I am a lawyer and public health advocate, and have worked reasonably successfully at reducing global cigarette smoking since 1983. My work on tobacco/nicotine has included a wide range of measures within the four broad categories of interventions used to reduce any cause of death, injury or disease – reducing uptake of a dangerous course of action, facilitating cessation by those engaging in it, protecting third parties from harm and reducing risks for those who continue to engage in the activity. I see these four areas of intervention as I see the four suits in a deck of cards in a poker game. A good player uses all four suits, and anyone who refuses to intelligently play ‘risk reduction’ cards in an effort to maximally reduce disease is like a poker player refusing to ever play diamonds. To the extent I focus a great deal on harm reduction in recent years it is because I see it as essential in efforts to effectively reduce the devastation of cigarettes. Harm reduction can garner big health advantages on its own, while also delivering synergistic results when used alongside the other areas of health interventions. If someone were playing poker with the lives of a great many people on the line, and refused to play diamonds, I would also speak out about the importance of playing diamonds.
David T. Sweanor J.D.
Adjunct Professor, Faculty of Law, University of Ottawa
Centre for Health Law, Policy & Ethics, University of Ottawa
Honorary (Consultant) Assistant Professor, University of Nottingham
Legal Counsel, Non-Smokers’ Rights Association and Smoking and Health Action Foundation, 1983-2005
- Invited commentary. Smoking, vaping and public health: Time to be creative, Canadian Journal of Public Health, published March 2016. Responding to this negative commentary.
“There is another way than a total ban on vaping. We can have nuanced rather than absolutist policies. We can have policies that normalize smoking cessation and fit within an overall framework of promoting health and dealing with social inequities.”
- Harm reduction over morals to reduce smoking deaths, CMAJ, December 2015.
“We’re just telling people ‘Thou Shalt Not’ and it doesn’t make any public health sense. We could virtually eliminate the risk by getting rid of the smoke”
- Big tobacco, E-cigarettes, and a road to the smoking endgame. International Journal of Drug Policy, December 2015 – with J. Robert Branston. View at IJDP site (abstract)
“A proper tobacco diversification and exit strategy for the shareholders of the profit-seeking tobacco industry would protect the public health by addressing the current addiction to the continuation of the cigarette market. The increasing popularity of e-cigarettes presents a particular opportunity in this regard, and we therefore suggest a possible policy response in order to start discussion in this area“
- E-cigarettes, nicotine and public health. C3 seminar, October 2015.
” . . . we know that it is the smoke in cigarettes, not nicotine, that causes the health carnage, and we need policies that reflect this in order to deal with the epidemic of smoking caused disease”
- How public health moralists are promoting harm from tobacco and helping the tobacco industry former BMJ editor blogs about David Sweanor’s presentation to C3, October 2015.
” . . . those who instinctively react against e-cigarettes on moral grounds are making a bad mistake. We all, he says, have the fast form of thinking that is often morally driven, but when it comes to ways of reducing harm from tobacco we need the slow thinking that is logical, scientific, and harder work. He made his case convincingly at a C3 Breakfast Seminar this week.”
- Differential Taxes for Differential Risks — Toward Reduced Harm from Nicotine-Yielding Products NEJM, August 2015 – with Frank Chaloupka and Ken Warner [access via tobacconomics].
“The current approach of imposing taxes on ENDS or raising taxes on cigarettes and other combustible products by the same amount as taxes on snus and other smokeless products has the opposite effect: it discourages tobacco users from switching to reduced-risk products, encourages dual use, and increases the likelihood that young people who initiate nicotine use will start with the most dangerous products.”
- Big Tobacco’s Little Helpers – on how public health hostility to harm reduction plays into the hands of Big Tobacco. Counterfactual, January 2015.
“There is a very long history of alternative products that appear to have the potential to challenge the market dominance of cigarettes by allowing consumers far less hazardous ways to get nicotine. In each case the threat has been seen off, leaving the tobacco companies free to continue their exceedingly lucrative and depressingly deadly oligopoly with its near-monopoly over the delivery of a very widely used dependence-producing drug.”
