Nicotine / THR - Change the Conversation

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The war to end smoking has turned into the war on nicotine.

The focus has been lost, and who the "winners" and "losers" will be has changed. It is now Tobacco Control (TC) and Public Health (PH) vs. Tobacco Harm Reduction (THR). Caught in the middle are consumers who smoke, consumers who used to smoke, and industry stakeholders. AS TC/PH fights THR with both sides trying to "win" against the other, the world has forgotten the real "winners" and "losers". People who succeed at quitting smoking are the only real winners in this battle. People who die from smoking are the only losers in this fight. This is what we should be concerned about - people who smoke. It is time to #ChangeTheConversation. For TC/PH and THR to sit down and talk real solutions. Work on ways to limit initiation of smoking (and all age restricted products) while keeping Safer Nicotine (THR) products on the market for adults who smoke.

We need to listen to the people and orgs below, who have put out the call to Change The Conversation.


2021, Apr 30 - Statement addressing the Scheer Report by Professor Heino Stöver

  • Via Google Translate: "We can only achieve our ideal of a smoke-free continent if we finally include the harm reduction approach on an equal footing in anti-smoking policy. An open-ended debate would be a first step in the right direction on the EU side and could enable many smokers to switch to less harmful products."

2020, Aug 10 - Polarization Within the Field of Tobacco and Nicotine Science and its Potential Impact on Trainees

  • Divisive, dominant perspectives on e-cigarettes move the field of nicotine and tobacco science away from scientifically rigorous discourse on this important public health topic, which involves millions of lives at stake. If norms do not change, the polarized climate may pressure trainees to choose or inherit an allegiance towards an uncompromising, one-sided stance. That allegiance can then restrict career development, undermine the credibility of research, and hinder public health progress. There is an urgent need to act to avoid negatively affecting the next generation of nicotine and tobacco research scientists. Though we have suggested some solution-oriented ideas, we are calling for reflection among everyone in the field and particularly among those with influence and power.
  • There are important questions that must be addressed, including: (1) as the field continues to conquer a range of research questions on e-cigarettes across a range of disciplines and career levels, how can we work better together toward the shared end goal of eliminating tobacco-related disease and death?; (2) how can scientists who perpetuate polarized viewpoints be incentivized and supported to improve?; (3) to whom can junior scientists turn for help with navigating the polarization in the field?; and (4) how can the academic community avoid contributing to the polarization that seems to pervade the field?

2020, Apr 23 - Tobacco harm reduction: Past history, current controversies and a proposed approach for the future

  • To date, more attention has been paid on the virtues or vices of potential harm reduction products such as e-cigarettes with less focus on cigarettes, which prematurely kills half of its long-term consumers. Most in the tobacco control community would agree that an immediate main goal is to rapidly eliminate tobacco-related death and disease. To effectively achieve this goal, a more cohesive and unified approach is urgently needed before million more lives are lost to tobacco use.
  • Perhaps this approach could be achieved by convening yet another strategic dialogue on harm reduction that is led by one of the governmental agencies, a scientific organization and/or by respected scientists who are not strongly associated with one particular ideology. At this meeting, the current and evolving science, modeling that projects population health effects under different scenarios, identification of research gaps and consensus on a potential path towards a sensible and agreeable harm minimization approach can be developed. Keeping focus on how best to regulate combusted tobacco products and ANDS and allowing tobacco harm reduction as a component of a comprehensive tobacco control program would be one such approach.

2018 Caught in the middle: early career researchers, public health and the emotional production of research

  • In this short report, I discuss how public health research, its assessment, and its dissemination outside the academy are produced, in part, through emotional circumstances. Using current debates on e-cigarettes as an example, I show that researchers find themselves uncomfortably positioned in complicated moral and affective landscapes, often making it difficult to represent the nuance of their research.
  • Mair and Kierans (2007, p. 109) warned us some time ago that: ‘adopting any normative stance towards tobacco, whether pro- or anti-, would actually interfere with our capacity to document and interpret the significance of tobacco in the lives of those we study’. This statement transfers to the contemporary e-cigarette situation.

Lawmakers / Public Officials

2021 Mar 23 - Lawmakers ask gov’t to repeal ‘unlawful’ CSC circular against tobacco companies

  • (Referring to influence from out of country NGO's) "We should not be misdirected by these interest-groups that instead of helping our country in our time of need, work to set us against each other."

