Public health’s war on vaping didn’t start with vaping—it began decades ago with secondhand smoke. The same deceptive tactics now target tobacco harm reduction. How did it begin, and where does it lead? Don’t miss this special two-part episode featuring renowned tobacco control expert Dr. Michael Siegel.
Featuring:
DR. MICHAEL SIEGEL, MD, MPH
Prof., Dept. of Public Health and Community Medicine
Tufts University School of Medicine
Professor Siegel on X
tobaccoanalysis.blogspot.com
Transcription:
00:10
Brent Stafford: Hi, I'm Brent Stafford and welcome to another edition of RegWatch on GFN.TV. The battle over tobacco harm reduction is unlike any other in public health. While harm reduction is a proven strategy that saves millions of lives, many within public health reject its application to tobacco and other nicotine products. Despite millions of adult smokers switching to vaping and the historic collapse in youth smoking, public health agencies and tobacco control groups are doubling down on misinformation, stoking fears and misleading the public. Why is this happening and who stands to benefit from such deception? Joining us today to explore these pressing issues is Dr. Michael Siegel, a leading voice in tobacco harm reduction and a professor of public health at Tufts University School of Medicine. With decades of experience in public health, including a tenure at the CDC, Dr. Siegel has been a fierce advocate for evidence-based policy and a vocal critic of the misinformation plaguing the fight against smoking. Dr. Siegel, it's great to have you back on Red Watch.
01:19
Michael Siegel: Great to be back with you, Brent.
01:20
Brent Stafford: Well, it is so great to see you. Before we begin, a quick note to our viewers here on GFN.TV. Today's episode is part one of our two-part interview with Dr. Siegel. Part two is scheduled for release on the RegWatch website, YouTube, Facebook, and X in just a few days. So keep watch for that. Dr. Siegel, how do you define tobacco harm reduction and why do you see it as an essential tool in the battle against combustible tobacco?
01:49
Michael Siegel: Well, I think let's start with the definition of harm reduction just generally in public health. The idea of harm reduction is that you can't always get people to stop doing an unhealthy behavior. But if you can get them to do something that's less risky, then the more risky behavior, you're still improving people's health. And we use this in a lot of areas of public health. The most familiar is probably with drug treatment, with opioid addiction, for example. We typically, if we're not able to get somebody completely off drugs, heroin, for example, we will put them on methadone or on buprenorphine. They're still opiates, they're still addictive, but they're far less hazardous. We do the same thing with sex education. If people are going to be abstinent, we encourage them to use safe sex practices. So harm reduction in the tobacco control concept, the concept is no different. It's basically the idea of taking smokers who are using the most hazardous product out there, and if they're not able to quit completely, giving them some alternative, such as electronic cigarettes or smokeless tobacco, something that they can use that is going to satisfy the nicotine addiction, but is much, much less harmful. For how long have you had this view and how did you come by it? Well, I mean, this has been my view ever since I got into the field of public health. This is one of the principles of public health that I was taught as a public health student, that I teach as a public health professor, that I bring into my research, and that in fact, the entire public health world has adopted in terms of harm reduction in general. So there's nothing new or unusual about this concept. It's been around for decades.
03:53
Brent Stafford: Now you are a medical doctor, is that not correct? Yes, I do have my training in medicine. Well, we always like to have Dr. Doctors on the show. For some reason, that actually provides a bit more authority sometimes. But of course, we are seeing right now that there is a dearth of knowledge inside the medical field about the actual relative risks of these products and the risks of nicotine.
04:23
Michael Siegel: It really is problematic because you're right that when you hear somebody is a doctor, they automatically have a higher level of credibility and people tend to believe what they say. And right now, there are a large number of physicians who are out there publicly making statements that are just blatantly incorrect about the relative quality risks of vaping versus smoking. And specifically, many doctors are saying that vaping is no safer than smoking. And that is, it's problematic, first of all, because it's wrong. But second of all, because these are very reputable people. These are people who the public is likely to listen to and to believe and not write off or think critically about. And so it's kind of a double whammy.
