Relative Risk Information

As you may know by now, I am a firm believer in ethics. Not ethics as a slogan or a decorative preface to policy documents, but ethics as a discipline, a set of principles that constrain power, demand honesty, and place the well-being and autonomy of individuals at the centre of decision-making. If public health is going to claim moral authority, it must be prepared to meet a high ethical standard. It cannot ask to be trusted while withholding material information. It cannot speak in absolutes when reality exists on a spectrum.

“Is Withholding Relative Risk Information Ethical?” is not just a provocative question. It is a foundational one.

Because at the heart of tobacco harm reduction lies a simple, almost mundane truth: adults make decisions every day based on comparisons. We choose between treatment options, between foods, between financial products, between routes home in traffic. Rarely are we choosing between “safe” and “dangerous.” We are choosing between more risk and less risk. Between worse and better. Between harmful and less harmful.

If those comparisons are distorted, obscured, or withheld, our choices are shaped not by knowledge, but by omission.

Public health messaging often emphasises that vaping is “not harmless.” That statement is true. It would be irresponsible to claim otherwise. Inhaling substances into the lungs carries risk. Nicotine is addictive. Long-term effects of newer products continue to be studied.

But cigarette smoking is not merely “not harmless.” It is extraordinarily lethal. Combustion, the act of burning tobacco and inhaling the resulting smoke, produces thousands of chemicals, dozens of known carcinogens, and is responsible for the overwhelming majority of tobacco-related disease and death. Lung cancer, COPD, cardiovascular disease, and stroke are not marginal risks. They are predictable outcomes of sustained smoking.

When alternative nicotine products are discussed without a clear comparison to that baseline, the public is left with a flattened risk landscape. In that flattened landscape, everything appears equally dangerous. Cigarettes, vapes, and nicotine pouches are all grouped under a generic banner of “harm.”

Ethically, this is not a neutral act.

In clinical medicine, informed consent requires context. A doctor does not say, “This surgery has risks,” and stop there. They explain the risks of the surgery relative to doing nothing. They compare the likelihood of harm from the intervention with the harm of the underlying condition. They quantify probabilities when possible. They distinguish common side effects from rare catastrophic ones.

Without that comparison, consent is not truly informed. It is procedural rather than meaningful.

Why should public health operate on a lower ethical standard?

When surveys in multiple countries show that large proportions of smokers believe vaping is as harmful as or more harmful than smoking, something has clearly gone wrong in communication. Those beliefs do not arise spontaneously. They are shaped by repeated exposure to messaging that stresses uncertainty and danger while rarely articulating magnitude. “Not safe” becomes “just as bad.” Cautionary framing becomes equivalent.

And this is where the contrast becomes uncomfortable.

Across disciplines, epidemiology, toxicology, behavioural science, and health economics, independent scientists routinely communicate in gradients. They speak in relative risks, absolute risks, confidence intervals, and comparative baselines. They publish hazard ratios. They model counterfactuals. They ask not only “Is there harm?” but “How much harm relative to what?”

An epidemiologist comparing two exposures does not simply state that both carry risk. They quantify the differential. A toxicologist examining aerosol emissions does not stop at identifying the presence of a chemical; they contextualise its concentration against combustible smoke. A behavioural scientist modelling substitution effects does not ask whether uptake exists in isolation; they examine whether switching displaces more harmful behaviour.

This is not advocacy. It is a method.

Independent researchers understand that context is the essence of scientific communication. Relative risk is not a political concession. It is a statistical reality. To remove it is to strip the analysis of meaning.

Indeed, many academics who operate outside institutional messaging constraints consistently emphasise proportion. They acknowledge uncertainty. They discuss limitations. They critique industry influence where it exists. But they also articulate gradients of harm when the data support them. Their ethical posture is grounded in transparency: show the comparison, explain the margin of error, and allow the audience to see the spectrum.

That is what scientific integrity looks like.

It is telling that in peer-reviewed literature, relative risk is unavoidable. Journals demand it. Reviewers insist on it. Findings are contextualised against baselines because, without that baseline, results are uninterpretable. Yet when the same topic moves from academic publication to public-facing messaging, nuance often collapses into a slogan.

The result is a widening gap between the way scientists speak to each other and the way institutions speak to the public.

Some argue that emphasising lower relative risk could encourage non-smokers, particularly young people, to experiment. That concern deserves serious engagement. Youth uptake matters. Prevention matters. No one serious about public health dismisses that.

