Carl V Phillips has a really good piece on the concept of “Harm Reduction” as it applies to ecigarettes and everything else. He argues that ecigarette advocates have lost their way:

And yet, many people who fancy themselves supporters of tobacco harm reduction actively support most of those caused harms. They actively support punitive taxes on cigarettes, social opprobrium heaped on smokers, prohibitions against publicans being able to offer smoking sections, etc. Indeed, those individuals often celebrate or advocate for the caused harms because they create further incentives for the only aspect of harm reduction they actually support, switching products. It reminds me of the Orwellian themes of about half the anti-smoking propaganda I see these days: “Quit because it is so expensive and forces you to take breaks from hanging with your friends!” Um, yeah, and whose fault is that? It is the same as those messages of “if you smoke weed, you might lose your student financial aid and future employment prospects, so don’t go saying it is not bad for you!” Needless to say, you will never hear a peep of condemnation of this hypocritical “concern” for users’ well-being from the faux supporters of harm reduction.

The bottom line is simple: Anyone who supports punishing smokers does not actually believe in tobacco harm reduction. None of those “but for the greater good we need to…” protests changes this. Causing harm is not harm reduction.

I agree with Phillips on some things within the larger debate, and disagree with him on others, but his criticism here does strike close to home. The pro-vaping community is an odd bunch that includes a lot of different perspectives. Phillips is something of a lefty, Clive Bates is a Tory, Robert West is Labour, and so on. Some are public health advocates that primarily see the value of ecigarettes in terms of being better than smoking, while others see it more through the lens of freedom or at least balancing that freedom with health concerns. That latter distinction is important because it informs how cigarettes are viewed, which is the subject of a lot of debate.

For the most part, the vaping community has hung its hat on how the product is different from smoking, and therefore take an anti-smoking stance. The harms of cigarettes are important, therefore little effort is put into contextualizing that harm or questioning some of the more questionable claims of public health advocates as it pertains to the harms of smoking. It helps that a lot of vapers are former smokers and, such as myself, proud of being former smokers. And less benignly, we know that when it comes to political relationships smokers, tobacco companies, and smoking make for a pretty toxic alliance.

And yet the enemies of smoking have, at least in the US, become our enemies as well. The FDA only begrudgingly acknowledges any difference whatsoever between smoking and vaping and often actively seek to obfuscate any difference.

So whether we like it or not, and whether it’s convenient or not, there is some common cause there. And many of the underlying arguments are not entirely dissimilar. Ecigarettes are not harmless, so in the eyes of many it’s an open question of whether or not it should be allowed. Cigarettes are very harmful, but not to everybody and as Phillips points out the shaming itself, whether through government action or social mechanism, is itself a harm. I have a catalog of things the government does to smokers for little no other reason than that it causes harm, in hopes of getting them to quit. By causing harm I don’t just mean some of the harder-to-justify mechanisms of making smoking more difficult, but intentionally making cigarette packaging or cigarettes physically revolting. When public health advocates express a fear of ecigarettes “normalizing” smoking, they tend to support policies with the primary effect of abnormalizing it. Formalizing the disgust of the public.

Now, maybe that is good public policy in the end if the net gains from people not smoking outweigh the psychological and emotional harm done to smokers. Maybe penalizing smokers through taxes can be justified if it discourages smoking. But Phillips is right: It’s antithetical to the notion of harm reduction. And it becomes clearer that does more than just make an enemy of smoking. It makes an enemy of the smokers themselves.

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11 Responses to Doing Harm For The Sake Of Reducing It?

  1. Thanks for the shout-out.

    I got thinking about your lefty-Tory-Labour comment. (Incidentally, good luck defining the first of those — in general, but especially in the context of me). My first thought was “is that disparity any more striking than observing X is a family man, Y is a bachelor, Z is a woman?” My next thought is that we would indeed expect some association between views on THR issues and one-word political identities. However, it would seem to be mostly associated with someone’s position on the authoritarianlibertarian spectrum, which is almost orthogonal to “left”-“right” or Tory-Labour.

    But continuing down that path, there seems to be an association with understanding public policy, or maybe just basic awareness and goodness. The election has caused me to cull Americans I follow on Twitter, to eliminate the ones posting many unsophisticated partisan statements, whatever the partisanship. (Note to any culled tweeps reading this: I also culled out most high-volume ecig cheerleaders after leaving CASAA and a few others, so please do not assume I don’t like your partisan comments.) They key word there is “unsophisticated”. I am left with some who post pro-D, pro-R, pro-Lib, and pro-Green comments. I do not select for policy agreement, just on reducing how often I have the urge to point someone’s basic understanding of the world is a complete fail. It is the difference between watching the likes of Conan comment on politics, rather than John Oliver, Larry Wilmore, or Samantha Bee — I am often annoyed with the latter group’s personal politics, but seldom infuriated that their joke is dependent on their audience being idiots.

