Living is risky behaviour. Nothing we do (or don’t do) is free of any risk, so the goal is to manage our risks; to avoid being subjected to unwanted, unknown, and unnecessary risks.
When government regulations and empowered individuals work in tandem great things are accomplished. As witnessed by the huge decrease in the everyday risks people face today compared to the situation a century ago.
It should go without saying that consumers have a huge role to play in efforts to lower risks. After all, it is the decisions made by individuals that will do so much to determine overall societal risks. We seek to control our risks, and regulations and information efforts can effectively empower us all to make better decisions.
Yet in many cases, consumers are placed in a situation of lacking either the information necessary to make informed decisions or of the ability to act on the information they can get due to a lack of available options. This failure to give people the information and options to enable informed choices is often compounded by then blaming them for the harm caused by their poor decisions.
This denial of fundamental individual freedoms can often be readily corrected, and correcting it can lead to significant breakthroughs in wellbeing.
The situation with nicotine use is a clear illustration of this issue. Those making regulations on a broad range of consumer nicotine products, from bidis, cigarettes, oral tobacco, heated tobacco, vaping or pharmaceutical products are often poorly informed about relative risks. Often, they have been deceived into thinking that all products are equally harmful or that an abstinence-only policy is somehow viable for addictive products used by well over a billion people worldwide.
When those making the rules are ill-informed, the consumers subjected to those rules will invariably be put at risk.
The fact is that the science of nicotine has been known for over half a century. Nicotine is the primary reason these products are used, but it is the method of delivery that dictates the harm. People smoke to get nicotine but die from inhalation of smoke.
All of which makes the case for telling consumers about relative risks, of regulating the full range of products in a risk-proportionate way, and facilitating the most rapid possible transition to the lowest risk products.
There are already significant transformations toward low-risk alternatives to lethal tobacco products in countries from Norway to Japan. It is not a matter of whether it is possible to employ product substitution to help deal with the global scourge of tobacco smoking, but whether we have the will to act and the foresight to act quickly and decisively.
Tobacco smoking currently vies with air pollution and COVID-19 as the world’s leading cause of preventable death. But if consumers were to get what they need or want from the lowest risk products the health toll would border on the inconsequential!
Few consumer rights and public health issues can be addressed as easily, or yield as big a global health gain. Consumers could readily move to products likely to be no more than a tenth or even a hundredth as harmful. The failure to inform them has horrendous consequences.
When the least harmful products are subject to outright or effective bans, as India has sought to do on vaping and heated tobacco, and has done with the ultra-low-risk Swedish form of oral tobacco, there is a policy failure.
When consumers cannot access information on relative risks, or readily access lower-risk products, there is a failure of basic rights.
When the formerly useful tobacco section of the WHO exhibits such a brazen combination of incompetence and arrogance as to commend India for banning the low risk products that could replace lethal combustible products there is a fundamental failure of rational thinking.
The way forward is not hard to find, and it entails working with those whose health and lives are on the line. We need to empower them to make better-informed personal decisions. Not just in quitting any form of tobacco use where that is possible, but in moving to the lowest risk acceptable alternatives in the meantime.
Regulations should ensure that the availability, taxation, packaging, and marketing of tobacco/nicotine products are based on relative risks. This will nudge consumers to make healthier decisions, and encourage businesses to adapt to, and facilitate, a rapidly transforming marketplace.
Combining scientific insights on the relative risks of nicotine products with a commitment to consumer rights will lead to rational policies that can in turn save truly large numbers of lives.
It is time to rethink nicotine. It is time to empower consumers.
Author – David T. Sweanor J.D. Faculty of Law and Centre for Health Law, Policy and Ethics, University of Ottawa, Canada