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This is a great moment for “The Fun Police”. Today is the day of the first guest blog! ****  Before discussing this particular guest post, I’d like to very much welcome other guest posts as  well. So if you have something interesting to share, please email me and we can work on it. With  guest posts, I don’t pick sides, so I am happy to discuss any contributions. ****  But back to “What is in the name?”… Dr Burstyn is an associate professor in the department of Environmental and Occupational Health  at Drexel University (Philadelphia, US). Most of his work is in occupational and environmental  epidemiology and exposure assessment. Occasionally, Dr Burstyn works on issues that populate  headlines of mainstream media and his contribution below is just of such flavor. There is more  about him at the end of the blog for reasons that should hopefully become apparent if you  choose to read on…   I may or may not agree with the content of Dr Burstyn’s blog. Regardless though, if you have an  opinion on it, I very much welcome you to posting this in the discussion forum below.

What is in the name?

Imagine this: headlines of all major news outlets read: “The smell of a flower discovered in  rainforest stops all headaches instantly!”  Would this not be wonderful news to wake up too?  Of course, the professional skeptics would want to know if that is all there is to the story and  whether there is some hidden danger in the miracle cure. Let us imagine that they discover that  one of the chemicals produced by the plant (after all, all smell is chemical acting on our senses)  is both naturally produced by human bodies and is known to cause cancer in the noses of a tiny  proportion of people who inhale it in high levels that occur in ill-maintained workplaces; at  these high levels the chemical has an easily recognizable unpleasant smell not noticeable in the  flower. The flower that cures headaches produces minute quantities of this chemical, at the  levels far below those where it is known to cause harm. How would that color your perception of the announcement of cure for headaches? This may depend on whether you or your loved one  suffers from migraines- for these people this news would make their lives much more enjoyable  and the risks would seem slim in comparison. For the people who do not suffer from the  headaches, this news would be of little interest but it is unlikely that they would worry very  much if someone nearby was discretely sniffing the flower to get rid of crippling pain.  Nobody  would bother much if chronic migraine sufferers started to cultivate the flower and keep it  around for the duration of their lives to get instant relief.  Some people would even keep the  flower around so that they never get headaches and because, to be frank, they like its sight and  aroma. Migraine research foundations would shut down but that would be their greatest mark of  success and they may even share a Nobel Prize in medicine, if they choose to promote the  flower cure. So, no great harm done and many people are happier for the discovery. Would you  not agree? But let us change the story a little and gauge how a reader interested in health of the public  would perceive this “new” story.  The discovery is not a flower but a device that makes smokers  either cut down a great deal, or stops smoking altogether. It does so by delivering nicotine that  smoker craves in a manner that is appealing. The device produces some toxic chemicals in  minute quantities, nowhere near the levels where harm to health occurs. (One of these  chemicals is exactly the same as the one described in the flower example.) By now you may be  wondering why I am writing about something as old news as nicotine patches and gums...  ...Except let me add a twist to the story: when smokers switch, they keep on using the device as an alternative source of nicotine instead of quitting.  In fact, that number of consumers of  nicotine is expected to increase because of the device. What does our public health “intuition”  tell us about this scenario?  Are you feeling a little uneasy because the second scenario has the  words “nicotine” and “tobacco” in it?  Are you worried about “addiction” that may afflict  devotees of the new device?  If so, please compare the two narratives.  Are your negative  reactions based on change in nouns only? Are you able to see past your own bias and  institutionalized revulsion towards “tobacco”?  Please also note that whatever your reaction  may be, it is likely colored by your personal experience.  If you are a smoker who switched, it is  definite that you are elated by the new device.  If you never smoked and have no desire to, you  should probably not care, unless it is your profession to improve health of the public and you  ought to be delighted that there is finally an intervention that stands a chance to displace  smoking without introducing any great risks.  In case you are still wondering, I am talking about  e-cigs.  I hope that this reflection will help us understand that looking past our biases and gut reactions  is important in making decisions that stand a chance to do some worldly good. At the very least,  if a decision is based on reason, then it is possible to trace where things went wrong, if they do. However, decisions based on pure beliefs and intuition are bound to produce experiences from  which we cannot learn and have no chance of doing better in the future… except perhaps to try to think about the problems next time instead of rushing to a solution.  So, on the subject of e-cigs, let us hope that public health researchers will adopt a “can do”  attitude and embrace harm reduction approach with the same gusto as they did needle and  condom exchanges, air and water quality guidelines, and workplace exposure limits. It is time  perhaps to imagine every potential intervention as a flower: it may eat you but it is equally  likely to make your life just so much better.  It is worth understanding it, instead of focusing on  how we feel about it. **************  More on Dr Burstyn: He is interested in tobacco harm reduction and the position of e-cigarettes  therein.  His scholarly contribution on the topic has been read by hundreds of thousands of  people: http://www.biomedcentral.com/1471-2458/14/18.   In the interest of transparency, please note that Dr Burstyn also sits on the board of CASAA (The  Consumer Advocates for Smoke-free Alternatives Association) which, according to its website  “donations to CASAA are accepted from many sources, CASAA has no financial or policy  agreements with the electronic cigarette, tobacco or pharmaceutical industries.” 
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Oh! E-cigs! That is going to  cause some controversy…  ...and of course, The Fun  Police is happy to contribute  to that…