The Nicotine Advocacy Divide: Why Consumer Advocates and Public Health Professionals Can't Talk to Each Other

The public health conference panel on nicotine harm reduction has the standard lineup: a professor of epidemiology, a director of a tobacco control NGO, a former FDA official, and a physician-researcher who studies smoking cessation. Their presentations are methodologically rigorous, their conclusions are carefully qualified, and their recommendations—'more research is needed,' 'the precautionary principle should guide policy'—are institutionally safe. In the audience, watching the livestream from his living room, is a 45-year-old former smoker from Ohio. He smoked for 25 years. He tried to quit with patches, gum, prescriptions, and cold turkey—each time, he failed. He switched to vaping five years ago. His chronic cough disappeared within weeks. His lung function, measured at his annual physical, has improved every year. He has not had a cigarette in half a decade. **He is not on the panel. He is never on the panel. The people whose lives are most directly affected by nicotine policy—the billion-plus nicotine users whose health outcomes the policy is supposed to improve—are systematically excluded from the rooms where the policy is made. The nicotine advocacy divide is not about evidence. It's about who gets to speak.**

**The exclusion of consumer voices from nicotine policy is not an oversight—it's a structural feature** of a field that has defined itself in opposition to the industry that profits from the products consumers use. The tobacco control movement was built on the insight that the tobacco industry could not be trusted—that its research was propaganda, its marketing was manipulation, and its participation in the policy process was a vector for regulatory capture. The insight was correct and remains correct. But the movement generalized from 'the industry cannot be trusted' to 'anyone who advocates for access to nicotine products cannot be trusted'—a generalization that sweeps in not just the industry but also the consumers whose health is at stake. **The consumer who advocates for access to vaping products because vaping saved their life is treated as an industry proxy—their testimony dismissed as 'anecdotal,' their motives suspected as 'industry-aligned,' their expertise (their lived experience of addiction and recovery) devalued relative to the professional expertise of the researchers and advocates who have never smoked.**

**The exclusion has consequences for policy effectiveness.** Policies designed without the input of the people they affect are policies that are less likely to achieve their intended effects. The flavor bans that were designed to reduce youth vaping but that also eliminated the flavors that adult smokers relied on—these were policies designed by people who had never depended on a specific flavor to stay off cigarettes. The product restrictions that limited nicotine concentrations but that made vaping less satisfying for heavy smokers—these were restrictions designed by people who had never experienced the craving that a too-weak vape fails to suppress. **The expertise of the professional public health community is real and valuable. It is also incomplete—because it lacks the dimension of expertise that only the people who have lived the experience can provide.**

**The path to bridging the advocacy divide requires a shift in how expertise is defined.** The public health community needs to recognize that lived experience is a form of expertise—that the smoker who has tried to quit ten times knows something about addiction that the researcher who has studied it in the abstract does not. The consumer advocacy community needs to recognize that professional expertise is valuable—that the researcher who has spent a career studying smoking cessation has knowledge that the individual vaper, drawing on their own experience alone, does not. **The bridging requires mutual respect—and mutual respect requires that both sides acknowledge the legitimacy of the other's knowledge. The public health community that dismisses consumer testimony as 'anecdotal' is not respecting the expertise of the people it claims to serve. The consumer advocacy community that dismisses public health research as 'ideological' is not respecting the expertise that rigorous science provides.**

**The institutional mechanisms for consumer participation are underdeveloped and underutilized.** The FDA's Tobacco Products Scientific Advisory Committee includes a consumer representative position—but the position has historically been filled by individuals from the tobacco control advocacy community, not by nicotine consumers themselves. The FCTC's Conference of the Parties has no mechanism for consumer participation—the proceedings are closed to the public, and consumer organizations are denied observer status. **The institutions that govern nicotine policy are among the least democratically accountable institutions in the public health landscape—and the exclusion of the people they govern is a structural failure that undermines both their legitimacy and their effectiveness.**

**💬 Do you feel that your voice—as a nicotine user, a former smoker, or someone affected by nicotine policy—has been heard in the policy process?** What would meaningful consumer participation look like? And how can we bridge the divide between the people who study nicotine and the people who live with it?