Next year, the European Tobacco Products Directive (TPD) is up for review. Politicians will have to decide if the TPD needs amending. An important part of that process will be consideration of the report commissioned by the EU Scientific Committee on Health, Environmental and Emerging Risks (SCHEER).

In 2018, the EU Agency Network for Scientific Advice (ANSA) published a report looking at how EU agencies approached the issue of scientific uncertainty in their different spheres of expertise.

The report concluded that, across the 12 EU agencies in the network, there were inevitable differences as to what constituted scientific uncertainty, depending on the type of data being used for scientific assessment – for example, the difference between clinical or toxicological datasets as opposed to social science population studies. Even so, ANSA said that agencies need to find a balance when communicating ‘truthful’ uncertainties without risking a fixed interpretation of ‘nothing is known’. “Finding this balance is a primary focus of risk communication and is of fundamental importance in all Agencies”.

So SCHEER needs to find the right balance in presenting their opinion using all the available evidence of what is known, while not over-interpreting the precautionary principle of establishing potential harmful impacts of innovation. But the problem is that the terms of reference for its opinion were weighted towards identifying risks rather than benefits:

“The assessment will address the role of vaping devices, in relation to:

  • their use and adverse health effects (i.e. short- and long-term effects)
  • risks associated with their technical design and chemical composition (e.g. number and levels of toxicants) and with the existing EU regulatory framework (e.g. nicotine concentration and limits)
  • their role as a gateway to smoking/the initiation of smoking (particularly focusing on young people)
  • their role in cessation of traditional tobacco smoking.”

SCHEER has now published a 117-page preliminary opinion on e-cigarettes. Bearing in mind that e-cigarettes have been available since 2006, at least the committee has determined that there is:

  • a low risk of respiratory problems;
  • generally weak evidence for carcinogenesis;
  • a lack of consistent data for any additional adverse clinical outcomes;
  • no data on potential adverse effects of flavourings;
  • only a weak to moderate range of evidence across the whole range of possible clinical risks to bystanders. (No real-world evidence found).

OK. Not dreadful all things considered. But as many of those advocating for THR know, the WHO’s outright hostility has sunk their ‘evidence’ bar to subterranean levels. WHO representatives sit on SCHEER, and EU and WHO tobacco control officials generally work hand in glove. No surprise then that SCHEER imagines there is ‘strong’ evidence linking e-cigarettes to long term cardiovascular disease, as this chimed precisely with the same conclusions from the recently published WHO document on tobacco and heart disease. The WHO document makes no differentiation between combustible tobacco products, where the evidence is strong, and non-combustible products, where the evidence simply does not exist. But it does exist, however only if you choose to include such discredited evidence as that from Bhatta and Glantz (reference 53 in the WHO document) whose paper was retracted by the publishing journal. The authors claimed that vaping had caused heart attacks when these attacks occurred in the former smoking cohort prior to vaping. 

Worse still from the SCHEER document is the conclusion – on the basis of no credible evidence whatsoever – that vaping is a gateway to smoking for young people where flavours contribute to initiation and use. Moreover, SCHEER concluded that there is little evidence for the effectiveness of e-cigarettes in helping adult smokers to quit. 

This opinion is hugely concerning for the health of smokers looking to switch away from smoking. NGO campaigners and public health and medical organisations have shown little interest in the health of adult smokers – quit or die folks. Instead, all the focus has been on young people and the fabrications around the vaping ‘epidemic’. These are the kinds of conclusions which will carry most weight with politicians looking for a good opportunity for virtue signalling, bolstered by the refusal to acknowledge the role of vaping in smoking cessation. 

As I say above, EU tobacco control officials work hand in glove with their Geneva-based opposite numbers in the WHO, who in turn have made it clear that recreational use of nicotine is unacceptable because the substance per se is ‘addictive’, even though the evidence for long-term physical, psychological and social damage is minimal. So as the balance of conclusions is weighted in favour of protecting young people from a largely non-existent problem, without the perceived compensatory benefits of switching for adults (unless they completely quit nicotine), the prospects for THR in the revised TPD look grim.

When is an open access event not an open access event? When it is being organised by an international tobacco control agency. The World Conference on Tobacco or Health invited delegates to an online webinar. It is billed as a “Leadership summit on tobacco control – navigating change”. All are welcome – well, not quite all. Aspiring delegates have to declare that:

“I have no interests, past or present, in any entity in the tobacco, ENDS/ENNDS, or pharmaceutical industry including (a) any manufacturer, distributor, importer, or retailer of the industries mentioned above, (b) any parent, affiliate, branch, or subsidiary of any manufacturer, distributor, importer, retailer of the industries mentioned above, or (c) front group or any individual or entity, such as, but not limited to an interest group, think tank, advocacy organisation, lawyer, law firm, scientist, lobbyist, advertising agency, business, or foundation, that represents, receives funding from, or works to promote the interests of the industries mentioned above. Note that the Foundation for a Smoke-free World is considered a front group of the tobacco industry.”

Interesting that those with any connection to Big Pharma are excluded. So Matt Myers of the Campaign for Tobacco Free Kids need not bother as his organisation was founded and receives funding from the Johnson & Johnson charitable foundation. Anybody from the Gates Foundation is certainly excluded, as are staffers from the WHO. In fact by virtue of the wording all the following could be excluded: anybody in receipt of a pension which includes pharma in the portfolio; anyone who has ever received Master Settlement Agreement money (like the anti-tobacco harm reduction Truth Initiative); or anyone who has been compensated by lawyers who have successfully sued (and thus received funding from) the tobacco or pharmaceutical industries. All those involved in clinical research into NRT or cessation medicines using pharma-funded products should also not waste their time applying. But saving the best to last, say goodbye to the webinar chair, Professor Luke Clancy, Director General of the Tobacco Free Research Institute Ireland (TFRI) Dublin, who has acted as an advisor to Pfizer. By the strict letter of the declaration, this online event will have virtually no delegates.