Opinion

By: Kashif Hussain, Senior Media Professional A half-truth does not always require a false statement. Sometimes, all it requires is half the evidence.In the digital age, journalism is under constant pressure to attract attention. A dramatic headline travels faster than a carefully qualified explanation. A statistic can be accurate but misleading without its baseline. A quote can be genuine but distorted when stripped of context. A scientific finding can be correctly reported while its limitations are left behind. This is where responsible journalism matters most. Health and science reporting are particularly vulnerable to this problem. There is a significant difference between saying that researchers found an association and saying that one thing causes another. Understanding that difference requires looking beyond the headline: Who was studied? What was their existing health history? What other risk factors were present? Was the research observational or experimental? And what limitations did the researchers themselves identify? The debate around smoking, vaping and tobacco harm reduction provides a good example. A few months ago, social media was flooded with claims suggesting that vaping could cause people to lose their eyesight. The headlines and short videos were alarming, but the underlying evidence required considerably more attention. When research involves people who have transitioned from smoking to vaping, their history matters. A person who has spent years smoking may already have accumulated significant health risks, and switching to vaping does not reverse damage that may have already occurred. Vaping is not a treatment for existing eye disease. At the same time, this does not mean that vaping should automatically be described as harmless. Studies have reported changes in retinal microcirculation among e-cigarette users, including differences in retinal vessel density and the foveal avascular zone. However, other research has found no significant differences in several retinal structural parameters. The evidence therefore warrants further investigation; it does not support the simplistic claim that vaping causes blindness, nor does it justify describing vaping as risk-free. That nuance is precisely what responsible journalism should preserve. Tobacco harm reduction is based on a relatively simple principle: not all nicotine products expose users to the same substances or risks. Combustible cigarettes burn tobacco and generate thousands of chemicals, including many toxic substances. Non-combustible alternatives remove combustion, but they do not remove all risk. The relevant question for adult smokers who cannot or will not quit is therefore not simply whether a product is “safe.” It is whether switching completely from cigarettes to a non-combustible alternative can reduce exposure to harmful substances compared with continuing to smoke. That is a question of relative risk, not an argument for calling any nicotine product harmless.There is also an important distinction between someone who has never smoked and an adult smoker looking for an alternative. A non-smoker does not need a nicotine product. For an existing smoker, however, the public-health conversation may involve cessation, nicotine replacement, or potentially less harmful alternatives. Treating all these situations as identical produces poor journalism and poor public-health communication. This does not mean journalists should become advocates for vaping or any other product. Quite the opposite. The journalist’s responsibility is to examine the evidence critically, including evidence that challenges the preferred narrative. If a study finds a possible health risk, report it. If the evidence is limited, say so. If participants had significant pre-existing risk factors, mention them. If a study establishes correlation rather than causation, do not turn it into causation through a headline. The same standard should apply in the opposite direction. Evidence suggesting that a non-combustible product may carry lower risks than cigarettes should not be presented as proof that the product is safe. The public deserves neither promotion nor fear disguised as journalism. It deserves context.Before sharing the next alarming health claim, perhaps the most important question is also the simplest: What does the actual evidence say beyond the headline? Because accuracy is not merely about publishing facts that are technically true. It is about giving people enough of the truth to understand what those facts actually mean.

