Lancet commentary – Nicotine without smoke: fighting the tobacco epidemic with harm reduction

Abstinence-only or alternatives?

I am proud to be a co-author of a commentary published today in The Lancet: Nicotine without smoke: fighting the tobacco epidemic with harm reduction (PDF) with Robert Beaglehole (lead author), Ruth Bonita and Ben Youdan. In a nutshell, we take issue with the anti-innovation stance of WHO and many groups working in public health:

Vaping and other smoke-free products have the potential to reduce the enormous harm of smoked tobacco products. The stakes of getting policy responses to smoke-free products wrong are high, especially if such restrictions stop millions of the world’s smokers accessing safer alternatives. It is disappointing that in its latest tobacco report,[3] WHO clings to outdated orthodoxy when it could embrace innovation. Equating smoke-free products with cigarettes only serves to protect the stranglehold of the cigarette trade on the world’s nicotine users and will nullify the potential of modern tobacco harm reduction strategies.

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Over 70 experts call on WHO to embrace technology innovation in the fight against diseases caused by smoking

Dear WHO FCTC, do not block the exits for people trying to quit smoking using vaping, smokeless, heated tobacco or novel products. Remember, the enemies of innovation can do more harm than good.

Every two years, the Parties to the WHO Framework Convention on Tobacco Control meet to discuss how to advance the treaty. The 8th meeting of the Conference of the Parties (COP-8) is being held this week, 1-6 October, 2018 in Geneva.

I was one of those agitating for the FCTC back in 1999-2003. Generally, the FCTC doesn’t do what normal international treaties do – address some transboundary issue like climate change, international trade or intellectual property. It tries to establish norms for regulation of tobacco commerce within countries – a kind of solidarity mechanism for national anti-tobacco policy.  The problem is that this idea all goes sour when the WHO, Convention Secretariat and/or Parties agree, in solidarity, to normalise truly terrible policies – for example, to encourage prohibition of e-cigarettes, to treat all smokeless tobacco as though it is the same and just as risky as smoking, or to regulate heated tobacco products as though they are cigarettes.   All really harmful ideas that protect the cigarette trade, perpetuate smoking and cause more disease and death.

Letter to WHO

So, determined to resist this drift into globally harmful policy promotion, a group of 72 of us have put together a letter to register our concern and to suggest there is a better way: to embrace tobacco harm reduction… here it is.  The PDF here: Innovation in tobacco control: developing the FCTC to embrace tobacco harm reduction 

The text of the letter is below:

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Letter to WHO’s DG against prohibition and for risk-proportionate regulation

Mike Bloomberg and the WHO DG  launching the Bloomberg-funded report on the Global Tobacco Epidemic 2017. An unsurfaced conflict of interest?

We’ve sent a letter to WHO and the FCTC secretariat in advance of FCTC COP-8 (1-6 October, Geneva) – protesting about WHO’s inclination towards prohibition and excessive regulation of alternative nicotine delivery systems (ANDS).  For background, see papers on vaping (FCTC/COP/8/10) and heated tobacco products and others (FCTC/COP/8/8).

The letter by David Abrams, Ray Niaura, David Sweanor and me is available in PDF form with all footnotes here – and the text is reproduced without notes below. Continue reading “Letter to WHO’s DG against prohibition and for risk-proportionate regulation”

WHO’s anti-vaping scientific castle of cards toppled

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Toppled!

Updated 9 November with UKCTAS report translations

The UK Centre for Tobacco and Alcohol Studies (UKCTAS) has produced a devastating critique of the WHO paper on ‘Electronic Nicotine Delivery Systems’ (e-cigarettes or vaping products to everyone else).  The paper by WHO is for the 7th Conference of the Parties to WHO’s tobacco control treaty, the Framework Convention on Tobacco Control, (FCTC COP-7) which will be held in Delhi 7-12 November, 2016.

A tremendous effort by the authors John Britton, Ann McNeill, Linda Bauld and Ilze Bogdanovica, and the reviewers (disclosure: I was a reviewer).

The report speaks for itself, so here are the relevant links to the report, some unofficial translations and the executive summary.

Contents

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WHO tobacco meeting – could the FCTC do something useful on vaping?

I’m sometimes accused of being a WHO-sceptic, or worse. No more! In the run up to the Framework Convention on Tobacco Control  COP-7  meeting in Delhi, 7-12 November, I have been challenged to say something positive about how the FCTC could do useful and constructive things on vaping and tobacco harm reduction from a public health point of view, other than the default answer “absolutely nothing at all”.

I sometimes refer to ENDS – Electronic Nicotine Delivery Systems – to mean vaping equipment and liquids, e-cigarettes etc. Apologies.

Here we go… Continue reading “WHO tobacco meeting – could the FCTC do something useful on vaping?”

First build your echo chamber – how WHO excludes dissent and diversity

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Most international treaties welcome observers and diversity of opinion. Not the WHO Framework Convention on Tobacco Control, which has its next major Conference of the Parties on 7-12 November 2016, in Delhi.  The WHO carefully choose who it allows to observe its secretive proceedings, ensuring only organisations that agree with it are admitted as observers. It betrays the intellectual void at the heart of the WHO and its treaty – it simply cannot cope with scrutiny, challenge or reconciling other interests or constraints. A comparison with the approach to observers taken by the UN convention governing climate change is instructive… Continue reading “First build your echo chamber – how WHO excludes dissent and diversity”

Who or what is the World Health Organisation at war with?

Dr Chan is at war
Dr Chan is at war – but who or what is she fighting?

The World Health Organisation does a good line in war-like rhetoric when it comes to tobacco policy. But what is it actually at war with? In this post, I examine the confusion in ‘tobacco control’ about what it is actually trying to achieve. Continue reading “Who or what is the World Health Organisation at war with?”

WHO’s Director General’s casual irresponsibility promotes death and disease through protecting the cigarette trade

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National governments should protect the cigarette trade

I’m always wary of calling a new low in public health, given the competition down in its murkiest, most depraved depths, but here is a strong contender…

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Professor Gerry Stimson – reaction to WHO FCTC position on e-cigarettes (ENDS)

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UPDATE: The E-cigarette (‘ENDS’) final language

Statement On the Declaration of the 6th Conference of the Parties of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC). 

By Professor Gerry Stimson*, Emeritus Professor at Imperial College, London and co-director of Knowledge-Action-Change (KAC) Continue reading “Professor Gerry Stimson – reaction to WHO FCTC position on e-cigarettes (ENDS)”