as will quickly become apparent, this is not a typical post for this blog, but it is quite relevant.
The title of this post is something I paraphrase periodically in a tweet. But that phrasing is something I would have rejected a decade-and-a-half ago, when I first started working in THR. At that time, I repeatedly objected to the opponents of harm reduction being referred to as public health, which is of course the diametric opposite of what they were and are assuming we think that public health is about improving people’s health.
At the time, there was no serious grassroots support for THR, so proponents of trying to provide tobacco users with information and products consisted of elements of the tobacco industry, a couple of pundits, and a few independent scientists. (And I do mean a few. There were not enough of us to have a conference, only about enough for a carpool.) So that is who talked about it, and so I had ample opportunity to be offended when the industry people referred to the harm reduction opponents, as they always did, as public health. As in “this could prolong millions of lives, but public health is going to object to it.” I objected that I was part of public health (it said so on my business cards, after all) but those people were just a special-interest group that was misappropriating the good name of public health.
For those who are new to this world and have never learned its history, anti-THR was alive and well from the 1990s, when the first concerted pro-THR discussion began, thanks largely to Brad Rodu and a few people from Sweden. In many ways, attacks on smokeless tobacco then (and still, for that matter) were worse than the current attacks on e-cigarettes. At least anti-ecig crusaders sometimes attempt to hedge with claims about unknowns, renormalization, gateway, and the like, while the anti-ST playbook was (and still is) simply out-and-out lying about health risks in the face of overwhelming evidence to the contrary. On the other hand, anti-THR at the time was pretty much limited to a small number of anti-tobacco extremists, though they were quite effective because they had already captured the U.S. government and other effective megaphones, and the falsehood that all tobacco is highly harmful was pervasive. Still, the typical public health professional was as much an ignorant victim of the monolithic disinformation campaign as the public, in contrast with public health’s widespread active support for anti-THR today, in an information-dense world where they have no excuse for ignorance.
I continued to protest crediting anti-THR activists as being part of public health for a long time, but with decreasing frequency and enthusiasm. As the discussion about THR grew, the anti-THR special interest movement grew and continued to claim that they were part of public health. So at some point the real public health people could no longer be credited with merely not knowing about this misuse of their increasingly-not-so-good name. In 2000, a state public health official, leader of a public health NGO, or even professor of public health whose focus lay elsewhere could be forgiven for not even knowing about THR, let alone that it was being attacked in their name. By 2010 that was clearly no longer the case.
In the 1980s the spiritual forebears of the grassroots THR movement taught us “silence=death”. Perhaps that is a bit strong for the present discussion, but it is certainly the case that silence=complicity. It was in a conversation with Chris Snowdon, at about the time that I was deciding I could not stand to have the phrase public health on my card anymore, that I finally conceded, “Yeah, screw this trying to defend that phrase against those who are abusing it this way; let the card-carrying public health people defend it if they want, and if they do not, let them share the disdain and disrespect that those abusers are earning for the whole field.” Of course there are and always were people doing good, valuable, real public health, and it is unfortunate that they are tarred with that brush. But, hey, that is what happens when you do not police your own. So now I do not hesitate to use the phrase in the derogatory manner that has become common.
An extremist political faction grew out of real public health work on tobacco that occurred decades ago, becoming the tobacco control special interest group. That has now metastasized such that a large portion of what is called “public health” is really about the nanny state. So the shoe fits. Of course, readers of this blog will know that I try to acknowledge the existence of real public health, despite the fact that its ugly progeny are now the tail wagging the dog, by using the scare-quoted “public health” to refer to the nanny-state political movement. But, as I said, I no longer to try very hard to draw the increasingly thin distinction. It becomes harder to condone the failure of self-policing as the nanny state becomes more the bully state, exhibiting the characteristics described below, and still there is no hint of self-policing.
But perhaps most important, it is now apparent to me that those progeny are not hybrid offspring that defy the core spirit of public health as an intellectual movement and institution. Rather, public health has bred true.
That is not, however, due to the reason you might think. Those who know the history of public health will realize that the germ of nanny-state behavior has always been there. Public health started as a strange combination of fad-diet and temperance nuts along with practicing health professionals who were enlightened enough to be concerned about eliminating disease rather than just treating it. It pulled in established good works such as food facility inspection, occupational health, and vaccine campaigns, and had a legitimate scientific and institutional identity by the mid-20th century. Through several ensuing decades it was mostly legitimate, but the temperance nuts were still there.
