September 25th, 2016

The wilful ignorance of tobacco control McCarthyites

Just when you thought public health could sink no lower, it pulls it off again! This time, a couple of “tobacco control” organisations, CTFK and ENSP, have been writing to several participants in a conference (GTNF 2016) to be held next week. The letters tell them they must be mistaken, that they can’t possibly have realised tobacco companies were involved and that they should pull out before it is too late. All backed with a threat of reputational damage if they don’t. I find this deeply depressing and disturbing. Let’s take a look at:

What’s wrong with these letters?

The Global Tobacco and Nicotine Forum is an annual conference organised by the conference arm of Tobacco Reporter, the main international specialist publisher in the field. It attracts a diverse range of interested parties, including from many parts of the tobacco industry, into what is mainly a debate about the future of tobacco and nicotine. According to CTFK and ENSP, no-one with an interest in health should attend – so they have written to several academics or experts to demand that they withdraw from the programme.

These sneering, threatening and vacuous (and unsigned) letters are not what they superficially claim to be. They are part of an effort to delegitimise people with whom these organisations disagree, but with whom they are incapable of debating facts and evidence. The tactic is to say “tobacco industry” like Senator Joseph McCarthy would once say “communist” and assume that the argument ends there. If you can taint the individual by association, you can safely ignore their challenge to the established order. By delegitimising the critic, you can sidestep the criticism.

McCarthyism is the practice of making accusations of subversion or treason without proper regard for evidence. It also means the practice of making unfair allegations or using unfair investigative techniques, especially in order to restrict dissent or political criticism.

Three especially offensive quotes will suffice to make my point:

1. Sneering

As you might not have noted, representatives from the industry, as well as its advocacy groups, have been invited to present or sponsor specific sessions:

Maybe they think this is being cute and clever? To me, it looks infantile. The participants all know this is a conference in which the tobacco industry has a high profile. That’s an important reason to participate. Those attending as public health experts and advocates want to change the market for nicotine products away from combustible products so it does less harm. A vital factor in that, either positively or negatively, is the influence of the tobacco industry.

2. Threatening

As professionals with high credibility, who should be placing patients’ health and well-being as their highest priority, we believe that your involvement with an industry that has been misleading and deceiving the general public for many decades could be not only detrimental to your reputation but also the notoriety of your affiliated association or institution.

Try reading that out in an East London gangster accent.

3. Vacuous

Physicians are at the forefront of the tobacco epidemic that is crippling our communities, targeting the most vulnerable, and need to embrace their professional responsibility not to get involved with an industry, which has fundamentally irreconcilable interests from public health and welfare.

Leaving aside the amusing illiteracy in the first line, this says to me that they just don’t get it. The fundamental interest of any tobacco or nicotine company (and any company) is in increasing or defending shareholder value, not the death of its customers. They are businesses and, as such, they are interested in the medium to long-term discounted profit pool arising from all their activities. The questions most often under discussion at these events are how these interests can be aligned with reducing the harms from smoking, what the disruption of the nicotine market by low-risk alternative nicotine delivery systems means for the various actors involved, and what is the appropriate way to respond. There are interesting answers to those questions if you have an open mind and are prepared to ask them in the first place. If you are in public health and you aren’t interested in that, then with all due respect, you aren’t doing your job.

If you think the tobacco industry should just cease to exist, that’s fine. Don’t come to these events. But when they politely decline your request to extinguish $700 billion (and rising) of shareholder value, what’s your next move? Maybe you should let someone else think about that without trying to intimidate them.

Why attend such a conference?

I go to industry orientated conferences for several reasons. As I recently said in response to a particularly puerile comment from an Australian academic:

Professor Daube finishes his contribution with what I can only assume is an attempted smear in pointing out that I sometimes speak at conferences where the tobacco industry is present, as if this is somehow, a priori, an immoral act. I speak at these events because I have an ambitious advocacy agenda about how these firms should evolve from being ‘merchants of death’ into supplying a competitive low-risk recreational nicotine market, based on products that do not involve combustion of tobacco leaf, which the source of the disease burden. So I, and many others, have a public health agenda – the formation of a market for nicotine that will not kill one billion users in the 21st Century, and that will perhaps avoid hundreds of millions of premature deaths [2]. There is a dispute about how to do this, and no doubt Professor Daube has ideas. However, the policy proposals for the so-called ‘tobacco endgame’ advanced by tobacco control activists do not withstand even cursory scrutiny [3]. The preferred approach of advocates of ‘tobacco harm reduction’, among which I include myself, involves a fundamental technology transformation, a disruptive process that has started and is synergistic with well-founded tobacco control policies [4]. If, like me, you wish to see a market change fundamentally, then it makes sense to talk to and understand every significant actor in the market, rather than only those whose convictions you already share.

