In my worst moments, reporting on the tobacco harm reduction space, as I’ve been doing for the past four years, can feel hopeless. Eight million people continue to die of diseases related to combustible tobacco use each year. Yet all over the world, the smoking-cessation tools most capable of transforming this situation are banned, restricted and smeared.
Considering what I do more closely reveals a kind of paradox, however.
If I view tobacco harm reduction (THR) from the outside, it seems as if nothing changes. The task—to inform and convince policymakers that THR is simply harm reduction, and that we already have the tools to dramatically reduce the world’s biggest cause of preventable death—is ostensibly a simple one. But the message seems incomprehensible, inconvenient or plain unwelcome to those in power.
If something’s not stagnant, there is hope: Change requires movement.
If, on the other hand, I step inside the THR world to report on it, I’m never short of things to write about. Why? Because despite the ubiquitous common obstacles, the detailed landscape is mercurial—there’s always something happening. And if something’s not stagnant, there is hope: Change requires movement. Reflecting on this made me realize how much there is to be optimistic about.
Nicotine consumers are at the heart of this optimism, just as they’re at the heart of the THR movement. They’re bombarded with misinformation, stigmatized for their choices and faced with many barriers to accessing products that could save their lives. Yet despite all this, despite the knee-jerk, reactionary anti-THR policies, as many as 150 million people worldwide now use safer alternatives like vapes, snus and pouches or heated tobacco products.
The vast majority have adopted these safer nicotine options in order to quit (or reduce) smoking. In many other cases, the availability of these options for people who may have a “common liability” to nicotine use means they will never pick up cigarettes in the first place.
Yes, the message that safer nicotine products save lives would have gotten through much faster, and to far more people, if governments and health authorities wholeheartedly promoted THR instead of blocking and denigrating it. Yet it is getting through to an extraordinary degree in these circumstances—and given the power of peer-to-peer word of mouth, that is likely to accelerate.
This thought is almost guaranteed to stop me feeling enervated—and that’s just as well.
My THR reporting for Filter stands in stark contrast to the stories published in giant media outlets, which again and again contradict powerful evidence and ignore the human agency of people who smoke, in favor of narratives rooted in hardened ideology. Plenty of times, I’ve wondered if there’s any point in my work when my colleagues and I are up against this misinformation juggernaut. It’s David-and-Goliath when you’re fighting to be heard over the din of the World Health Organization and organizations backed by Bloomberg millions. It’s hard not to feel small and insignificant amid the cacophony of voices hellbent on telling you you’re wrong.
Writing about THR is also about celebrating its wins, which are just as important to report—after all, this is why the movement exists.
But before I get too disillusioned, along comes the news that Sweden has become the world’s first “smoke-free” country because of safer nicotine products. News like that, I’ve always felt, is a privilege to report. This is THR in action: Saving lives, improving quality of life, keeping families together, reducing health inequalities, and carrying special value for populations that have been most sidelined and ignored—such as people with mental health conditions and people who use banned drugs.
These are stories that need to be written and read. And they remind me that being a journalist in this space is not just about correcting flawed science that somehow managed to get published, or criticizing bad policies, of which there is a never-ending supply. Writing about THR is also about celebrating its wins, which are just as important to report—after all, this is why the movement exists. And there are enough positive stories, even in the last few months, to convince even the most hardened of cynics that the times they are a-changin’.
In July, for instance, I wrote an article on how nicotine pouches are becoming increasingly popular in the United Kingdom. Anti-vape sentiment plays a role here, but the adoption of a new safer nicotine option is a good thing; choice is key. And with women leading the way, I can’t help but be optimistic that perhaps, in the not so distant future, we Brits might replicate Sweden’s success.
In May, I was able to report on how Argentina ended its 15-year prohibition of vapes and other safer nicotine products. Sure, further improvements need to be made, but it’s a big step in the right direction. Things are happening and moving: The landscape is mutable.
That same month, I wrote about calls to integrate THR routinely in HIV care. And yes, much of that article concerned stigma and other barriers to this common-sense approach. Yet in speaking with experts who have witnessed the trajectory of improved HIV care over decades, it was impossible not to entertain the idea that THR, delivered to high-smoking populations, might similarly have a better future.
THR advocates have faced derision, ostracization and slander. They have made things happen all the same. The victories belong to them.
And in April, I reported on an uplifting project, built by consumer advocates, to systematically collate the kind of lived experiences of safer nicotine use that are almost entirely absent from media narratives.
I am not an advocate in the strictest sense of the word, nor (by any stretch!) a scientist. I’ve seen myself as a conduit between the world of THR and those who are open to knowing more about it. To play that role at all effectively requires the help of experts, and I’ve gotten to know many who have inspired me.
People like THR maven Clive Bates, consumer advocate Skip Murray, Michael Siegel of Tufts University School of Medicine and Damian Sweeney of European Tobacco Harm Reduction Advocates (ETHRA) have been integral to my own learning. Their incredible knowledge and perspicacity, generously shared, have helped readers and me to understand nuances of THR, the repercussions of ill-conceived policies and so much more. In a field that can often feel bleak, the passion of these experts, and many others, makes me feel that the future of THR is bright.
THR advocates have fought against the odds for a better world. They’ve faced derision, ostracization and slander. They have made things happen all the same. The victories belong to them—to a whole ecosystem of scientists, policy experts, smoking-cessation advisers and consumer activists determined to help others benefit as they have. This fills me with hope. Sometimes, change comes almost imperceptibly—or perhaps, “gradually, then all at once.” I think we’re on our way.
Photograph via PublicDomainPictures.net
