THR-rendez-vous 2, October 16, 2017
Michael Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He created his blog The rest of the story: Tobacco News Analysis and Commentary in 2005. I just reread his post for December22, 2005 that I found very applicable to the present period in the tobacco control movement including his quote of John Maynard Keynes: "Sir, when the facts change, I change my mind. What do you do?" . Without further ado here are his answers to our questionnaire. PS: this interview for WBUR, by Karen Weintraub, on January 24, 2018.
Q1. Some people (like Jean-Francois Etter I just interviewed) consider that e-cigarettes are a revolution in the tobacco control field, an unprecedented opportunity to save millions of lives by implementing their promotion as a harm reduction strategy. What do you think?
Michael Siegel: I agree. Electronic cigarettes represent a huge breakthrough in tobacco control because for the first time, we have a smoking cessation tool that doesn’t just treat the pharmacological addiction (i.e., nicotine addiction), but also addresses the psychological, physical, and social aspects of the smoking addiction. Almost all previous efforts to develop smoking cessation medications have focused on nicotine as the complete basis for addiction. While nicotine is certainly a huge component, almost every smoker will tell you that there are other aspects to the addiction, including the hand motions, the feeling of holding something, the throat hit, the oral sensation, the psychological aspects, and even the social aspects. By simulating the smoking experience, e-cigarettes can address these aspects of smoking addiction instead of just replacing nicotine, like traditional nicotine replacement therapy. This truly is a revolution and if its potential is properly harnessed, could be a game changer in the effort to reduce smoking-related disease and death.
Q2. Some advocates and public health organizations (like WHO?) are still very opposed or skeptical toward e-cigs, claim they represent many risks, are a new trick from the tobacco industry, are not worth considering nor helping to market. What is your opinion about those assessments?
Michael Siegel: They are wrong. This is clearly not a new trick from the tobacco industry because prior to 2011, the tobacco companies were not even involved in the e-cigarette industry. It is also not a trick because there is no deception. E-cigarettes truly are much safer than real cigarettes. So no one is deceiving anyone. In truth, the only ones deceiving the public are the anti-nicotine groups that are misleading the public into thinking that vaping is just as harmful as smoking. Now, it is true that vaping is not absolutely safe. There is still some chemical exposure. But there is no question that vaping is much safer than smoking. We know from national surveys that in the U.S., approximately 2 million former smokers have quit smoking using e-cigarettes. This is not a “trick.” It is a bona fide harm reduction strategy that is literally saving the lives of hundreds of thousands of people.
Q3. Do you think the harm reduction approach, including the promotion of e-cigs is presently promoted at the right level or not enough (if at all)?
Michael Siegel: Not enough. There is too much opposition in the tobacco control field to harm reduction as a tobacco control strategy. The movement has largely adopted an all-or-nothing, “abstinence-only” approach. Keep in mind that I’m talking mainly about U.S. organizations. In the UK, the situation is very different. There, public health advocates have largely supported electronic cigarettes, and as a result, e-cigarettes are actually part of the National Health Service approach to smoking cessation. No question that there is too little promotion of harm reduction for smokers in the United States.
Q4. How did/do you feel about Derek Yach's initiative to create a Foundation for a Smoke-Free World, that claims to promote a harm reduction strategy including e-cigs while being funded by Philip Morris International?
Michael Siegel: The problem is not with the initiative itself. Nor is it with Derek and his sincerity in this effort. The problem is that Philip Morris International is not sincere in its claimed desire to create a smoke-free world because PMI continues to aggressively market cigarettes internationally and to aggressively fight public health efforts to reduce tobacco use. If PMI were truly serious about its claimed desire to end smoking, it would stop lobbying against international tobacco control efforts. It would also halt all lawsuits against health agencies for efforts to reduce smoking. This in no way reflects my attitude towards the Foundation or the people working for it, nor does it reflect any doubt about the sincerity of the Foundation and its staff. It relates specifically to PMI and its sincerity in establishing a smoke-free world when it continues to aggressively lobby against public health efforts to reduce tobacco use.
Q5. You wrote that you had been contacted by this Foundation to be a consultant but you declined because of the way PMI still behave in its marketing of cigarettes that cause diseases and deaths for so many smokers. Can money from a tobacco company be used for a good cause or should it always be refused as completely tainted? How different is the money PMI will give to this Foundation different from the taxes they pay to the states or to judicial settlements or punitive damages awarded by the courts that seem to be widely accepted?
Michael Siegel: There is a difference between funding that a tobacco company voluntarily offers and funds that are court-mandated to be paid as punishment for a history of irresponsible behavior. The voluntary contributions that a tobacco company makes are actually a part of its marketing expenditures. Their primary purpose is to improve the corporate image and ultimately, to increase the bottom line. In contrast, court-mandated punitive damages are something that the industry fights vigorously against, and these damages are not part of the industry marketing portfolio. So I would not say that all funds that come from the tobacco industry are automatically “tainted” and therefore should not be accepted and used for public health efforts. But corporate philanthropy is a well-recognized part of corporate marketing and public relations. This is not just true of the tobacco industry, but pretty much all industries. I would reiterate that there could be a point in time when it becomes legitimate to accept tobacco industry funding for public health initiatives, but we are not there yet. First, the industry would have to discontinue its vigorous opposition to public health efforts to reduce smoking.
Q6. Have you ever met Derek Yach? What do you think of his record as a tobacco control advocate? Stan Glantz wrote that Derek's journey to the dark side is now complete and referred to your refusal to collaborate as exemplary. Derek claims the Foundation will be independent and he agreed to the deal because much more should be done to promote e-cigs and other less dangerous products that could save millions of lives. What do you think about Derek's claims? Do you see any chance for him to succeed?
Michael Siegel: As I noted above, this isn’t about Derek, his record in tobacco control, or what “side” he is on. Derek has been a long-time leader in the tobacco control movement and continues to play a very important role. This also isn’t about the “independence” of the Foundation or the validity of efforts to promote e-cigarettes which I agree could save many lives. This is about how the Foundation fits into the overall corporate marketing plans of PMI and whether the company is sincere in its stated desire to end smoking if at the same time that it funds the Foundation, it is also funding lawsuits against health agencies that promote tobacco control and lobbying against efforts to reduce the morbidity and mortality from smoking. So to be clear, Derek is not on “the dark side.” He continues to make very important efforts to promote a transition from combustible cigarettes to much less hazardous alternatives such as e-cigarettes. The problem is that PMI continues to aggressively fight tobacco control efforts throughout the world and therefore is not sincere in its stated desire to end smoking.
Q7. Is there anything else you would like to add?
Michael Siegel: Simply that I think there is a tendency in tobacco control to dichotomize everyone working in this space onto one “side” of the issue There is similarly a tendency towards increasing polarization on many issues. I don’t see it in such stark terms. I think one can be a tobacco control advocate and at the same time support harm reduction as a tobacco control strategy. And one can work for the Smoke-Free Foundation funded by PMI, yet still make a legitimate contribution to tobacco control. In our “Trumpian” society, we have a tendency to divide everyone into the “good guys” and the “bad guys.” It’s not that simple. There needs to be a place for a more balanced and nuanced position. That’s the role that I have tried to play in tobacco control for the past 12 years, ever since I initiated my tobacco policy blog – the Rest of the Story.
Thank you Michael for having taken the time to answer our questions.
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