Tobacco companies have pivoted from producing combustible products, (which kill 8m people annually), to non-combustibles, which pose a fraction of the health risk, but are doing far less than they should writes Chris Bateman for MedicalBrief.
Publisher’s Note: This MedicalBrief article may be freely republished with acknowledgement to MedicalBrief and a backlink to the original article.
That’s the view of two tobacco harm reduction advocates, a Canadian lawyer who’s won millions of dollars mounting civil suits against global tobacco companies, and a top British oncologist critical of his “treatment-benefit myopic” colleagues.
They were speaking to Juta MedicalBrief on the sidelines of the Fifth Global Scientific Summit on Tobacco Harm reduction, Novel Products, Research and Policy, held in Athens last month (21/22 September).
Lawyer David Sweanor, who claims to have worked for 40 years on ways to reduce smoking globally, including in South Africa, said researchers have known since the 1970s that “people are smoking to get nicotine – and dying from the inhalation of smoke”.
“We know there are ways for people to get the nicotine they need or want without inhaling smoke. And if we do that, it’s one of the biggest breakthroughs we’ve ever had in public health because cigarette smoking is killing 8m people globally. We have the products and ability to give people accurate information to empower them to make informed decisions. We are also able to understand why people are using nicotine. We need to meet them where they are, to empower them, to do public health work, and treat this like other public health issues,” he asserts.
Sweanor says tobacco companies are doing “far less than they should”.
“They give a particularly good story about how they want to transform, but when push comes to shove, are they really willing to do what’s necessary to actively shift from cigarettes, which is where they make a fortune, with no risk? These new ‘heat-not-burn’ technologies are a huge threat to them and it’s to the credit of some, like Philip Morris International, (PMI), that they want to make this transition,” he adds.
Professor Peter Harper, a prominent British oncologist and consultant to PMI, says the company derives 60% of its income from non-combustible products, ranging from snus, to vaping, to heat-not-burn products.
“They’ve been very professional about their pivot, but part of the problem is the research data have not been generated by governments. Countries should have clubbed together to try to sort this out so that when the data emerges from a tobacco company they can engage in proper scientific debate. But the data have been widely reproduced independently and the consensus is the alternatives to combustible tobacco have less carcinogenic effects and enable a higher quit rate than the alternatives of nicotine replacement therapy,” he says.
Sweanor differs from Harper in his estimation of PMI’s harm reduction product-to-combustible tobacco product output ratio, saying the latter was still in the majority, “although they’ve been increasing their sales of their heat-not-burn tobacco products quite markedly”.
He says PMI refuses to show data on how rapidly they’re reducing their cigarette sales worldwide.
“We need to know from a health standpoint, not just that they’ve got less harmful products, but that they will substitute the far more hazardous products for enough people. Going back forty years, we’ve known we can make safer automobiles, but can you get people who drive unsafe vehicles to switch to them? We know you can make condoms available, but can you get people at high risk of HIV/Aids to use them?”
Sweanor says knowing how to change behaviours to allow substitution is critical.
“The (tobacco) companies have that information, but they don’t release it,” he claims.
Repeated attempts by Juta MedicalBrief to get PMI to reveal its harm-reduction to combustible tobacco product manufacturing output ratio proved unsuccessful.
Collegial myopia
Harper is critical of his colleagues in oncology and medicine, saying, “they believe they’ve read everything they need to know about smoking, but they’re not reading what the new products are offering”.
From a government perspective, he says, there’s reluctance to say these new products should not be taxed as heavily because they’ll be for the good of the nation.
Another obstacle to harm reduction was that tobacco farming was ubiquitous globally, especially in many rural communities that depended on it for a living.
“You’re going to have to substitute it for something else or else you’ll empty our rural areas,” he warns.
Asked what his message would be to a global oncology convention, Harper says the smoke of tobacco combustion “is severely damaging to health, especially the arteries”.
“It you can get your patients to quit, have no need for cigarettes or nicotine and have no addiction of any sort, then fine. But if not, you’d better convert them to a less harmful alternative.” He said 65% of his patients, some with end-stage cancer, were unable to quit.
“Nicotine is very addictive and the paraphernalia of the social bit of smoking and how you relate socially to others who smoke – it’s all part of who and what you are. It’s a ritual that’s extremely hard to break. I’d also tell my colleagues that chewing gum and patches delivering longer term doses cannot match the high impact and gradual fading of smoking a cigarette. So, to an extent you’re reproducing that with vaping and heat-not-burn products – but with less toxic chemicals. We’re showing a higher quit rate, (30-40%), by partially replacing a cigarette with these products – all of which reduces the dosage of carcinogens, which is good,” he elaborates.
Unlike South Africa’s recent almost-undifferentiated tobacco law amendments, the UK’s “Tobacco and Related Products” regulations ensure minimum standards for the safety and quality of all e-cigarettes and refill containers, information to consumers for informed choices, and an environment that protects children from starting to use these products.
“There’s been a big shift with Public Health England’s progressive approach, but with my colleagues, not at all. I don’t think they hear the data. They’re very wrapped up in their treatment modalities, like immunotherapies. They don’t stop and say, ‘we have to stop these cancers in the next generation’. Eighty percent of effort goes into diagnosis and treatment of diseases and 20% on prevention.
“Most healthcare systems are going to have to change to 60% prevention and 40% treatment. What’s coming down the health motorway is dementia, with which no health service globally can cope – and chronic diseases, which I think will overwhelm us,” he adds.
Harper says patients, “don’t just wake up with hypertension – they’ve been developing blood pressure for years”.
“You don’t wake up on a Monday morning with cancer. We’re simply not looking at what we must do to stop the disease hard.”
Presenters at the conference displayed graphs showing a drop among UK “current smokers” from 45% in 1976 to 14.1% last year, the latter representing 6.7m people, mostly aged 25 to 34. E-cigarette uptake was highest among men at 7.2%, with 5.6% of women using them. Reflecting other country surveys, Britons with degrees were least likely to smoke (prevalence seven percent), while smoking prevalence among Britons with no education was 29% (2019 figures).
South Africa’s 2021 Global Adult Tobacco Survey, (GATS), of 7 245 households shows that 12.7m adult South Africans (29.4%) use tobacco and that 8.3% use smokeless tobacco. An estimated 42 100 of SA’s 61m inhabitants die annually of smoking related diseases, according to a Tobacco Atlas (University of Illinois, Chicago) global survey.
Disclaimer: Chris Bateman, a freelance healthcare journalist and former news editor of the SA Medical Journal, was sponsored by PMI to attend the 5th Global Conference on Tobacco Harm Reduction, in Athens, Greece. He was not in any way influenced on what stories to write or whom to interview.
Publisher’s Note: This MedicalBrief article may be freely republished with acknowledgement to MedicalBrief and a backlink to the original article.
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