My first encounter with that undercurrent was when I was in grad school, in a different field, writing a paper on the benefits of moderate alcohol consumption. (Please don’t go look it up. It was naive. I was young and had not figured out that the economist penchant for carpetbagging in fields where they lacked expertise — see, e.g., almost every popular book written by an economist — was a bad thing.) I came across a lot of “public health” papers that insisted that the observed health benefits of alcohol consumption were not real, grasping at straws to deny overwhelming evidence. I was genuinely baffled at how people could be making such errors. It would be years later before I realized that they were simply lying because that is what you do in “public health” when the facts do not support your preferences about how people should behave.
But it turns out that it was not those temperance nuts that created the foundation that doomed public health to become what it is today. They found fertile ground for their crusades there, of course. But it was actually the narrow-minded health professionals who doomed it.
Back to the present, we have a compelling illustration of the descent of “public health” and its abandoning the pretense of caring about people: the John Ashton scandal.
For those who do not know, he is the head of a British organization that fancies itself The Faculty of Public Health and claims to represent public health (so take that as your starting point, even though it is really more a political think-tank like any other). He recently went off like a drunken adolescent on Twitter, personally attacking people who questioned or expressed disagreement with his extremist anti-ecig positions.
He then pushed a fabricated story into the press in which he claimed that he was merely retaliating for nasty things that were said about him, though it turns out those were all said after his tirade. His attacks were of a tone that might even cost an NFL player his job, let alone a professional who is supposedly working in the public interest. Surprisingly, the FPH suspended Ashton from his duties and claimed to be conducting an investigation. Not so surprisingly, a week later, they proudly announced he was returning to his duties. The FPH did not apologize for the lashing out itself or the attitude — merely for the profane language used. Ashton stated that he regretted what he had done — no kidding! — but he too failed to apologize.
(For more on the story in case you are not familiar, follow back the links fromDick Puddlecote and Clive Bates, and see in particular Lorien Jollye who led the charge about it.)
The real scandal here is not that one self-important think-tank was unwilling to get rid of its president over grossly unprofessional behavior (though that is ascandal), but that “public health” rallied around him. Here is a supposed adult who publicly said “fuck you” to members of the public who he is supposed to care about (he did not use that exact phrase as far as I know, but actually did use other words that I would not type into this blog). The people he attacked were disagreeing with him almost entirely in a polite and professional way. And yet I have not seen one single statement along the lines of “this is a real shame because I respected Aston for years, but for the credibility of public health, he has got to go.” Not one sign of remorse from the institutions of public health. Instead, I have seen a number of public health academics and other supposedly respectable professionals actively speaking up in his defense. These communications represented (and in some cases, basically explicitly stated) the attitude that “public health” does not owe the public any consideration at all.
Put another way, public health stopped being about health when they started denying the health benefits of THR or alcohol. Then they stopped being about the public when the decided that it was not a problem that the public hates them for what they are doing.
Taking another trip back in this fugue, I recall a conversation with a fellow economics-trained assistant professor of public health. I forget the specific trigger for our observation, but it came after a meeting of faculty, when we both realized that we were surrounded by idiots. The issue was public-health-based policy recommendations and their absurd implicit objective function. Our observation was that in economics we often lean on the convenient myth that people’s goal is to maximize their lifecycle welfare, and that social policies should be based on that. It is easy to demonstrate that this is an oversimplification of behavior, and to argue from an ethical standpoint that there should be some departures from this in policy. But at least our simplified fiction is basically sound, both practically and ethically: Trying to maximize their welfare is roughly what people do, and there is an obviously defensible case to be made that trying to assist with such maximization is an important ethical goal — if not the ethical goal — of public policy.
We observed how sharply this contrasted with the implicit objective function in almost every public health policy discussion, which is basically “maximize longevity at any expense, and everything else be damned.” The economists who study medical care at least interject into this the caveat that some financial expenditures are too much to pay for the tiny bit of extra longevity they provide. But to the public health people, all other costs and benefits are trumped by the one objective. Economists’ objective function, we agreed, was not quite right, but at least it was generally defensible. The public health view, on the other hand, was utterly absurd. No one wants to live their life according to such an objective. Not even close. And therefore there is no possible way to justify it as an ethical goal for public policy.
