Change the Conversation (Part 2)

 

Are we ready to “roll up our sleeves and work together”?

Part 2

On February 18th I added “Change the Conversation (Part 1)” (CTC) to my blog. In the early morning on Saturday the 26th I discovered a message from someone on Twitter (I’m not saying their name to protect their privacy). They found the link to CTC because someone retweeted it. After checking out my Twitter account, they felt compelled to message me. They believe it’s not possible for all sides to get together and discuss the controversy over tobacco harm reduction because pro-vaping people are a bunch of rude trolls not willing to budge an inch or be willing to admit that vaping is dangerous. They felt that I must be one of those people based on my pro-vaping tweets. They looked at my blog quick and saw a bunch of hyperlinks, but didn’t see an actual list of what I was referring to. They assumed I’m biased and said so in their message. I asked if they read my CTC commentary and checked out the links. They said no, they weren’t going to waste their time and said I was probably working for a tobacco company.

I got angry. The response I started typing was not kind. I didn’t send it. Instead, I told them if watching loved ones die from smoking and then watching others - including myself - finally quit smoking thanks to vaping makes me biased, then yes I am biased. I went on to explain I don’t mean the CTC entry to be pro-vaping, that I’m concerned about how many people die from smoking and I think we could save more lives sooner if the pro/con people would stop fighting and try to work together. I asked them to please read my commentary on the subject.

They were surprised I’d admit to being biased but weren’t ready to agree to read my blog. They commented again on there’s no list at the end of what I used for links. They were sure that everything I used would be pro-vaping and that garbage is a waste of time. 

I put a lot of thought and time into writing that piece so once again I found myself angry. I sat and thought about this over a cup of coffee. How do any of us ever change the conversation if someone won’t listen to us (or read the words we wrote)? I started to doubt myself based on that person’s accusations. Did my personal beliefs motivate the writing of that piece and if yes, is that a bad thing? 

The answer is yes, my personal beliefs motivated me to write my commentary on CTC. And no, that’s not a bad thing. The reason it’s not a bad thing is because of WHY I wrote it. I wrote it because I’ve seen many people who in the past couldn’t quit smoking and thanks to tobacco harm reduction products, including vaping, they have finally quit. I wrote it because I want the needless deaths to stop. I wrote it because I care.

I started another reply to the person. Again, my anger and frustration got the better of me and luckily I paused and didn’t send it. I was going to tell them off. I’m tired. I’m tired of being judged. I’m tired of seeing people die. I’m tired of being thought of as evil. I’m tired, tired, tired. It shouldn’t be so hard to save lives. Why can’t this be easy? Is my head even in the right place to try to reply to this person?

My heart is heavy. My husband’s best friend, Jim Constenius, died last week. Dropped 

dead from a heart attack. He smoked from his teen years until the day he died. He’s only a year older than my husband. Another painful loss. Would this have happened at his age if he didn’t smoke? We’ll never know. Thanks to isolating because of COVID, my husband and I can’t go to the funeral. Our smiling Finnish friend is gone. We haven’t made the trip back to my husband’s childhood home for a couple of years, so it’s been a while since we’ve spent time with Jim and his family. Now, we’ll never get to.

It would be so easy to tell someone off. To give my sadness, anger, and frustration a release from my brain. It might even feel good for a little while until I get around to feeling like a jerk for being a dick. I want to do the wrong thing but am stuck on my mission to do the right thing and to always #BeKind. Reminding others to be kind is something I Tweet about daily.

Now lost in self-doubt and stuck on how to respond to the person I’ve been messaging back and forth with I had to decide what to do. If I wasn’t going to tell them off, the next option that I thought of was to just not reply to them anymore. I’m grinning because it crossed my mind that if I walk away, they’ve won. So here I am, preaching “Change the Conversation” and encouraging people to stop fighting and start talking while I’m thinking about winners and losers! ARGH, it is hard to drag myself out of fight mode! 

After a lot of deliberation in my head, I went back to what the person mentioned twice. There’s no list at the end of my blog of what I used to make my case for wanting people to CTC. Is that really a big deal? Well to the person I’m exchanging messages with it is, or it’s an excuse not to read my blog. There’s really only one way to find out. So, I messaged them back and asked them if I made a list of where my information came from and an indication of why I used it, would they read my blog.

