Expert statements on WHO and tobacco harm reduction

100 experts sign a public letter on the failure of the WHO approach to tobacco smoking and public health. In this post, they express their views in their own words 

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Psychoactive Podcast: The E-cigarette revolution – vaping, nicotine and harm reduction

I had an excellent conversation with Ethan Nadelmann, the founder of the New York-based Drug Policy Alliance for his outstanding Psychoactive podcast series about all aspects of drugs and drugs policy, which I highly recommend.

In this episode, “The E-cigarette revolution”, we covered vaping, nicotine, harm reduction – science, policy, politics and controversy – with Ethan as host putting the challenging questions.   Listen via your usual podcast provider (search on Psychoactive)… or via these links.

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CHEST journal point and counterpoint – E-cigarette use for harm reduction in tobacco use disorder: Yes/No?

A debate about the merits of e-cigarettes for tobacco harm reduction

The September 2021 edition of CHEST, the respiratory journal, features a point/counterpoint debate on the value of e-cigarettes for tobacco harm reduction.  I am making the case in favour (the Point) and Dr Hasmeena Kathuria (Boston University) and Dr Frank T. Leone (University of Pennsylvania) are making the case against (the Counterpoint).  We each provide a shorter rebuttal to the arguments made by the other.  We also recorded a 30-minute podcast to air these arguments face-to-face.  Recognising the broader interest in the subject, CHEST has kindly made this content open access so far.

Whatever you think of the respective arguments, it was refreshing to find a forum willing to air them in a respectful and measured way, I am grateful to Drs Kathuria and Leone for engaging and making their case and to CHEST for providing the platform.  I wish we could have much more debate like this.

For ease of access, I have added the relevant links below.

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Will FDA harm health, destroy businesses, and protect the cigarette industry through regulatory overkill? A preview.

This blog gives my take on how to think about the FDA’s decisions (some taken, some forthcoming) on approving or denying thousands of “pre-market tobacco applications” (PMTAs) to allow vaping products to remain on the US market.  FDA must make decisions no later than 9th September 2021, following legal action brought against the agency. FDA’s Director of the Center for Tobacco Products, Mitchel Zeller, provides the background in a February 2021 blog.

There’s a lot to be written on this, but I will settle for 16 observations and questions that will shape my take on FDA’s announcements.

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Health Canada consults on the really dumb idea of making vaping a less appealing alternative to smoking

Health Canada is trying to ban almost all vaping liquid flavours. This is on top of measures to limit nicotine strengths and marketing. It is the nearest they can get to a prohibition without actually having to prohibit the most promising low-risk rival to cigarettes. The likely effects are obvious: more smoking. But in a bizarre twisting of reality and evidence, Health Canada finds that making vaping less attractive relative to smoking will… um … reduce smoking. And that’s how it justifies the measure.  We respond with a counter-analysis.

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Letter: WHO must urgently reassess its tobacco & nicotine policy and stop causing harm

WHO should be building public trust, not giving its critics further justification

It’s World No Tobacco Day and we have sent our detailed letter and multiple critical expert comments to the WHO Director-General.   The covering note and links to relevant documents are reproduced below.  I hope it causes them to pause and reflect.  My guess is that Tedros has been very badly advised here.

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WHO has gone rogue on tobacco policy – millions at risk from tired dogma and a refusal to grasp innovation

WHO has a self-defeating approach to the global burden of tobacco-related death and disease

A message for World No Tobacco Day, 31 May 2021

If you just want to go straight to our unforgiving and detailed letter to WHO – it is here.

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Holding the Bloomberg anti-vaping propaganda complex to account

An investigative report criticising Bloomberg’s anti-vaping stance draws a petulant response – we review the case

Bloomberg scrutinised. Unusually, a journalist decided to take a sceptical look at Bloomberg Philanthropies and its many proxies and the impact of their war against vaping.  The result is an excellent must-read piece by Mark Gunther (@MarcGunther) in the Chronicle of Philanthropy: Bloomberg’s Millions Funded an Effective Campaign Against Vaping. Could It Do More Harm Than Good? (web archive) (23 March 2021).

