One of the tragedies of fighting the losing battle against tobacco related deaths and disease globally is that those active in tobacco control have relied more on a ‘religious campaign’ against tobacco companies than on scientific endeavour, writes Chris Bateman for MedicalBrief.
Says harm reduction expert Professor Karl Fagerstrom, President of Sweden’s Fagerstrom Consulting and a member of the Department of Clinical Sciences at Lund University: “Most of us have forgotten how hard it’s been over the centuries for society to get rid of nicotine as long as there are cigarettes. We paint tobacco companies as corrupt and evil, requiring obliteration – instead of exploring alternatives.”
He was taking part in a panel discussion on risk-proportionate regulation and supporting science during the 3rd Global Scientific Summit on Harm Reduction: Novel products, research & Policy.
The annual summit was held virtually from 24-25 September 2020, organised in Greece by the University of Thessaly and the University of Patras with the University of West Attica and National and Kapodistrian University of Athens.
Fagerstrom said that with so many modern, less harmful alternatives to cigarettes “we could easily within 20 years get rid of cigarettes. Even the former commissioner of the US Food and Drug Administration has acknowledged this harm continuum and advocated that we move from the more harmful products to the less harmful.
“Once we’ve got rid of cigarettes, we can discuss whether we need to go further and completely eliminate nicotine from mankind.”
Harm reduction – Getting perspective
He said a global review of illegal and semi-legal drugs, from cannabis to hard drugs, illustrated how difficult it was to “go from cigarettes to nothing”, with the dominant conservative approach currently summed up in the phrase ‘quit or die’.
“For example, how much death and disease are oral nicotine pouches – very similar to nicotine replacement therapy – actually causing? If you compare risk with cannabis, sedentary lifestyle, unhealthy diet, smoking, blood pressure and cholesterol, I think these alternative nicotine products could be closer to coffee,” he declared.
Panel facilitator Professor Panos E Vardas, President of the Hellenic Cardiovascular Research Society, said there seemed to be two groups of campaigners – those for smoking cessation and those for harm reduction.
He asked provocatively: “Do we have enough scientific information about the benefits of the new products versus smoking? Do we need more solid scientific data to speak about the benefits?”
Dr Michael G Toumbis, a pulmonologist and a member of the Cyprus National Addictions Authority, and Mr Clive Bates – an engineer, environmental technologist, public health campaigner and former advisor to ex-British Prime Minister Tony Blair – answered with an unequivocal ‘yes’.
Said Toumbis: “There’s evidence that the new products are much safer than smoking cigarettes. We do not know the long-term effects, but we certainly don’t have to wait 50 years to see them. The solution is surveillance of these new products to see if there are any negative effects, and if so, to measure them.”
Bates said the relative safety of new alternative products was beyond doubt. “People say there’s no long-term data – but look how long it took for us to uncover the danger of cigarettes. We forget that modern science has advanced incredibly quickly.
“Now we have disciplines like systems toxicology, we can measure the exposure of toxicants in the body. We know what is cardio-toxic, what causes respiratory disease. We can see that exposure is much lower for somebody who uses heat-not-burn reduction alternatives, or who vapes. It would require a bizarre theory of the human body for that not to lead us to some dramatic reduction in health risks,” he said.
Bates warned that over-regulation based on uncertainty would steer people towards products that “we know are many times as harmful. We also know that people use them instead of cigarettes, not in addition to. There’s strong evidence that there’s no real gateway – and we do know how to make good policy,” he added.
Nicotine another escapist drug
Vardas, the panel facilitator, asked panel members whether they could see a humanity free of smoking.
Bates said all societies had their drug of choice, with nicotine around for more than 2,000 years. “The question is, can we get a product for taking nicotine down to acceptable risk levels compared to the other risks we generally accept in society? We have a high risk appetite for alcohol, for example.”
Vardas said that with society being predominantly hedonistic, Catholic priests battling HIV in Africa and promoting condom use despite papal injunctions against their use, was a stellar example of the ‘doctrine of reality’.
Fagerstrom closed on an equally philosophical note. “Why are people using drugs? To me, it’s because paradise is not earthly. Maybe in paradise we don’t need drugs. The problem is simply that people are living miserable lives and seeking solutions, even if very short term.”
[link url="https://www.nosmokesummit.org"]3rd Global Scientific Summit on Tobacco Harm Reduction: Novel products, research & policy[/link]