This was brought on by a thread on X, the kind of thread that doesn’t just sit quietly in the background but circulates, is endorsed, reshared, and absorbed as if it reflects settled truth.
Unfortunately there is no universally accepted definition of what harm reduction actually is. Also, harm reduction is very strongly associated with particular values such as policy or practice based on evidence and protection of human rights, and an appreciation of incrementalism. When harm reduction is applied to psychoactive drugs, the objective is to uncouple harm from consumption and just focus on reducing harm. In the last half century in Australia, road crash deaths have been decreased by over 85% with harm reduction making a critical contribution including car seat belts, airbags, motorcycle helmets, safer car interiors, and larger and more brightly illuminated road signs. Car usage increased in this period with more cars on the road, more drivers and a greater number of passenger kilometres travelled. So road safety is an excellent example of the uncoupling of reducing harm from consumption. Unfortunately, in the last decade, opponents of tobacco harm reduction have uncoupled themselves from evidence. They have often made preposterous claims which contradict evidence. It’s true that some of these THR critics have been doctors but more often than not these were doctors who were not clinicians. Caring for real live human beings seems to have helped many clinicians appreciate that harm reduction almost always results in benefits far exceeding adverse effects.
Where I think the tension lies is that harm reduction in tobacco is still being treated, by some, as if it sits outside that same evidence framework. Instead of being evaluated on outcomes, it is often judged through a lens of idealised abstinence or perceived risk, rather than actual comparative harm. That’s where the conversation starts to drift away from evidence and into values, or sometimes into instinct.
I have passed trough several episodes of skin cancer, so I have been in close contact with a group of oncologists that I hold in high esteem and respect. I noticed that they were open minded about my vaping. Not that they opposed it or supported it, they were just willing to listen without being judgemental and understood explanations on harm reduction based on my research on emissions. However, they are open minded in private, would not express the same open mindedness in public because they know they would be against the mainstream and this could affect their work, which is treating patients, so they avoid controversy as much as possible. I suspect there are a lot of MDs who are open minded privately but will not manifest it publicly. I call them "closet Gorbachov's" and hope they will become assertive when conditions are favorable, just as Gorbachov remain silent during the 70's and early 80's, but by the late 80's he acted.
Unfortunately there is no universally accepted definition of what harm reduction actually is. Also, harm reduction is very strongly associated with particular values such as policy or practice based on evidence and protection of human rights, and an appreciation of incrementalism. When harm reduction is applied to psychoactive drugs, the objective is to uncouple harm from consumption and just focus on reducing harm. In the last half century in Australia, road crash deaths have been decreased by over 85% with harm reduction making a critical contribution including car seat belts, airbags, motorcycle helmets, safer car interiors, and larger and more brightly illuminated road signs. Car usage increased in this period with more cars on the road, more drivers and a greater number of passenger kilometres travelled. So road safety is an excellent example of the uncoupling of reducing harm from consumption. Unfortunately, in the last decade, opponents of tobacco harm reduction have uncoupled themselves from evidence. They have often made preposterous claims which contradict evidence. It’s true that some of these THR critics have been doctors but more often than not these were doctors who were not clinicians. Caring for real live human beings seems to have helped many clinicians appreciate that harm reduction almost always results in benefits far exceeding adverse effects.
Where I think the tension lies is that harm reduction in tobacco is still being treated, by some, as if it sits outside that same evidence framework. Instead of being evaluated on outcomes, it is often judged through a lens of idealised abstinence or perceived risk, rather than actual comparative harm. That’s where the conversation starts to drift away from evidence and into values, or sometimes into instinct.
I have passed trough several episodes of skin cancer, so I have been in close contact with a group of oncologists that I hold in high esteem and respect. I noticed that they were open minded about my vaping. Not that they opposed it or supported it, they were just willing to listen without being judgemental and understood explanations on harm reduction based on my research on emissions. However, they are open minded in private, would not express the same open mindedness in public because they know they would be against the mainstream and this could affect their work, which is treating patients, so they avoid controversy as much as possible. I suspect there are a lot of MDs who are open minded privately but will not manifest it publicly. I call them "closet Gorbachov's" and hope they will become assertive when conditions are favorable, just as Gorbachov remain silent during the 70's and early 80's, but by the late 80's he acted.