Tobacco harm elimination: An experiment with human life and health

I was reading an article published on Norwegian TV channel NRK's website (http://goo.gl/1Nb3PC, in Norwegian) some days ago. It's written by cancer researchers Dr. Tom K. Grimsrud (from the Norwegian Cancer Registry) Professor Tore Sanner (from the University in Oslo I think). The headline:

"An experiment with life and health"

I'm not going to go through all the details here (don't bother trying google translate, it changes the meaning of a lot of stuff in there) but the heading says a lot about the content I think. This is how they choose to start their article:

"For long we believed that nicotine was relatively harmless, and that the harm in tobacco use came from other substances in smoke and tobacco. This understanding characterizes the debate on e-cigarettes, but it is obsolete"

Basically it's a collection of vague references to studies that the don't even provide links to. Dr. Grimsrud and Professor Sanner are, if not deliberately lying to scare people, and I'm not saying they are not, guilty of just plowing through summaries and conclusions and without any further investigation cherry picking the ones that fits well into their scaremongering tactics. And there is a lot of "reason to maybe believe that nicotine is dangerous" and "we can't rule out that nicotine causes some harm". They go public with a headline that will scare a lot smokers enough to keep them smoking and eventually die because of it, followed by an article based on some vague study that can't rule out that nicotine may have caused some Swedish mice that already had cancer to die a faster and a gateway argument that has been proved wrong by a bunch of studies lately. The ASH study for example: http://goo.gl/Rz3BH0. The numbers they use for supporting their gateway argument seem to come from the CDC study published last year (http://goo.gl/Zyscks) that actually shows nothing of the sort but is rather a study in how to twist your irrelevant numbers to fit your pre-written conclusion. If anything is obsolete here it's their gateway argument and the so called science they use to back it up.

I'm convinced that Grimsrud and Sanner are fully aware of these studies, as they are fully aware of the studies of Dr. Farsalinos (http://www.ecigarette-research.com), but these does not support their case, and they have not been able to find any good arguments against them so they just refrain from mentioning them. If you're going to put Dr. or Professor in front of your name you should know better.

I am also convinced that if Grimsrud or Sanner had to choose either e-cigarettes or cigarettes for themselves or their children, they would go for the e-cigarette. Well, actually they would probably try to choose neither. And this seems to be their biggest problem, and the biggest problem with the whole anti-e-cig movement: They seem completely unable to understand that for a lot of people there is no third option, which is kind of dangerous actually, considering the influence their statement may have on smokers. They simply refuse to accept the fact that a lot of smokers are unable to get rid of their nicotine addiction. So they cling to their harm elimination strategy.

One of the problems with only going for harm elimination is that it is only successful if a user manages to completely manages to quit whatever he is addicted to. If it fails, you're back to square one. Another problem is that the barrier an addict has to cross to succeed is much more intimidating, making a lot of users reluctant to even try. Harm reduction on the other hand, is more user friendly and more motivating for the user, and you're not back to square one if you fail. If you want to quit smoking and your strategy is to quit cold turkey, and you fail, you're back on the cigarettes (unless a harm reducing option is available). If your strategy is to switch to e-cigarettes and then gradually reduce the nicotine content, failing to do the latter means you're just standing still or in the worst case you've just taken a step back. But the biggest problem is that a lot of users are simply unable to succeed at harm elimination. This leaves them with no other option than to stick with the cigarettes.

Harm reduction can also be a gateway to harm elimination. The steps to cut down your nicotine content from say 18mg/ml, via 12 and 6 (just examples) are much easier and less intimidating to users than having to take one giant leap and quit cold turkey. In addition to this harm reduction can act as a safety net for people failing in harm elimination. I've read several forum posts and blog posts from former smokers that tried to cut cold turkey and "failed", but instead of reverting to cigarettes, they've started vaping. I think even Grimsrud and Sanner would agree that this is better. As I said, if they were left with two options, cigarettes or e-cigarettes, they'd both go for e-cigarettes. (If any of you two are reading this, feel free to comment if you disagree.) And why is that? Well, it lets the user get rid of thousands of known carcinogens, and leaves them with just one potential one, reducing the chances of a premature death dramatically.

So do Sanner and Grimsrud really understand the concept of harm reduction and why it's the solution to the worlds tobacco problem. I think they do, but they still chose to publish that article, with no mention of nicotine gum or patches I may add. In fact they end their article with this: "The marketing of e-cigarettes is a gigantic experiment with human lives and health". Which is a bit strange as they're main argument is that nicotine itself is dangerous. Their motives for doing so? I don't really know, but the options I can think of scares me a bit. Whatever their motives are, I say the the real experiment with human lives and health here lies within their harm elimination only strategy and their choice to publish this article.



photo credit: Brad Bethell Photography via photopin cc