So let me lay it out: the reasons why there are people committed to public health who would attend such conferences:

Advocacy. We represent a ‘harm reduction’ philosophy in public health. In the case of tobacco, that means we want the market for nicotine and the companies that supply it to move as rapidly as possible into low-risk nicotine products, of which e-cigarettes are one example. This is not that different from wanting the energy market to move to low-carbon supply as a response to climate change. For that to work, a wide range of things will have to go right: appropriate consumer protection regulation; a framework that encourages competition and innovation; a risk sensitive fiscal regime; corporate strategy and resources allocated to transformation; R&D focus on a reduced risk products pipeline; consumer and public health insight; risk assessment and risk communication to name a few. These are subjects under discussion at these meetings. Of course, we don’t make the decisions – that’s not what advocacy is. But we are trying to move things in the right direction to the extent that we can.

We represent a ‘harm reduction’ philosophy in public health. In the case of tobacco, that means we want the market for nicotine and the companies that supply it to move as rapidly as possible into low-risk nicotine products, of which e-cigarettes are one example. This is not that different from wanting the energy market to move to low-carbon supply as a response to climate change. For that to work, a wide range of things will have to go right: appropriate consumer protection regulation; a framework that encourages competition and innovation; a risk sensitive fiscal regime; corporate strategy and resources allocated to transformation; R&D focus on a reduced risk products pipeline; consumer and public health insight; risk assessment and risk communication to name a few. These are subjects under discussion at these meetings. Of course, we don’t make the decisions – that’s not what advocacy is. But we are trying to move things in the right direction to the extent that we can. Insight. Most attendees learn a lot from these meetings. There are good presentations and an abundance of technical and regulatory information and insights. As important for me, I have acquired a much better understanding of the tobacco industry and the nicotine market than I would get if I just read about it in Tobacco Control, listened to tobacco control’s so-called ‘experts’ or relied on internal documents that are 30-50 years old. I’ve done plenty of all of that and I still do, but I have gained a richer understanding by listening and speaking to those directly involved. To listen to someone, you don’t need to uncritically accept everything they say, but I have definitely gained insight from listening to them. I am also open to and welcome challenge and I’m prepared to have my own received wisdom shaken up. I will accept good arguments if I hear them, whoever makes them. What’s the alternative approach? For example, I was asked by a research scientist my opinion on whether it was ethical to use additives to make vapour products more ‘addictive’ if it meant they replaced cigarettes more effectively. To me, this is a challenging question. His view was that it was not. I’m still not sure what I think, but I’ve been made to think about it – and I’ve written on additives before in a different context.

Most attendees learn a lot from these meetings. There are good presentations and an abundance of technical and regulatory information and insights. As important for me, I have acquired a much better understanding of the tobacco industry and the nicotine market than I would get if I just read about it in Tobacco Control, listened to tobacco control’s so-called ‘experts’ or relied on internal documents that are 30-50 years old. I’ve done plenty of all of that and I still do, but I have gained a richer understanding by listening and speaking to those directly involved. To listen to someone, you don’t need to uncritically accept everything they say, but I have definitely gained insight from listening to them. I am also open to and welcome challenge and I’m prepared to have my own received wisdom shaken up. I will accept good arguments if I hear them, whoever makes them. What’s the alternative approach? For example, I was asked by a research scientist my opinion on whether it was ethical to use additives to make vapour products more ‘addictive’ if it meant they replaced cigarettes more effectively. To me, this is a challenging question. His view was that it was not. I’m still not sure what I think, but I’ve been made to think about it – and I’ve written on additives before in a different context. Interaction. Many different types of professional are present at these events – people from various parts of the industry, non-tobacco nicotine companies, policy analysts, investment analysts, analytical services companies and scientists, academics and some of the most pragmatic public health advocates. In my view, it is better to interact with and understand people than it is to construct an abstract and unrealistic model of who they are and what they think. Not all engagement is about finding agreement and common cause. It is often about understanding where you differ and the precise reasons why. In adversarial situations, it too easy to attribute motives or views to your adversaries that they don’t actually have. Tobacco control as a profession is notoriously insular, circulating in its own forums, journals and conferences. In many respects, it has become an exercise in groupthink, with a mass mindset and enforcement that suppresses dissent and inconvenient truths [see the treatment of Michael Siegel for example]. I can’t stress this enough – interaction with diverse perspectives is an antidote to groupthink, intellectual monoculture and polarisation to extreme, unworkable positions.