It is first-class public-interest journalism, with some hard messages for Bloomberg but plenty of balancing comment too.

The response. The interesting thing is that this drew a joint response from Kelly Henning of Bloomberg Philanthropies, Matthew Myers of the Campaign for Tobacco-Free Kids and Robin Koval of the Truth Initiative. See Vaping and Philanthropy: Debating Strategies That Work (web archive).  There is a substrate of anger and panic in the letter that suggests that Gunther hit a raw nerve.

What is unusual about this letter is that Henning, Myers and Koval actually try to defend their positions.  Normally, they don’t defend their positions, they just assert them with millions of dollars of amplification. It offers a rare opportunity to provide a critique of their stance.  So I have taken their response letter, broken it down into 15 propositions, and provided a response to each.  Each section starts with a quote from the letter pulled out in a quote box in bold dark-blue. The letter is analysed in its entirety.
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Will the Netherlands become the next casually negligent ally of the cigarette trade? Twenty-four experts advise a rethink

So let’s make the e-cigs less appealing and see what happens… what could possibly go wrong?

The Netherlands is proposing to ban e-cigarette flavours – what could possibly go wrong?

The government of the Netherlands,  led by Paul Blokhuis, State Secretary for Health, Welfare and Sport, is in imminent danger of fooling itself into becoming an unwitting ally of the cigarette trade.  By taking measures to make vaping less attractive (notably by proposing a ban on all non-tobacco flavours for e-cigarettes), it threatens to degrade the appeal of a low-risk rival to cigarettes, provide regulatory protection to the cigarette trade, prolong smoking, obstruct quitting, and add to the burden of disease and death. All this in the name of protecting youth, while managing to harm both adults and adolescents. Quite a feat for any politician.

The problem is hubris – believing that the world responds to regulation in the way the regulator thinks it should. Experience suggests foreseeable perverse consequences will be the result of the ill-conceived prohibitions of much safer alternatives to smoking, including flavoured e-cigarettes.

It really isn’t difficult to understand why and how this would happen – I can only assume the State Secretary received very poor advice, which would not be unusual in this field.  Nevertheless, twenty-four international experts have set out the arguments and evidence in detail in a submission to the Dutch government, hoping to spare Mr Blokhuis later embarrassment and, even more importantly, to avoid yet more death and disease from smoking in the Netherlands.  It should also be a wake-up call to like-minded politicians and naive policymakers in the United States, European Union, and the World Health Organisation who continue to fail to grasp the impact of low-risk products in the real world.

The case is set out in 30-page submission to a Dutch government consultation on the measure.  The relevant documents are:

To provide a more digestible version of the submission, I have included below the twelve sections of the summary below with a link to the corresponding twelve sections with more detail and references.

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Response to the extremely poor European Commission SCHEER preliminary opinion on e-cigarettes

….and another thing.

 

Further to my 30 Sept blog: European Commission SCHEER scientific opinion on e-cigarettes – a guide for policymakers.

I have made a short submission to the consultation on the European Commission SCHEER Committee preliminary opinion on e-cigarettes.  You can respond to the consultation on this very poor scientific assessment here, where you can find all relevant documentation.  The closing date is just before midnight CET, Monday 26 October 2020. All contributions are helpful, but keep it polite, objective and on the subject – the science of e-cigarettes – and most importantly, in your own words.

In my view, the problems with the report are too serious and fundamental to justify a line-by-line and paper-by-paper incremental review.  I set out the fundamental problems on my 30 September blog:  European Commission SCHEER scientific opinion on e-cigarettes – a guide for policymakers.  So rather than pretend that this dreadful report can be easily fixed with a few more references and some different takes on the evidence, I have reiterated the main themes of that blog in the “Summary” box of the consultation submission form and provided the blog as a link and upload.  I’ve no idea whether they will give this the slightest attention, but they should, because I’ll back when they’ve done the final report.

Update 26 Oct 2020. It’s the closing date and I’ve made an additional submission.

Here’s my response: Continue reading “Response to the extremely poor European Commission SCHEER preliminary opinion on e-cigarettes”