I was thrilled when they said yes!

I went through my CTC commentary and made the list. I put it in a google doc and sent them the link this morning (it’s below if you want to see it). I’d been waiting hours for a response. While I waited I thought about what was on that list. There are several people and organizations I usually don’t agree with on that list. Yet, if I dig deep enough I can see where we do have common ground or the potential to find some. I have spent the last few days having private conversations with people who don’t share my views about tobacco harm reduction. Sometimes it takes a lot more effort to be kind and respectful, but I think it’s worth it.

The wait for the reply from this latest person has felt like days instead of hours. In the end, it wasn’t what I expected. I thought they'd tell me to go jump in a lake. Instead, they were surprised that my commentary on the need to CTC wasn’t more pro-vaping than it was. They didn’t know people had tried to reach some kind of understanding in the past. They still don’t think it will happen in the future and they don’t think if it did it would do any good. They were disappointed that I didn’t make a point of how dangerous vaping is and how it’s addicting kids. They think that all nicotine products should be illegal. They were surprised I'd use WHO, Cancer Society people, and the Truth Initiative as forms of information.

And then the strangest thing happened. They wanted to know why this is such a big deal to me and wanted to know more about how smoking has affected my life. They just opened to door for me to tell my story and have a more open conversation.

It’s a good thing I was sitting down when I read their message. 

—---------------------------------------------

Here’s the list;

Don't Forget the Smokers - 1998 Washington Post by C. Everett Koop (United States Surgeon General 1981 - 1989)

“We must not focus our efforts so narrowly on preventing tobacco use by youth that we 

send smokers the message that we have abandoned them -- that their addiction is their 

own fault and that we don't care about them.”

The Truth Initiative - Citing 2015 data from the World Health Organization (WHO)

“Every 6 seconds, someone in the world dies from a smoking-related disease”

Pan American Health Organization (PAHO) - 2019 Tobacco kills one person every 34 seconds in the Americas

“Tobacco use has a major impact on health, killing one person every 4 seconds globally, 

and one person every 34 seconds in the Americas. This accounts for a total of 8 million deaths worldwide each year, with almost 1 million in the Region. Over half of lung cancer cases are related to tobacco, as are almost half of the cases of chronic obstructive pulmonary disease (COPD).”

World Health Organization (WHO) - 2021 Tobacco

“Tobacco kills more than 8 million people each year. More than 7 million of those deaths 

are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke.”

Tobacco harm reduction: conceptual structure and nomenclature for analysis and research - 2002 Shiffman S, Gitchell JG, Warner KE, Slade J, Henningfield JE, Pinney JM. - Nicotine Tob Res.

“Decisions made about THR are likely to shape tobacco control policy for decades to 

come, with potentially profound implications for public health. Clarity in analysis and debate is essential if we are to make the right decisions on these weighty questions.”

The stigma system: How sociopolitical domination, scapegoating, and stigma shape public health - 2022 Friedman SR, Williams LD, Guarino H, Mateu-Gelabert P, Krawczyk N, Hamilton L, Walters SM, Ezell JM, Khan M, Di Iorio J, Yang LH, Earnshaw VA - J Community Psychol

“Stigma is a fundamental driver of adverse health outcomes. Although stigma is often 

studied at the individual level to focus on how stigma influences the mental and physical health of the stigmatized, considerable research has shown that stigma is multilevel and structural.”

Words Matter: Preferred Language for Talking About Addiction - 2021 National Institute on Drug Abuse (NIDA)

“Stigma is a discrimination against an identifiable group of people, a place, or a nation. 

Stigma about people with substance use disorders might include inaccurate or unfounded thoughts like: they are dangerous, incapable of managing treatment, or at fault for their condition.”

Depression Causes Vaping! - 2021 Professor Caitlyn Notley, E-Cigarette Summit UK

Epidemic discussed from 5:57-6:44 

Addiction Center - 2021 Addiction vs Dependence 

“The difference between addiction and dependence can be difficult to understand. Some 

organizations have different definitions, use the words interchangeably or even abandon both terms altogether. (Substance use disorder, or SUD, is a preferred term in the scientific community.) Because of this lack of consistency, some ground rules can help differentiate between the two terms.”

