In the Tobacco Harm Reduction Debate, Civility Has Gone Up in Smoke

    In the pursuit of reducing the harms caused by cigarettes, those of us who advocate for vaping as a public-health harm reduction tool are constantly battling with bullying and harassment, “justified” by moral outrage.

    During my first foray into this world, at the US E-Cig summit in 2017, I was surprised at the level of vitriol I witnessed, at the jeering and boos as different opinions, approaches and research were presented. Since then I have personally experienced such attacks, with the most recent coming at me on January 15.

    My fellow panelists and I were invited by a state tax board to present on tobacco harm reduction and epidemiology, and traveled at our expense to do so. It turned out that we were walking into an ambush, complete with lies, attacks and humiliation.

    At one point we were aggressively cornered into disclosing personal informationlike who we associate with and the health status of our family members. We were even openly mocked when answering questions from the board members: Examples that we gave of other harm reduction approaches, like car safety and syringe access programs, were laughed at and dismissed as “not controversial and off topic.”

    The result was that it was a waste of time and money. Rather than discussing the matters at hand, our personal lives and professional careers were called into question.

    “I’ve been privy to reports of graduate students’ careers being threatened, and witnessed people’s livelihoods being questioned in private meetings.”

    Those who advocate for, or produce and sell e-cigarettes or e-liquids, are also too often guilty of incivility. And we should acknowledge that, with trendy advertising and products seemingly appeal to children, there are definitely bad actors in this industry. Accounts of harm reduction advocates behaving badly are often shared, and there is vitriol on both sidesjust look at any Twitter debate around the issue (and yes, I’m ashamed to admit that I’ve taken the bait a couple times myself). It’s easy for those of us on either side of the debate to imagine that the unprofessionalism is one-sided, but that is not the case.

    Still, given my role as a tobacco harm reduction advocate, my experiences are skewed toward examples of bullying and harassment from those who are unwilling to concede that reduced-risk products have the potential to drastically reduce the death and destruction associated with cigarettes.

    I’ve been privy to reports of graduate students’ careers being threatened, witnessed people’s livelihoods being questioned in private meetings, and seen and been a part of panels where equal time was promised, only for unwelcome voices to be filibustered offstage.

    Opponents of tobacco harm reduction have legitimate concerns: Youth shouldn’t have access to these products, and there is an uptick in youth use. But while consensus on appropriate use, marketing, flavor options and packaging may never be achieved, one could hope that public health advocates—and that’s what we all are—avoid dividing into factions, hurling insults and claiming moral superiority.

    The roots of anti-industry stances are understandable. Even for those of us not old enough to have seen the original testimony, watching old videos of the CEOs of the “big seven” tobacco companies saying with a straight face that nicotine isn’t addictive and that smoking isn’t bad for you is nauseating. As a result, acknowledging that industry could play a role in solving a problem of its own creation is a tough pill for many to swallow.

    Anyone who works as a harm reduction advocate of any kind knows that a soft touch and evidence of positive outcomes are required to even get a foot in the door with policymakers. Being a jerk is a quick way to find the exit. This often means remaining civil in the face of personal attacks and rude behavior from the other side. In tobacco harm reduction advocacy, it’s difficult to name anyone who hasn’t had to take their licks when suggesting that industry, by developing and selling vaping products, could play a role in solving a health crisis—and to be clear, smoking, as the leading cause of preventable death, is a public health crisis.

    To put an end to hostile work environments and promote civil discourse, the major charity Cancer Research UK (CRUK) recently adopted strict anti-bullying and harassment policies. (While this was not born out of a need to protect those who espouse tobacco harm reduction, it is noteworthy that CRUK does view e-cigarettes as potentially beneficial to public health.) CRUK has issued a notice to all grant recipients that abusive behavior will not be tolerated and will put research funding at risk. Interestingly, this extends past the grantee to include panel members and event speakers that are the guests of the grantee—putting the onus on funding recipients to ensure collaborative environments.

    Anti-bullying and harassment policies should perhaps become much more widespread. After all, progress rarely happens without some degree of conflict, but I would argue that it never happens without a willingness to remain civil, to find common ground and compromises. The US surgeon general has correctly pointed this out, stating that personal attacks make future discussion or collaboration unlikely.

    It’s high time we recognize that we harm reduction advocates, too, are complicit in a world where we often have to kowtow to those who feel they are on the side of virtue. Clearly, we in tobacco harm reduction underestimate the extreme and visceral feelings that nicotine and the tobacco industry elicit. Nevertheless, there is nothing to be gained from attacking each other personally instead of attacking the problem. The onus for maintaining civility lies with all of us, not just those with a controversial point of view. No matter who they come from, harassment and abuse are harassment and abuse.

    Photo by Yosh Ginsu on Unsplash

    • Carrie Wade, PhD, is a senior fellow and the harm reduction policy director for the R Street Institute, where she is responsible for directing R Street’s harm reduction agenda, including opioids, tobacco and sexual health.

      She previously worked as a drug researcher at the University of Minnesota and the Scripps Research Institute in La Jolla, California. She received her bachelor’s in Neuroscience and PhD in Pharmacology from the University of Minnesota, and a master’s in Public Health from Johns Hopkins University.

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