Tobacco harm reduction, which I’ve been covering as a journalist for a couple of years now, has often felt a strange space to work in. Polarizing, compassionate, full of justified hope, yet often dispiriting. Beset with hostility and falsehoods, yet fascinating. People who smoked cigarettes and then found tobacco harm reduction (THR) often talk about their “journey.” And that’s how I’ve come to see my work: a purposeful journey, with surprises around the corners.
I don’t have much of a personal smoking story to share with you. It’s nothing more than a few inebriated nights. Or those occasional times, studying in the university library, when I’d pop out for a smoke with a friend who smoked, just because it gave me a break.
That sounds frivolous now. I am lucky that my brief affairs with the cigarette somehow never led to a long-term relationship. I was spared that conflict—between the urge to smoke and the desire to quit—which countless people have now described to me in their own lives.
I’ve often been asked why I work in this area when I don’t have that history. It’s a strange question in some ways: Many people’s jobs don’t represent their personal lives, and health journalism has, or should have, an obvious altruistic component.
When received wisdom differs so starkly from the truth, it’s hard to leave that alone.
But if I’m honest, I used to wonder if THR would sustain my interest. The basic message that vapes, pouches or heated tobacco products are hugely safer alternatives to cigarettes is simple enough to get repetitive.
Yet it’s the massive, organized opposition to THR—the bad policies, the disinformation and the resulting public misconceptions—that demands monitoring, adaptation and rebuttal. When received wisdom differs so starkly from the truth, it’s hard to leave that alone.
I also wasn’t ready for how inspired I would feel by human THR stories.
Tobacco harm reduction is harm reduction. That involves understanding how, as humans, we will all engage in activities with risks: Putting on a seat belt or wearing a hard hat is just sensible. Harm reduction also means centering the agency of people whose lives hinge on the issue—something far more often said than done.
Though I never smoked regularly, I do have indirect but very personal experience of addiction. It made me skeptical of concepts of addiction that don’t involve serious harms—”nicotine addiction,” in the absence of disease and death, should not qualify—but also taught me how addiction is never just one person’s issue. My father struggled with alcohol addiction his whole life, and it became my family’s struggle: We all became part of the story.
My work in THR has led me to a similar understanding that smoking-related harm is less an individual misfortune than an indictment of society. When people from lower-income and other marginalized groups are much more likely to smoke, it feeds inequality. Denial of THR information or access does the same. Every case of debilitating disease or death is devastating for a family, or a community. Smoking is a societal issue.
One of the most unexpected things I’ve encountered in my work is a climate of fear that infiltrates THR.
One of the most unexpected things I’ve encountered in my work is a climate of fear that infiltrates THR. I have lost count of the number of times I’ve reached out to experts in academia, medicine, advocacy or other fields, asking for comments, and been refused.
The reason they give is that the funders of Filter’s nonprofit include both tobacco companies and a foundation that previously received tobacco funding. But it’s often given with a qualification that the person would happily speak with me, only they fear what their employer, or people in their wider professional community, would say.
I can understand this reluctance—experts have been reprimanded and criticized for giving me quotes. But I’ve found it harder to understand over time. Because knowledge, especially knowledge with the potential to save lives, deserves to be shared—regardless of the funding sources of a platform covering subjects that most outlets ignore or misrepresent.
I am in awe of researchers who spend painstaking hours looking into something for the greater good; it’s a noble pursuit. So I feel dismay when I can’t be a conduit between them and people (most of us) who rarely read academic studies. How can cutting off that communication be beneficial to anyone except those who seek to stifle information?
I blame the creators of this climate of fear much more than those who have to live in it. The hostility is real and I’ve experienced it—on social media, and in my personal circles. I have friends, some in the medical field, who have questioned the ethics of my THR work. I am a puppet for Big Tobacco, I’ve been told, and my articles are pseudo-science. It’s telling that few of the critics focus on disagreements they might have with the substance of what I write—instead, it’s about discrediting the messenger.
This context explains how I no longer see that familiar question—Why are you in THR?—as strange. To work in THR requires a level of passion. I have never before taken a position that can leave me feeling like I’m swimming in treacle. I have never before had to justify the ethics of my job to friends and acquaintances. I’ve never written about a topic surrounded by so much noise. Without a personal connection to it all, why would you put yourself through that?
People reacted with indifference to the notion of harm reduction as a path to better long-term health, which led me to a humbling realization.
In March, I had an opportunity to travel to Mumbai, India, where vapes have been banned since 2019. I visited Dharavi, often referred to as one of the world’s largest slums. I spoke with people who smoke, or use tobacco in other high-risk forms, about safer nicotine products. I’d known opposition. But this was the first time I felt uncomfortable talking about THR.
I was speaking with people who barely had the basics in life. People doing dangerous jobs, such as welding, without safety equipment. People reacted with indifference to the notion of harm reduction as a path to better long-term health, which led me to a humbling realization: It was seen as a luxury that people couldn’t afford to prioritize.
It made me more determined and committed. Harm reduction and THR should never be reserved only for those who can afford it. We should all have the facts and resources to make informed decisions about our own health, but we should also all be in a position to consider the longer term. India’s government is far from alone in having let people down.
A happier thought is that THR is contagious. Well over 100 million people around the world now use safer nicotine products instead of smoking, and word-of-mouth is often the reason. Many credentialed and acclaimed experts have spoken with me. But so have people whose expertise consists of the nicotine use in their own lives—knowledge that is not just valuable, but indispensable.
They’ve told me about the transformations in their lives, or the lives of people around them, thanks to safer nicotine products. And many now see it as their moral duty to help others. It is the exact opposite of self-serving or grubby, as detractors characterize the THR movement. I’ve met people who work voluntarily to fight for the right of people who smoke to make informed choices. Every day, they take on misinformation and a whole ecosystem that frames safer nicotine as part of the problem.
Consumers have taught me—and can teach others—so much. I see it as my mission to amplify their voices.
I admire the strength and solidarity of these people I have come to know. They have made it their business to hold governments accountable for ushering people towards the riskiest nicotine products; to challenge mendacious press releases from the World Health Organization and many other “public health” bodies; to help people who are often stigmatized, and dismissed as not worth the trouble.
Nicotine, without a harmful delivery system, is not the enemy. I’ve learned there are myriad reasons people use this drug. No one uses nicotine because it feels bad. It makes people feel good, or focused, or comforted, when other things can’t, and no harm reductionist ought to object to that.
One person I interviewed has ADHD and schizophrenia. He smoked very heavily, as people with mental health conditions often do. He couldn’t quit. Then he discovered vapes, and he did quit. Nicotine, which he now uses in a way that doesn’t threaten his life, helps with his ADHD. And he now advocates to help others in his position.
Consumers like him have taught me—and can teach others—so much. I see it as my mission to amplify their voices—from the tuk-tuk drivers I met in Mumbai, to a retired man who stepped in to save his local vape shop, near where I live in rural Wales.
Despite the noise, it’s a simple equation for me. There are millions of people who would like to stop smoking before it kills them. By writing about alternatives for people who can’t or won’t quit nicotine, I’m committed to trying to help.
Photograph by Ryan Anderson via Flickr/Creative Commons 2.0
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