Smoke Art

Don’t Bother Me with Facts about Harm Reduction

Does harm reduction cause a short circuit in the American psyche? Over time, many examples have brought this phenomenon into the spotlight. The latest example in the headlines is news about adolescent use of conventional cigarettes and electronic cigarettes.

A new study from CDC shows a large reduction in the use of conventional burning cigarettes by adolescents since 2011 and an offsetting increase in the use of electronic cigarettes. Clearly, the best case would be for no adolescents to use any nicotine product. But that’s not where we are. About 24% of high school students use some form of tobacco products and that number has been pretty constant since 2011.

Electronic cigarettes are not safe for adolescents. They are, however, dramatically safer than burning cigarettes. In one analysis, nicotine and tobacco researchers estimated that burning cigarettes were 20 times more harmful than electronic cigarettes. Another recent study shows that burning cigarettes are more addictive than electronic cigarettes.

So why do headlines and public officials say nothing about reduced use of the most dangerous product (burning cigarettes) by high school students? In a situation that one might describe as a glass half empty or a glass half full, the dominant story is that we are scared half to death of that glass.

Scholars of nicotine and tobacco use in the UK describe this sort of reaction as “moral panic.” Such a description seems both apt and consistent with America’s Puritan history. Parallels are visible in HIV and obesity. Needle exchange programs were proven to be an effective tool for reducing HIV transmission, but moral and political objections slowed their adoption for years. People died as a result.

Likewise, people who need bariatric surgery for severe obesity are frequently discouraged from seeking this evidence-based treatment. They are told that “they shouldn’t have to resort to surgery.” Speaking at the annual Weight Management DPG Symposium, Nina Crowley of the Medical University of South Carolina remarked that some healthcare professionals will tell her that they “don’t believe in bariatric surgery.” She wondered aloud what they mean and quipped, “It’s not the Easter Bunny.”

Pseudo-moralistic judgments that impose real harms upon marginalized people have no place in health-related decision making.

Click here to read the CDC study and here to read coverage in the Washington Post.

Smoke Art, photograph © Olli Henze / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


4 Responses to “Don’t Bother Me with Facts about Harm Reduction”

  1. April 20, 2015 at 12:21 pm, Joe Gitchell said:

    Thanks, Ted–I can’t resist the self-promoting step of cross-referencing my earlier guest post here that I think has a lot of relevant info.

    • April 20, 2015 at 5:03 pm, Ted said:

      Joe, actually, your earlier post goes right to the point of what bugs me about disregarding and marginalizing people whose health is compromised — especially when the subject is public health. Sheesh!!!!

  2. April 20, 2015 at 3:48 pm, David Sweanor said:

    I think the tendency to make moralistic judgements about others, rather than pragmatically looking at how best to improve public health, is a field that cries out for study by cultural anthropologists. The tendency varies between countries, but seems particularly pronounced in the United States. Whether it is obesity, fitness level, nicotine use, alcohol consumption, sexual preferences, mental health, illicit drug use, incarceration policies or a myriad of other issues, a great many people encourage snap moralistic decisions about their fellow citizens even while deploring when others do the same to them.

    It might well be a cultural artifact related to beliefs about the perfectibility of man. An atavistic thing based on pre-Enlightenment world views untouched by scientific underpinnings of behavior and considerations about the limits and harms of shame as a means of social control. Perhaps, as Jessica Warner wrote in her book on why abstinence matters so much to many Americans, it can be traced back to biblical writings on the Rapture.

    Whatever the cause, the pursuit of absolutist policies based on moralism rather than pragmatic ones based on knowledge is exacting a huge toll of unnecessary suffering.

    Moralism has a long history of being practiced and an equally long one of having failed. The nice thing about pragmatism is that, well, it works.

    • April 20, 2015 at 5:04 pm, Ted said:

      Exactly right, David. I hope I’ll get a chance to meet you and maybe share a meal during the Canadian Obesity Summit.