This absurdity is the seed of destruction that was built into public health, uncritically accepted even by those who are not part of the “public health” political faction because they are so immersed in it that they do not even realize they are making a very strong (and indefensible) assumption. It is effectively built into the language of public health discourse and thus it is almost like the Sapir-Whorf hypothesis or its literary extension as Newspeak: the available language makes it impossible to think contrary thoughts.
This pseudo-ethic was not created by temperance nuts, but by health researchers and especially medics, who in their arrogance and narrowness decided they could recommend decisions for society based entirely on technical analyses, just like they do in the clinic. They morphed clinical science and decision-making into a social science without ever acknowledging they were now applying a model that is right for fixing biological machines to actual humanity. They adopted the word public, but it did not mean what we normally think the word to mean. It just means “the people as a whole”; it does not mean that people are anything other than machines that need to be fixed. In their arrogance, they did not think they needed to consider the views of economists or other social scientists who are immersed in the study of humans as something other than biological machines, nor that they should not create an ethical system without reference to the wisdom of people who study ethics. (It is telling that the field of “medical ethics” is basically a subfield of law; it is about compliance with rules, and bears little resemblance to discussions of ethics.) Of course, neither the denial of other considerations nor the process by which their pseudo-ethic developed was a conscious decision by any individual or group — it just happened that way because that is how those people roll.
The temperance nuts were present at the creation and there all along, and they may have found a better home for their social engineering goals than they could have ever hoped for, but it was not their doing. It was the medical professionals who doomed public health to become the comfortable home for the likes of John Aston and the others who think his actions were perfectly fine.
Now, I do not want to overstate that point. The goal of preserving bodies without reference to the people in them obviously does not explain why public health objects to the fact that alcohol is good for you and opposes THR. But because the pseudo-ethic of maximizing longevity at the expense of anything else is inherently indefensible, it offers no defense against attaching amendments that are even worse excuses for ethics. Thus the temperance nuts took their chance, and amended the pseudo-ethic into maximizing longevity at the expense of all else, but with “proper” behavior trumping even longevity. While there is a bit of pushback against that amendment from some quarters of public health, it is generally pretty feeble. Thus, not only is drinking to excess a violation of the one goal of public health, but drinking at the level that is healthy violates the amended version. Not only is choosing to smoke a violation of the one goal, but choosing to use a low-risk alternative violates the amendment.
To the extent that people’s preferences and choices run contrary to objectives embodied in this pseudo-ethic, they are part of the problem. It is not a big step, then, from “people’s preferences and choices are part of the problem” to “people are part of the problem.” Each of us is, to ourselves, largely defined as our preferences, desires, behaviors, and experiences. But to “public health” we are just a steward of a body, and we are not doing the right things with those bodies. (The resemblance to those who think we are just a steward of a soul and are not doing the right thing with that soul is not coincidental.)
So, “public health” does not mind that the public hates them. They do not even embarrass when they demonstrate that they hate the public. They do hate the public (as most of us would define it) because we are hurting the public (as they define it). That is, they hate all these actors whose volition often hurts or defiles the bodies that they are the self-appointed defenders of. To us the public is those actors and that volition. To them, it is just the sacks of meat that have the misfortune of being controlled by those pesky actors.
Circling back, Clive Bates, in the above-linked post, pointed out that it was inappropriate for public health professionals to whine about people saying mean things to and about them on social media, and even more inappropriate when they lash out. He sagely observed that this is an asymmetric relationship and then (oh so politely, and definitely not in so many words) ridicules them for sounding like children protesting, “He hit me first! I was just hitting back.” The public does not owe the public health grandees (his phrase) respect or the civility that is earned through respect.
I would add that when those in public health habitually lie and casually act to upend others’ lives in pursuit of their personal vision of proper living, they earn the same disrespect owed to a marauding horde. Despite that, members of the public actually show a lot more civility than the accusations suggest, and the whining professionals rewrite it in their heads as disrespectful for the reasons observed in the final passage in this fugue.
