The term was coined by an economist to explain why those with seemingly opposing interests can sometimes find themselves in accord with one another. His example was how those campaigning for Prohibition found unwitting common cause with bootleggers whose fortunes were made with the passing of the Volstead Act. Regarding the battle over vaping, it’s more to do with the Baptists aiding the bootleggers to preserve their existing mega bucks.

The narrative constructed by those who oppose tobacco harm reduction (THR) through the use of safer nicotine products (SNP) is that the whole business is a Big Tobacco ploy to hook kids on nicotine through the promotion of cool products in order to compensate for falling cigarette sales. Campaigners, the medical establishment and politicians have convinced themselves that prohibition of SNP will be a notable victory against Big Tobacco machinations.

Hang on though. It was noticeable last year that when flavour bans were mooted in the USA alongside an outright ban in India, tobacco company share prices in those countries rose. You don’t need to be a stock market guru to deduce that some investors at least thought this was good news. Contrary to anti-THR propaganda, the major companies only control about 20% of the global SNP market. The rest is owned by a plethora of much smaller independent companies (and probably some hefty Chinese ones too). They must represent a threat to the big companies over time as the number of SNP consumers continues to rise.

I have no idea how much tobacco company lobbying is undertaken to persuade politicians not to pursue a prohibitionist agenda against SNP. Whatever goes on behind the scenes though, it doesn’t seem to be working and I vaguely wonder how hard companies are trying. (By contrast, Big Pharma definitely does not want to see a booming market in non-medical nicotine products undercutting NRT profits and part of their strategy is to fund anti-THR organisations to that end).

A recent blog pointed out that incoming tight regulation of SNP in the USA will hand the whole industry over to the major companies as the only one able to afford the crippling costs of bringing new SNP to market.


But I am willing to bet that some investors in those companies, along with board members and those senior executives who are not interested in new product development, are looking askance at the whole SNP endeavour. On the one hand, the global value of SNP compared to cigarettes is still tiny – yet the market is growing. So while it is still a relatively small market - and before it becomes a real threat to cigarette profits - the thinking may be ‘let the evangelists do the heavy lifting for us, get their fifteen minutes of fame, leaving us free once again to focus on where the big money is’.

This might be slightly tangential to the main argument here, but I am reminded of the scene from The Simpsons, where Homer joins the secret Stonecutter society of influential businessmen who sing at one point, ‘Who held back the electric car? We did! We did!’

In the apparent absence of any heavyweight champions of THR with their faces in high places, serious collective pressure needs to be applied by the thousands of individual health professionals having to treat the fall-out from smoking-related disease. Sadly, the prospects for that are not promising. A recent study from Rutgers University shows the continuing level of ignorance about the ‘dangers’ of nicotine among doctors in the USA, confirming studies from elsewhere. (I would put the link in, but in this case, science is helpfully fire-walled).

Even so, and however naïve this may sound, there has to be a way for those clinicians who understand and support THR to get the messages across to colleagues who are clearly reluctant to suggest harm reduction alternatives to their patients beyond NRT and drugs. If they were more convinced and were prepared to lobby on behalf of their patients, maybe the pressure on policy makers can play out in more sane and compassionate tobacco control policies. And if companies were then allowed to make valid health claims for SNP without the even more expensive process of registering them as medicinal products, then they might see real business advantages in investing in new SNP and we could be off to the races. Moreover, all of this can be achieved at minimal cost to government and of maximum benefit to all those looking to switch away from smoking.