Tobacco Control / Public Health

2022: Understanding experts’ conflicting perspectives on tobacco harm reduction and e-cigarettes: An interpretive policy analysis

  • Our findings indicated that the majority of meanings attached to tobacco harm reduction were rooted in values, ideology, politics, and opinions, rather than straightforward disagreements about the scientific evidence. Respondents had different ideological positions on the War on Drugs, the role of the private sector and the tobacco industry, social justice principles, the inevitability of nicotine use, and the acceptability of addiction. Throughout, experts struggled and disagreed with precisely where and how to define “harm reduction."

2022: A Proposed Policy Agenda For Electronic Cigarettes In The US: Product, Price, Place, And Promotion

  • All members of the public health community should unite to pursue a shared commitment to the principle that both youth and adults deserve a future free of tobacco-related disease.
  • Our fondest hope is that the public health community will unite again and fight for a set of policies that, through measured compromise, will both reduce the use of e-cigarettes by youth and increase adult smoking cessation.

2022: A Bold U.K. Plan to End the Smoking Epidemic

  • In stark contrast with the consensus of government and public health organizations in those nations, the U.S. is mired in a polarized debate pitting concern regarding the risks of e-cigarettes for youth against their potential to help addicted adult smokers stop smoking.

2021, Mar 29 Letters to the Editor (see letter #2): Vaping and Philanthropy: Debating Strategies That Work

  • Written By: Eric N. Lindblom, Senior Scholar, O’Neill Institute for National & Global Health Law, Georgetown University Law Center
  • Lindblom was director of the Office of Policy at FDA’s Center for Tobacco Products from 2011 to 2014.
  • Mark Gunther’s article on Bloomberg’s funding of efforts to prevent youth e-cigarette use did a good job presenting the current conflicts in the public-health community about e-cigarettes and how best to regulate them. But it did not suggest any ways those conflicts might be resolved or, perhaps, made less important.
  • Given the common, overriding goal of reducing tobacco-nicotine deaths and harms as quickly as possible, there are many new tobacco-control policies that all sides of the e-cigarette conflict should be able to agree on and actively support.
  • Even those arguing for stronger restrictions on e-cigarettes could at a minimum agree that government tax and price measures should not make e-cigarettes more expensive than smoked tobacco products.
  • Another possible consensus antismoking strategy might not raise any significant conflicts, even if it were extended to e-cigarettes (or to all tobacco products). That is requiring that all tobacco products be sold only in adult-only sales outlets.
  • To promote switching from smoking to vaping (without any downside risks), even those opposing an e-cigarette harm-reduction approach should also be able to agree that all sales outlets that sell smoked tobacco products should be required to offer e-cigarettes, as well (but not vice versa).

2021: Cliff Douglas Manifesto: It is Time to Act with Integrity and End the Internecine Warfare Over E-Cigarettes

  • "I urge all of us in the tobacco control community to climb out of the bunker, come to the table, and try to genuinely work together. Stop skirting the truth when it feels inconvenient and open your minds and ears to all of the science that is before us. But the same goes for my other community, with whom I agree regarding the evidence-based promise of THR, but which also bears some responsibility for the adversarial nature of the relationship and for not consistently acknowledging areas of ambiguity or concern, including significant rates of experimentation with vaping by youth and youth-oriented marketing by some segments of the vaping industry. We won’t come together if we don’t come together."

2021: Balancing Consideration of the Risks and Benefits of E-Cigarettes

  • The topic of e-cigarettes is controversial. Opponents focus on e-cigarettes’ risks for young people, while supporters emphasize the potential for e-cigarettes to assist smokers in quitting smoking. Most US health organizations, media coverage, and policymakers have focused primarily on risks to youths. Because of their messaging, much of the public—including most smokers—now consider e-cigarette use as dangerous as or more dangerous than smoking.
  • The authors are former presidents of the Society for Research on Nicotine and Tobacco (SRNT), the world’s leading professional organization dedicated to the subject. The opinions expressed in this article are solely those of the authors. They do not represent those of SRNT, which has taken no organizational position on the issues discussed in this article and had no involvement in the preparation of this article.

2021: Polarising the e-cigarette debate confuses people

  • We read with interest the article on whether the NHS should recommend e-cigarettes. It struck a polarising tone, which we fear will further confuse the public. In an effort to take a sensible position on this divisive issue Sheffield Tobacco Control Board has published an updated consensus statement. We aim to be a vape-friendly city …

2021: Tribes of Trust or Distrust, "Attitude Roots" and Encouraging Scientific Participation in the Tobacco Harm-Reduction Debate

  • PDF of full paper
  • Trust reassures, while distrust disqualifies. Battle lines between tobacco harm reduction (THR) supporters and abstinence-only supporters provide an example of more or less trusted or distrusted factions in opposition. Some may think of tobacco control science as an evidence-based, objective, rational scientific citadel. The present account of tribal clashes on THR issues, biased by feelings of trust and mistrust, and arising out of values, moral emotions and attitude roots, seems pertinent to me. That attempts at rational thought are subject to many biasing influences has been recognized for decades...

