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In his recent article, “Co-optation of harm reduction by Big Tobacco,” Timothy Dewhirst opens with a correct and critical message: “Harm reduction is a respected public health strategy for managing addictive behaviours that pose severe health risks.” Yet, his further treatment of the topic aims to delegitimize the most vital harm reduction project of our generation—namely, the development and adoption of tobacco harm reduction products.
Dewhirst appears unsettled by the fact that multinational tobacco companies are joining the harm reduction revolution via investment in tools like e-cigarettes and heat-not-burn products. Given the track record of this sector, his leeriness is certainly understandable; and Dewhirst is correct to characterize such companies as profit-driven. Where Dewhirst goes astray is in his inability to identify ways in which profit-seeking can align with the public good.
Many “dirty” industries are actively shifting their actions to correct negative health, environmental, and social impacts. Through research and disruptive technologies, they are ushering in: the decline of the internal combustion engine; increased sales of foods with less salt, sugar and saturated fats; the emergence of a sustainable energy companies; and more. In each of these instances, companies are taking strides that simultaneously reduce harms and ensure revenue. No one is claiming that these actions reflect altruism in its purest form. Rather, they exemplify industry response to consumers and investors who express their values through their dollars.
When industries profit from doing the right thing, their choices necessarily appear less than magnanimous. Yet, profit itself doesn’t negate the public benefits of such actions. The new generation of tobacco harm reduction products (HRPs) has the potential to save millions of lives and finally end the use of toxic combustible cigarettes. This promise exists not in spite of industry involvement, but because of it. This dirty legacy industry now has a vested interest in the success of HRPs and, by proxy, in helping consumers replace their deadly cigarettes.
Here, I should address Dewhirst’s invocation of the Foundation for a Smoke-Free World (FSFW), of which I am president. Attempting to dismiss the good work of FSFW, Dewhirst notes that its independence “has been questioned.” Yes, it has been questioned, and we have answered: FSFW is a nonprofit organization that acts with the utmost transparency and complete independence from Philip Morris International. Questions notwithstanding, there is no evidence to suggest we have acted in ways contrary the independence outlined in our bylaws.
Indeed, through FSFW’s Tobacco Transformation Index, the behavior of tobacco companies is being critically evaluated, including actions that either support or impede tobacco harm reduction. In doing so, the Index provides objective, transparent information to all stakeholders and incentivizes companies to act more quickly and responsibly than they otherwise would. In short, this tool serves to catalyze the alignment of corporate action and public good, described above.
Finally, Dewhirst states that FSFW aims to get “existing users of cigarettes and combustible tobacco to switch to innovative non-combustible products that are positioned as harm reduced.” Though we are not a consumer-facing organization, we certainly do not dispute that our organization hopes smokers will make such a switch if they cannot quit entirely. And the accompanying reduction of risk is more than a matter of positioning—it is a fact.
While Dewhirst worries that Big Tobacco will “co-opt,” the harm reduction movement, he simultaneously co-opts such efforts in service of his own ideological agenda. By recasting the entirety of harm reduction as greedy act by Big Tobacco, Dewhirst risks conveying the message that combustible cigarettes and HRPs are equally tainted, equally dangerous. And that is a risk we cannot take.
I would have preferred to publish this response in Tobacco Control, in order to stimulate needed debate. However, the journal bans submissions from authors funded in any way by the tobacco industry. This policy severely limits debate at a time when we should welcome all with solutions to be at the table. A recent publication examining better models for smoking and its impacts is a welcome example of how collaborative research—involving tobacco industry and leading academic researchers—can lead to new and needed insights.
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