By Mirza M. Abeer, Founder ASAP Every significant public health breakthrough has depended on two things, the first one being strong science and the second one being public trust. Scientific evidence shapes recommendations, while public understanding determines whether those recommendations influence behaviour. Together, they have transformed the way societies respond to challenges ranging from infectious diseases and road safety to nutrition and mental health. Public health has always advanced through a combination of research, communication and informed public engagement. Scientific progress also has another characteristic. It rarely closes conversations, more often, it opens new ones. As knowledge grows, existing assumptions are revisited, new evidence is evaluated and public health strategies continue to evolve. That process is fundamental to scientific progress, but it also places greater importance on the quality of the conversations that accompany it. Tobacco harm reduction has become one of those conversations. Around the world, researchers, clinicians, economists and policymakers are examining questions about relative risk, smoking behaviour, regulation and the potential role of smoke-free alternatives for adult smokers who continue to smoke despite repeated attempts to quit. These discussions reflect the natural progression of scientific inquiry and also demonstrate why complex public health issues deserve thoughtful examination instead of immediate conclusions. Public debate, however, often follows a different path. Complex issues are condensed into simple narratives that travel quickly across television screens, newspaper headlines and social media. Nuance gives way to certainty, context is stripped away and individual studies or isolated findings are presented as definitive answers to complex questions. Before long, the conversation shifts away from understanding the evidence and towards defending competing viewpoints. Complexity should never be mistaken for confusion. Public health deals with complexity every day. Medicines are evaluated by balancing benefits and risks. Nutrition is discussed through moderation and long-term health outcomes. Road safety combines engineering, regulation, education and individual responsibility to reduce harm. These conversations acknowledge complexity because complexity is often where better decisions begin. Tobacco deserves the same thoughtful approach. Smoking remains one of the leading causes of preventable disease and premature death worldwide, and helping smokers quit entirely remains the most effective way to reduce smoking-related harm. That objective continues to unite healthcare professionals, researchers and policymakers. The questions emerging around tobacco harm reduction seek to address a different challenge – how best to reduce harm among adult smokers who continue to smoke despite understanding the risks and making repeated attempts to quit. Whether, and to what extent, different approaches contribute to that objective is precisely the kind of question that should be explored through research, evidence and open discussion. For Pakistan, the quality of that discussion matters enormously. Information now reaches millions of people within minutes, often detached from the scientific context needed to interpret it responsibly. Headlines compete for attention, opinions spread rapidly and complex issues are frequently reduced to a few words or a short video clip. In such an environment, misinformation and sensationalism become public health challenges in their own right because they shape how people understand evidence, assess risk and make decisions about their health. This places a shared responsibility on everyone involved in shaping public discourse. Researchers have a responsibility to communicate findings clearly and transparently. Healthcare professionals play an essential role in translating evidence into practical guidance. Policymakers strengthen public confidence by engaging openly with evolving evidence, while the media contributes by providing context alongside headlines and creating space for informed discussion. Each of these institutions plays a distinct role in building public trust. Disagreement has always been part of scientific progress. Questions lead to research. Research generates evidence. Evidence informs better decisions. Public health benefits most when this process is allowed to unfold through rigorous inquiry, respectful debate and a willingness to engage with complexity rather than avoid it. Every important public health conversation ultimately shapes more than policy. It influences public confidence in institutions, trust in science and society’s willingness to engage with future health challenges. Tobacco harm reduction should be approached in that same spirit. Careful research, responsible communication and informed dialogue will not eliminate disagreement, nor should they. They will, however, create the conditions for better decisions, stronger public trust and more effective public health outcomes.

By Anwar Kashif Mumtaz, Lawyer and Economist For decades, tobacco control has pursued a clear objective – reducing smoking and the devastating health consequences that follow. Few public health policies have been more successful. Through higher excise taxes, comprehensive advertising restrictions, smoke-free public spaces, prominent health warnings and expanded smoking cessation support, governments have significantly reduced smoking rates and reshaped public attitudes towards tobacco use. These measures remain the foundation of effective tobacco control and should continue to be strengthened. Success, however, brings its own challenge. As markets evolve, technologies change and scientific understanding advances, policymakers must decide whether existing regulatory frameworks continue to deliver the best possible outcomes. One question increasingly sits at the centre of that discussion – should every nicotine product be regulated as though it presents the same level of risk? For decades, combustible cigarettes dominated the tobacco landscape, making a largely uniform regulatory approach both practical and appropriate. Today, that landscape is more diverse. Scientific research increasingly distinguishes between the risks associated with combustible tobacco and those associated with smoke-free alternatives, largely because the overwhelming majority of smoking-related disease is linked to the toxic by-products created when tobacco burns. That distinction has prompted policymakers in many countries to examine whether regulation should continue treating all nicotine products identically or become more proportionate to the risks they present. This is not just a scientific debate but fundamentally a question of regulatory philosophy. Effective regulation is not designed to eliminate complexity. It is designed to manage it in ways that best protect the public interest. Across sectors, governments routinely distinguish between products according to the risks they present, applying different standards, requirements and safeguards where appropriate. Tobacco policy should be evaluated through the same lens. From