05:18
Brent Stafford: I'm sure you've heard about it, but there's been some controversy over the last year with regards to continuing education for practicing doctors on safer nicotine products and nicotine specifically. Now, I take it that you are trying to do something at the actual med school level on that.
05:39
Michael Siegel: Yeah. So, I mean, I am I teach a class here on the first year medical students. It's essentially it's a public health class for. medical students. And here at Tufts, it's the very first class that students take. So this is the day one of medical school. It's awesome that these students are getting a public health education to start out with. And one of the concepts we talk about in the class is harm reduction. It's one of the very first concepts that I introduce to the class.
06:11
Brent Stafford: Are nicotine vapes a valuable tool to help people to quit smoking and to stay quick?
06:19
Michael Siegel: There is no question, no question based on the scientific evidence that electronic cigarettes are an effective tool for smoking cessation. In fact, they are probably, maybe undoubtedly, more effective than nicotine replacement therapy or drugs like varenicline. Population-based data shows us that e-cigarettes are actually the number one method for smoking cessation among adults in the United States. So this is not only a method that's effective, it's a method that is the most commonly used by smokers who are trying to get off tobacco cigarettes.
07:07
Brent Stafford: Now, Dr. Siegel, for our global viewers who may not know you, please share a bit more about your background and work in tobacco control for us.
07:16
Michael Siegel: So I've been in tobacco control essentially my entire career. After I got my medical degree, I went on to do a residency in preventive medicine. And as part of that, got a master's in public health. at UC Berkeley. And then I went on to spend two years at the CDC, where I worked in the Office of Smoking and Health for two years, working on a range of issues in tobacco control. Got a chance to really see how the federal government works, got an inside look at CDC. And then for the past, Almost 30 years, I've been serving as a professor, first at Boston University and now here at the Tufts University School of Medicine. My research has been in actually three areas. In addition to tobacco, I do research in alcohol and the area of gun violence. So those have been my areas. uh the areas that i've branched out to um but clearly tobacco control has been uh one of the areas that i've focused on for my entire career are there any inequities uh around the use of tobacco products and that might factor into some of the disparities in terms of tobacco controls treatment of this area there are disparities in in tobacco use uh and the main disparity is a class People with lower levels of education are much more likely to smoke. That's been the case for a long time. And so when we talk about interventions that harm smokers, we're talking about a disproportionate amount of harm to people with a lower educational status.
09:16
Brent Stafford: When you look at all of the interventions that tobacco control has implemented in the States, and a lot of that happens in Canada and so forth, when you look at the total number of interventions and what they've done, can you point to any one that's had a real positive impact?
09:35
Michael Siegel: Well, we've had, yes, I mean, we have had successes in the tobacco control movement. Certainly, adult smoking has dropped drastically, even though it's still, you know, there are millions of smokers. It certainly dropped from where it was decades ago. Youth smoking has dropped almost to close to zero. I mean, you can hardly find youth in the US that are still smoking combustible cigarettes. So we've had tremendous progress in fighting the tobacco industry and in reducing smoking rates, more so among youth than among adults. But certainly, in both populations, we've made substantial progress.
10:22
Brent Stafford: it seems to me that tobacco controls interventions while some may be successful they don't come without pain for the user taxes pain flavor bands pain stigmatizing smokers pain i mean i guess that's what i mean about positive like i mean have any of the tobacco control uh interventions you know been Well, yeah, positive for the end user without having to put, you know, squash them with a boot.