People have every right and reason to say terrible things about politicians and oligarchs whose actions affect their lives, while it is gross and pathetic for the oligarchs to respond in kind. But Clive argues that the asymmetry goes beyond that generic version in this case: Public health people complaining about the public “is like sailors complaining about the weather…. They are the subject of your profession – get used to them”.
Ah, but there I think is the problem. It certainly should be the case that the public, as we define ourselves as people, is the subject of their profession. But it is not. The weather analogy is perhaps more apt than originally intended. Sailorsdo complain about the weather (often using much the same profane language used by public health professionals on Twitter) even as they get used to it and try to understand it. The weather, like those pesky preferences and volitions, is a critical variable that sometimes cooperates with the goal — which is not about the weather any more than the goal “public health” is about making people happy — but is sometimes a threat to the goal. The voyage and the bodies are the goals of the respective professions, and the weather and the uncooperative human actors often work against those goals. Though in fairness to the sailors, I suspect they are professional enough to not feel a personalized hatred for the weather when it is not cooperating with their goals.
I am reminded of my undergraduate days when I made a study of, among other things, ecology (the biological science, not the associated political movements). In my last term, on a whim, I signed up for a graduate “insect ecology” class and was quickly struck by the different underlying policy undertone. All these classes focused on assessing the material reality, which is amoral and without goals. But when the conversation did stray into preferences and actions, the underlying motif in most ecology classes was about helping preserve the organisms and systems we were studying. But in the world of insects, it was mostly about how we could best kill them. Indeed, the dominant purpose of entomology is to figure out what insects do and why in order to better stop them from doing it.
I have been struck many times since then by how “public health” studies of people’s preferences and behavior generally serve basically this same purpose. Sailors study the weather so they can pursue their goal in spite of the weather’s “attempts” to divert them. Practical entomologists try to figure out how to stop bugs from taking some actions the bugs “want” to take. Tobacco control and others in public health study people’s preferences and volition only for the purpose of figuring out how to stop people from doing what they want to do. The difference among these statements is, of course, the lack of scare quotes around the want in the latter one. People, unlike the weather or bugs, really dowant what they are pursuing. But “public health” often sees their goal as being the same as that of exterminators, to prevent autonomous actors from achieving their goals.
Coming forward again to another moment from this week, there was apparently another one of those seemingly monthly conferences on the “endgame” (which, incidentally, is a laughable misnomer), the tobacco control fantasy of eliminating all tobacco product use. Ruth Malone, channeling Stanton Glantz (as she often does) mused on Twitter about whether e-cigarettes should be part of the endgame strategy too. The predictable responses ensued, but I interjected with the observation that the real problem here is goes deeper than that question. The real problem is that people like her think they have some kind of popular mandate or ethical basis for trying to engineer their “endgame”. They do not. They are trying to force people who want to take a particular action, in spite of its costs which they are fully aware of, to stop doing it even though it imposes basically no substantive costs on anyone else (and, indeed, provides net benefits for the rest of society). There is no defensible or accepted ethical system that offers justification for this. None.
Sometimes I observe that the nanny state supporters must believe in a feudalistic or fascist ethic, in which all of someone’s possible labor belongs to his lord or his state, and thus any behavior by the individual that reduces his available labor is morally wrong. But even that does not really work in this case. Not only do low-risk tobacco products not cost any productivity, but even smoking provides net benefits by feudalistic standards, generally allowing people to finish their working life, and then taking away some of the retirement years when they are just a drain on resources. Plus, all of these products enhance productivity for most people. Thus even fascists and neo-feudalists are hard put to ethically justify an “endgame”.
But not “public health”, or even public health. Because their underlying ethic — one that has never been accepted by any society and is impossible to defend as an ethical rule based on any moral system or empirical observation — is that the only objective is keeping all these bodies “pure” and walking around as long as possible. This roughly describes the goal of many a computer game, but it is not the actual preference of any people nor of any free society. Indeed, if you asked the people in public health who are capable of understanding the question (which is a minority, but not a tiny minority), “what is the underlying ethic or objective function you are working in pursuit of,” approximately none of them would articulate this absurdity. If you articulated it to them, most would agree it is absurd. Yet they would turn around and continue to make pronouncements and recommendations based on exactly that implicit objective function. They do not even realize they are implicitly basing their professional lives on an indefensible ethic because their professional culture denies them the language to question it and few are intellectual and honest enough to think beyond their profession.