Many different types of professional are present at these events – people from various parts of the industry, non-tobacco nicotine companies, policy analysts, investment analysts, analytical services companies and scientists, academics and some of the most pragmatic public health advocates. In my view, it is better to interact with and understand people than it is to construct an abstract and unrealistic model of who they are and what they think. Not all engagement is about finding agreement and common cause. It is often about understanding where you differ and the precise reasons why. In adversarial situations, it too easy to attribute motives or views to your adversaries that they don’t actually have. Tobacco control as a profession is notoriously insular, circulating in its own forums, journals and conferences. In many respects, it has become an exercise in groupthink, with a mass mindset and enforcement that suppresses dissent and inconvenient truths [see the treatment of Michael Siegel for example]. I can’t stress this enough – interaction with diverse perspectives is an antidote to groupthink, intellectual monoculture and polarisation to extreme, unworkable positions. Damage limitation. Perversely, there a continuing need to encourage the tobacco companies not to take the gift that CTFK, WHO and other tobacco controllers are stupidly and recklessly offering them. It would be lazy and easy for the industry to embrace the tobacco control agenda of massively burdensome e-cigarette regulation or even prohibitions. Those will wipe out all their competitors, slow down the disruption of the tobacco market and protect the cigarette trade. All this, while shaping the residual e-cigarette market, if any, to exactly fit the default business model of large tobacco companies. (Nice work Matt!). One industry manager said to me recently: “you do know that we can just carry on making money from cigarettes if that’s what public health really wants.” I do know this – they will make money whatever happens. There is a range of arguments – consumer, market, economic, ethical, and legal – why they shouldn’t just brazen it out while tobacco controllers make sure the only market is that in cigarettes. The extent to which these arguments are accepted in the industry varies between companies and within companies – the arguments are still be won. While tobacco control advocates continue to press the opposite, misguided, case, these arguments will need constant reinforcement.

I’m not suggesting attendance at GTNF should be obligatory for everyone in tobacco control. Just that they should try harder to understand and respect the reasons of those of us who do go.

Money. One thing isn’t a reason to attend and that’s money. Though I am a freelance and time is therefore money, I do not ask for payment from the organisers for work and time put into these conferences in preparation or attendance, and they do not offer it. The conference organising company, the Tobacco Reporter journal, does offer to cover travel and accommodation for non-commercial speakers – a normal practice for conferences in most fields. I don’t think there is anything wrong with a conference covering speakers’ actual travel costs. Even so, I will probably cover costs from my own business and combine the trip with other work. I’ve had a similar approach to covering my own costs in the past, depending on the conference.

What does this say about tobacco control?

I can’t really express enough despair about these letters and the attitude that lies behind them. Not so much for the attempt at bullying, though that is deplorable, but for what it says about the state of so-called ‘tobacco control’.

This type of infantile McCarthyism is a sign of how intellectually stunted the tobacco control establishment has become, or always was, and it is not the only sign. If their mission was really about health and reducing tobacco-related diseases surely they would be relentlessly curious and self-challenging in order to find any edge that could help take the disease burden down a notch or two?

If you were trying to do everything you can to reduce tobacco-related disease and death:

Would you really just instinctively reject any new low-risk, consumer-orientated and disruptive technology and construct a wall of misinformation about it?

Would you be contemptuous and indifferent to any change in business strategy or any opportunities to shift the incentive structures of the main actors to cause less harm?

Would you really rely on documents that are 20-50 years old to understand how today’s industry responds to disruption by technologies that didn’t exist 10 years ago?

Would your instinctive approach to dissenting ideas be to use your comfortably secure and unaccountable position to shut them down and to intimidate the people who hold them?

Would you be dismissive of or uninterested in the experience of Sweden and how a tobacco product marketed by a tobacco company has produced the lowest rate of smoking in the developed world and with it the lowest rates of tobacco-related disease? Or is this ‘dirty knowledge’ you would simply exclude from your purist struggle?

Would you really think there are business insights that are not worth having and business actors not worth understanding, and that it is better you don’t test your understanding against reality?

Would you be afraid to have an argument with a tobacco industry executive and to change your mind if they are right? It might happen – you don’t know that until you’ve tried it.

Would you be so insecure in your own position that you would shy away from challenging a different view held by a tobacco company executive? They might change their mind if you are right – you don’t know that until you’ve tried it.

Would you just not be interested in how they see the future, what is in their labs, what they want from regulators, where you agree and disagree with them? Is it that you just wouldn’t want to know, or you think you already know but without speaking to them?

Would you be uninterested in the divisions between and within the companies you have defined as your adversaries? Or have you become complacent with the Manichaean certainty of declaring your enemies to be unidimensional manifestations of evil? Is that really how advocacy works? Not in my experience.

Would you rather believe that Big Tobacco is in terminal decline and somehow about to disappear? If so, you’re not paying attention. Here is BAT’s share price (up by +700%) vs the Dow Jones Industrial Average (in red up by +111%) over the period the FCTC has been in place.

What I’m trying to say is if you are in public health and you carry with wilful ignorance about the most significant economic actor in the market that is the source of the public health detriment, then you are doing something that isn’t public health. Rather, you are doing something amateurish, insular and ideologically motivated. If you aren’t willing to try every possible angle to realise the goal, you shouldn’t be in the job.