10:53
Michael Siegel: I mean, I think what I would argue is that the interventions themselves have been, you know, have been reasonable and have, for the most part, you know, accomplished their purpose of reducing smoking and reducing, you know, tobacco-related deaths. But the philosophy, the ideology of the tobacco control movement has changed over time such that it has, in my opinion, gone beyond what is reasonable. So for example, you mentioned stigmatization of smokers. One of the first signs to me that the tobacco control movement had kind of morphed into something that was not consistent with public health was when we, meaning those of us in tobacco control, started pushing for policies that punish smokers. For example, there was a period of time in the mid to late 1990s where one of the popular policies that tobacco control advocates were pushing were policies to have workplaces not hire smokers. And, you know, which is clearly employment discrimination and stigmatizes smokers and does nothing to help smokers. And, you know, what we need to be doing is helping smokers. The reason I'm in this to begin with is because as a physician, I saw so many smokers suffering, so many smokers dying, getting sick. And I'm here to prevent that. I decided I'm going to dedicate my career to trying to prevent that. Smokers are our patients, in a sense, our clients who we're trying to serve. To do interventions that stigmatize them or put them out of work or don't allow them to have a job makes no sense whatsoever. I think it's more of a question of the tobacco control movement going too far than it is that nothing they've done has been appropriate. I think that up to a point, we did a good job and we succeeded, but rather than celebrate the success, we've pushed and pushed and pushed beyond what I would consider a legitimate public health.
13:25
Brent Stafford: Dr. Siegel, I want to call out the amazing blog you started back in 2005. It's called The Rest of the Story, Tobacco and Alcohol News Analysis and Commentary, providing the whole story behind tobacco and alcohol news, which can be found at tobaccoanalysis.blogspot.com. Dr. Siegel, why did you start the blog and what can people find there?
13:52
Michael Siegel: So initially I started the blog because I felt that there had been a major change in the tobacco control movement in the ways that we were just talking about. I felt that the tobacco control movement, there were really two changes. One is that zealotry took over rather than being a movement that was based on science, based on public health principles. It started to become based on pure zealotry. And secondly, the second change was that public health groups, tobacco control groups started to use misinformation to promote their goals and that was a change that was a major change uh there are a number of reasons why that was able to change at that time but the the main reason that i i started the blog back in 2005 was to really kind of try to search it serve as a watchdog for the tobacco control movement to call out the misinformation to call out what i saw as going too far With the goal of changing the movement, I wasn't just trying to be a complainer. The goal was by speaking out, hopefully these organizations would see the misinformation that they were giving out and they would change their practices. That was the original goal.
15:14
Brent Stafford: Now, I think that's important. And in fact, I wasn't so clear on that. So the misinformation that we'll talk more about in this episode and in part two, obviously the misinformation around vaping and safer nicotine products. Are you telling me that that same kind of practice of misinformation was happening within tobacco control before vaping even existed?
15:38
Michael Siegel: Yes. And it started with the effects of secondhand smoke, where I first saw the tobacco control movement starting to deviate from scientific rigor was shortly after 2000. And there is some significance to the year 2000, which I can tell you about in a minute. But shortly after 2000, we started to see it. And the first place it came out was exaggerated statements about secondhand smoke. So there were statements like secondhand smoke can cause heart disease within 20 minutes. 30 minutes of secondhand smoke exposure is enough to cause a heart attack. And these statements started to come out and that was when it caught my attention. And I realized, you know, this is not correct. And the technique that we were using was not appropriate. You know, honesty... is actually a core value of public health, honesty and transparency. And even though the idea was, okay, well, let's scare people more by telling them how bad secondhand smoke is, but that's not ethical. The ends don't justify the means in public health. So those were the very first area of misinformation was really these exaggerations about secondhand smoke and to try to support efforts to ban smoking essentially everywhere, including in outdoor places.
17:10
Brent Stafford: Were those exaggerations actually being promulgated by the public health agencies, CDC, FDA, so forth?
17:19
Michael Siegel: Not at that time. At that time, it was really a much smaller group of tobacco control advocates, individual advocates that were obligating this information. It had not yet spread to the major organizations. So it just kind of started at a much smaller level.
17:44
Brent Stafford: What was the impact of that? Because, you know, that concern kind of moral panic, if you will, around secondhand smoke really led to the actual first laws that were put in place that banned smoking with inside commercial, you know, locations and so forth.
