Deconstructing anti-harm-reduction metaphors; mortality risk from falls and other traumatic injuries compared to smokeless tobacco use

Carl V Phillips¹ , Brian Guenzel² and Paul Bergen³

¹University of Alberta, Department of Public Health Sciences. 215 College Plaza, Edmonton, Alberta T6G 2L9, Canada

²Center for Philosophy, Health, and Policy Sciences 10923 Atwell Dr, Houston TX 77096, USA

³University of Alberta, Department of Public Health Sciences. 13-103 Clinical Sciences Building, Edmonton, Alberta T6G 2G3, Canada

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Harm Reduction Journal 2006, 3:15doi:10.1186/1477-7517-3-15


Published:	18 April 2006

Abstract

Anti-harm-reduction advocates sometimes resort to pseudo-analogies to ridicule harm reduction. Those opposed to the use of smokeless tobacco as an alternative to smoking sometimes suggest that the substitution would be like jumping from a 3 story building rather than 10 story, or like shooting yourself in the foot rather than the head. These metaphors are grossly inappropriate for several reasons, notably including the fact that they are misleading about the actual risk levels. Based on the available literature on mortality from falls, we estimate that smoking presents a mortality risk similar to a fall of about 4 stories, while mortality risk from smokeless tobacco is no worse than that from an almost certainly non-fatal fall from less than 2 stories. Other metaphors are similarly misleading. These metaphors, like other false and misleading anti-harm-reduction statements are inherently unethical attempts to prevent people from learning accurate health information. Moreover, they implicitly provide bad advice about health behavior priorities and are intended to persuade people to stick with a behavior that is more dangerous than an available alternative. Finally, the metaphors exhibit a flippant tone that seems inappropriate for a serious discussion of health science.