For several years, I have repeatedly written about how the debate over harm reduction, especially electronic cigarettes, has brought out personal attacks, distortion of the science, and even lies among a number of opponents of this novel approach to smoking cessation. Over the past several days, I have learned that there is venom on both sides of the debate, and I had a chance to experience that venom from supporters of harm reduction.
If you read the comments to yesterday's post, in which I opine that it is time for Major League Baseball to ban the use of smokeless tobacco by its players during games, you'll see that I was battered by a number of harm reduction advocates. This battering also took place on Twitter and Facebook, where further pot shots were taken.
The interesting thing is that these attacks were in response to two very simple contentions:
1. That there is a causal link between traditional smokeless tobacco use and oral cancer; and
2. That Major League Baseball should follow the lead of the minor leagues and ban the use of smokeless tobacco, such as not to set a bad example for the millions of youth who idolize these athletes and are viewing on television or at the ballpark.
The Rest of the Story
This demonstrates just how contentious harm reduction debates are, especially in tobacco control. Both sides are acting on zealous idealism, with science playing very little role.
The ironic thing is that no one actually disagreed with me on the science. Most of the advocates of smokeless tobacco acknowledged that there is a small, but real, causal relationship between traditional smokeless tobacco use and oral cancer (this relationship does not appear to hold for snus). However, simply because I made the statement that this causal link exists, I was blasted. Apparently, the simple statement that smokeless tobacco causes oral cancer is too much for many harm reduction advocates to tolerate.
As I found out when I simply proposed the rather benign, but crucial to science, idea of conducting a clinical trial to examine the effects of electronic cigarettes on smoking behavior (in comparison to the nicotine patch, a well-accepted standard), there is very little room for balanced, objective thinking in the current tobacco control/harm reduction environment. The simple proposal to conduct such a crucial study brought out personal attacks and profound criticism. This despite the fact that every single electronic cigarette company representative I talked to about the proposal felt that the study was critical and needs to be conducted. There was no opposition to conducting sound science among the electronic cigarette companies. All the opposition came from the harm reduction "community."
The impression I am left with is that the entire harm reduction debate is a toxic one, with venom on both sides, which is leading to irrational thinking, blind adherence to ideology, a focus on ad hominem attacks rather than rational scientific discourse, and a biased perspective on the scientific evidence.
This polarization is a disappointment to me, but I guess in an era where ideological-driven debates are raging over climate change, gun control, and immunization, I should not have expected this one to be any different.
I can only hope that science will be restored to its rightful place in tobacco control and public health. But right now, I am not at all optimistic.