18:03
Michael Siegel: So what I'm talking about happened really after we had already banned smoking in most indoor places. And that was the problem is that I got involved in the field because I wanted to, I mean, I'm concerned about the effects of secondhand smoke. A lot of my research is on health effects of secondhand smoke. And I actually have promoted smoke-free laws to prevent smoking in workplaces, in restaurants, in bars. What happened is that We succeeded. We got smoking banned in almost all of those places. And so apparently we needed to find something else to do in order to raise money from contributors. And so we started working on banning smoking outdoors, in outdoor places, public parks. um you know some entire downtown areas entire areas of the city complete areas of college campuses outdoors i'm talking about not just the inside spaces and so when that happened um that's that that was when we really got started getting off track and going too far and i think that in order to support those laws advocates had to start distorting the facts because the facts alone don't support banning smoking in outdoors places that are, you know, other than places where you're kind of packed in and you can't move. But in an outdoor park or something where people can freely move about, you know, there's no scientific justification. It's not causing health harm. So the truth wasn't enough. And so they started using misinformation and lies to try to support that. And that was really the origination of what turned out to be, what has turned out to be really, I would call a campaign of deception around electronic cigarettes.
20:05
Brent Stafford: So one practice led into another. Let me ask you just briefly, without us going too deep in the weeds here, there has been some discussion over the years that the lead researcher, that one of the lead researchers that really drove the science around secondhand smoke, that that science may not in the end be robust. And in fact, Could some of this reaction be a self-defense around the fact that the actual original research that helped ban secondhand smoking might've been weak?
20:41
Michael Siegel: I think that it's interesting because the early work on secondhand smoke I think was quite reputable and quite accurate. But I think it got to the point where somehow it just wasn't enough and we had to go further. And in fact, they've developed a term called third-hand smoke. Second-hand smoke wasn't enough, so they developed a term called third-hand smoke, which is smoke that you're not getting from somebody in the room smoking, but from... people who were there before and who, you know, there may be some residue left in the room or from the clothing of smokers or something like that. And that's when I realized things had gotten out of control when they started, you know, focusing on third-hand smoke and trying to, you know, scare people about, you know, oh my gosh, if you're sitting in a room with a smoker, even if they're not smoking, it's going to cause you to have health damage. And that was just going too far. So I guess for some reason, we in tobacco control, we're just not able to recognize when we reach a finish line. I feel like the way the analogy I use is that I feel like we were running a marathon. and you know i was part of the group i was out there running with everyone and that we reached the finish line we reached the agreed upon finish line and i stopped and everyone else kept going not everyone else but the majority uh just kept going and i stopped and i'm just looking ahead and saying where are these people going the race is over
22:29
Brent Stafford: The World Health Organization certainly appears to be playing a prominent role in promulgating the misinformation around nicotine vapes. I have on screen here a series of tweets they posted, seeding debunked health concerns around vaping. They also tweeted out last year this question and answer. Question, what looks cute, smells good, but is designed to kill? Answer, a vape. Dr. Siegel, what do you make of this? And why is the World Health Organization doing this? And maybe more importantly, why do they feel so free to deceive the public in this way?
23:09
Michael Siegel: It's really, I think, beyond my comprehension. I think I have a pretty clear idea in the United States of how this happened. I could see it happen early with secondhand smoke and how it progressed into the vaping debate. But how this happened at a worldwide level i don't really understand uh you know how this how this happened um i think that the uh you know and even as you saw the progression through the the the tweets that you that you showed you know they get more and more outlandish to the point that by the time we saw the most recent one They're actually saying that e-cigarettes, they're not just saying e-cigarettes are harmful. They're saying that they are designed to kill, that they're intentionally made with the intent to kill people. I'm not even sure you could say that about real cigarettes. I mean, but certainly they don't kill people intentionally. So the level to which the World Health Organization has gone is just astronomical. And really, more than just inaccurate, it's distasteful because they're essentially accusing anyone who is selling e-cigarettes of being killers, murderers. And that's just completely inappropriate. It's not just wrong, but it's terribly inappropriate.
24:40
Brent Stafford: So, and justify the means then for WHO.
