Harm Reduction & Principles of Public Health

[Vocalek]

We are seeing tobacco control policies emerge that specifically reject the concept of harm reduction. Example from California:

TEROC’s vision of a tobacco-free California does not support the harm reduction strategy and believes that promoting these products as an alternative to maintain an addiction will not reduce risk.

Today I researched "public health" and found this:
Published by the Public Health Leadership Society

Principles of the Ethical Practice of Public Health

1. Public health should address principally the fundamental causes of disease and requirements for health, aiming to prevent adverse health outcomes.
2. Public health should achieve community health in a way that respects the rights of individuals in the community.
3. Public health policies, programs, and priorities should be developed and evaluated through processes that ensure an opportunity for input from community members.
4. Public health should advocate and work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all.
5. Public health should seek the information needed to implement effective policies and programs that protect and promote health.
6. Public health institutions should provide communities with the information they have that is needed for decisions on policies or programs and should obtain the community’s consent for their implementation.
7. Public health institutions should act in a timely manner on the information they have within the resources and the mandate given to them by the public.
8. Public health programs and policies should incorporate a variety of approaches that anticipate and respect diverse values, beliefs, and cultures in the community.
9. Public health programs and policies should be implemented in a manner that most enhances the physical and social environment.
10. Public health institutions should protect the confidentiality of information that can bring harm to an individual or community if made public. Exceptions must be justified on the basis of the
high likelihood of significant harm to the individual or others.
11. Public health institutions should ensure the professional competence of their employees.
12. Public health institutions and their employees should engage in collaborations and affiliations in ways that build the public’s trust and the institution’s effectiveness.

http://www.apha.org/NR/rdonlyres/1CED3CEA-287E-4185-9CBD-BD405FC60856/0/ethicsbrochure.pdf

It doesn't look to me as if the "I don't believe in harm reduction" attitude is in keeping with the principles of public health.

 

[lordmage]

moved out of general E-cig talk. good write up

 

[dperino]

vocalek, thanks so much for your post. here's my take. as one who's been in human services for an ungodly number of years, teroc's non-concept of harm reduction doesn't jibe with prevailing views. in fact, what they are arguing for isn't harm reduction at all. their nannified position actually can do more harm. just like the argument posed concerning pv's, where banishing them forces many users to return to analogs. teroc's position takes away the opportunity to "step-down", from one substance to another. in the world of addiction that would mean something to effect of using pot instead of ....... there will be those who buy in to their tripe, and where tobacco products are concerned there won't be much sympathy extended our way. but, taking all things into consideration, their concept would almost be laughable if there wasn't so much ignorance concerning the pv user's dilemma.

 

[Vince1]

So it would seem that these people are just the usual "anti-smoker" hate group hiding behind the guise of "harm reduction" and care nothing for harm reduction but have the "quit or die" attitude.

I am beginning to feel like this has never been about the public health at all, but just some biased hate toward smokers in general.

 

[Michelle M]

I am beginning to feel like this has never been about the public health at all, but just some biased hate toward smokers in general.

You nailed it right there.

The whole thing is not unlike the teen sex thing of recent years.

Many argued against sex education and availability of contraceptives for teens. To them, the only acceptable course was abstinence.

Forget the harm reduction accomplished by offering education.

There is no middle ground for these rabid people.

 

[TropicalBob]

I believe it was Sherid who said that the whole anti-smoking movement has become anti-smoker. We can all see it happening.

I'm a long-time believer in the harm reduction principles and they are indeed being rejected by those who govern. Harm reduction was argued in speeches to both the House and Senate before the vote on the Family Smoking bill not long ago. Harm reduction amendments were overwhelmingly voted down. The philosophy is not prevailing among those who make law.

It gets lip service in the bill by asking the FDA to evaluate "reduced risk" tobacco products for market approval. Every concerned group -- snus, cigars, etc -- feels the committee doing the evaluation will REJECT virtually every product as merely continuing an undesirable addiction.

So much for "harm reduction." Quit (using ineffective, expensive Big Pharma NRT products) or die. That really is the official position. But unhappy at the rate of smoking's decline, the new tactic is to price smokes out of reach of any but the richest among us. That paper contained a request for another $1.50 a pack cigarette tax increase.