But ethics cannot be built solely around hypothetical future uptake while ignoring the very real, ongoing harm of combustible cigarettes. Millions of adults already smoke. They are not hypothetical. Their risks are not theoretical. For them, the question is not whether nicotine is ideal. It is whether continuing to inhale burning tobacco is worse than switching to a non-combustible alternative.

If public health messaging fails to answer that question clearly, it is not neutral. It is defaulting to the status quo, and the status quo is combustion.

Withholding relative risk information may feel protective. It may feel strategically prudent. It may simplify communication in a media environment that prefers slogans to nuance.

But it carries consequences.

If smokers come to believe that switching offers little or no health advantage, many will simply continue smoking. Why endure the inconvenience, cost, or social friction of switching if the health payoff is negligible? In that case, silence functions as a behavioural nudge not toward abstinence, but toward the most dangerous option.

There is also a deeper institutional issue at stake: trust.

Public health authority depends on credibility. When people later discover through independent researchers, international health bodies, or personal networks, that risk differences were known but routinely downplayed, trust erodes. And once trust erodes, it does not confine itself neatly to one issue. It bleeds into others. Vaccine campaigns, infectious disease guidance, and environmental health messaging all rely on the assumption that officials communicate proportionately and transparently.

If the public perceives that information was curated to produce a desired behaviour rather than to convey the full picture, suspicion replaces confidence.

Transparency does not require cheerleading for any product. It does not require dismissing uncertainties. It does not require ignoring emerging evidence of harms. It simply requires acknowledging proportion.

It requires stating clearly that while no nicotine product is entirely safe, the method of delivery matters profoundly. Burning tobacco and inhaling smoke are not in the same risk category as using a non-combustible alternative. The difference is not cosmetic. It is mechanistic. Combustion generates toxins at levels that drive chronic disease. Removing combustion removes the primary engine of harm.

Pretending otherwise or allowing ambiguity to persist because clarity is politically inconvenient is not caution. It is a distortion by not telling the whole truth.

Public health often invokes the principle of autonomy. Adults, we are told, have the right to make their own choices, even risky ones, provided they are informed. Autonomy is framed as a cornerstone of modern health ethics.

But autonomy without access to comparative facts is hollow. If the information environment suppresses or softens meaningful gradients of harm, then choice becomes performative rather than real. People may technically be free to choose, but the framework within which they choose has been subtly engineered.

Some defenders of blunt messaging argue that the public cannot handle nuance. That simplified risk communication is necessary to avoid confusion. That once gradients are introduced, messaging becomes muddled, and uptake may increase.

Yet in nearly every other domain of life, we assume adults can understand trade-offs. We trust them with complex medication instructions. We explain relative survival rates for cancer treatments. We discuss percentages for cardiovascular risk reduction. We communicate probabilities about surgical complications.

To suggest that nicotine risk gradients are uniquely incomprehensible is less an evidence-based claim than a paternalistic instinct.

And paternalism, even when well-intentioned, carries ethical costs.

The ethical standard should be straightforward: communicate clearly, contextualise honestly, and trust adults with the full picture. If a safer alternative exists on a risk spectrum, that fact should not be whispered or buried in footnotes. It should be stated plainly, alongside caveats, uncertainties, and youth protections.

Independent scientists already model this approach. They publish comparative data. They debate interpretations openly. They correct errors publicly. They accept that risk exists on a continuum. Their ethical commitment is not to narrative control, but to evidentiary proportion.

The question is not whether vaping is harmless. It is whether omitting or minimising relative risk information aligns with the ethical principles public health claims to uphold: autonomy, beneficence, non-maleficence, and justice.

If reducing suffering is truly the goal, then accuracy, even when uncomfortable, must take precedence over optics. It must take precedence over institutional self-protection. It must take precedence over the fear that clarity might be misused.

Withholding comparative risk information may shield agencies from criticism. It may avoid messy headlines. It may preserve rhetorical simplicity.

But it does not shield smokers from the consequences of incomplete knowledge.

And if the consequence of incomplete knowledge is the continuation of the most lethal consumer product ever sold, then the ethical trade-off is not abstract. It is written in hospital admissions, in cancer registries, and in early deaths.

The moral question, then, is not whether public health should warn about risks. Of course it should.

The question is whether it dares to describe those risks proportionately as independent scientists routinely do, even when doing so complicates the narrative.

Because harm reduction is, at its core, an ethical commitment to gradients. It acknowledges that while perfection is ideal, improvement is meaningful. That while abstinence eliminates risk, substitution can drastically reduce it. That while no option may be harmless, some are undeniably less harmful.

If public health is serious about reducing suffering rather than preserving simplicity, then relative risk is not a peripheral detail.

It is the point.