Perceptions & Misperceptions:  communication has become a battleground

sarah summit 2018

Here is the text from Sarah's talk at the E-Cigarette Summit at the Royal Society on 15 November 2018:

The veterans of harm reduction will tell you that they’ve seen all this before. Some see it as a battle between absolutism and pragmatism, and that a pragmatic view necessitates the involvement of all parties, including industry.

Others see it as a fight for the vulnerable against powerful commercial interests, and so those interests must be excluded and fought at all costs.

These fundamental differences in what are essentially opinions, have led to a war of words which has spilt into arenas which are accessible to the public, and in particular, to those who are at risk of harm and could benefit the most from harm reduction strategies.

At the moment in the U.K. there are parallel battles going on over illicit drug use and cannabis in particular.

I know very little about cannabis, but I see the same tactics employed – stigmatisation of consumers, inflation of often minimal risks and denial of benefits, plus real harm caused by the criminalisation of an activity which many people find pleasurable and beneficial enough to take their chances with the law.

Much like vapers in countries like Australia and Brazil.

The public, and in particular the consumers of whatever substance is currently under the spotlight, need to be able to trust that the information given to us by public health authorities is accurate and complete.

In the days before the internet there was an inherent trust in health organisations, and few people questioned their motives. But times have changed.

Like never before, the internet has given a global platform to dissenting voices and opposing views. Sometimes this is a force for good, but not always.

Consider where the vocal antivaxxer movement would be today without the internet. Or indeed, Donald Trump.

On the good side though, it is now easier than ever before to scrutinise evidence and commentary and highlight any failings – if you have the time and energy to do so.

However, because most people don’t have those resources, what this abundance of information has led to is confusion and mistrust.

When people distrust the information they’re given they tend to stick with the status quo, even if they know that what they’re doing (or not doing) is harmful. This much should be obvious since we’re all human.

But what happens when in order to discourage the use of a product, evidence is …shall we say…selectively presented?

We can look to America for an example of this.

For years, public health groups there have been demonising vaping by amplifying possible harmful effects and largely ignoring the benefits for smokers, and then using that imbalanced view to call for a political agenda of far greater restriction.

Despite this, the vape industry continued to grow, smoking continued to decline as smokers switched to vapour products, and kids continued to experiment but not become regular users in significant numbers.

Then, about a year ago The public health focus turned to a product called Juul, a high tech pod system which is sleek, discreet and simple to use.

Unfortunately, those features apparently appeal to kids as much as adults. Who’d have guessed that the adult and young of the same species could like the same things.

What followed was an epidemic of panic.

Almost as one, health departments and organisations across the states turned their sights on Juul. They were rarely out of the news for months. We were told that they were marketing to kids. That flavours are clearly for kids (adults don’t need them apparently).

Several complaints were filed by parents alleging that Juul had addicted their offspring. Even from a viewpoint several thousand miles away, the media hysteria over Juul appeared to reach fever pitch.

Not wishing to be left out, the FDA chimed in with ever more hyperbolic claims of, in Scott Gottlieb’s words, a “tragic epidemic of nicotine use among kids” and threats of extinction if the vapour industry doesn’t come up with a solution.

So, what happened in the real world whilst all this anti-Juul rhetoric was going on? Juul’s estimated value saw a stratospheric increase in the space of just a few months.

Of course, If you’re in the business of advertising to kids, having your product perceived as dangerous and frowned upon by the grown ups in the government would be the perfect hook to appeal to their risk taking and rebellious natures.

You could almost believe it was a clever double bluff by Gottlieb to popularise the safer alternative by demonising it, but apparently not.

In response to an apparent, and if true, perhaps predictable increase in youth vaping, the FDA now intends to impose further restrictions. In Gottlieb’s words, “in light of growing youth use, we may have to narrow the off ramp for adults, to close the on ramp for kids”

Tobacco stocks soared on the news of the regulatory obliteration of the competition. Juul responded by committing corporate suicide.

