Etter is an establishment researcher who is unbiased and comes out with honest research results. However he is about 10 years behind others in tobacco control who realise that medicine changes over time, and who have moved on. If it didn't then we would still be using bloodletting.
In 1900, doctors looked back at the practices of 50 years before, in 1850, and marvelled at how crude and ineffective they were. But keep in mind that the doctors of 1850 considered themselves educated, capable, and expert.
In 1950, doctors looked back at the practices of 50 years before, in 1900, and marvelled at how crude and ineffective they were. But keep in mind that the doctors of 1900 considered themselves educated, capable, and expert.
In 2000, doctors looked back at the practices of 50 years before, in 1950, and marvelled at how crude and ineffective they were. But keep in mind that the doctors of 1950 considered themselves educated, capable, and expert.
In 2062, doctors will look back at the practices of 50 years before, in 2012, and marvel at how crude and ineffective they were. But keep in mind that the doctors of 2012 consider themselves educated, capable, and expert.
What do we learn from this? If your answer is, "Nothing", you are destined to be just another journeyman doctor (or scientist of any flavour). The people who move medicine (and science) forward are the people who don't agree with current ideas or practice.
Some scientists never seem to learn that some of what they think they know is just not true. They don't seem to be able to grasp the fact that although they think of themselves as clever, in just fifty years time others will look back and view them as ignorant bunglers.
Of all the sciences, medicine is the worst: it clearly demonstrates, better than any other, that in a few short decades the knowledge you think you have is shown to be grossly inadequate and in some cases just plain wrong.
Doctors need to be able to look ahead, if they are doing anything other than putting a splint on a broken arm. The idea that they fully comprehend areas in which there is debate is simply laughable. I believe that medical science has known for about twenty years that Harm Reduction works better than direct withdrawal if the measurement used is the number of lives saved. Normally, we expect doctors to start using something widely when it has been proven to work for twenty years, so around now is when the majority should wake up to HR.
Etter is not at fault, he is a symptom of establishment medicine: don't support anything unless your national college of surgeons recommends it officially. By that time it has been the best option for thirty years; but if you go against this established practice, you risk being seen as a dangerous revolutionary. In the professions, that is usually an unacceptable risk - it is far easier to take the safe, cautious approach and do as everyone else does. Let someone else move medicine forward, and let them take the risk.
In a lot less than fifty years time, the idea of using NRTs with a proven success rate of 2% - 10% will be so ludicrous that doctors will ask how anyone can have supported it, when Sweden reduced both their smokers and their smoking death rate by 40% with THR, and the other countries only manage a paltry 0.4% per year with their NRTs. But right now NRTs still look attractive to those who have to toe the party line - because they have been told they work.
It is important to the system that NRTs work and are well-supported - otherwise, look how ludicrous many thousands of doctors' work will appear. So, like the emperor's new clothes, they seem rather good to the believers. Belief is impervious to facts.
It is important to believe in the system, because a sudden realisation that things are not all they should be can be shattering to some. Tell me again how many doctors commit suicide?
If only it was possible to know what they will know in fifty year's time... Actually it's not that hard - what is known at any given time was already realised by some, thirty years before. They just had to keep quiet about it, in order to hold on to their jobs.
