Tobacco Control in the 21st Century from a Socio-Ethical Perspective

September 26, 2023

With the global burden of smoking still growing, tobacco control remains an issue of public health that needs urgently to be addressed. But quitting smoking is extremely hard for most smokers and many of them are eventually unable to quit. Tobacco Harm Reduction represents a complementary tool in the efforts to control the smoking pandemic that has been proven to be effective as an alternative for all these people in order to minimize the harm caused to their health.

In his extremely interesting keynote speech, chaired by Professor Konstantinos Poulas, Professor Konstantinos Farsalinos discussed the complex sociopolitical and ethical aspects of tobacco control in the 21st century, focusing on Tobacco Harm Reduction and the obligation of politicians, regulators, and scientists to have an open-minded, honest, and evidence-based approach, beyond ideologies and prejudice.

Today, we are living in “risk societies”, Professor Konstantinos Farsalinos said at the beginning of his speech, in the sense that our societies are increasingly occupied with debating, preventing and managing risks that they have produced themselves, and smoking is a characteristic example of that. Unfortunately, he continued, Tobacco Control―a risk management/regulation “instrument” (or industry) in which various organizations participate―efforts seem to be rather ineffective in resolving the problem since prevalence of smoking continues to be extremely high.

Tobacco Harm Reduction is a strategy that could help, he underlined, but the interaction between Tobacco Harm Reduction and Tobacco Control is rather problematic. Although FCTC mentions harm reduction as part of the strategy to tackle smoking, in fact real application of harm reduction in smoking has been minimal and largely unacceptable by the Tobacco Control movement.

The truth is, Prof. Farsalinos emphasized, that Tobacco Harm Reduction is a human rights issue. Harm Reduction is not just about reducing the harm from substance use, but is also about addressing stigma, marginalization, criminalization, inequalities and oppression, in an effort to protect health, dignity and liberty, including the liberty of making informed personal choices.

In 1991, the speaker said, Michael Russell―the father of Tobacco Harm Reduction―suggested that nicotine delivery systems can be useful not only as temporary aids to cessation, but also as long-term alternatives to tobacco that can make the virtual elimination of tobacco a realistic future target. But today, after more than 30 years, regulatory authorities have adopted a growing, overwhelming, authoritarian and restrictive-prohibitory approach, up to the point of equating tobacco cigarettes with lower-risk, combustion-free harm reduction products, which constitutes a clear violation of the principle of risk-proportionate regulation, he pointed out.

To be realistic, this approach is not science, Professor Farsalinos stated, and it does not serve the purpose of properly communicating scientific facts and truth, as many examples show.

The stance of Tobacco Control, he explained, is problematic, because it is extremely dogmatic -they are frequently misinterpreting evidence, they attempt to suppress any criticism with ad hominem attacks, and they engage in a fearmongering campaign based on an extreme application of the precautionary principle, emphasizing on potentially devastating (but to a significant extent theoretical) future risks and continuous uncertainty ―invariably assuming that worst case scenarios are the only possibility.

The precautionary “better safe than sorry” principle that is used, Prof. Farsalinos continued, is also very problematic since it lacks objectivity, it distracts us from greater threats, it is vague and largely unclear, it lacks comprehensiveness, it is frequently asking for inappropriate burden of proof, it is―of course―asymmetrical since it fails to account for the fact that the risks created by inaction and technological stagnation are at least as real as those of action and technological advancement, and, finally, it fails to accommodate tradeoffs and tends towards authoritarianism. And because of all these characteristics, Prof. Farsalinos added, it is vulnerable to corruption, and therefore should not be used as a basis for decision-making.

Tobacco control tactics today, he underlined, is based on emotion, using children as the main/persistent “slogan”, it lacks solidarity and empathy for smokers, and it focuses on nicotine use instead of focusing on smoking-related health harms. These characteristics, together with the strongly prohibitory agenda, transform the science produced by Tobacco Control into a form of a new atheistic religion that should be trusted blindly. “Experts” know better than anyone else, he explained, are the “owners” of scientific truth and (most importantly) moral knowledge, justice and injustice, and represent the sole defenders of human rights -even though they fail to respect many of them. Still, their knowledge is based on past experience with tobacco cigarettes, failing to consider and acknowledge the strong harm reduction prospects of reduced-risk products, at least for some individuals.

Unfortunately, today the anti-harm reduction hysteria is becoming an oppressive, intolerant and authoritarian form of political correctness for smokers and for scientists with different views. But we all should not forget the provisional nature of scientific knowledge ―that proper skepticism is the foundation of intellectual progress. Professor Farsalinos concluded with a citation of the British philosopher Bertrand Russell, who wrote: “we should not fear to be eccentric in opinion, for every opinion now accepted was once eccentric.”