an economic perspective, regulation succeeds when it changes behaviour in ways that improve public welfare. That requires more than good intentions. It requires policies that are practical, enforceable and capable of adapting as markets evolve. Treating products that present different levels of risk in exactly the same way may appear administratively straightforward, but simplicity does not always produce the most effective outcomes. The objective should not be uniform regulation. It should be effective regulation. This principle is particularly relevant in Pakistan, where regulatory effectiveness is already challenged by a large illicit economy. According to a recent study by the Policy Research Institute of Market Economy (PRIME) and the Transnational Alliance to Combat Illicit Trade (TRACIT), illicit trade across sectors including tobacco, fuel, pharmaceuticals, tyres and tea is estimated to cost the national exchequer approximately Rs. 751 billion in lost tax revenue each year. Tobacco remains one of the sectors most affected. The consequences extend well beyond fiscal losses. Illicit markets weaken legitimate businesses, reduce regulatory oversight, limit consumer protections and undermine the effectiveness of public policy itself. That reality reinforces an important lesson. Regulation cannot be judged solely by the laws that are enacted. It must also be judged by how effectively those laws function in practice. Strong enforcement, robust product standards, age verification, manufacturing oversight and action against illicit trade are not separate policy objectives. They are all essential components of a regulatory framework that seeks to protect public health. It is within this broader context that tobacco harm reduction has become an increasingly important policy discussion. The issue is not whether smoking is harmful, that question was settled decades ago. Nor is it about replacing smoking cessation, which remains the best possible outcome for every smoker. The question is whether adult smokers who are unable or unwilling to quit despite repeated attempts should have access to regulated alternatives that may reduce their exposure to the harmful effects of combustion, while remaining subject to strict regulatory oversight. Different countries have reached different conclusions, reflecting their own legal frameworks, healthcare priorities and regulatory capacities. That diversity should not be viewed as a weakness. Comparative policymaking has never been about copying another country’s approach. It is about understanding how different regulatory models perform, learning from their outcomes and adapting relevant lessons to local circumstances. Public policy has always evolved by asking difficult questions and evaluating whether existing approaches continue to serve their intended purpose. Tobacco control should be no different. The objective remains exactly as it has always been: reducing smoking-related harm and protecting public health. If that is the outcome policymakers seek, then every regulatory assumption should remain open to thoughtful evaluation. Effective regulation is not measured by how consistently it treats every product. It is measured by how successfully it reduces risk, protects the public and delivers better outcomes for society.

For a smoker trying to quit, the advice often comes down to two words: just stop. Put out the cigarette. Fight the cravings. Get through the withdrawal. Move on. For some smokers, that approach works. But for many others, quitting is far more complicated. Research in Pakistan has found that only around one in four smokers attempt to quit, with successful cessation historically remaining very low. Studies have also identified nicotine dependence, stress, anxiety and social pressures among the factors that can contribute to failed quit attempts. Yet when another attempt fails, the smoker is often left with the same conclusion: perhaps the problem is a lack of willpower. That assumption deserves a closer look. A person who has smoked for years is not simply breaking a casual habit. Nicotine dependence can make cessation difficult, and repeated attempts are not necessarily evidence of unwillingness to quit. In fact, recent research from Pakistan has highlighted just how common multiple quit attempts can be. A 2026 study of smokers in Hyderabad found that among those who had attempted to quit, more than 40% had made three or more attempts. Willpower alone was also the most commonly reported cessation method. The question, therefore, is not whether smokers should quit. They should. The more difficult question is what should happen when the conventional approach repeatedly fails. This is where the conversation around smoking cessation needs to become more nuanced. Instead of treating “cold turkey” as the universal measure of determination, smokers can be encouraged to understand nicotine dependence, examine credible scientific evidence and learn about the different approaches available to adults who want to move away from combustible cigarettes. That distinction matters because the greatest harm from conventional cigarettes comes from combustion and the complex mixture of toxic substances produced when tobacco is burned. It also explains why the conversation around Tobacco Harm Reduction (THR) has increasingly entered discussions about smoking cessation. THR does not mean that nicotine products are risk-free, nor should alternatives be presented without scrutiny. It means examining the evidence around products and approaches that may expose smokers to fewer harmful substances than continuing to smoke combustible cigarettes. For Pakistani smokers, access to that information is particularly important. A previous study found that 68.2% of surveyed smokers were interested in quitting, while 52.9% identified nicotine addiction as the main obstacle to doing so. At the same time, 71.3% said they were unaware of available tobacco harm reduction products. That creates an information gap at precisely the point where smokers need it most. “Smokers should not be made to feel that repeated failure means they lack the willpower to quit,” said Shahida Khan, CEO of VCPHR. “They need access to credible information so they can understand nicotine dependence, examine the evidence around different approaches and make informed decisions. The goal should always be to move away from combustible cigarettes, and people deserve to know what options may help them get there.” The idea is not to replace one instruction with another. It is to give smokers the ability to make a more informed decision. Someone who has tried to quit once may try again. Someone who has failed five times may try a sixth. But if every attempt is based on the same approach that has already failed, perhaps the conversation should include more than simply telling the smoker to try harder. Research, evidence and informed choice can give smokers another starting point. Because quitting smoking should ultimately be measured not by how convincingly someone is told to quit, but by whether they are given the knowledge, support and realistic options needed to actually leave combustible cigarettes behind.