In the last 20-30 years, numerous alternative, non-combustible nicotine products have been developed, offering the potential to eliminate our leading cause of preventable death. Yet, the evidence about harm reduction is ignored and many people, including many public health authorities and experts, mistakenly believe or support that non-combustibles are at least as dangerous as cigarettes. Why is that? David T. Sweanor invited Peter M. Sandman, an expert in risk communication, to comment on this issue and to suggest strategies to fight back these misconceptions.
Perceived hazard and outrage
As Dr. Sandman explained, hazard —how dangerous a risk is— has an extremely low correlation with people’s outrage — how upset people are about that risk. On the contrary, the correlation between perceived hazard and outrage is quite high, and this leads to the following question: Are people upset because they think something is dangerous, or do they think it’s dangerous because they are upset? It seems like a vicious circle, and there are arrows in both directions, but the most robust arrow is in the unexpected direction. People tend to think something is dangerous because they’re upset; trying to correct their hazard misperception is not likely to work, Dr. Sandman pointed out. On the other hand, if you can reduce the outrage, then you can reduce the hazard perception much more easily. If you deal with the legitimate reasons for outrage, you’ll have a better chance of getting a hearing on the hazard data.
Why are public health officials so outraged?
Analyzing this further, Dr. Sandman added that many public health officials and experts genuinely believe that non-combustibles are more dangerous than the evidence so far says they are, and they believe that because they are very angry at the tobacco industry. And they have legitimate reasons to be outraged:
- Trust. The tobacco industry is the canonical example of an industry that has earned profound distrust: denial, concealment, manipulation of science, marketing practices, and so forth.
- Moral relevance. Tobacco industry was morally culpable, knowingly selling an addictive lethal product and endlessly denying that that was what it was doing.
- Fairness. It feels profoundly unfair to let the tobacco industry make another fortune claiming to fix the catastrophe it caused in the first place.
- Responsiveness. The industry has a long history of being unresponsive to efforts to control it.
- Control. Public health professionals feel like the tobacco industry is out of control; they feel outgunned by the industry’s financial resources and marketing sophistication.
They may be wrong about the hazard of non-combustibles, but they are right about the outrage, Dr. Sandman remarked.
How could their outrage be reduced?
The speaker then clarified that although some non-combustible industries have never worked for combustibles, they are all considered to be in the big tobacco industry today, whether this is fair or not. Moreover, many academics, long-term anti-tobacco warriors, and public health renegades who advocate harm reduction could be considered the industry’s ally. They should respond, “I hate them too”, and state that they had to make a tough choice between getting even with the bads or help them save some smokers’ lives.
Acknowledging that his strategies to reduce outrage are not a cure-all, Dr. Sandman proposed that the tobacco industry should do the following:
Acknowledge prior misbehaviors. The industry tends to want to say: let’s put that behind us. The industry has to keep wallowing in its own misbehaviors.
Stake out the middle. Exaggerated or erroneous warnings are acceptable if you’re on the alarming side; they are unacceptable if you’re on the reassuring side. The industry should also include the critics’ points in its own messaging, so there’s nothing truthful left for them to say that the industry is not saying itself.
Acknowledge current problems. Tobacco industry knows what these problems are: youth uptake, dual use, safety data, etc. “Do not pretend you are not doing this for money!” he advises. Denying that gets in the way of acknowledging current problems.
Share control and be accountable. The industry should stop fighting being regulated. “It cannot be the good guys, he advises, it can let the good guys regulate it.” Accountability can be built in many ways: set up external advisory committees, pre-register industry studies, make their raw data available, get people who hate non-combustibles to do the research jointly with industry. The industry’s moto should be: “Track us, don’t trust us.”
Give away the credit. The cigarette industry would have been happily selling cigarettes forever. But public health officials and experts have transformed tobacco industry. They forced them to look for ways to stay in business while doing less harm. Therefore, Dr Sandman suggests industry should give public health officials credit for the broader transition away from combustible products. In other words, the core message for the industry shouldn’t be, look how innovative and responsible we have become; instead, their core message should be: “You made us do it”.
Discussion
In the discussion that followed, Mr. Sweanor focused on people who have nothing to do with the cigarette industry, but they are lumped in with it because they support non-combustible products, and he asked the speaker how they should react. Dr. Sandman replied that these people first need to acknowledge that they are “fellow travelers” with the industry. Even if they are very careful not to take a nickel of industry money, they are helping them. Secondly, they must emphasize that they hate the industry and that they do not like the fact that it’s an evil industry that’s profitable, profiting now from ameliorating the problem it profited from creating. But after careful thinking, it’s a victory of rationality over emotionality to decide to help big tobacco sell non-combustibles. They hate being a fellow traveler, but they are willing to do it to save lives. The same goes for independent companies that are not part of the big tobacco industry; in their case, they should also be emphasizing that their products compete with combustibles and undermine the traditional tobacco business.