2020: E-Cigarettes, Harm Reduction, and Tobacco Control: A Path Forward?

  • "Consider that in the few minutes it took to review the points in this Commentary, approximately 25 Americans and 300 people worldwide died of complications arising from their use of combusted tobacco. This is a toll that should be unacceptable to all of us, no matter where one stands on the issues presented here. We should not and can not continue to engage in the divisive and shameful conflict that the e-cigarette era has visited upon the tobacco-control community; the lives of too many people are at stake. We can and must do better and move on to the combusted tobacco endgame."

2018: How to Think—Not Feel—about Tobacco Harm Reduction

  • Taken literally, tobacco harm reduction—reducing the harms created by tobacco—is what everyone in tobacco control wants to accomplish. But, the term “tobacco harm reduction” (THR) has become the source of one of the most divisive, often acrimonious debates in tobacco control history. Intense emotions, on both sides, have obstructed objective consideration of complicated THR issues.
  • Participants on both sides of the divisive THR debate need to examine the complicated issues and evidence more objectively. This entails considering both the potential benefits and costs associated with reduced-risk products like e-cigarettes.
  • THR can be a complement to, not a substitute for, evidenced-based tobacco control interventions. Tobacco control professionals need to focus on objective assessment of and discussion about the potential costs and benefits of THR.
  • Importantly, we need to assess that evidence in a fair and objective manner, and to move forward together toward the elimination of tobacco’s harms. That, after all, is the THR goal shared by every single tobacco control professional.

2016: Mitch Zeller (FDA/CTP) - The E-Cig Debate Has Been Detrimental to Harm Reduction

  • Zeller went on to discuss the all-too-familiar argument about the potential pros and cons of e-cigs and vaping, wondering if tobacco-control groups and vaping advocates were “having the wrong debate.”
  • “The e-cig debate has been emotional, divisive and is not advancing common ground on harm reduction,” he said. “Where and how can we apply the principle of harm reduction to this debate and find common ground? It’s been horribly ineffective to date.
  • “Part of the challenge with tobacco-control groups and public-health advocates is a historic distrust of the tobacco industry,” he continued. “Every sector has a role to play (in finding common ground).”

2016: FDA's Zeller: Let's Reframe Debate to Focus on Nicotine

  • Explaining this in more depth, the CTP director said "looking at nicotine differently" starts with addressing a few key points:
    • Recognize there is a continuum of nicotine-containing products;
    • Understand people smoke for the nicotine but die from the tar; and
    • Acknowledge the public health opportunity to move tobacco users down the risk spectrum.
  • "Are we having the wrong debate? For me, yes. The debate has been about e-cigarettes. It should be about nicotine," he said, adding that "someone needs to step up to the plate" and reframe the debate. Once that is successfully done, the nicotine debate needs to center on some critical questions, according to Zeller. These include: What is the longer-term use for those who need it? Is there a potential need for a period of dual use and, if so, for how long? What are the unintended consequences? Where does the principle of harm reduction come in?

2015: A Proposed Collaboration Against Big Tobacco: Common Ground Between the Vaping and Public Health Community in the United States

  • An unfortunate conflict is underway between the public health community and the vaping community over e-cigarettes' harmfulness or lack thereof. This conflict is made worse by an information vacuum that is being filled by vocal members on both sides of the debate. This conflict is avoidable; common ground exists. If both groups rally around what is in their own and the public's best interest-the end of combustible tobacco--all will benefit significantly. If not, the result may be missed opportunities, misguided alliances, and--ultimately-poorer public health.

2009: The Strategic Dialogue on Tobacco Harm Reduction: a vision and blueprint for action in the US

  • The issues related to tobacco harm reduction continue to challenge the tobacco control research and policy communities.
  • For more than 2 years a group of tobacco control researchers, policy and communications experts participated in a process called the Strategic Dialogue on Tobacco Harm Reduction
  • The topic of tobacco harm reduction is complex and, at times, contentious. No unified vision or strategy has guided research and policy. No opportunities have existed for individuals with diverse perspectives, such as researchers, policy experts, communications experts and advocates to come together to produce a strategic vision on issues related to this area. Instead, while there is broad support for the need to regulate tobacco products, there has been a fractured and sometimes divisive debate over issues such as the appropriate role of regulation as it relates to harm reduction and, particularly, the roles of smokeless tobacco and nicotine replacement therapy (NRT) in harm reduction.