24:45
Michael Siegel: I think that's the bottom line with the WHO and with all of the organizations that are making these statements is that, yeah, the ends, they think that since our end is good, we're trying to get people to not smoke or to not use e-cigarettes. Since the end is a good one, we can use any means we want. It's okay. Yeah, we're exaggerating. Yeah, we're pushing things farther than the science supports, but it's okay. But the thing that I want to clarify something, which is that at first, I think that was true. In other words, at first, I think that it was a question of the ends not justifying the means. It was a matter of just they were using misleading information to try to achieve a legitimate health outcome. Okay, even though I disagree with the technique they were using in the strategy, the end to which they were working was reasonable. But now they don't even meet that standard because the ends that they're working towards are no longer public health ends. So for example, when they're misleading people by saying, oh, well, e-cigarettes are just as harmful as cigarettes, That's not leading to a positive end. That's leading to a very negative end. That's actually discouraging smokers from quitting. And it's actually supporting smoking. I mean, it's actually leading. There's demonstrable evidence that the misinformation that these health groups have been putting out there and their actions in terms of banning flavored cigarettes and increasing e-cigarette taxes have resulted in increases in smoking rates, or at least a deceleration of the progress in reducing smoking. So I would argue that now it's not a question of the ends not justifying the means. Right now, it's a question of the ends not being justified themselves. And so the means to justify the unjustified ends is also unjustified. So neither their means nor ends are now justified. How can you call that public health then? I don't. I think that that is not public health. That is not who we are. that those are not the principles of public health. And one of the things that I've done on my blog and in other public statements is trying to keep the public health movement and the tobacco control movement accountable to basic public health principles and standards. And I'm not calling for things that are just beyond basic beyond the pale, you know, that just are unachievable or that just are idealistic. This is not aspirational. You know, these are basic principles that should be followed.
27:56
Brent Stafford: Now that must win you a lot of friends within your colleagues in tobacco control.
28:01
Michael Siegel: So one of the really unfortunate things that has happened to me in my career is that I have been largely ostracized or attacked by colleagues in the tobacco control movement. It was a shock to me because I didn't anticipate that. When I started speaking out and pointing out that, hey, we're making misleading statements, I expected that organizations would say, oh, Dr. Siegel has pointed out that we are saying something wrong. Let's fix it. We definitely don't want... because I was viewed as a reputable scientist in the tobacco control field and nobody had any problem with my statements when I was arguing that secondhand smoke was harmful. Nobody said, well, this guy is really, we shouldn't listen to this guy. Everyone was like, yeah, look at Dr. Siegel's work. But all of a sudden, when I started the same person, the same scientists, the same credentials, when I started saying, hey, I don't think 30 seconds of exposure to secondhand smoke is enough to cause a heart attack. All of a sudden, people started attacking me. And in fact, I was accused of taking tobacco money. They were convinced that I must be on the tobacco payroll. Why else would I be saying this? So I faced, I would say, pretty serious repercussions in my career. I was no longer invited to tobacco control conferences. I was no longer invited to speak on tobacco control panels. One organization specifically refused to appear if I was going to be there. I was actually invited to speak at an event. And when this organization heard that I was gonna be there, they said, well, if he's there, we're not coming. And so they ended up disinviting me because this organization, which is much bigger, was going to, they really needed them to speak there. So there were definitely serious repercussions that I'd never even considered would happen. I was considered one of the leaders of the tobacco control movement nationally until I started saying things that were not part of the the agenda. When I started getting off the agenda, I started, you know, it's almost like a religion. Like, you know, if you can't dissent, you're not allowed to dissent. And if you express any dissent, you have to be expelled. They can't tolerate dissent. And that's something that I learned painfully along the way.
31:00
Brent Stafford: So is this something that this totalitarian mentality, for the lack of a better term, that seems to be rife through tobacco control public health, do we see that operating anywhere else within public health or is it just strangely narrowed into only the tobacco field?
