Thread by @samrat

Okay, here goes, in well-meaning spirit. First, few tweets on who is this army of THR proponents? Some are scientists, but the most vocal are ex-smokers from various walks of life who've greatly benefited from switching and now want others to have the same opportunities. (1/20)

https://twitter.com/RijoMJohn/status/1499273205592125446

Yet, coz they oppose tobacco control (TC) ideas, they are cast as tobacco shills, since why would anyone rally for nicotine products if they weren't from tobacco cos, right? Wrong. Tob users don't share same visceral hatred for tobacco cos as TC for whom this is a moral fight. /2

Tobacco consumers want safer products at affordable prices, just like for any product users, with the pragmatic understanding that it's tobacco cos who can make them cheap and available widely. If the govt wants to make them, or anyone else, sure, that's good! /3

Tobacco cos have long used front groups so it's natural for TC to bracket the current lot in same corner, but these are different – it's an organic, worldwide, well-informed grassroots movement of ex-smokers demanding safer options to a deadly product that kills 8mn/yr. /4

Coming to harm reduction as a TC strategy. HR is a well-established concept in many fields, especially drugs control, where HR principles are enshrined at the UN level, and include methadone replacement, needle exchange, safe use centres etc. /5

undp.org/press-releases…

It's moving beyond the punitive approach that you advocate (higher taxes, etc) to a human rights approach which is humane, puts people at the centre of policymaking, respects their agency, and is also pragmatic. Has shown great results, drugs HR did what drugs war couldn't. /6

Then there is the blatant TC dichotomy. While on one hand you say tobacco use is a deadly addiction, on the other you refuse to include it within the addiction framework and expect users will simply quit due to higher prices and policy restrictions. Pick a side, maybe? /7

Yes, we need pharmacological support and counselling, but how realistic is that to provide to 28 crore Indians? NRTs are not even subsidised, forget proper in-person counselling (quitlines are a sham). So while you say 'deadly addiction' what meaningful help are we providing? /8

One real option users have is to proactively reduce harm, and that also you are in favour of denying them. The goal of TC was to reduce tobacco deaths/disease, not a moral crusade against nicotine use itself. And that too a silly my nicotine (NRT), your nicotine (vaping) war. /9

Ofcourse delivery mechanism is key. Same nicotine is also in NRTs. Combustion is the problem – even with Indian SLT being among deadliest in world: 200mn users = 350k deaths/yr, while 120mn smokers = 1mn deaths! Nic is also not a carcinogen (IARC). /10

https://twitter.com/RijoMJohn/status/1499272443055067137?s=20&t=MYvnXZMa5-iys2vnMF3wdQ

Not saying we need no controls, just that let's not lose sight of the goal – to reduce mortality/ morbidity. What kind of controls? Risk-proportionate measures that incentivise moving current users down the harm spectrum. Vaping for smokers, snus/nic pouches for SLT users. /11

If every smoker switched to vaping will population harm not go down? And if every khaini/gutka user switched to snus/nic pouches? There can never be a justifiable excuse against lower-risk substitutes, more so when deadlier ones are killing millions. /12

https://twitter.com/RijoMJohn/status/1499272447014490112?s=20&t=MYvnXZMa5-iys2vnMF3wdQ

Secondly, its infinitely easier & quicker to get users to switch to a less deadly substitute than to get them to quit altogether. So, while 'gradual' progress through policy restrictions is welcome, we also need a more practical/immediate path of allowing them to transition. /13

On new users: it's not that no one is smoking their first cig/bidi as I write this, and most in TC ignore 'common liability' – that teens who vape are also as likely to smoke. Having less deadlier options helps all segments of society. /14

20 yrs since vaping, how many died from it? ZERO people. Meantime, 140 mn have died from smoking. People continuing to use nic is not the problem, people dying from it is. The 'quit or die' approach does not factor in human conditions and choices. Let's learn from drugs HR. /15

While UK has begun process to medically licence vaping and it's welcome, the problem is: a) tob users don't think of themselves as patients, and b) pleasure principle – quitting smoking has to be pleasurable for it to work (which is why NRTs don't). /16

https://twitter.com/RijoMJohn/status/1499272455667400705?s=20&t=MYvnXZMa5-iys2vnMF3wdQ

What you call extra headache is for many the most viable pathway to not die from nic use. Should they not have the option to reduce harm? Or to continue using nic (WHO btw condones long NRT use, poses minimal risk; many do) while managing the risk? /17

https://twitter.com/RijoMJohn/status/1499272459777835008?s=20&t=MYvnXZMa5-iys2vnMF3wdQ

Also, if more products are a problem, why not champion banning harmful ones to replace with safer substitutes, instead of other way around? This is what NZ did – phase out cigs, leave vaping only way to recreationally inhale nic. Banning safer options perpetuates the crisis. /18

Lastly, let's mirror your points in other crises. Climate: ban less polluting cars as they will add more product range, will help automobile industry which created the problem and attract new drivers. Pandemic: don't adopt harm reduction measures like masks, distancing. /19

This was all meant with no disrespect, and doesn't covers all issues but is a glimpse of my and colleagues' thinking. Always open to more discussion and engagement, because finally the goals are the same but with different approaches. (end)