Tobacco Harm Reduction

2022: Can the US Tobacco Control Debate Ever Find Common Ground?

  • With the occasional exception, dialogues about tobacco are dominated by elites—the leaders of [anti-nicotine] advocacy groups, government regulators and academics. Adults who smoke or vape are not often heard, except on Twitter, where they are very active.
  • It’s hard to know why the groups that oppose vaping are reluctant to engage with critics. Perhaps it’s because they are mostly winning the debate. They have support in Congress, at the regulatory agencies and at the state and local level. Most Americans now believe, wrongly, that e-cigarettes are just as dangerous or more dangerous than combustible cigarettes. The relentless anti-vaping messaging from the CDC, FDA and the Bloomberg-funded coalition government has been effective.

2021: Comment by Alex Wodak to blog by Clive Bates: Holding the Bloomberg anti-vaping propaganda complex to account

  • "If US Government and Taliban can sit down and try to negotiate an end to military activities in Afghanistan then supporters and opponents of tobacco harm reduction should be capable of a polite and respectful discussion to identify and expand common ground. After all, both want to see a worldwide substantial and rapid reduction in smoking related deaths. Need to be carefully planned and have excellent Chair. How about it?"
  • Alex Wodak Bio: "Dr Alex Wodak is a physician who was Director of the Alcohol and Drug Service, St. Vincent’s Hospital, Sydney (1982-2012) but has now retired. Major interests include prevention of HIV among people who inject drugs, prevention of alcohol problems and drug policy reform. Dr. Wodak is President of the Australian Drug Law Reform Foundation and was President of the International Harm Reduction Association (1996-2004). He helped establish the first needle syringe programme and the first supervised injecting centre in Australia when both were pre-legal and often works in developing countries on HIV control among among people who inject drugs. Dr Wodak helped establish the National Drug and Alcohol Research Centre, the Australian Society of HIV Medicine and the NSW Users AIDS Association."


  • "Human rights activists and health workers in Uganda have embarked on a Tobacco Harm Reduction (THR) campaign aimed at reducing or minimizing harm or risks suffered by people and communities as a result of using tobacco products."
  • "He stressed that the THR advocacy is not going to fight or conflict with the on going government programs, but to raise an intellectual conversation seeking a deeper understanding of THR and nicotine."

2018: Joe Gitchell How to feel AND think about nicotine and those who use it

  • Presentation at the Global Forum on Nicotine

2001: Clearing the smoke: the science base for tobacco harm reduction—executive summary

  • For the purposes of this report, a product is harm reducing if it lowers total tobacco related mortality and morbidity even though use of that product may involve continued exposure to tobacco related toxicants.

2001: Applying the risk/use equilibrium: use medicinal nicotine now for harm reduction

  • As has been pointed out by others,the current regulatory system is upside down, with the more dangerous products (that is, tobacco products) receiving the least regulation and the least dangerous products (that is, MN) subject to the most stringent constraints.

Tobacco Industry

2022: Transformation and Its Enemies

  • But what if there are policies, practices and messages that are good for the tobacco industry and public health? Or bad for both? One of the accusations frequently thrown at public health advocates who favor tobacco harm reduction is that they are doing the bidding of Big Tobacco. No one likes to be accused of that. But implicit in that accusation is either the assumption that tobacco harm reduction cannot be good for both or worse, that it is more important to hurt the tobacco industry than to serve public health.
  • In public health, we need to stop our warrior rhetoric and think harder about the world as it really works and what will change it for the better.

2021: Finding ‘common ground’ on shifting sands: observations on the conflicts over product regulation

  • Commentary by: Dr. Moira Gilchrist, Vice President Strategic and Scientific Communications and Mr. Antonio Ramazzotti, Vice President Consumer Insights
  • We do not speak for the entire tobacco industry, but we do speak for Philip Morris International.
  • Businesses—and what they make—change over time because of scientific and technological advancements. In any other sector, it is unthinkable that companies with valuable expertise would be excluded from discussions on the development, commercialization and regulation of innovative technologies that fulfil consumer demand and improve lives.
  • There is an alternative to the author’s suggested common ground: listening to the needs, wants and opinions of people who smoke. They are the ultimate decision-makers. They will decide what course of action they want to take, provided they are empowered to do so by science-based regulation.