Our fight should not be for e-cigs. It should be for all harm reduction products. Standing alone, waving unapproved Chinese metal tubes containing a liquid nicotine solution, will not result in victory. We need education on harm reduction, that it is in the best interests of all, that it will save lives and expenses, and that e-cigs are part of a healthier addiction that really isn't a problem at all.

 

[Vince1]

It will definitely be interesting to see just how this plays out over the next 5 years. It really is a quite complicated situation when you figure in the governments position, big tobacco, Pharma, state taxes, FDA, cancer society, ASH and the Anti's and harm reduction thrown in.

Interesting indeed.

 

[Stubby]

Our fight should not be for e-cigs. It should be for all harm reduction products. Standing alone, waving unapproved Chinese metal tubes containing a liquid nicotine solution, will not result in victory. We need education on harm reduction, that it is in the best interests of all, that it will save lives and expenses, and that e-cigs are part of a healthier addiction that really isn't a problem at all.

Thank you TB. You have stated what I have tried to argue in the past, but largely on deaf ears. E-cigs are part of a family of reduced harm products which include Swedish style snus, dissolvables, and nasal snuff. Unfortunately for those on this forum, e-cigs may be the hardest to defend. It's way to easy for the "quit or die" thugs to shoot it down with a "show me the studies," or even rudimentary testing argument. It may not be the best place to draw the line in the sand and make a stand. With the lack of science backing it up it's certainly not the best place to try and educate the public on reduced harm.

With decades of study behind it and Swedish Match now conducting Phase III clinical trials I still have hope that snus will be a harder target for the antis. I can only hope that some amount of reason and sanity prevails. If not my chances of starting smoking again are almost certainly assured.

 

[Vocalek]

Our fight should not be for e-cigs. It should be for all harm reduction products. Standing alone, waving unapproved Chinese metal tubes containing a liquid nicotine solution, will not result in victory. We need education on harm reduction, that it is in the best interests of all, that it will save lives and expenses, and that e-cigs are part of a healthier addiction that really isn't a problem at all.

I absolutely agree. My friends, if you aren't for this concept simply on moral & ethical grounds, then be for this concept on the grounds of self-preservation. It may come to a point where the only reduced harm product we can get our hands on would be smokeless tobacco.

 

[PlanetScribbles]

Our fight should not be for e-cigs. It should be for all harm reduction products. Standing alone, waving unapproved Chinese metal tubes containing a liquid nicotine solution, will not result in victory. We need education on harm reduction, that it is in the best interests of all, that it will save lives and expenses, and that e-cigs are part of a healthier addiction that really isn't a problem at all.

Education does not help when the audience is intentionally deaf to all logical debate. If it wasn't so insane it would be laughable.

 

[JLeigh]

As someone said above, it's not "anti-smoking", it's "anti-smoker". As a WI analog smoker (at the moment), I have spent hours and hours and hours contacting my legislators (among other things) and they simply.don't.care. They aren't interested in what smokers (and now vapers) have to say. It has become popular to target smokers, period.This has nothing to do with our health. It has to do with money, and that's really the bottom line. Big Tobacco can't stand e-cigs because it cuts into their profit, drug companies can't stand e-cigs because it cuts into their profit, and the powers-that-be can't stand e-cigs because it cuts into their tobacco tax revenue. They all support either outright banning or draconion regulations and taxes on e-cigs, and the FDA, who doesn't really give a tinker's damn about our health, is trying to do whatever is necessary to see that this happens. Our only hope is to fight.

I don't mean to sound pessimistic, but the fact that this is all about money is a reality, and I wish more people (I don't mean the members here, I mean the general public) understood this. You (general you) can't fix the problem if you can't even diagnose it.

 

[dragonpuff]

Education does not help when the audience is intentionally deaf to all logical debate. If it wasn't so insane it would be laughable.

Depends on who we're educating. Sure, if we keep trying to convince ASH and the FDA of our point of view, it will fall on deaf ears. However, if we focus our effort on rallying those who are sympathetic to our cause and educating current smokers, we stand a much better chance.

Smokers make up approximately 20% of the U.S. population-- that's 60 million people. If even most of them were on our side, our numbers will speak even louder than our words.

IMHO, that's who we need to focus on educating.