A junk history of tobacco harm reduction

An article in Tobacco Control by a pair of professional anti-smokers from San Francisco asks why the US and UK have such different approaches to e-cigarettes and other reduced-risk nicotine products.

Major British health organisations support tobacco harm reduction for smokers struggling to quit. The USA, in contrast, classifies e-cigarettes as tobacco products and leaders are less supportive of tobacco harm reduction.

Historians have attributed this transatlantic difference to the tobacco industry’s long history of deception over ‘safer’ products resulting in scepticism towards tobacco harm reduction.

Have they? That's news to me. Elias and Ling cite three articles as proof, but only one of them was written by a historian and that was published in 2004, long before e-cigarettes hit the market. None of them makes the argument that Elias and Ling say they do.

But never mind because the rest of the article makes the argument - such as it is - anyway. They do this by going over the story of the Independent Scientific Committee on Smoking and Health (ISCSH) which conducted safer cigarette research with the tobacco industry in Britain in the 1970s. The story they tell has been mostly drawn from the excellent work of the historian Virginia Berridge. You can read a very short summary of the initiatives of the 1970s in Vaping Solutions, but the gist of it is that nothing really came of them because smokers tend to draw more deeply on low tar cigarettes and regulation prevented more imaginative safer cigarettes from succeeding in the market.

Elias and Ling go through the British experiments for several pages and then, finally, get to the point:

In the eyes of the broader British public health community, the ISCSH work was largely for naught. Yet in recent years, the Committee’s guiding logic and premises of risk reduction have enjoyed a reanimation among British public health organisations.

Hear that dog whistle? The message is 'once bitten, twice shy'. History is repeating. Beware!

British public health should mind past experience, in which industry-backed ‘safer cigarettes’ undermined public health.

Elias and Ling argue that efforts in the UK to make cigarettes safer were an industry-led distraction which caused the British government to shelve effective anti-smoking policies. By contrast, the USA got on with the job of clamping down on cigarettes and had no truck with tobacco harm reduction.

As if that weren't bad enough, it's all happening again. When will those limeys learn?

If the past is any guide, the promotion of tobacco harm reduction may serve the interests of tobacco companies more effectively than the public.

The problem with this narrative is that it's ahistorical nonsense from start to finish. It turns a blind eye to the inconvenient fact that America had its own industry-government working group that spent millions of dollars trying to make cigarettes safer. The US National Cancer Institute set up the Tobacco Working Group in 1968 (five years before ISCSH was formed) for this very purpose, but the only acknowledgement of this in the Tobacco Control article is one sentence in the discussion section:

Government and industry collaborations to develop a ‘safer cigarette’ were not unique to the UK. From 1968 to 1979, the US National Cancer Institute spent US$50million to sponsor the Tobacco Working Group (TWG).

Government-approved efforts to launch safer cigarettes in Britain and the US were effectively dead in the water by 1978 and 1979 respectively. The two countries did not have different experiences and, therefore, their different attitudes to tobacco harm reduction today cannot be explained by them.

Moreover, the USA did not choose tough anti-smoking measures over tobacco harm reduction, and the UK did not choose harm reduction over anti-smoking policies. From the 1980s to the present day, the UK has had higher tobacco taxes, more restrictive advertising laws and larger health warnings. It also managed to ban snus, the only viable reduced harm product that existed until e-cigarettes came on the scene.

Elias and Ling's little morality tale is a travesty of history and explains nothing. Britain's approach to tobacco harm reduction, and vaping in particular, doesn't require much explanation. From around 2012, lots of smokers spontaneously switched to vaping and the government ultimately decided that this was a good thing. 

Britain is not unique in this. Across the developed world, governments have recognised the benefits of vaping and have regulated e-cigarettes accordingly, ie. more lightly than cigarettes. The sale of e-cigarettes is now legal in every EU country, for example, albeit with some silly restraints from the EU. The USA is the outlier insofar as it has moved from a tolerant position to a more extremist one. It is this American exceptionalism that requires an explanation.

My explanation is that US policy has been influenced by people, such as those at Elias and Ling's Center for Tobacco Control Research and Education, who are more interested in fighting tobacco companies than in fighting smoking. There is also a stronger puritanical element in the US anti-smoking movement than there is in the UK, and America has a stronger history of prohibition. Furthermore, the pharmaceutical industry has more clout in the US than it does in the UK and funds anti-smoking groups to a much greater extent.

In both countries, the 'public health' lobby is divided between those who are genuinely interested in health and those who are, in effect, moral or political crusaders. In Britain, the former just about managed to gain the upper hand, despite opposition from the likes of Martin McKee and Simon Capewell. In the USA, the latter are in charge. They are all awful, illiberal people to varying degrees, but in America the very worst have risen to the top.