Of course, this is not the story for all of them. An insightful and nicelyapropos comment from Brian Carter just appeared on one of my posts from over a year ago (this blog is far more like a scientific journal than a bulletin — most of the older posts are just as useful now as they were the day they appeared, so people should still be reading and commenting on the archives). The commentator made the observation that the tobacco control extremists are driven by a moral zeal which causes them to genuinely believe that those who disagree must be stupid, dishonest (a version of which is “bought off”), or evil. I will offer a corollary to this: If there are no other possible explanations, then expressing disagreement — including in the form of refusing to obey the behavioral diktats — is, in itself, sufficient evidence that those who disagree are unworthy of consideration. A neat little package.
The commentator goes on to indirectly suggest that lying about the evidence is an extension of this from the people to science. My further extension of that is that while those people are frequently guilty of overt ad hominem attacks, it turns out that their lying about the science is arguably always, at its core, ad hominem. That is, any analysis or results that do not support the One True Message can only have been written by someone who is stupid, dishonest, or evil, and thus need to be ignored because of the character of the author. Similarly, anyone questioning the public health grandees on social media, no matter how reasonable or polite, is insulting them by the very act of being a stupid, dishonest, or evil person who dares speak to them.
This is the logical and inevitable (through predictable subconscious processes) extension of the underlying public health pseudo-ethic: The longevity and purity of bodies is the only goal that matters. Sometimes the annoying actors who occupy those bodies want to do things that are contrary to the goal, at which point they need to be forced, cajoled, or tricked into doing the right thing (compare: insects sometimes want to eat the crops, and they need to be manipulated into not doing it). But now some of those people are not merely quietly taking bad actions; they are actively speaking up against the public health goal and those who pursue it. As such, they are no longer just automata who need to be reprogrammed (without sympathy for their preferences, but also with no more personal hatred than one directs at the weather). By speaking up, the public have become the active enemies of the goal of public health.
Public health professionals — and this is not just the extremists but most everyone who exists in that culture — are so narrow-minded that even this obvious contradiction is not enough to make them realize the fundamental flaw in their worldview.
So the actual people who make up the public go from being ignored by “public health” to being genuinely hated. And with that, the temperance nuts find their home, not so much because they destroyed public health, but because public health made its way to them. They always hated people, thinking of them as sinners who needed to be controlled. The rest of public health joined them in this hatred when the public started rebelling against their pseudo-ethic and the grandee opinion leaders in the field redoubled their defense of it because they are not capable of seeing its absurdity.
It is easy to despise “public health” for what they do. But it is a different matter if you can understand what it looks like from the inside and how they got there. Once you understand that, you can still despise them for what they do, but you might want to consider despising them even more for how they got there.

ASH UK lies to censor criticism: bogus legal claim against critic
31 January 2014
by Carl V Phillips
As you know if you read this post from a few days ago, @TobaccoTacticss is one of the most spot-on critics of the lies and other evils of the tobacco control industry.? The anonymous author is also clearly strong supporter of THR.? Thus, it is in the interests of all of us who dare criticize that rich, powerful, and genuinely evil industry to publicize the fact that ASH UK is attempting to censor that feed.? (I.e., please publicize this, write your own blog about it, etc. to whatever extent possible.)
@TobaccoTacticss received the a notice from Twitter that several posts had been removed based on this complaint:
Read More.

The usual clueless complaints about spending on anti-smoking
December 13, 2009
By Carl V. Phillips
Does anyone recall any articles about proposed or actual government anti-smoking spending that did not follow the same script as the recent ones (NYT, PressConnects) that complained about U.S. state government spending?
Reported spending on anti-smoking programs was $X (it does not matter what X is) and the anti-smoking activists complain that this is far less than the governments collect in sales taxes and MSA money, implying that somehow they are entitled to the full take. Sometime they even claim, contrary to all evidence, that if they were “fully funded” then they could work miracles.
(Part of the propaganda is that the Master Settlement Agreement payments come from the manufacturers, but it is effectively an additional national sales tax, arguably created in violation of constitutional rules about who can impose taxes, but that is a different story.)
Do the anti-tobacco extremists really think that nothing else government spends money on has any benefit, and thus there is no reason to spend money on anything other than their projects?