2019: Philip Morris International: time for a new conversation

"By demonising a company that is doing exactly as the Editors demand, we might never know exactly how much of an opportunity a tobacco harm-reduction strategy will bring to public health. The only losers if this happens will be the men and women who continue to smoke."

The Science of Disputes and Negotiations

2019: Civil Dialogue on Tobacco, Nicotine, and Alternative Products Harm Reduction

  • 10. Engagement and Dialogue: Encourage Civil Dialogues with Broad Stakeholder Involvement
    • There is a need for greater civil engagement between a growing number of stakeholders and experts that includes governmental agencies, public health organizations, tobacco, nicotine and alternative product manufacturers, researchers, consumers, health care professionals, laboratory testing facilities, retailers and wholesalers, and agricultural interests. Engagement should be encouraged in both public and private sector venues.

Minors, Moral Psychology, and the Harm Reduction Debate: The Case of Tobacco and Nicotine

Understanding the origins of anger, contempt, and disgust in public health policy disputes: Applying moral psychology to harm reduction debates

Goals & Tradeoffs

Suggestions to add to this page

2020: The Past Is Not the Future in Tobacco Control

  • "We should encourage product innovation and support civil dialogue on issues related to smoking harm reduction."

2020: The Harm-Reduction Quandary of Reducing Adult Smoking While Dissuading Youth Initiation

2020: Accelerating an end to smoking: a call to action on the eve of the FCTC’s COP9

  • Respectful dialogue. The Morven Dialogue has tested the value of multi-player engagement on the many complex issues facing the future of tobacco control. This approach encourages debate and discussion on the issues and minimizes ad hominem attacks or direct harassment of people with different views. Across the sciences, such antagonism is, sadly, far too common and can undermine valuable research. COP participants should condemn this type of behavior and embrace the view of the Wellcome Trust, which deems “bullying and harassment of any kind, in any context, to be unacceptable.”
  • PDF of whole paper

2020: Perceptions of nicotine in current and former users of tobacco and tobacco harm reduction products from seven countries

  • An ongoing emotional debate surrounding THR products has so far kept many governments from promoting THR products to lessen the burden of disease caused by tobacco.
  • A reason why users of tobacco and THR products around the world find it hard to distinguish between the health risks of smoking and nicotine use may be due to conflicting messages from the media that deviate from the most recent scientific evidence base, overemphasize certain opinions or omit findings that do not align with their readers’ beliefs.
  • When examining the media dialogue leading up to the poll, we found that selective coverage was used, sometimes in addition to spreading misleading stories and omitting stories that potentially contradicted a desired message. The conveyed messages seemed to both confirm and strengthen widespread negative beliefs about nicotine. Therapeutic effects and potential beneficial applications of nicotine were completely ignored by the media leading up to the poll despite ongoing research in this field.
  • The media could play a decisive role in raising awareness that nicotine is delivered through various products that represent a continuum of risk. Tobacco cessation through THR product use requires a more pragmatic and balanced approach in communications. It remains uncertain how much of the confusion surrounding nicotine can be blamed on inaccurate media messages but this phenomenon has been observed with other topics as well.

2019: Is civil dialogue and engagement between diverse stakeholders with respect to tobacco harm reduction feasible? A review of the past, present and future

  • The third area will be on whether it is possible in a regulated environment for diverse stakeholders to engage in a civil dialogue that focuses on making harm reduction a legitimate way of significantly reducing disease and death from cigarettes.

Written Version of presentation

2019: The E-Cigarette Debate: What Counts as Evidence?

2016: Taking Sides in E-cigarette Research

2015: Reliving History: How the Tobacco Wars Became the Vapor Wars

2013: After the Smoke Has Cleared: Reflections from a Former Smoker and Tobacco Researcher

Is Nicotine All Bad?

Evidence, alarm, and the debate over e-cigarettes

The Problem With Certainty

Tobacco Harm Reduction: Polar Opposition Must be Resolved

Tobacco Harm Reduction as a Path to Restore Trust in Tobacco Control

INNCO tweet about above link

Framing and scientific uncertainty in nicotine vaping product regulation: An examination of competing narratives among health and medical organisations in the UK, Australia and New Zealand

Re-thinking nicotine and its effects

The challenge for policy makers and regulators is to imagine how policy levers, regulations, and other tobacco control activities can be used in tandem to optimize population health: Preventing youth initiation and escalation, while helping 40 million smokers move to less harmful products and making it easier for them to quit and stay quit.

2014 Memo to public health grandees: vaping, vapers and you

2017 There’s No Such Thing As ‘Sound Science’

2021 Scientists: don’t feed the doubt machine

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