National Harm Reduction Coalition - 2020 Principles of Harm Reduction

“Harm reduction is a set of practical strategies and ideas aimed at reducing negative 

consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”

Tobacco Harm Reduction: Past History, Current Controversies and a Proposed Approach for the Future -2020 Hatsukami, D. K., & Carroll, D. M. - Preventive Medicine

“Tobacco harm reduction has been defined as minimizing harms and decreasing total 

mortality and morbidity, without completely eliminating tobacco and nicotine use”

Truth Initiative - 2021 Truth Initiative Statement on Harm Reduction

“There is a contentious and ongoing debate regarding what role the concept of “harm 

reduction” should play for smokers who have rejected FDA approved cessation methods, 

who find those alternatives unattractive, or simply wish to continue using nicotine”.

Who or what is the World Health Organization at war with? - 2016 Clive Bates - The Counterfactual - Section 3, The wrong war: the confusion of tobacco policy aims

“Possible goals for tobacco control. This is why we have to be precise about goals. Is the 

overarching goal to:...”

Electronic cigarettes: achieving a balanced perspective - 2012 Wagener TL, Siegel M, Borrelli B - Addiction

“...we hope that continued discussion about the promise and perils of e-cigarettes is 

based on a balanced view of the available science, rather than an ideology that opposes harm reduction without consideration of both sides of the issue, including potential public health benefits.”

Inside Health - 2019 Professor Marcus Munafo - Why vaping is dividing public health experts causing a polarised split

“…but to reach that middle ground that you mentioned, that balanced position does 

require healthy debate where we genuinely engage with the nuances around these arguments and accept the possibility that we might be wrong. And when you bring very strong feelings to those discussions, it can be difficult to move your position.”

How to feel AND think about nicotine and those who use it - 2018 Joe Gitchell - Global Forum on Nicotine 

…much of the discussion over goals and trade-offs rely on “deeply held values and 

feelings' ' that “dominate much of our thinking”.

It is Time to Act with Integrity and End the Internecine Warfare  Over E-Cigarettes - 2021 Clifford E. Douglas, J.D. - Commentary

“Throughout the 33 years that I have devoted to combating the epidemic of 

Smoking-related illness and death in the United States and globally, I have embodied the 

mainstream American tobacco control community. …1988 as the associate director of the National Coalition on Smoking or Health …I was for five years a member of the senior leadership of the American Cancer Society, where I served as the vice president for tobacco control and founded and directed the organization’s Center for Tobacco Control. …as well as Americans for Nonsmokers’ Rights and the Public Health Law Center, in addition to serving as a special counsel on tobacco issues in the U.S. House of Representatives, as a tobacco control policy advisor for the U.S. Assistant Secretary for Health and the U.S. Surgeon General in the Obama administration,”

New Evidence of Smoking Disparities Underlines That Tobacco Harm Reduction Is Social Justice - 2019 Sessi Kuwabara Blanchard - Filter Magazine

“Irrefutable evidence of the disproportionate impact of smoking harms on marginalized 

populations underlines that tobacco harm reduction is a social justice issue.”

Balancing Consideration of the Risks and Benefits of E-Cigarettes - 2021 Balfour DJK, Benowitz NL, Colby SM, Hatsukami DK, Lando HA, Leischow SJ, Lerman C, Mermelstein RJ, Niaura R, Perkins KA, Pomerleau OF, Rigotti NA, Swan GE, Warner KE, West R (15 past Presidents of the Society for Reasearch on Nicotine & Tobacco - Please see Acknowledgements and Conflicts of Interest sections) - American Journal of Public Health

“The use of nicotine-containing electronic- or e-cigarettes has divided the tobacco control 

community along a spectrum from fervent opponents to enthusiastic supporters.”

Balancing Risks and Benefits of E-Cigarettes in the Real World - 2022 Cohen JE, Krishnan-Sarin S, Eissenberg T, Gould TJ, Berman ML, Bhatnagar A, Barnett TE, Soule E, Popova L, Tan ASL, Blank MD, Ling PM, O’Connor R (13 Experts in Tobacco Control - Please see Acknowledgements and Conflicts of Interest sections) - American Journal of Public Health

“We challenge the public health and scientific community to move away from 

characterizing scientists as “opponents” or “supporters” of e-cigarettes for three primary reasons.”

