Michael J. McFadden (1951-2025) and the fight for smokers’ rights / tobacco harm reduction

a tribute

I found out about the December death of my friend and tireless campaigner for smokers’ rights (among other human rights), Michael McFadden, several weeks after it happened. Some friend, huh? We fell out of touch when my health was consuming most of my energy, and I kept meaning to.... Well, you know that old story and its moral. It doesn’t hurt to be reminded. (You can find his family’s remembrance statement here.)

I met Michael via correspondence in the 2000s when he was at the peak of his campaigning for smokers’ rights. We lived in the same metro for some of the 2010s, allowing me to hang out with him face-to-face, often in “smokeeasy” bars that evaded the blanket indoor smoking bans, something I cannot imagine enduring for anyone else. (No, I am not worried about the trivial health risk of environmental tobacco smoke, which is epidemiologically BDL for anything short of near-constant long-term exposure, but I really don’t care for the aesthetics of a smoke-filled room.) His disabilities made it difficult for him to get around, but he always did so with the enthusiasm and joy he seemed to always exhibit despite minimal worldly comforts. He is my touchstone for the concept of “if he could remain so happy and energetic, then....”

With his death, I am hard put to name an active American smokers’ rights advocate. That probably does not matter much, given that there is little chance of such advocacy making any difference. Notice that I used the words “tireless” and “energetic” to describe Michael, but not “effective”.

Of course, there remains an area of widespread advocacy for one right of smokers, the right to quit smoking the way they want, particularly by switching to vaping. Kind of an interesting situation, wherein the most defended right of people in a particular category is their right to exit that category in the most pleasant way possible. That advocacy focus would not look too good if the category were, say, being LGBTQ. This is not to say that promotion of low-risk alternatives to cigarettes is a thinly veiled form of anti-smoker hatred; the comparison was not meant to be an analogy, but merely a motivation to pause and think about what is the same and what is different about the two cases. What might be closer to an analogy is the weight-loss industry, which has developed some very effective new drugs for people who wish to stop being fat. How might that affect society’s treatment of people who do not prefer to stop being fat or who do not consider the profound side effects of the drugs to be worth it?

The use of the term “tobacco harm reduction” has become badly mangled, treated as if it only means providing low-risk substitute products for cigarettes, losing the meaning of “harm reduction”. I bear some of the guilt for that, as the one who created¹ that term in the context of our new² area of public health research and advocacy. Our work tied the phrase strongly to low-risk product substitution. But in fairness, our core thinking and some of what we wrote was focused on a genuine harm reduction philosophy, thanks in part to Michael’s influence (which in turn was thanks to my research associate, Paul Bergen, reaching out to involve him in our conversation from early on).

Absent a recognition of smokers’ rights, studying and promoting low-risk alternatives to smoking is just another form of “public health” paternalism, something akin to the nazi notion of “useless eaters”, rather than treating people as having inherent worth and dignity. Low-risk product advocacy without respect for the choices of the people involved fails to meet the moral standards inherent in the concept of harm reduction. Wars on drug consumers and frowned-upon sexual behaviors are the moral opposite of harm reduction even if they include some attention to exit ramps.

Efforts to punish smokers via taxation and restrictions (beyond protecting involuntary bystanders from the negative externalities) are deliberate harm creation, and difficult to justify under any widely-accepted moral code. There is a strong argument that smokers in the US and other high-tax jurisdictions suffer a greater lifecycle welfare loss from the punitive taxes than they do from the health effects of smoking. This is similar to the net harmful effects of drug prohibitions and other control measures that are not based on harm reduction. Michael did a great job of reminding anyone who would listen of points like these. Harm reduction is about informed autonomy and overall welfare, making Michael an advocate of tobacco harm reduction well before anyone called it that. Indeed, smokers’ rights and tobacco harm reduction are close to synonymous. Michael became an advocate for low-risk products (and eventually switched to vaping from smoking, at least mostly) for the right reason -- because it was the right of smokers to have access to and know about that option, and to be able to choose it if and only if they wanted.

The “anyone who would listen” description of Michael reflects the fact that listening to him required some effort. He was widely recognized by the early advocates of tobacco harm reduction who sought out his message. But as others started to misuse that term, they had no interest in his message and it was difficult to find any hint of it. Self-styled “THR” advocates who celebrate punitive taxes as “effective”, who do not support smokers’ rights (and thus do not support genuine harm reduction), drowned out the discourse about human rights. Michael himself also made listening to him a bit of a challenge, never quite mastering the leap from having something to say that is useful and correct (at least arguably so) to saying it in ways and in forums that reach people who are not actively seeking it. He was also, um, a bit intense, the most intense totally laid-back person you could ever meet outside of holy people.

I feel a lasting kinship with Michael, a shared spirit akin to Diogenes or a wandering monk, being interested in pursuit of truth to the neglect of interest in the material world, including not worrying enough about whether the truth is heard. A fine trait for a monk. Not great for an advocate. Some of us will miss him in his absence; most missed him when he was present.

1. My research group and I were not the first to ever use the phrase. I am aware of one reasonably prominent publication that used it a few years earlier. But the phrase was not used in practice until we made it a thing, starting c.2005. Indeed, we debated for a while what to call this new area of research and advocacy we were creating, so everyone might be using different vocabulary if I had made a different decision.

2. (I am genuinely disappointed that Substack would not let me go full David Foster Wallace and make this a footnote to the previous footnote.)

Ours was not the first venture into this area of research and advocacy. Brad Rodu was the father of the field, starting his advocacy for advocacy (meta-advocacy!) for low-risk alternatives to smoking a few years before me. But ours was the first research group focused on the topic, and so we made it so Brad was no longer a voice in the wilderness.