The global public health establishment has adopted a “statist, coercive and punitive” approach to tobacco harm reduction, squandering the opportunity to avoid millions of premature deaths and cases of disease, the annual London-anchored E-Cigarette Summit heard last month, writes Chris Bateman for MedicalBrief.
This was said by Clive Bates, a former strategic advisor to Tony Blair and director of Counterfactual Consulting, a public health and sustainability practice in the United Kingdom, in a presentation entitled “The New Tobacco Wars”.
He said “hostile and supportive forces” were stubbornly slowing down the inevitable transition to low-risk alternatives to smoking, causing unnecessary death and disease.
Bates was addressing “The E-Cigarette Summit – Science, regulation and public health”, held from 7-8 December 2021. The summit describes itself as a neutral meeting point for scientists, regulators, industry, public health and practitioners “to explore the latest research on e-cigarettes and facilitate respectful debate on what remain highly controversial issues”.
Owned by Smooth Event Management in the United Kingdom, the summit is funded by delegate ticket sales, does not accept sponsorship or funding from commercial or government organisations, and has no involvement with the tobacco, pharmaceutical or e-cigarette industries.
Bates said that governments and bodies like the World Health Organisation (WHO) and Bloomberg Philanthropiesused disinformation and misinformation in a “desperate search for harm”, driven by cultural and institutional inertia and anchored in an outmoded struggle against Big Tobacco.
The inconvenient truth was that much like the automotive industry’s evolution from petrol to electric vehicles and the transition from fossil fuels to renewable energy, innovation in nicotine consumption was driven by battery technology instead of hugely more harmful tobacco combustion.
“Is this an opportunity or a threat? You have to ask, whose interests are threatened? It’s not the consumers, and certainly not the public,” he added.
Exaggerated harm
Bates outlined a litany of scientific abuse and misinformation by the tobacco control community in their “desperate search for harm”, saying this exaggerated harm (as in coffee or caffeine), was central to justify the continued efforts of a “formidable” billion-dollar coalition of organisations that had “swivelled the gun turrets onto new things and is blasting away”.
Quoting Paracelcus, the pioneer of minerals and other chemicals in medicine, he said: “Poison is in everything, and no thing is without it. The dosage makes it either poison or remedy.”
Opponents of harm reduction manipulated toxicology, “talking up” tiny traces of metal into major health risks, abusing in vitro cell studies and “overinterpreting” them into human health effects. The biggest manipulation came in deliberately conflating correlation with causation.
Bates illustrated this with a study published in the American Journal of Open Medicine, which found a relationship between vaping and bone health. A press release, issued before the study was published, spun this association into causation. The limitations of the study included ignorance of exposure and that e-cigarette use may have started after fracture occurrence and diagnosis.
Other examples including public broadcasts about “vape facts”, such as “vaping is as safe as skydiving without a parachute”, and the United State Food and Drug Administration linking nicotine use to a “weird worm effect in the face that looks like an alien chrysalis” – without any substantiation, and “designed to created panic”.
Posters declared; “nicotine is brain poison” – a direct contradiction to findings that teenage smokers grew up with no measurable negative effects from nicotine itself. “Perhaps from smoking, but not nicotine,” commented Bates.
The EVALI – Vaping Associated Pulmonary Injury – scandal in the United States from April 2019 to January 2020, in which 68 people died and 2,800 were hospitalised, was found to be consistent with localised supply chain contamination. Injury fell dramatically once the acetate contaminant in the illicit cannabis supply chain was isolated – which had nothing to do with vaping, per se.
The Brussels Times on 10 November 2021 published a statement purportedly signed by 40 organisations about heated tobacco products, stating: “These are falsely marketed as safer and more sustainable options, but are no different to deadly cigarettes, misleading consumers, medical practitioners and international institutions.”
The Sun tabloid newspaper in the United Kingdom declared: “Tobacco firms promote snus as safer than smoking”, adding commentary that “if you jump from the 10th story of a building or the 20th, the effect is the same”.
Countered Bates: “Yes, that’s probably true, but it’s hardly a good analogy for snus and cigarettes. Using snus would be more or less the same as walking down the stairs.”
The lust for prohibition
“That’s just one more big lie.” He added that the “lust for prohibition” was nowhere better illustrated than with a Bloomberg Philanthropies-funded respiratory foundation explaining why lower- to middle-income countries should prohibit e-cigarettes and heat-not-burn products “to truly tackle tobacco”.
“These countries cover the bulk of the world’s smokers, yet they want to deny them access to these life-saving products,” said Bates.
The WHO even conferred an award on India’s Health Minister, Dr Harsh Vardhan, for spearheading Indian legislation banning e-cigarettes and heated tobacco products in 2019.
“There’s no evaluation of whether these interventions were successful or had unintended consequences – the policy is the thing that matters. They prohibit something that would have a health benefit to people who switched to using it instead of cigarettes,” he added.
The ‘poster child for prohibition was Bhutan, where a tobacco ban in 2000 led to a huge youth-driven surge in illegal trafficking in tobacco and related products. Bates said that any study on prohibition of alcohol, drugs or related products would expose the absurdity of such a policy.
“You’d have to switch to the Netflix series Narcos to get a more entertaining view of how prohibitions work in practice,” he chuckled.
The ban on e-liquid flavours
Another counterproductive clampdown was banning e-liquid flavours for use by youth, which failed to address the huge adult population using vaping flavours.
A “thousand different’ evasive tactics could be employed to get around the flavour ban, like people mixing their own flavours or using black markets. Unintended negative consequences included people relapsing from vaping to smoking, not switching from smoking to vaping, or continuing to smoke.
“It simply does not take into account the real world behavioural response,” said Bates.
The banning of e-liquids by San Francisco also prompted perverse consequences, leading to increased teenage smoking, while the US federal government was debating raising e-cigarette taxes to the level of combustible cigarettes.
Instead of reducing e-cigarette usage by 2.7% as claimed, two in three teenagers – dissuaded from using e-cigarettes by the tax – would turn to combustible tobacco. The move would create half a million extra teenage smokers and reduce adult vaping by 2.5 million people – but increase adult smoking by the same number. For every e-cigarette pod eliminated by the tax, some 5.5 extra packets of cigarettes would be sold.
“Who could possibly think that’s a win? Are the public health people even looking at this? If it was in good faith, the opposition to vaping and tobacco harm reduction would look very different. It would be consumed with concerns about trade-offs and unintended consequences, both about particular population groups and appropriate objectives – yet we see none of that,” Bates stressed.
Hope for the future
He said claims about the promise of new technology were at times greeted with scepticism, vilification or outright opposition – often dominated by slander, innuendo, scare tactics, conspiracy theories and misinformation.
The assumption that new tech carried unknown risks guided much of the debate and was often amplified to levels that overshadowed the dangers of known risks.
“This is why I think we will prevail; because the underlying benefits will prevail. All this noise and vitriol will subside and be forgotten, and we’ll have a more sensible way of using nicotine,” he concluded.
The E-Cigarette Summit – Science, regulation and public health
Vaping – Time for doctors to get on board
Real Vikings don’t smoke – Norway’s successful stance on snus
See also from the MedicalBrief archives
Daily vaping dramatically ups quit rate in heavy smokers – FDA, NIH
Tobacco harm reduction – Patients before prejudices
WHO versus Public Health England over e-cigarettes
In world first, NHS may prescribe e-cigarettes for smoking cessation
Draft UK guidelines to tackle the health burden of smoking
Prominence of e-cigarettes is a symptom of failure to address smoking