title: Withholding differential risk information on legal consumer nicotine/tobacco products: The public health ethics of health information quarantines.
abstract: The United States provides an example of a country with (a) legal tobacco/nicotine products (e.g., snus, other smokeless tobacco, cigarettes) differing greatly in risks to health and (b) respected health information websites that continue to omit or provide incorrect differential risk information. Concern for the principles of individual rights, health literacy, and personal autonomy (making decisions for oneself), which are key principles of public health ethics, has been countered by utilitarian arguments for the use of misleading or limited information to protect public health overall. We argue that omitting key health relevant information for current or prospective consumers represents a kind of quarantine of health-relevant information. As with disease quarantines, the coercive effects of quarantining information on differential risks need to be justified, not merely by fears of net negative public health effects, but by convincing evidence that such measures are actually warranted, that public health overall is in imminent danger and that the danger is sufficient to override principles of individual autonomy. Omitting such health-relevant information for consumers of such products effectively blindfolds them and impairs their making informed personal choices. Moral psychological issues that treat all tobacco/nicotine products similarly may also be influencing the reluctance to inform on differential risks. In countries where tobacco/nicotine products are legally sold and also differ greatly in disease risks compared to cigarettes (e.g., smokeless tobacco and vape), science-based, comprehensible, and actionable health information (consistent with health literacy principles) on differential risks should be available and only reconsidered if it is established that this information is causing losses to population health overall.
authors.affiliation: University at Buffalo, State University of New York, School of Public Health and Health Professions, Professor, Department of Community Health and Health Behavior, Buffalo, NY, USA. Electronic address: lk22@buffalo.edu.
authors.forename: Lynn T
authors.initials: LT
authors.lastname: Kozlowski
authors.affiliation: Adjunct Professor of Law and Member of the Centre for Health Law, Policy and Ethics, University of Ottawa, Ottawa, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Sweanor
mesh_terms: D002755:Choice Behavior; D057220:Health Literacy / Q000941:ethics; D006801:Humans; D033181:Information Dissemination / Q000941:ethics*; D026684:Personal Autonomy; D011634:Public Health / Q000941:ethics*; D012306:Risk; D062789:Tobacco Products / Q000009:adverse effects* / Q000331:legislation & jurisprudence; D014030:Tobacco, Smokeless / Q000009:adverse effects / Q000331:legislation & jurisprudence; D014342:Truth Disclosure / Q000941:ethics*; D014481:United States
keywords: Cigarettes; Health information; Public health ethics; Smokeless tobacco; Vape