Are We Seeing Early Signs of Common Ground in US Tobacco Control? - 2022 Alex Norcia - Filter Magazine

“Still, the letter is a relatively balanced response, and can be read as a rare olive branch 

in an ongoing exchange where common ground remains shaky at best.”

Protecting American Families: Comprehensive Approach to Nicotine and Tobacco - 2017 Scott Gottlieb, M.D., Commissioner of Food and Drug Administration (FDA) (No longer holding that position)

“To succeed, participants from all sectors in the ongoing harm reduction debate need to 

take a step back and work together to reach greater common ground.” “Reframing shared objectives around the need to rethink nicotine is a start.  It could help all of us achieve the one public health goal I know we all share, and that’s to save the lives of current and future cigarette smokers.”

How and why I changed my mind on e-cigarettes - 2015 Jim McManus 

“People of widely differing opinions and views spoke, and the audience was one of the 

most mixed I have seen at a scientific and policy event like this.”

Toward a comprehensive long term nicotine policy - 2005 Gray, N., Henningfield, J. E., Benowitz, N. L., Connolly, G. N., Dresler, C., Fagerstrom, K., Jarvis, M. J., Boyle, P. - Tobacco Control Vol. 14(3)

“Reaching consensus is important because a nicotine policy is integral to the target of 

reducing tobacco caused disease, and the contentious issues need to be resolved before the necessary political changes can be sought.”

The Strategic Dialogue on Tobacco Harm Reduction: a vision and blueprint for action in the US - 2016 Zeller, M., Hatsukami, D., & Strategic Dialogue on Tobacco Harm Reduction Group (Please see list of funders and participants) - Tobacco Control Vol. 18(4) 

“The harm reduction debate has at times been divisive. There has been no unifying set 

of principles or goals articulated to guide tobacco control efforts.” “This paper discusses recommendations from a strategic dialogue held with key, mostly US-based tobacco control researchers and policy makers to develop a strategic vision and blueprint for research, policy and communications to reduce the harm from tobacco for the US. Short-term and long-term objectives are described.”

Polarization Within the Field of Tobacco and Nicotine Science and its Potential Impact on Trainees - 2021 Dana Mowls Carroll, PhD, MPH, Rachel L Denlinger-Apte, PhD, MPH, Sarah S Dermody, PhD, Jessica L King, PhD, Melissa Mercincavage, PhD, Lauren R Pacek, PhD, Tracy T Smith, PhD, Hollie L Tripp, PhD, MPA, Cassidy M White, BA - Nicotine & Tobacco Research, Volume 23, Issue 1

“Divisive, dominant perspectives on e-cigarettes move the field of nicotine and tobacco 

science away from scientifically rigorous discourse on this important public health topic, which involves millions of lives at stake. If norms do not change, the polarized climate may pressure trainees to choose or inherit an allegiance towards an uncompromising, one-sided stance. That allegiance can then restrict career development, undermine the credibility of research, and hinder public health progress. There is an urgent need to act to avoid negatively affecting the next generation of nicotine and tobacco research scientists…we are calling for reflection among everyone in the field and particularly among those with influence and power.”

Michael Bloomberg loves data. Except when he doesn’t. - 2022 Marc Gunther

“The billionaire philanthropist who finances campaigns against vaping won’t listen to 

dissenting views”

Letter to Bloomberg: Tobacco control: the danger of doing more harm than good 2021 signed by 23 public health experts

Response Letter - 2021 signed by Kelly Henning, MD, Public Health Program Lead, 

Bloomberg Philanthropies 

Response from the experts - 2021 

(Note: as of Jan 2022) no Bloomberg/Bloomberg Philanthropies as not agreed to meet.

Jonathan Haidt - Social psychologist at NYU-Stern. I study moral and political psychology and business ethics

How to Think—Not Feel—about Tobacco Harm Reduction - 2019 Warner K - Nicotine & Tobacco Research, Volume 21, Issue 10

“The debate over tobacco harm reduction (THR) has divided the tobacco control 

community into two camps, one expressing serious reservations about THR whereas the other believes that reduced-risk products like e-cigarettes will disrupt the cigarette market. The often emotional debate would benefit from dispassionate data-based evaluation of evidence.”