Authors: Joe Gitchell*
Abstract: Background: The role of explicit harm reduction approaches to tobacco smoking has been debated for decades. From the historical deception of reportedly low-tar filtered cigarettes versus actual low-toxin exposure smokeless tobacco and snus, to the current focus around e-cigarettes and other noncombustible tobacco and nicotine products, the issues and positions have not changed much even as the evidence has continued to mount. Why has science not been able to drive convergence towards truth and a solid evidence base for regulation and policy?
Aims: To describe why harm reduction remains unresolved and to suggest paths forward.
Methods: Relying on lessons from moral psychology, group dynamics, and cognitive science, this presentation will outline factors that stubbornly resist alignment and forward progress to maximize improvements in public health and suggest ways to manage these factors.
Results: The presentation will argue that there are two major barriers to agreement around harm reduction issues. The first is the unwillingness or inability of too many involved to establish clear priorities for tobacco and nicotine regulation and policy, particularly as this process requires confronting and working through trade-offs. This barrier is pernicious as policy to control cigarettes evoked minimal trade-offs. The second source of friction is a misplaced hope that evidence, even strong evidence, will suffice to change strongly-held beliefs and identities without surfacing and discussing underlying values supporting these positions.
Conclusions: Without identifying and grappling with these issues, it is unlikely that sufficient agreement will be achieved within the global tobacco control community to take full advantage of nicotine without smoke substituting for tobacco cigarettes to accelerate declines in smoking.
Disclosures: My employer, PinneyAssociates, provides consulting services regarding tobacco harm minimization and vaping products to JUUL Labs, Inc, on an exclusive basis. I also own an interest in a nicotine gum that has not been developed nor commercialized.