31:22
Michael Siegel: This is very strange, Brent, because I have only seen that in the tobacco control I'm not aware of any other areas where the same thing has happened. And in fact, when I talk to other colleagues in public health who are outside of the tobacco area, they are shocked and appalled. by what's going on. I don't think there's ever been a time when I've talked to someone who doesn't work in the tobacco control field, who I tell these stories to, and they don't have a problem with it. They're not shocked and appalled by it. So for some reason, this is something that is happening in the tobacco control area. And we don't see it we don't see it happening in many, many other areas of public health.
32:22
Brent Stafford: Dr. Siegel, do you think tobacco control still has an interest in smoking cessation?
32:28
Michael Siegel: I think that largely the interest in smoking cessation has disappeared and the movement has morphed into almost an exclusive focus on youth e-cigarette use. And I'm very careful in saying youth e-cigarette use and not youth vaping. I don't think the tobacco control movement is actually that concerned about youth vaping. They don't want youth vaping nicotine. When we had the Valley outbreak with the severe lung disease that was being caused by THC vaping, Largely illicit, I mean, not largely, 100% illicit THC cards that were being sold on the black market that were laced with vitamin D acetate. When that was happening, what were the tobacco control groups doing? They were saying, don't use e-cigarettes. You need to ban e-cigarettes. They weren't telling kids, hey, be very careful if you vape and you're vaping THC. be very careful, don't use black market products. Their entire campaign was saying, don't buy e-cigarettes at retail stores. And that was, if they were truly concerned about youth vaping, they would have directly hit the cause of the epidemic. The cause of that epidemic was THC vaping. It was not e-cigarettes. Yet they said almost nothing I saw in Massachusetts, not a single word was said to discourage youth from using, not discouraged, but to tell youth not to use THC vapes. They were specifically told don't use e-cigarettes. And so I don't even think the tobacco control movement is really, you know, I don't think they're concerned about vaping. I think they're concerned about the use of e-cigarettes specifically. But the larger question of smoking cessation has been completely lost. And in fact, the movement is doing everything it can to maintain combustible tobacco on the market. We're doing everything we can. We're taxing e-cigarettes, we're banning e-cigarettes. We're in fact banning e-cigarettes, but letting real cigarettes stay on the market. And that's ridiculous. The city of San Francisco is a prime case where they said, we're not gonna allow electronic cigarettes to be sold But if you want to sell cigarettes, you're, you know, no problem. And that's ludicrous. And that is that is completely turning your back on the original goal, which was to which was smoking cessation.
35:20
Brent Stafford: It's almost as if tobacco control is treating smoking as a problem of the past. Exactly, exactly.
35:28
Michael Siegel: Well, among adults, they are. Here's the irony, Brent. Among adults, the tobacco control movement is treating smoking as a thing of the past when it's actually not. But among youth, the tobacco control movement is not treating tobacco smoking as something of the past. They claim that we've made no progress. Because kids are still using nicotine products. In fact, they call them tobacco products. In fact, very often you see quotes like, the use of tobacco among youth has not gone down, which is a lie because e-cigarettes are not tobacco products. So the movement largely is ignoring the tremendous successes that we've had in reducing youth smoking, But essentially giving up on adult smokers and concluding that, well, the battle's over. And I think they have it exactly the opposite of what the truth is.
36:42
Brent Stafford: Dr. Siegel, as you know, the 12th edition of the Global Forum on Nicotine, the annual conference on safer nicotine products, takes place again this year in Warsaw, Poland from June 19 to 21, 2025. The conference theme is challenging perceptions. In your mind, what are some solutions to address the misunderstandings, misconceptions, and mischaracterizations that are holding back progress for safer nicotine products?
37:13
Michael Siegel: I don't know that you can change these groups. I have tried for a long time, years and years, really since 2005, to try to change these groups and to say, look, stop giving this information out. So I don't think we can do that. I just I don't think that they're reachable. So I think what the focus has to be is on policy. We need to directly impact policy and and forget about what these groups are saying. We need to directly go to policymakers and try to get. the policies in place that make sense. And I think that that's the only thing that will, I think, change the tune is if our policies start saying different things than what these groups are saying, that's when things may start to change. But we've got to go directly to influence policy because it's too important. There are too many lives at stake. if we allow this misinformation to dictate policy.