NTR soliciting papers designed to reinforce e-cigs as ethical harm reduction; I’ll pass

The journal Nicotine and Tobacco Research is soliciting papers to support e-cigarettes for harm reduction as the ethical thing to do.    

The call (reproduced below) frames the question the need to address the fact that “The tobacco control field has become deeply divided over the question of how to respond to the advent of e-cigarettes, vaporizers and other non-combustible nicotine products.”  They also say that “Papers are intended to be illuminating to the current discussions around harm reduction and may contribute to some extent to a re-unification of the field, or at least to further clarification of the current disagreements and of what would be required for moving towards consensus or compromise.”  But, far from offering a neutrally worded call to debate the issues around e-cigarettes, it accepts, without question, the assertions that e-cigarettes are beneficial, at least for adults, and hedges on the overwhelming evidence of harm to youth.

For example, the statement that e-cigarettes “have the potential to help smokers who cannot or will not quit tobacco, by delivering nicotine without the toxic constituents of tobacco smoke” assumes that there is a substantial “hard core” of smokers who simply will not stop using tobacco products, despite the evidence that the population of remaining smokers is softening not hardening as smoking prevalence falls (including people with psychological distress and across ethnic groups).  It also ignores rapidly growing evidence that e-cigarette aerosol may be as toxic than cigarette smoke, despite growing evidence that e-cigarette use increases risk of heart attacks, stroke, and respiratory disease. 

It says “there is a concern that non-smokers, particularly young people, enticed by these products may go on to use combustible tobacco.”   The evidence is way past “may.”  The evidence is overwhelming that e-cigarettes are attracting low-risk youth to nicotine use with many going on to add cigarettes.  There is not a single study I know of that does not show this gateway effect.  Even if kids just use e-cigarettes, nicotine is brain poison.

Despite the rapidly accumulating evidence of harm enhancement, they ask “Judging how much weight should be given to sheer numbers of lives saved in deciding how to respect other basic ethical concerns of public health.”  They completely dismiss the possibility – I would say likelihood – that e-cigarettes are as dangerous as cigarettes (just different).  They also ignore the evidence that, for most smokers, e-cigarettes reduce, not increase the likelihood that they would quit smoking.  This is not “helping current smokers.”

Their list of topics includes industry framing like “personal responsibility” but doesn’t say a word about the role of the tobacco industry or how e-cigarettes fit into industry efforts to protect the global tobacco market.

The call is built around a conference on this topic that was a who’s who of e-cigarette advocates.

I’m taking a pass on this invitation:

Nicotine & Tobacco Research intends to publish a themed issue on the ethics of alternative nicotine delivery systems (ANDS) and harm reduction approaches in tobacco control. Guest editors will be Tessa Langley, Richard Ashcroft, Dan Wikler, Samia Hurst, Nir Eyal and Monica Magalhaes.

The tobacco control field has become deeply divided over the question of how to respond to the advent of e-cigarettes, vaporizers and other non-combustible nicotine products. These products have the potential to help smokers who cannot or will not quit tobacco, by delivering nicotine without the toxic constituents of tobacco smoke. However, the health risks from long-term use of these products or exposure to secondhand aerosol are unknown. Moreover, there is a concern that non-smokers, particularly young people, enticed by these products may go on to use combustible tobacco.  

The themed issue will focus on the ethical questions raised by tobacco harm reduction and the controversy around it. Papers are intended to be illuminating to the current discussions around harm reduction and may contribute to some extent to a re-unification of the field, or at least to further clarification of the current disagreements and of what would be required for moving towards consensus or compromise.  

We invite submissions which apply current insights from philosophy, population-level bioethics, and other relevant disciplines to explicitly discuss value choices in tobacco control policy. This call is open to, but not restricted to, papers presented or inspired by discussions at a conference on this topic that was held in 2018.

Examples of possible manuscript topics include, but are not limited to:

• The relative priority of protecting non-smokers vs. helping current smokers
• Weighing benefits to current smokers against those of potential future smokers
• Discounting the relative importance of future lives saved in relation to present lives
• The moral importance, if any, to be attached to personal responsibility of the smoker
• Judging how much weight should be given to sheer numbers of lives saved in deciding how to respect other basic ethical concerns of public health
• Ethical questions relating to regulation of non-combustible nicotine products, eg. how paternalism, liberty and autonomy bear on these policy questions
• Ethical questions relating to the implementation of tobacco harm reduction policies

A more neutrally framed call for papers in this issue would include things like the ethics of

• ignoring mounting evidence of substantial harm of e-cigarettes
• clinging to always-questionable claim that e-cigarettes are 95% safer than cigarettes
• dismissing evidence that e-cigarettes are a gateway for cigarettes by nit-picking methodological issues in individual papers rather than looking for overall patterns in the evidence
• recommending e-cigarettes for smoking cessation despite the fact that no e-cigarette company has even submitted the evidence for FDA approval of such claims
• recommending e-cigarettes for cessation over other products that have demonstrated efficacy
• claiming that flavors help adult smokers quit despite the paucity of quality evidence to support this claim  
• government agencies turning a blind eye while e-cigarette companies make therapeutic (cessation) and modified (reduced) risk claim without proper independent vetting
• a major journal sponsoring a special issue on ethical questions from such a one-sided perspective