But public health communicators have a moral duty simply to present the evidence.
The title of this blog is the title of a famous poem by the American poet, Wallace Stevens. It has been quoted since to symbolise that there are many different perspectives on any number of societal issues – anything from the Trump indictment and conflicts in the Middle East to arguments about nuclear power and re-wilding. So there can be any number of ‘truths’, but when it comes to providing accurate public health information, this must be founded on evidence – not convenient versions of the ‘truth’ to align with moral preferences or vested interests.
Professor Lynn Kozlowski has written several papers on the human rights aspect of providing accurate public health information, arguing that people have a right-to-know so they can be equipped with agency over their own health. Using smoking as an example, Professor Kozlowski observes that both governments and NGOs took a simplistic and misleading approach by blandly stating ‘There is no safe cigarette’. This is a basic truism but gives no specific information about the various potential health risks. Studies show that most smokers already knew that smoking was harmful to health, but far fewer knew about the actual risks. The tobacco industry bought into this too; it promoted the same message which left smokers with the idea that while there is no such thing as a safe cigarette, low-tar and ultra-light versions might be safer. Which they aren’t.
Worse still, by stating that there were no safe tobacco products, public health swerved around the inconvenient evidence that smokeless tobacco in the US was indeed significantly safer than smoking. Following a legal challenge in 2004, the US National Institute on Ageing was forced to re-examine its policy on smokeless tobacco.
Since the advent of other safer nicotine products such as vapes and heated tobacco products, the level of misinformation produced by national and global public health agencies has reached new depths. This has gone far beyond simplistic messages about ‘not safe’: violations of all the basic tenets of bioethics are now ubiquitous, unmoored from the independent evidence-base of relative safety. A few examples will suffice:
- Safer nicotine alternatives containing no tobacco (a plant) are now called “tobacco products.”
- US teen nicotine vaping has plummeted 50% over the past three years, but it is still called an “epidemic” which apparently harms developing brains.
- The World Health Organization (WHO) has recently argued that liquid aerosol (vapor) is “smoke.”
- Continued claims that teen vaping is a gateway to smoking even though US teen smoking has dropped 90% over the past decade.
- Misinformation from official US sources is as influential as that from the WHO: many health ministries take their (mis)cues from the FDA, CDC and various influential NGOs.
- As well as actual misinformation, there is the sin of omission. The WHO and others have done nothing to dispel the myth that nicotine causes cancer. This belief among health professionals is the primary reason why doctors are not recommending safer nicotine products to patients who cannot quit smoking and/or have failed to quit using nicotine replacement products.
There is a justification for promoting certain public health interventions even if they are not 100% accurate. For example, maybe not everybody suffering from depression will benefit from exercise as many health promotions claim, but obviously many will. There is little science behind eating five portions of fruit and vegetables a day (and the number differs across the world). But it is a good idea to eat more fruit and veg, so there must be some number that public health can promote and the public latch onto.
However, the public are being subjected to outright deception by the communication strategies about safer nicotine products. This can only have negative public health outcomes if smokers are dissuaded from switching and choose to carry on smoking. The authors of one paper on “non-honesty” in public health communication are happy to use the term “bullshit” as part of their taxonomy. This certainly applies to the world of public health communication about safer nicotine products.
Probably the most important constituency who need to be convinced about tobacco harm reduction using safer products are politicians. They make the rules governing access to these products. TobaccoIntelligence recently released the results of a survey of Members of the European Parliament (MEPs) soliciting their views about safer products. Since 2020, the percentage of those thinking safer product were actually safer than smoking fell from 68% to around 50%, matched by an increase in the numbers of those who don’t know. Asked about their knowledge of safer products, those respondents with some knowledge were most likely to view them as less harmful, compared to those with little or no knowledge. Even here though, those with some knowledge fell from 89% in 2020 to 76% in 2022. This reveals that the continuing spread of misinformation from tobacco control leaders via the media is causing increasing doubts in the minds of politicians. Deception is not countered by voices in support of tobacco harm reduction as these are invariably ignored, actively silenced or briefed against.
Flashing back to the court case involving the US National Institute on Ageing, who were forced to amend their information on smokeless tobacco. Maybe a few legal challenges will give science its day in court. The media would be more hard pressed to ignore the counter-narrative. Politicians might take more notice. Indeed, as I was writing this, came the news that the Dutch consumer activist group Esigbond have launched a lawsuit against the Dutch government flavour ban. Hopefully others will follow suit and ensure maximum publicity beyond the THR community whatever the outcome. After all, if you can put a former US President in the dock, who knows where the axe could fall?