Purity, Pragmatism, and Bias in Public Health
It’s interesting to see purity, pragmatism, and bias collide in public health, whether the subject is tobacco, nutrition, or obesity. One example came in news this week that Reynolds American Tobacco is pushing forward with new plans to develop products designed to help more people stop smoking.
Pinney Associates — a Bethesda consultancy that has been at the forefront of policies, regulations, and products to reduce the harm of smoking — inked an agreement with Reynolds “on products, regulations, and policies related to smoking cessation and harm minimization.”
This sort of public health pragmatism is creating apoplexy for some health advocates who insist that anything short of total abstinence from nicotine will lead to ruin. Somewhere in the mix is an understandable bias against Reynolds, a tobacco company with a legacy of deception. Such reactions led California health officials recently to declare that e-cigarettes are a public health threat.
The unfortunate result of all this conflict is deeply confused consumers.
In Roanoke Rapids, NC, a young woman barely 20 years old was talking with an older barista in a coffee shop on the day that Reynolds’ new initiative was announced. She wants to quit smoking, she said. The older woman advised her to stick with her cigarettes until she is good and ready to quit forever. “You wouldn’t want to get hooked on that gum. It’s nasty.”
Likewise, in the realm of nutrition and obesity, you can find some people urging food manufacturers and fast-food companies improve the health impact of their products. Others regard any such dialog with deep suspicion. Researchers who participate are occasionally and wrongly portrayed as untrustworthy.
Sometimes, the perfect is an enemy of the good.
Click here to read more about Reynolds’ drive into the smoking cessation business. Click here to read more about calling on the food and restaurant industry to improve the health impact of their businesses.
Purity Milk Plant, photograph © Brent Moore / flickr
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February 22, 2015 at 6:15 am, Joe Gitchell said:
Thanks, Ted, for outlining the issues so clearly.
Some further somewhat related reading for those interested:
https://nicotinepolicy.net/blogs/guest-blogs/33-jg/98-what-drives-anti-ecig-sentiments
In public health pragmatism – Joe
February 22, 2015 at 6:20 am, Ted said:
Thanks for the link, Joe.
February 22, 2015 at 9:29 am, Lizabeth said:
Excellent post! In all industries, expecting the Giants to walk away from all expectation of revenue generating opportunities is naive. If we want harmful policies changed we must enlist those who have profited from the policies in creating opportunities for change. It’s more important to kill the bad practice than it is to kill the ppl who originally supported it.
Really solid piece.
L
February 22, 2015 at 2:46 pm, Ted said:
Thanks, Lizabeth.
February 22, 2015 at 12:16 pm, Susan Burke March said:
Call me cynical, but it seems to me that Reynolds is moving toward Unregulated e-cigarettes and other nicotine delivery products as a way to encourage and maintain addiction since tobacco is (finally) more highly regulated. “As part of the agreement, Reynolds American’s Niconovum USA unit will partner with a Pinney affiliate to develop a new kind of nicotine gum and other nicotine-replacement products like electronic cigarettes. The Winston-Salem, North Carolina, company bought Niconovum, which makes nicotine gum, pouches and spray products, in 2009.”
February 22, 2015 at 2:49 pm, Ted said:
Susan your skepticism is perfectly reasonable. I do think, however, that California labeling e-cigarettes a public health threat is irresponsible.
February 22, 2015 at 7:58 pm, deirdre said:
I like this post, was planning on shared with my public health students, but I was perplexed by this ending ‘phrase’
Sometimes, the perfect is an enemy of the good..
What do you mean by this exactly?
February 23, 2015 at 3:46 am, Ted said:
Pursuing perfection can sometimes prevent progress toward improvement. For a detailed explanation, see: http://en.m.wikipedia.org/wiki/Perfect_is_the_enemy_of_good
February 23, 2015 at 9:46 am, David Sweanor said:
Having worked as a public health activist on tobacco/nicotine issues for over 30 years I think the absolutism of many in the field is a huge barrier to improving health. To engage with a company that claims it genuinely wants to reduce the risks of its products (and sees a competitive advantage in doing so) is risky. What if they are wrong? What if they are not sincere?
But the failure to engage almost certainly has greater risks. What if they are right? What if they are sincere? Should we seek to stymie measures that can save lives just so we can continue demonizing a company while protecting the lethal status quo?
A tremendous range of companies have transitioned away from products that were unreasonably dangerous. The list includes makers of automobiles, electrical goods, medical devices, pharmaceutical products, foodstuffs and industrial equipment.
There is a strong ethical argument that if a company claims, or even just feigns, an interest in reducing the risks of its products that those with expertise should make a sincere effort to facilitate the process. If the interest is genuine the public benefits. If it wasn’t we will all know soon enough, and the public benefits.
February 23, 2015 at 10:54 am, Ted said:
Beautifully expressed, David.
February 23, 2015 at 12:01 pm, Joe Gitchell said:
Dang, David Sweanor–I wish I could’ve said it that well!
And let me further add that we also have the “insurance” of a regulator in FDA–true, still learning, asserting, building, but there is now (and will be) an objective third party with the charge to protect the public health. Not a guarantee of success, but I’ll take that hedge!
February 23, 2015 at 1:40 pm, Deirdre said:
Ted, thanks for the clarification and link. Not sure how I’ve lived this long and never been exposed to the aphorism. Now my students and I have even more to discuss!