Have you not reason then to bee ashamed, and to forbeare this filthie noveltie, so basely grounded, so foolishly received and so grossely mistaken in the right use thereof? In your abuse thereof sinning against God, harming your selves both in persons and goods, and raking also thereby the markes and notes of vanitie upon you: by the custome thereof making your selves to be wondered at by all forraine civil Nations, and by all strangers that come among you, to be scorned and contemned. A custome lothsome to the eye, hatefull to the Nose, harmefull to the braine, dangerous to the Lungs, and in the blacke stinking fume thereof, neerest resembling the horrible Stigian smoke of the pit that is bottomelesse.
James I, A counterblaste to Tobacco, 1604

Tobacco control campaigners have seen themselves as crusaders, their triple goal to end the death and disease caused by tobacco, to end nicotine addiction and to destroy the tobacco industry.
Deborah Arnott, 2012

James clearly had a way with words. Interestingly his approach also shows that very little has changed in over 400 years with respect to the arguments against smoking and smokers: you should be ashamed to be a smoker; you are stupid to be a smoker; you should be scorned and held in contempt by others; you are harming yourself; and you smell. The only thing missing from today’s repertoire is the alleged risk to others. Of course James I’s position was a personal attitude rather than a scientifically arrived at judgement. In this he has gained much support over the years.

Although his “Counterblaste” was delivered in 1604 James was by no means the first to take against tobacco. The first two recorded European smokers were Rodrigo de Jerez and Luis de Torres who sailed with Columbus in 1492. On returning to Spain de Jerez was jailed by the Inquisition for seven years. In 1588 Lima was the location for the first recorded restriction on tobacco usage, when Catholic priests were banned from taking snuff or from smoking before administering mass.

Over time smokers have been taxed (frequently, heavily, everywhere); maimed (Russia); permitted to smoke only once a day (Connecticut); and banned entirely (New Amsterdam in history, Bhutan today). With the exception of Bhutan, no generally recognised government currently prohibits the sale of tobacco products, with government’s generally preferring to warn against the use of tobacco (to varying degrees) but to enjoy also the benefits of taxing the consumption of tobacco.

The aims of tobacco control campaigners, who see themselves as “crusaders” are threefold:

  • To end the death and disease caused by tobacco
  • To end nicotine addiction
  • To destroy the tobacco industry

We should highlight immediately that these are not our interpretations of how tobacco control campaigners see themselves and their aims they are the words of the current head of ASH in the UK, Deborah Arnott writing in 2012.

Of these three objectives the last two are immediately questionable. As we have discussed, nicotine per se is not harmful and for many brings benefits. Addiction is moot and whether it should matter more broadly that someone seeks to use nicotine is questionable. Remember that ASH promotes the use of nicotine replacement therapy (NRT) and so cannot be “anti-nicotine” but is, quite clearly, anti-smoking and anti-smoker.

Seeking to “destroy” an industry which produces a product which is legal, very heavily regulated and very heavily taxed has to be brought into question by shareholders in any industry where any individual or group may choose to consider the product “controversial”. Moreover it seems scandalous that this should be the stated aim of an organisation which is funded in large part by taxpayers.

Returning to the first there is the issue of conflating “tobacco” with “cigarettes”, a common “oversight” made by tobacco controllers but rarely corrected. It has long been established that there is a continuum of risk in tobacco, with the highest risks being associated with combustion, i.e. with cigarettes.

There are other ways of using tobacco without combustion and have been for many centuries. Snuff was the predominant form of usage when tobacco was first introduced into mainland Europe, and snus is the dominant form of tobacco usage in Sweden and Norway. Sweden has the lowest rate of cigarette consumption and the lowest incidence of lung cancer in the EU. There is no evidence of any greater risk of mouth cancers or dental problems. Indeed one commentator has pointed out that, statistically, the risk of dying from smokeless tobacco use is about the same as the risk of dying in a car accident.

Chart 5: Lung cancer mortality, deaths per 100,000, males

Chart 6: Smoking prevalence (%)

Despite this snus remains banned in the EU, except for in Sweden and under the EU Tobacco Products Directive snus in Sweden now needs to carry a health warning that (translated) says “This tobacco product damages your health and is addictive”, i.e. the same warning as on cigarettes. The original ban on snus was orchestrated by ASH in the UK and WHO, who in June 1987 has called for “a pre-emptive ban” on snus and all forms of smokeless tobacco to prevent a new public health epidemic. Concerns were expressed regarding alleged carcinogenic impacts, dual use and the possible “gateway impact on children”. Despite the accumulating and very clear evidence of “harm reduction” over the years, the ban on snus in Europe remains firmly in place while the introduction of new warnings in Sweden demonstrates that there is no interest from tobacco control in offering a safer way of using tobacco apart from in the form of NRT supplied by the pharmaceutical industry. It appears that the desire to “destroy the tobacco industry” is held to be more important that to “end the death and disease from [cigarettes]”.

As “crusaders” for a cause, it appears that those seeking to control the use of tobacco by others are not averse to being “economical with the actualite”. The American Lung Association, for example, carries a list of “a few of the chemicals in tobacco smoke and other places they are found” including “Tar – material for paving roads”. The tar used for paving roads is short for “Tarmacadam”. “Tar” as it refers to tobacco is an acronym of “Tobacco Aerosol Residue” and is the weight of particles collected on a filter pad after smoking a defined number of cigarettes under precise puffing and atmospheric conditions and to a certain length, and with the amount of water and nicotine collected on the filter pad away from the weight. It is not used to surface roads, although it appears that this distinction has also been lost on the Center for Disease Control.

Figure 5: Just “no” [Source: CDC twitter feed, 27 July 2016]

Perhaps the most alarming recent example of how much the Tobacco Control movement is seen as a crusade we can consider the 1 June 2016 comments of Ms Elizabeth Hoff, a WHO representative. Speaking at a World No Tobacco Day event which “featured presentation of poems, essays, and cartoon drawing by youths and school children to reflect the harmful effect of tobacco consumption” she urged “health authorities at all levels to collaborate with WHO and implement the ‘plain packaging approach’”. She “stressed the urgency for controlling tobacco and shisha consumption among the population – especially among youths, women and teenage school children”. The event was held in Syria.

It’s not about you, it’s about me