I recognize that they seldom seem to have sensible policy analysis in their repertoire — witness how often one of them writes, in effect, “this small study looked at one chemicals analysis (or maybe health endpoint) in isolation, without any consideration of the big picture or any mention of economics, benefits, policy, etc., and based on these results we conclude that the entire world should change public policy regarding nicotine products as follows….”
(For readers interested in an illustration of this phenomenon, the best recent example is the study of PAHs in smokeless tobacco by the anti-THR group at the University of Minnesota. This was a single non-replicated study of limited scope that did not even address human health outcomes, let alone offer any cost-benefit analysis of manufacturing changes. Yet the authors breathlessly concluded that, “Urgent measures are required from the U.S. tobacco industry to modify manufacturing processes”. This policy declaration would still be absurd – completely unsupported by the study results and delving into realms beyond the authors’ apparent expertise — even absent the fact, as Brad Rodu reported in detail,, that the study found levels of chemicals that were so low that any potential health risks lie between trivial and none.)
But even given the behavior of the extremists, you would think that a news reporter would occasionally stumble upon someone to interview about this whose education included one course on law and economics or applied micro, and thus could explain that there is absolutely no reason to expect that the optimal amount to spend on smoking cessation bears any relation to what is collected in cigarette taxes. The most obvious reason for this conclusion is that U.S. states and other governments are taxing the heck out of smokers for the purpose of making ends meet because it is the one tax increase that they can usually get away with without complaint. So of course not all of the revenue is going to anti-smoking – that was never what the taxes were designed for.
But even if the taxes were entirely based on the goal of discouraging smoking, rather than just seeing smokers as a convenient ATM, there would still be no reason to expect that spending it all on anti-smoking would be useful. A simple analogy is that some governments put deposits on soda bottles, batteries, and other objects to increase the chance that they are recycled rather than littered. But whatever the government might net from this (because not all the bottles are returned and the government can choose to claim the balance for itself rather than letting merchants keep it) is not necessarily the right amount to spend on anti-littering campaigns. This is obviously the case since some jurisdictions collect a lot of money this way while some collect none at all — which is, of course, similar for cigarette taxes. An even simpler illustration: If a government collected no money because it did not impose bottle fees or cigarette taxes, would that mean that the optimal level of spending on anti-littering or anti-smoking would be zero? Obviously not.
So what determines the right amount to spend?
Anti-smoking efforts, like all government projects, should be funded until the value the next dollar produces is as high as the value that would come from the next dollar of spending on education, roads, police, social services, and whatever else competes for scarce resources. Spending more than that lowers overall social welfare by taking away from a better use of the money.
So what about the marginal product of a dollar spent on anti-smoking?
It is quite difficult to assess, which is probably why those who want that money can get away with saying “gimme more, more, more!”, but my guess is that a careful analysis would reveal is that an extra dollar on top of the billions already spent produces approximately nothing. It might be that the first few hundred million spent on the most useful targets is helping hundreds of thousands of people a year become nonsmokers. (It might also be that even this slice of the budget accomplishes almost nothing because social forces and common knowledge so dominate smoking behavior – we cannot really know because the assessments of the effectiveness of interventions are generally pretty useless.) But beyond some expenditure, there are clearly severely diminishing returns.
Evidence for this is patent: There is so much spent on silly advertising, pointless research, and barely-useful cessation aids that we clearly have run out of ways to spend the money on high-payoff anti-smoking efforts. If activists who call for bigger budgets have such good ideas about how to spend more money on new projects, why are they not redirecting the portion of the first couple of billion per year that is clearly wasted?
Meanwhile, the U.S. states are in a nasty financial situation, with difficulty paying for schools and other basic services. It is a reminder of the egocentrism (i.e., inability to recognize that other people have different viewpoints or preferences) of the anti-tobacco extremists that they do not seem to care that meeting their demands might well mean that someone goes hungry. Just to keep things in perspective, I should note that the net social damage done by overspending on smoking cessation in the U.S. is trivial compared to the Framework Convention on Tobacco Control demanding that countries with health budgets of a few dollars per person-year devote substantial resources to anti-smoking efforts. If poor countries keep the promises they were arm-twisted into making, the social costs will be enormous. This should clearly illustrate that calling for more spending on anti-smoking eventually becomes grossly unethical. The Framework Convention demands are so extreme in trying to direct public money away from where it is desperately needed and giving it to one special interest group as to nearly fit the definition of embezzling or at least major corruption.