    Anyway, an interesting side effect of that is that I get almost nothing that is anti-harm-reduction (other than a few feeds that I follow because they are anti-THR). I think this is because that decent people who restrict their comments to things they actually understand do not oppose harm reduction (of any sort), regardless of their political stripe. They might favor more or less government action on a matter, but they are always cognizant of real effects on real people. They might not be particularly interested in some aspect of harm reduction, but when they do comment in that realm they are concerned about caused harm. In other words wisdomfoolishness seems to be the key spectrum rather than some version of leftright.

    (P.S. I notice we both have the whole mountain east transplant / take care of daughter / wife-bacon thing going.)

    • trumwill says:

      Pinning you down was kind of difficult. I changed it a couple of times before settling on what I figured people would gather if they read your political comments. There’s the right goalpost, there’s the left one, and you’re kind of over there. As best as I can determine, but it’s rarely simple.

      It’s not too surprising that there isn’t a huge political skew of vaping advocates because it often speaks to the apolitical (life experiences) and runs along different non-L/R axes. On the other hand, it’s hard for any government policy issue to remain non-partisan indefinitely. And we can already see in congress where the politicians – if not the people – will line up.

      Most of my Twitter feed is not vaping-related (I maintain a separate list to consult when an issue arises), so what pertinent material I get is mostly from people who follow it superficially. Some supportive of ecigarettes, most against but rather superficially as it’s not an area of interest but rather a piece of a bigger conflict against corporations or bad aesthetics. Then they go back to talking about Monsanto or Game of Thrones. There are some, like Aaron Carroll and William Shadel, that seem to believe in THR in theory but for one reason or another are skeptical of vaping in particular. Very, very, very, very few in favor of the War on Drugs as it is currently being waged. Which is not something I seek out for (either way).

      It’s not terribly unlike how I follow a lot of conservatives, but few who argue on the efficacy of abstinence-only education. The few I know who do argue in favor of it tend to admit straight-up that it’s about religious-specific morality and not efficacy. There are some parallels, except that few argue straight-up that they’re against ecigarettes or smokeless tobacco on the basis of purity (religious or otherwise).

  2. Oscar Gordon says:

    See also – treating sexting teens like sex offenders?

    • trumwill says:

      Reminds me a bit of Bill Hicks, who talks about how it was good for him to do drugs, and it was good for him to stop doing drugs, but what wouldn’t have been good for him was to go to jail for doing drugs. One can agree or disagree with that first part, but the argument that the last is a bigger deal than the first is getting harder to deny.

      Sexting is indeed another good example.

  3. Mike Hogan says:

    Of interest here in DC, our Congress spent most of this year debating an opioid treatment bill in which they (fairly unanimously) learned that treating addicts like criminals is self defeating in terms of public health, and that abstinence only approaches have not worked at all. They seem completely incapable however of applying the lessons learned to smoking and nicotine. We’ll continue to try to educate regardless….

    • trumwill says:

      It’s interesting to watch the public health community’s mind go generally in the right direction in so many ways, and then forget all of that when it comes to cigarettes.

      • SFG says:

        Cigarettes are Evil. It’s funny how the human mind can’t live without some demon–we don’t have witches or Communists anymore, so…

  4. SFG says:

    You have traditional moral values, so I’m curious to hear your thoughts. Apparently the Europeans are lax on teen sex, teach them how not to get pregnant, and have a lot fewer of these problems than we do.

    I’ve also heard that abstinence education is actually a sneaky way to get the kids knocked up early so they (a) don’t leave the small town and (b) produce lots of white babies. I’m always willing to believe the worst of people (and this includes my fellow big-cityfolk), but I’m curious to hear what someone from this milieu actually has to say. You were there, I wasn’t.

    • trumwill says:

      I favor preaching restraint, but not freaking out about it. Either comprehensive sex-ed or Abstinence Plus. Whatever it takes to convey the information in a manner in which it’s likely to be heard (and the parents likely to allow it to be heard. But the information is important.

      I’m more an extremist than a lot of otherwise harder-core sex-ed advocates because I think the information on withdrawal should be conveyed, but when I bring it up suddenly they start sounding like the abstinence people (“But if you give them any indication at all that’s acceptable they’ll do it!”).

      That last part is something that liberals think conservatives think. (Which means that Donald Trump will probably endorse the notion next week.) They mostly just fear endorsement will lead to more activity. Never mind other kids, their kids won’t do such a thing. And sometimes they’re right! It’s just not especially right in the aggregate.

      • SFG says:

        Yeah, I basically agree. But I don’t have any kids so I kind of don’t have a dog in this fight. (I just get sick of seeing poor people with seven kids they can’t pay for.)

        Point well taken about the other thing. It’s funny to see the things conservatives think liberals think–that liberals like to make big government programs just because, that environmentalism is a way to raise property values, and so on. Any other things liberals think conservatives think?

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