- Disruptive technology: a blessing and a curse. Rulebreaker Research, 2014.
“Can the rise of the e-cigarette, as a class of products that is still in the early phase of innovation and improvement, do what the refrigerator did for stomach cancer – by making the cigarette and perhaps all forms of combusting of tobacco obsolete?”
- Looking for the next breakthrough in tobacco control and health (PDF). South African Medical Journal, 2013 – with Derek Yach.
“One of the most striking realities about tobacco control activities over the past two decades is that they fail to address the product itself. Instead, measures to date have focused on such things as where cigarettes can be sold, to whom, the price, where they can be used, what warnings must be displayed, and disclosure of toxic constituents. This oversight is rather extraordinary since we have known for decades that ‘smokers smoke for the nicotine but die from the smoke”
- Effective beats dramatic: A commentary on Australia’s plain packaging of cigarettes. Drug and Alcohol Review [link], 2011.
“Fighting for politically and legally difficult measures like plain packaging without having in place a comprehensive public health agenda that includes consumer acceptable nicotine risk reduction strategies puts us in the unenviable position of being our own worst enemy.”
- Limits of Tobacco Regulation (or how our ideology limits our ability to reduce smoking). William Mitchell Law Review, 2008.
“The second broad category of limits on regulation is, paradoxically, effectively self-imposed by the culture of the tobacco control movement. Canada has done much to reduce smoking onset, encourage cessation, and protect non-smokers. Now, the country is running up against the limits of tobacco regulation caused by the attitude of the now-entrenched anti-tobacco community to regulation.”
- The basis of a comprehensive regulatory policy for reduced harm tobacco products. Journal of Health Care Law & Policy, 2008 – with Rachel Grunberger.
” . . if the goal is reduction of death, injury and disease, product regulation must be narrowly focused on reduction of harm. Regulators should replace the abstinence-only paradigm with a pragmatic science-based public health approach that includes risk reduction strategies for continuing users.”
- It’s smoking that kills – discusses hostility towards introduction of a snus product to Canada. Ottawa Citizen, 2008.
“Rather than attacking Imperial Tobacco for introducing a much less toxic alternative to cigarettes maybe we should welcome the opportunity to discuss a rational, health-based regulatory approach for the full range of nicotine delivery products. If in the end there is a better recognition of the limitations of a “just say no” approach to tobacco and nicotine, so much the better.”
- Tobacco harm reduction: How rational public policy could transform a pandemic, International Journal of Drug Policy, 2007 – with Phil Alcabes and Ernie Drucker.
“Applying harm reduction principles to public health policies on tobacco/nicotine is more than simply a rational and humane policy. It is more than a pragmatic response to a market that is, anyway, already in the process of undergoing significant changes. It has the potential to lead to one of the greatest public health breakthroughs in human history by fundamentally changing the forecast of a billion cigarette-caused deaths this century.”
- Legal strategies to reduce tobacco-caused disease. Respirology, 2003.
“All forms of nicotine delivery could be placed on a spectrum of risk with the least hazardous products given the greatest advantages.”
- Is the nicotine or the tobacco? Bulletin of the World Health Organisation, 2000.
“Once other choices are available to consumers, existing tobacco products can more effectively be subjected to greater product regulation and market-place disadvantages”
- The Emerging Market for Long-term Nicotine Maintenance, [PDF image copy] JAMA, 1997 with Ken Warner and John Slade.
“A nicotine-maintenance market will emerge from the present ferment in device innovation. Its precise characteristics remain to be established. We urge the health community, and the broader public as well, to engage in thoughtful research and discussion on the nature of this market and on the characteristics it ought to have. The stakes are extraordinarily high.”
Video and radio
On Ottawa Morning: No Vaping – March 2016
Chatting with Dave and Keith on VTTV – February 2016
Disruptive Technologies: Vaping and Ride-Sharing- January 2016
Dragon Slayers – Powering the public health war on vaping – Regulator Watch – January 2016
Related article: Public health war on vaping: Dragon slayers