Dr. Michael Siegel has long been a prominent expert voice making the case for tobacco harm reduction. He’s published large numbers of studies and media articles, as well as his own influential blog.
A professor of public health and community medicine at the Tufts University School of Medicine, Siegel has been conducting research in areas including tobacco control and racial health inequities for 32 years. His resume also includes having served as an expert witness in landmark litigation against the tobacco and pharmaceutical industries.
As a staunch believer that vapes and other safer nicotine products do and will play a major role in reducing smoking-related disease and deaths, Siegel stands in contrast to many others in the public health field. His former teacher and mentor Dr. Stanton Glantz, for instance, is known as one of the most vociferous anti-vaping academics around. Some of Siegel’s past research refuted claims by previous papers—among them, one by Glantz that was retracted—that vaping was associated with heart attacks.
Siegel went silent on tobacco harm reduction for a while, but is now back, using blog posts and media appearances to combat persistent misinformation around vapes. Filter took the chance to ask him about his mission and its enemies. Our interview has been edited for length and clarity.
Kiran Sidhu: You took a hiatus from posting about tobacco harm reduction (THR). Why was that, and what prompted your return?
Michael Siegel: I took a hiatus because I became so frustrated with the continued deception about vaping by public health groups. No matter how many times I asked them to correct information they had posted, they refused. I felt like I was banging my head against the wall every day.
The reason I returned is that when I started looking at the same websites after about four years, they were still saying the same incorrect things, even though the science has advanced greatly. I couldn’t stand on the sidelines any longer. I also realized that there is a secondary purpose for my blog. Even if it doesn’t change the actions of the health groups, it does provide vapers with information that is very useful in advocating for appropriate regulation of vaping, and it does help correct the misinformation that is out there.
“My theory is that tobacco control advocates have a vitriolic hatred of smokers and smoking. The idea of someone gaining pleasure from nicotine is anathema to them.”
KS: Harm reduction is not a new concept. A lot of people have been familiar with it for decades, in areas such as sexual health and illicit drug use. Why is harm reduction in the context of smoking still such a contentious issue?
MS: This is a great question and a bit of a mystery. You’re right—harm reduction is a core concept in public health, and health advocates accept harm reduction in virtually every other issue, such as sexual health, drug addiction, etc.
My theory is that the main reason tobacco control advocates do not accept a harm reduction approach in the context of smoking is that they have a vitriolic hatred of smokers and smoking, and they cannot accept the idea that someone could be using nicotine in a way that improves their health. The idea of someone gaining pleasure from the use of nicotine is anathema to them.
KS: You’ve spent many years in THR research. In your experience, has tobacco control changed over the years?
MS: Sadly, I haven’t seen any changes in the past 15 years. The tobacco control groups—including the American Lung Association, American Heart Association, American Cancer Society, Campaign for Tobacco-Free Kids, Truth and CDC—are saying the exact same thing today about vaping as they said in 2009. Literally nothing has changed.
Actually, a lot has changed: The research has clearly shown the value of vaping for smoking cessation. Nevertheless, these groups are still saying exactly what they said back in 2009. The scientific evidence doesn’t seem to be informing their communications.
KS: While the FDA has rejected marketing applications for most flavors in vapes, it recently authorized 20 Zyn nicotine pouch products in an array of flavors. Many see this as a win for harm reduction. How do you view it?
MS: Well, it’s definitely a win for harm reduction. However, the tobacco control groups are all denouncing the FDA for this decision. They are so inconsistent in their arguments, because they were the ones who supported giving the FDA authority to approve [Premarket Tobacco Product Applications], yet when FDA goes ahead and approves any PMTA for a flavored product, they condemn the agency for doing its job.
“You don’t have to be a rocket epidemiologist to see that given extremely low rates of youth smoking, there is no possible way that e-cigarettes could be a gateway to smoking.”
KS: The FDA has proposed putting a cap on nicotine levels in cigarettes. Some THR advocates argue this would have negative unintended consequences. Do you think it’s a good THR policy?
MS: Yes, I believe that if the level of nicotine in cigarettes were regulated down to a level that could not sustain addiction, it would be much easier for smokers to quit. It would also create a competitive advantage for safer products such as electronic cigarettes because tobacco cigarettes would no longer satisfy smokers’ cravings, but e-cigarettes might. I do think it would have a significant effect in reducing smoking. It could be a lifesaving intervention in public health.
KS: Youth smoking rates in the United States have fallen to incredibly low levels since vapes have been around. Yet some anti-vape academics continue to argue that vapes are a “gateway” to smoking. What’s the problem here, when surely the evidence speaks for itself?
MS: The evidence does speak for itself. You don’t have to be a rocket epidemiologist to see that given the extremely low rates of youth smoking, there is no possible way that e-cigarettes could be a gateway to smoking among youth. Anti-vape academics are not paying attention to the science. They apparently have an agenda to promote, and they don’t let the science get in the way.
Vaping is a huge threat to their ideology so they have to attack it vigorously. They can’t do it with the truth, so their only resort is to misinformation.
KS: What would you say is the driving force behind misinformation on vaping?
MS: Again, I think the reason why electronic cigarettes are so bothersome to tobacco control groups is that they cannot accept the idea that someone could get pleasure out of a product containing nicotine and not be punished by harming their health. They can especially not accept the idea that someone could use a pleasurable nicotine product and improve their health. It is just outside the ideology of the movement. Therefore, vaping is a huge threat to them and their ideology so they have to attack it vigorously. They can’t do it with the truth because the facts don’t support their position. So their only resort is to misinformation.
KS: In the face of such well-funded opponents, what’s the future for THR? Are we fighting a losing battle?
MS: As difficult as the fight is, I do not think it’s a losing battle simply because there are so many people who vape and they are not going to let e-cigarettes be decimated because they need these products to maintain their health and to stay off real cigarettes. If e-cigarettes are banned, they will turn to DIY products or an underground market will develop. In fact, right now, 70 percent of the e-cigarette market is technically underground.
KS: How should we move forward?
MS: The most important thing we can do to get smoking rates down is to promote e-cigarettes as an alternative. This approach has worked for at least 4 million Americans. I would vacate the FDA’s current regulatory scheme that requires PMTAs for e-cigarettes and instead, require Post-Marketing Tobacco Applications for real cigarettes.
Why should e-cigarettes—a much less harmful product—have to justify their right to be on the market while real cigarettes don’t? If anything, it is the cigarettes that need to be justified.
Second, I think that tobacco products should only be sold in adult-only, 21-plus stores, like vape shops. If smokers had to go into vape shops in order to get cigarettes, it would be a constant reminder that there is a safer alternative. It would expose them to vapers who have succeeded in quitting smoking, and engage them in meaningful conversation and education about this approach.
Photograph by Vaping360 via Flickr/Creative Commons 2.0
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