“The finger and the Moon” in tobacco control| Tabaccologia

Article

“When the wise man points to the moon, the fool looks at the finger”: so, goes an ancient Chinese proverb. Its meaning is clear: one must not stop at the surface of things and events, but rather grasp their depth and truth, without ever losing sight of the central issue, the Moon, which, across time and cultures, has acquired increasingly rich and nuanced meanings. In its common interpretation, the Moon represents the real problem that risks being obscured or neglected when attention is focused on the finger that points to it. The finger, by contrast, refers to a contingent issue – sometimes merely apparent or secondary – which may nevertheless serve as a gateway to the deeper problem: the Moon itself.

The “fool” is often a cunning figure disguised as a sage. Such an individual has every interest in denying the objective existence of the Moon, diverting public and political attention toward the secondary facets of the issue, thereby avoiding engagement with its essential core.

Similarly, when matters of the common good are debated, the “fool” instrumentally reduces the question to subjective, narrow, and partial claims, relinquishing any holistic vision of the real problem.

This dynamic cuts across all domains of human existence: from geopolitical scenarios to everyday traffic disputes, from climate and health emergencies to the most mundane condominium meetings.

Contemporary mass-media representations, however, seem in part to reverse the warning embedded in the ancient proverb: it becomes necessary to dwell on the processes that construct reality, on the “gestures” and social actions that frame and define it. From the perspective of media systems and those who seek to analyse them, there is no Moon without a finger pointing to it, nor any finger without a hand, an arm, an agent, and a context directing it toward the underlying issue.

At first glance, the concept of the “finger and the moon,” when applied to tobacco control, may appear to be a purely metaphorical, symbolic, or philosophical reference. Yet, once we move beyond metaphor and consider the tobacco problem in its concrete reality, it becomes immediately evident how extraordinarily relevant and necessary this image truly is. Tobacco and conventional cigarettes – the Moon – continue to represent the most severe global public health emergency, with approximately eight million deaths each year attributable to smoking-related diseases [1-4].

This staggering human toll compels the scientific community and public institutions never to lower their guard. Novel nicotine products – electronic cigarettes (both disposable and refillable), heated tobacco devices, and nicotine pouches – represent the finger. These are not harmless products: they are generating a new wave of nicotine dependence, particularly affecting younger generations. This is a cause for serious concern, as early exposure to nicotine alters neurological development and significantly increases the risk of long-term addiction.

The typical trajectory of many young users is now well documented: initiation occurs with novel products – often perceived as less harmful or simply more accessible and fashionable – followed by progression to conventional cigarettes. In Italy, more than 80% of electronic cigarette users are dual users, meaning they concurrently use both conventional and electronic cigarettes. This group exhibits the highest risk profiles for health, as dual exposure amplifies harm without providing any real reduction in overall risk. Some individuals subsequently abandon novel products and smoke exclusively conventional cigarettes, confirming that combustible tobacco – the Moon – remains a frequent endpoint.

Likewise, many long-term adult smokers, mistakenly believing they are reducing their risk of disease, supplement conventional cigarettes with one or more novel products without abandoning combustible tobacco. The result is a multiplication of harmful exposures, not their reduction.

It is therefore essential that tobacco science and tobacco control adopt a comprehensive, balanced perspective guided by independent scientific evidence: a perspective capable of simultaneously addressing both the finger-novel nicotine products, with their specific criticalities – and the Moon – conventional tobacco and its devastating health consequences. To look only at the finger is to risk underestimating the epidemic of traditional smoking; to ignore the finger is to fail to recognise the new dynamics of dependence that sustain and perpetuate that same epidemic. What is required, in short, is the wisdom to keep both perspectives in view: the finger and the Moon.

References

1. U.S. Centers for Disease Control and Prevention (CDC). Smoking and Tobacco Use.Publisher Full Text
2. World Health Organization (WHO). Tobacco fact sheet.Publisher Full Text
3. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The health consequences of smoking – 50 years of progress. A report of the Surgeon General. Centers for Disease Control and Prevention (US): Atlanta (GA); 2014.
4. Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease 2023: Findings from the GBD 2023 Study. IHME: Seattle, WA; 2025.