Professor David Sweanor presentation from E-Cigarette Summit 2014

1. Prof David Sweanor
Adjunct Professor
Faculty of Law
University of Ottawa

2. Evidence and harm reduction – what are the legal and ethical responsibilities of Public Health?
E-Cigarette Summit, Royal Society
November 13, 2014
David Sweanor, University of Ottawa

3. Legal and ethical responsibilities
•These are important – and related
•Ethics informs how we should act
•Law codifies it

4. ‘Thou shalt not lie’
•Not a bad starting point for a discussion on ethics and consumer information

5. The Noble Lie?
•We have learned that much deceit for private gain masquerades as being in the public interest
•Those in government and other positions of trust should be held to the highest standards.
•Their lies are not ennobled by their positions; quite the contrary
•Sissela Bok, Lies for the Public Good, in Lying

6. The impact of vested professional interests
•Thomas Kuhn, The Structure of Scientific Revolutions
•Vested Interests are everywhere, and they shape world views.

7. Moral psychology
•Six fundamental ideas that commonly undergird moral systems:
•Care, fairness, liberty, loyalty, authority and sanctity
•People are fundamentally intuitive, not rational
•When you ask people moral questions they reach conclusions quickly and produce reasons later only to justify what they’ve decided
•Jonathan Haidt, The Righteous Mind

8. Blinded by ideology
•An example: A belief in social determinants and not biological bases for nicotine use.
•Political orientation: Anti-markets, antipathy to ‘selling addiction’. Or . . . pro-markets and liberal on drug use.
•Anti-tobacco industry
•Often . . .
•Simplistically
•Non-strategically
•Counter-productively

9. Responsibilities
•The Role of Consumer Information in Public Health:

10. The biggest breakthroughs often come from two very simple principles:
•Give people enough information to make informed decisions
•Give them the ability to act on that information

11. Victim Blaming
•People can only make decisions that are as good as the information provided to them.
•Robert Cirino, Don’t Blame the People,

12. Responsibilities of Public Health Groups
•There are consequences from not meeting an acceptable standard:
•Reputational, Regulatory, Legal

13. Evidence: Where to set the bar?
•Should the onus change when the risk differential from the status quo is immense?

14. How have we dealt with past cases of market transformation?
•The role of precedent
•Food, pharmaceuticals, automobiles, etc.
•Some innovation is welcomed.
•Some is only initially opposed.
•Some is destined to be a prolonged cultural war.

15. Watch out!
•Unintended consequences of oversight from those concerned about unintended consequences!
•Administrative law – the evidentiary basis for getting laws vs. applying them.
•Fear of change protects the status quo.

16. Tort responsibilities
•Government agencies and non- governmental organisations
•They CAN be sued
•They can lose reputation even if not successfully sued

17. Understanding tort implications for tobacco companies
•They have learned from past experience.
•They cannot oppose reduced risk products that are an existential threat to the cigarette business.
•Anti-smoking groups have hopefully learned more than that Nietzsche was correct.
•‘Choose your enemies carefully, for you will take on their characteristics’

18. Obstacles or Opportunities?
•Finding a shared goal
•Science Council: "Science is the pursuit of knowledge and understanding of the natural and social world following a systematic methodology based on evidence."
•That systematic methodology must be based on finding the truth rather than supporting a pre-existing view.
•Objectivity, rigour, humility, empathy, messaging:
•Best practices from other areas of public health.
•Learning from other issues.