10.2. SR 09-08-2015 - Laserfiche WebLink

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14 through the mechanism of market-based competition. The real danger from tobacco companies arises from excessively burdensome regulation, eliminating competition from more agile or innovative competitors, leaving them with an oligopoly protected by regulatory barriers to entry, and endorsed paradoxically by health organisations. Unfortunately many public heath establishment organisations and individuals are doing their utmost to cause this to happen, though not always realising that protection of tobacco companies from competition will be the effect, if not their aim 52. 3.6 Disruptive technology also challenges public health E-cigarettes have empowered smokers to take control of their risks and have greatly enhanced the welfare of hundreds of thousands of UK citizens. It has challenged the tobacco industry, but it has also challenged interests in the public sector and civil society who have played no role – or a hostile role – in its rise. For many smokers and vapers, the hostility of the public health establishment to vaping or tobacco harm reduction is highly perplexing. Here are several possible explanations: • Not invented here: the products and harm reduction benefits have emerged through free play of producers and consumers in a lightly regulated market. No one in public health has given their approval or been asked for it, no public spending is required and public health organisations have no controlling influence. • Hostility to the private sector: culturally, the public health establishment is inclined to paternalism, and state-based or not-for-profit interventions. It instinctively distrusts the private sector and capitalism, and is ill at ease with the idea of consumers as empowered agents. • Countercultural: the toolkit of tobacco control is replete with coercive measures: restrictions penalties, (regressive) taxes, fear based campaigns, medicalisation of smoking and so on. Harm reduction approaches are non-judgemental, ‘meet people where they are’ and allow them to judge their own interests and preferences. • Undeclared motives: some in tobacco control have a ‘non-smokers’ rights’ orientation, rather than ‘population health’ orientation, and these have different implicit objectives. As with any issue that involves a recreational drug, there are prohibitionist instincts at work, there may be affronted authority figures (‘doctor knows best’) and those with concerns about bodily purity 53. • Conflicts of interest: public health academia, science, and advocacy is beset by ideological biases, prior positions to defend, funders’ interests to respect, charities’ declared policy positions, pharmaceutical funding, and highly prone to insularity and group-think. • Tobacco industry focus: many activists and academics have defined their fight as with the tobacco industry and assume what is harmful to them is beneficial to health. This leads to lazy and muddled thinking in the area of tobacco harm reduction. Not all individuals or organisations involved exhibit all or any or these characteristics, but they are drawn out here to emphasise that it is not safe to assume that anyone with a public health profession or remit to protect health is actually acting rationally in the interests of health. 52 See David Sweanor, Big Tobacco’s Little Helpers, The Counterfactual, 27 January 2015. [link] and Clive Bates, Turning the tables on public health: let’s talk about the risks they create, 3 July 2014 [link] 53 See for example discussion by Alderman J, Dollar KM, Kozlowski LT. Commentary: Understanding the origins of anger, contempt, and disgust in public health policy disputes: applying moral psychology to harm reduction debates. J Public Health Policy 2010; 31: 1–16. [link]