One further thought – perhaps the effort to ‘denormalise’ everything associated with tobacco and nicotine may have worked disproportionately on the very individuals pressing this strategy. The danger for them, is that their own self-generated disgust has cut them off from normal life and led them to lose all sense of perspective – see for example, Are they nuts? The dysfunction and decadence of tobacco control in one chart (by me) and more formally:

Kozlowski LT, Abrams DB. Obsolete tobacco control themes can be hazardous to public health: the need for updating views on absolute product risks and harm reduction. BMC Public Health 2016;16:432. doi:10.1186/s12889-016-3079-9

What the WHO FCTC says about this?

Various commentators in tobacco control think that going to this conference might violate an international convention. That’s ridiculous.

Here’s one:

From: Stan Shatenstein [mailto:[email protected]] Editor’s Note: A new issue of the e-cigarette industry magazine Vapor Voice (No. 4, 2016) is now online. It lists many of the speakers, from both the tobacco control community and the tobacco industry, notwithstanding any arguable violations of article 5.3 of the FCTC, who are set to appear next week (September 27-29) in Brussels at the GTNF (Global Tobacco & Nicotine Forum). The issue should be free to download but, if you have any difficulty, you may request a copy of the full issue. An extensive list of scheduled GTNF speakers also appears here.

Predictably, here’s another:

Putting aside the offensive rhetoric of this ignorant oaf, his substantive point refers to article 5.3 of the FCTC, which reads:

Article 5.3 of the WHO Framework Convention on Tobacco Control In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.

This treaty provision quite reasonably guards against policy capture by vested interests. It also requires respect for national law, which in most civilised jurisdictions requires governments to consult, understand the costs and benefits of its actions, and to try to take reality into account when designing policies. Taking reality into account can’t be done if you don’t understand it.

Article 5.3 applies to Parties to the FCTC (i.e. governments). International treaties only apply to governments and sometimes to other bodies that are empowered to sign them (e.g. UN agencies). They do not bind anyone else unless a government implements policies that apply to their citizens.

Article 5.3 does not require governments to abandon cherished principles like academic independence and impose restrictions on universities. It is very unlikely that governments in Europe, for example, would intervene to suspend academic freedom to impose restrictions on academics talking to anyone. To my knowledge, none have. The fact that tobacco control leaders think that curtailing the larger principle of academic freedom might actually be a good idea is telling – a sign of preferring in an echo chamber of authoritarian weirdness, rather than in a free society.

Article 5.3 provides no basis for barring academics, advocates, consumers or anyone outside government from talking to tobacco industry people or attending conferences. Nor does it require anyone to remain ignorant about one of the most important industries in the field of public health.

Even the non-binding Guidelines for Implementation of Article 5.3, which go far beyond the meaning of the article itself, provide guidance to the Parties and all recommendations are addressed to the Parties.

How will this end?

After a few glory years, it didn’t end well for McCarthy. If you are pursuing this kind of wilfully ignorant McCarthyism, it won’t end well for you either.



Eventually, people will see through the petty narrow-minded authoritarianism of today’s tobacco control establishment. Tobacco control will be radically scaled backed, its leaders put out to grass, and the current era spoken of in whisper as a period of shame and collective derangement.

Believe me, Matt, that is going to happen. For a glimpse of the future, think Wayne Wheeler and the Anti-Saloon League.

What should they be doing?

Two things…

1. Have a real debate. Instead of trying to delegitimise the people you disagree with, how about engaging in actual debate about the substantive issues… here’s a taste of what a debate may involve:

2. Think more broadly. Here is a little contextual reading.

Jonathan Powell, Talking to Terrorists – how to end armed conflicts. 2014 [Amazon UK US]

Across the world governments proclaim that they will never ‘negotiate with evil’. And yet they always have and always will.

I genuinely recommend this book for anyone with any interest in conflict. Powell was Tony Blair’s consigliere, and perhaps the major backroom player in the agreements that brought peace to Northern Ireland.

Boston Globe, Who ended the Cold War?, 2009 – about Reagan and Gorbachev:

Both leaders were products of a bitter, decades-long enmity stemming from the very core of their national identities, yet the two men looked beyond their expected roles in preserving the adversarial relationship between the two superpowers and their polarized ideologies and took giant steps toward peace and cooperation for the sake of their own people and the world

The point is not to compare smoking to the Cold War or anyone involved to giants like Gorbachev and Reagan. The point is about “looking beyond expected roles in preserving the adversarial relationship“. In our case, that would be for the sake of a major public health opportunity that a few tired old Cold Warriors in tobacco control would rather forego in order to retain the terms of conflict they are comfortable with.

On this subject