The issue of diminishing marginal benefit reminds me of the same principle manifesting in a different way: When I first started doing research in public health, in the mid-1990s, I was quite interested in trying to help reduce the health burden from smoking. But after observing how many people were working in that area and what they were doing, it became apparent to me that the marginal contribution was basically useless, and that the area was (already back then!) grossly overpopulated. Thus, though the issue was the biggest public health issue in rich nations all totaled, the marginal contribution another researcher (like another million dollars) could make was quite small. So I decided to focus my attention elsewhere.
Of course, if I had been more open minded at the time and looked past the orthodox discourse, I might have found the THR work of Rodu and a few others and realized there was an under-populated and potentially valuable area to work on. I only discovered that half a decade later and by accident. (I try to remind myself of that now and again when I get frustrated with people who are genuinely interested in promoting public health but are tricked by the anti-tobacco extremists’ rhetoric into believing that harm reduction is not a good option.) This story does suggest that there may be a few approaches to reducing the health risks from smoking that are indeed underfunded — like, say, harm reduction. Total government and NGO spending on researching and promoting THR is a small fraction of 1% of the total anti-smoking budget (and most of that depends on industry grants). Of course it does not seem terribly likely that the activists clamoring for more state spending want any of it directed to THR since both they and the states have a history of wanting to just do more of what they have been doing even though the marginal value has diminished to zero.


Consumers not getting accurate information about smokeless tobacco

05 Apr 2005

Information on the internet about the health risks associated with the consumption of smokeless tobacco usually overstates the risk. This is the conclusion of research published today in the Open Access journal BMC Public Health, entitled “You might as well smoke; the misleading and harmful public message about smokeless tobacco”.
A study of 316 internet websites showed that most government, health advice, and advocacy websites suggested that smokeless tobacco use is as harmful as cigarette smoking, even though the risk is actually extremely small compared to that from smoking.
Carl V. Phillips, of the University of Texas School of Medicine Center for Clinical Research and Evidence Based Medicine and School of Public Health, and colleagues report that the public is unlikely to find accurate information on the comparative risks of smokeless tobacco and cigarettes, leading to misconceptions amongst consumers. Phillips notes, “smokers can dramatically cut their risks by switching to smokeless tobacco, a strategy called ‘harm reduction’, but they have little chance of learning this. Similarly, authoritative organizations are telling smokeless tobacco users, in effect, ‘you might as well smoke,’ a public health message that actually encourages people to switch to a much more dangerous product.”
Phillips and colleagues conducted a systematic review of popular sources of information available on the internet, by looking at the content of websites that provide information about smokeless tobacco and health, found using a Google search. They found that of the 316 sites that were suitable for inclusion in the review, “almost every website had statements that played up the health risks from smokeless tobacco without caveat”. Furthermore, “a large portion of websites directly stated or implied that the risks from smokeless tobacco and cigarettes are similar”. The websites of organisations including the U.S. National Cancer Institute and other government agencies, the American Cancer Society, and several of the most popular health advice sites contained information that either explicitly or implicitly suggested that the risks of smokeless tobacco and cigarettes are comparable.
According to the authors, this association of the risks of smokeless tobacco and cigarette smoking may have important negative health implications. “Through these websites, smokers and policy makers are told there is no potential for harm reduction, an unethical message that is both false and harmful to people’s health”, conclude the authors.
The harmful effects of cigarette smoking have been well researched and documented. Different tobacco products are associated with different levels of health risks, and smokeless tobacco (the most popular form of which in Europe and North America is moist snuff, held between the lip and gum) is substantially less harmful when compared with cigarettes. Estimates typically put the risk of dying from snuff use in the range of 1% or 2% of that from cigarette smoking, though some experts put the estimate at or near zero since snuff use has not been definitively linked to any fatal disease.
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This press release is based on the article:
You Might as Well Smoke;
the misleading and harmful public message about smokeless tobacco
Carl V. Phillips, Constance Wang, Brian Guenzel,
BMC Public Health 2005, 5:31 (5 April 2005)
This article is available free of charge, according to BMC Public Health s Open Access policy at Please quote the journal in any story you write, and link to the article if you are writing for the web.

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