Compare this to the UK situation where vaping is treated as an opportunity not a threat, and vapers as allies in the effort to reduce the harm of smoking and not as enemies.

A country where at policy level at least, the health and lives of adults are considered valuable, and not something to be sacrificed in order to avoid minimal unproven but theoretical risks to children. After all, there can be few things more harmful to a child than the loss of a parent.

Perception in the context of public health is not just about who’s wrong and who’s right about relative risks. The vast majority of the public are not scientists, so they go with what they perceive to be a trustworthy source of information. But who can you trust when the authorities and experts are so divided?

There is one group of perceptions that stand in the way of progress in harm reduction like no other. They prevent us from engaging, discussing and sharing ideas.

They prevent us from properly considering alternative views and result in ever more entrenched positions. Those are the perceptions which we have of each other.

Some academics, politicians and others who support vaping for harm reduction are under constant attack. Regularly accused of being industry shills, the insults don’t stop there – words like quisling and collaborator are thrown around like confetti at a wedding.

The motives behind this are as transparent as they are lazy – rather than address the substantive arguments they prefer to shift perception to discredit the source. Consumers aren’t immune to this either.

Depending who you ask, vapers are either loudmouthed ill informed trolls who advocate for vaping because we are hopeless nicotine addicts seduced into doing so by our evil overlords, the tobacco industry, or we are experts by experience fighting for our lives and those of people like us.

Actually, most of us are neither of those things for the most part. The vast majority of vapers don’t advocate, or even identify as vapers. They are simply people getting on with their lives who also happen to vape.

This silent majority are mothers, fathers, grandparents, brothers and sisters with ordinary and extraordinary lives to lead but our humanity is often obscured from view when the label of ‘vaper’ is applied.

We become numbers in a dataset, or a trend on a graph, defined more by what we do than who we are. We must never lose sight of the fact that behind every data point is a real person with strengths and weaknesses, desires and ambitions, and that every life is precious.

Engaged vapers see opponents as dogmatic ideologues who are happy to lie in order to win the debate, no matter who is harmed in the process. This comes from years of watching the same people manipulate evidence and publicise conclusions that no honest expert would be expected to come to.

At this point I’d have liked to be able to say that that view is clearly wrong. That the objections raised by opponents are honestly held beliefs and that they say what they do because they want to protect people from harm. I prefer to look for the good in people so I’m sure that’s true of many, but it certainly isn’t true for everyone.

People who care don’t shy away from engagement with the people they claim to care about. They don’t belittle and insult them or attempt to have them excluded from debate.

And they don’t discredit the value of the choices they make in order to stop others making those same choices.

As Martin Dockrell has said in the past, They support people to be as safe as they want to be, and respect their right to decide how to balance the risks and rewards of whatever they choose to do.

It’s easy for those of us engaged in this battle to think that the public is watching from the sidelines waiting to see who will win, but they’re not. They simply glance over every time it gets a bit noisy. Then they shrug their shoulders and say ‘I guess we still don’t know’.

As long as the apparent controversy continues, the public will trust only what they see with their own eyes, and what they see is bans, restrictions, warning labels and something that looks like smoking.

They perceive something dangerous, or at the very least, something antisocial and to be avoided.

They see addicts. Weak willed, social exiles just like smokers. Other people who should be prevented from doing something they don’t like – so who cares if their habit kills them – right? Just so long as they don’t do it near me.

They don’t see people who have given up smoking, or people who enjoy the use of nicotine just as they enjoy their morning coffee. They don’t see people who have given themselves the chance of a longer, healthier life.

Misperceptions are harmful in more ways then one. They breed intolerance, which supports restrictive policy, which in turn creates more misperceptions and more intolerance. Is it any wonder that many smokers don’t see the point of switching.

Those veterans I mentioned at the start say that harm reduction proposals are always met with denial and obstruction at the start but that common sense and pragmatism usually prevails eventually. I do hope they’re right.

But even in the U.K., which is supportive of harm reduction, the battle for hearts and minds is very far from being won.



 Watch the video of Sarah's talk here: