This is an update to an earlier post about the PMI-funded Foundation for a Smoke-Free World (FSFW). My main argument in that post can be summarised as:
- The FSFW is a good thing with sound and important objectives that are valuable to public health
- It has sufficient irreversible funding commitment and independence from the funder’s competing interests to do useful work that can be trusted
- That the criticism and position-taking of many in tobacco control was premature and an unthinking ugly reflex in advance of knowing the foundation’s financing system, legal structures and governance
- That it is unethical to prefer $1 billion allocated for public health research to be wasted and to work towards wasting it, rather than trying to make it work
- That the opposition is built on anti-corporate “tobacco warrior” mindset or dislike of anything that challenges an “abstinence-only” agenda that would be mocked in any other field of public health
- Its critics need to grow up and rethink
Update from the World Conference on Tobacco or Health
My views have not changed much, but I wanted to provide a quick update from the World Conference on Tobacco or Health (twitter:#WCTOH2018) in Cape Town, where the subject of the FSFW is a hot talking point. And not in a good way…
The ignorance and strategy failure of tobacco control
The bloodlust of the critics of the Foundation on display here is vile – an unethical and mindless reflex response to innovation. The tobacco warriors are now explicitly defining their mission as a war on Big Tobacco, and not a war on disease. While these may have been one and the same some years ago (it was never the case for smokeless tobacco), now is exactly the wrong time to double down on a war with Big Tobacco (see David Sweanor’s post: Tobacco control and the tobacco industry – a failure of understanding and imagination).
Haven’t they noticed that there is an emergent major technology disruption? Can they not see that a move to non-combustible tobacco products has a fundamental technology driver (the improving energy and power density of batteries) that will revolutionise this industry, both in terms of its technology and its impacts on health?
Can anyone explain what bad things are supposed to emerge from a foundation with these objectives (“to accelerate global efforts to reduce health impacts and deaths from smoking, with the goal of ultimately eliminating smoking worldwide”)? How this leadership and the degree of independence it has secured could lead to bad outcomes? What, exactly, is the threat to health behind all this vitriolic opposition?
Opportunity lost
I keep hearing good people say “if only we had money to do this survey” or “we need to know more about dual use” or “what causes smokers to take up or reject low-risk products and what could change that?” or “why hasn’t someone developed standard testing protocols?” or “how could harm reduction work in poorer countries?”or “if only we could work out what is going on in Japan”… the list is endless. But that is exactly what this foundation is for. And it meets a real need.
The established funders, notably FDA/NIH do not fund this kind of thoughtful inquiry – they are mainly looking for reasons to intervene and to regulate. It is another failure of imagination to be unable to see what good can come of this. But it is deliberate. The Campaign For Tobacco-Free Kids has forgotten what it is supposed to do and is focussed on its plan to ‘isolate’ the tobacco industry.
Isolation, it seems, is more important than the conduct of valuable public health research. They would rather a billion dollars for public health was wasted or returned to PMI shareholders than allow the possibility that a tobacco company is doing a good thing. A tobacco company doing a good thing just cannot be allowed to happen in their world-view narrative and strategy (as above). And for that reason, the FSFW must be defined, a priori, as a bad thing… whatever the reality.
My reaction
So how am I feeling about this …? Appalled, basically…
- at the bullying and hounding of Derek Yach (branded a pariah) and his team: people trying to do the right thing with an innovative approach;
- by the chilling effect on researchers and potential staff and board members that the bullying culture rife in tobacco control has created – this is deliberate McCarthyism;
- that the interests of those who are at greatest risk, that is smokers, have been disregarded and their views ignored;
- by the unthinking rush to judgement and condemnation of the foundation well before the financial, legal and governance machinery was in place;
- by the primacy given to ‘industry denormalisation’ over public health;
- by the righteous ‘useful idiots’ who are trying to block any product or research innovation in the tobacco field and are doing their bit to protect the cigarette trade;
- that the FSFW was excluded from the conference and in particular that it was barred from representing itself in a conference session devoted to the foundation itself. What sort of discussion is that?
- by the lack of open-minded and relentless curiosity in ‘tobacco control’, which I think is a professional duty given the life and death consequences involved
- by the astonishing stupidity of trying to ensure $1 billion allocated for public health is wasted.
Disclosure: other than counting Derek Yach as a friend since we both worked on the gestation and birth of the WHO FCTC from 1999, I have no connection with the foundation and I have no plans at present to apply to be on its staff or board or to apply for grant funding. However, I wish the initiative well.
CFTFK is a hate group. Period.
I think the ‘war on big tobacco’ and the associated unwillingness to allow a tobacco company to be seen to be doing a good thing are smoke screens for the other issue you touch on Clive – the fact that billions of dollars are being funnelled into creating evidence to support prohibitionist policies on reduced risk products and FSFW will fund research that threatens to shine a light on the appalling anti-science that is being carried out.
Up until recently there has been a massive imbalance between funding for ‘tobacco control’ science and funding for independent research asking the questions you identify as being important. In the UK CRUK have recognised this and some better research is starting to come through. FSFW represents a potential large scale boost to the funding of that sort of research and quite simply, tobacco control do not want those questions answered – therefore FSFW must be vilified at all costs and researchers should be aware that their careers will be ended before they’ve started if they as much as glance in FSFW’s direction. It wouldn’t surprise me if before long one of the entry requirements to the tobacco control club is to have published a paper about the evilness of FSFW.
Why they do this is anyone’s guess and probably fertile ground for conspiracy theorists, but one thing is for sure: the behaviour surrounding Derek and FSFW at WCTOH makes me more sympathetic to Derek’s aims, not less so.
I think an intelligent response to the FSFW is the same regardless of the intentions behind it. Logically, the foundation might be a serious effort to facilitate a move away from combustibles, or it might be mere cynical public relations. The response can either be to act like the stated intentions are accepted as genuine, or to simply oppose the whole enterprise (as is currently being done).
There are four possible outcomes.
If they are serious and their stated goals are facilitated (promote risk-proportionate regulation, getting support for measures that disadvantages combustibles, etc.) we likely get a public health breakthrough of historic significance.
If they are serious and are simply opposed, we very likely forgo that public health breakthrough. Or they pull it off despite the opposition and historians write uncomplimentary things about those opponents that their grandchildren will someday read.
If they are engaged in a PR sham and people work to facilitate the stated intentions, their scurrying away will very quickly show their statements to be hollow. So, they lose the PR battle.
If they are engaged in a sham and people simply oppose them we forgo the opportunity to show it is a sham, they get to trumpet their sincerity and the way they were blocked, continue selling cigarettes, and win the PR battle the sham was designed to accomplish.
The only rational response I see is to seek to facilitate their stated commitment. In public policy this comes up a lot. If someone announces an intention to do something you want to see done, the rational response is to publicly welcome it regardless of whether you think they are sincere, and to seek to facilitate the stated intention as effectively as possible. That makes it more likely that you get what you want and prevents anyone getting away with mere posturing. The least logical response is to attack and oppose their stated aim based on a belief in their insincerity.
The intolerant evolution of tobacco control resembles the evolution of alcohol prohibitionists a century ago in the US. After per capita consumption of alcohol declined by 90% in the US from 1840 to 1900, Wayne Wheeler, the WCTU and other alcohol prohibitionists doubled down and campaigned to ban all alcohol.
Like the alcohol (and marijuana) prohibitionists, the church of tobacco control is controlled by intolerant abstinence-only moralists (even though most support harm reduction for all other public health problems).
Seems like the only thing CTFK, WHO, Bloomberg and tobacco controllers know about the tobacco industry is how to demonize it (and all tobacco products), at the same time they’ve double down on their own deep denial (that is delineated in their many anti-THR policies) of the obvious fact that demonizing/banning/censoring/taxing the least hazardous tobacco products only protects the most hazardous tobacco product (cigarettes). They’ve been denying basic principles of economics.
CTFK’s chart plan to destroy the tobacco industry reveals CTFK’s ignorance of the industry (and the ignorance of anyone who takes that chart seriously).
For the past 25 years, Big Pharma funded CTFK, ACS, AHA, ALA, AMA, AAP, etc have prohibited themselves and other tobacco controllers from meeting or talking with anyone from the tobacco industry.
The only exceptions I recall were when Matt Myers negotiated the 1997 Global Bailout (that immunized cigarette companies from lawsuits, and that I and others defeated in the US Senate), the 1998 MSA, and the anti-THR Tobacco Control Act with Philip Morris/Altria & GSK/J&J in 2003/04, which CTFK then served as PM/Altria’s useful idiot by falsely telling Congress and the news media that the cigarette protecting TCA was necessary to protect another generation of children from Big Tobacco.
An effective way to prevail over the tobacco control extremists is to take away their public funding. American THR advocates need to urge/convince Congressional Republicans and Trump to further slash the anti-THR budget of FDA/NIH/CDC, and to reduce US taxpayer funding for the intolerant WHO.
If it had decreased by 90% there wouldn’t have been a need for the Temperance movement.
Google ‘Prohibition in the USA’ and see the 1898 Congressional Report on spirits consumed
per capita and total consumption of spirits 1860 to 1898, population grew fourfold, drinking
decreased by 30%. They drank a lot of whiskey!
Tobacco control in the UK coincided with the Election of Robert Mugabe in Rhodesia. All our
fine Virginia tobacco came from white owned plantations, farmed by cheap black labour.
Were we going to let a Black Communist fund his war against apartheid with money from Rhodesia’s greatest cash crop.
In the USA foolish advertising left the Giants of Tobacco to being sued for claiming smoking was healthy.
I’m often wrong, but smoking harms, alcohol harms, these are risks we as adults have to accept in the lifestyle choices we make. Today bicycles appear more dangerous than any drugs I know of.
Tobacco Control has become a corrupted industry full of vile people with vested interests. Its time for fresh thinking and time for Tobacco Control to go away. So, how is that to be made to happen??? Wish I knew. But it SHOULD be made to happen.
Perhaps I am naive for asking this question, but here it goes: what would happen if a critical mass of pro-THR health scientists simply and suddenly decided to take up the funding from FSFW? They could reach a sort of public contract stating that (i) PMI will have no access to the research until it is published and also to get from PMI an agreed timeline to start the gradual end of cigarette sale and promotion, not only in rich countries but also on developing and middle income countries. The contract could also include an end clause and heavy penalties to PMI if it is breached.
Surely this hypothetical critical mass of researchers will be vilified and ostracized by the usual suspects, perhaps they will be banned from publishing in many (if not most) public health journals. However, they will be doing good science and, with the available funding, several journals could be founded. The funding would also allow to recruit students and postdocs and to do (yes yes) PR work (science does involve PR). It could develop into a high quality parallel academic and research system.
I know this is utopian, but people should evaluate this by looking at the present situation. I may be completely mistaken in what I write below (and I accept and welcome criticism) as I work in a completely different field (physics), but nevertheless here it goes:
There are tons of money (NIH, MSA, Bloomberg) poured into junk and quasi-junk research to misrepresent vaping, HnB and snus. This produces a massive flow of publications ranking from the utmost junk to the mediocre, all of them dwelling in emphasizing micro-risks from these products. This creates in outsiders (political class, media, researchers in other fields, the broad society) the illusion of a legitimate scientific controversy, that the junk producers seem to be winning (as from outside) by mere “number counting” of articles and institutions producing and sponsoring them.
It would take a similarly massive effort to counterbalance this and the few heroic researchers doing good work on THR simply lack the resources and time to do it. They are able to counter some of it, the more scandalous pieces, but not the steady flow of “only deficient but not junk” articles or those that are “more or less OK” the damage is made by authors reporting alarming conclusions that do not follow from their actual results (a clever way of deceiving because most pundits will only read the abstract and conclusions). It would take a lot of well funded effort (individual and institutional) to counter this.
Just as an example: It took Jenssen et al in Portland a few days and a few $$ to carry on a crappy analytic chemistry lab experiment, with vaping machines puffing dry hits, to get a letter to the editor of NEJM published that was screaming BEWARE BEWARE FORMALDEHYDE and bingo !!! over 100 fast citations and results amplified by hundreds of media outlets and charities round the globe. It took a much larger effort for Farsalinos to replicate and refute this junk and none or very few of the outlets said “sorry”. This is just an example of SCREAMING scandalous junk, but what about the huge flow of hush hush murmur junk? There are not enough pro-THR researchers and their funding cannot compete with the NIH, MSA money and Bloomberg
Given this grim perspective, perhaps it is time for health scientists supporting THR to take up the challenge and say yes to the anti-Bloomberg (private funding for a cause but with opposite polarity).
The Tobacco Control Industry and any Control Industry empowered by those who aggressively demand Govt support for their own particular belief systems are inevitably dangerous and undemocratic. I remember no vote on the banning of smoking, everywhere people congregate. As adults we are able to decide whether we want to bungee jump or smoke cigarettes. We know the risks, but controls come from what are deemed “stake holders”, the stakeholders enjoy well paid jobs, the money spent failing to control drugs is vast, the issue on all drugs should be one of civil liberties. If western societies can accommodate alcohol, the most anti social drug known, their arguments on self harm, about mad drug users are pure hypocrisy. Instead of smoking at work people take litres of Coffee in with them to keep them going. Eradicating the pleasures humans enjoy is simply puritanical, often spiteful and makes the world a poorer place. Tobacco haters who drink , drive cars, eat meat, wear leather, will find the future an unpleasant place to live in if this endless growth in intolerance , appeasing pressure groups, continues in the way it is going. Young people might not smoke tobacco, but they have no problem smoking crack, skunk, heroin, taking Ecstasy , Cocaine and anything the net says will get you stoned. I’m sick of trying to fight the stupidity of the drug laws, young people don’t fear being busted, they think the law is a joke. Soon they will come to feel all laws are a joke and then it will be too late.
What seems to be lost in any discussion of Tobacco Control is that the notion that they’re fighting The Tobacco Industry (a group of faceless,bloodless corporations) is just the politically acceptable cover for their actual targets which are first, smokers, and maybe second, a mere plant.
Everything they propose and applaud–bans, taxes, “denormalization,” denial of employment and medical care, incitement of hatred and fear, and now the denial of allegedly “safer” alternatives– is aimed at punishing people (the actual human beings)
who smoke cigarettes, the very people they ironically (and hypocritically) claim they want to “help.” So, taken, in that context, it’s perfectly logical that they would campaign to deny the real objects of their loathing any avenue at all except total capitulation.
Yes, they’re a hate group–a coven of irrational inhumane zealots. Who else would blithely eject octogenarians from their apartments and nursing homes? would force hospital patients to the curb with their IVs? deprive mental patients of a relieving cigarette? deny necessary surgery to people in pain?
No discussion of TC can proceed without acknowledging that basic fact.