Keeping up to date with the proceedings of the World Conference on Tobacco or Health, in Cape Town recently, I was reminded of the wonderful film, directed by Richard Attenborough - ‘Oh what a Lovely War!’ - which summarises and comments on the events of the First World War using popular songs of the time, many of which were parodies of older popular songs, and using allegorical settings such as Brighton's West Pier to criticise the manner in which the eventual victory was won.

The reason this sprang to mind was the constant references to war made by the tobacco control zealots who were present at the conference. This being reminiscent of scenes in the film showing the diplomatic manoeuvrings and events involving those in authority set in a fantasy location inside the pierhead pavilion, far from the trenches. A comedy, heavily laced with irony, which I think is not dissimilar to the actions witnessed at the WCOTOH.

The language of ‘war’ is a curious one to use for those who are supposedly concerned with the promotion of better health, for individuals and communities. But given the tone of some of the presentations and also the junk science, distortions and lies presented as fact during the conference, it is perhaps understandable. It should also be noted that consumers of nicotine were not visible during the conference – certainly in the formal agenda.

Triumphalist posturing and calls for evermore control, as opposed to informed consent, widen the divide between tobacco control and tobacco harm reduction in a way rarely seen before – and certainly not with this intensity. I thought at least those on the control side of the debate and those driven by the desire to reduce harm at least agreed on the basic principle that improved health was the motivation for their respective positions, but this now appears not the be the case. Tobacco control’s primary objective is to destroy the tobacco industry, whatever the collateral damage to the lives – and deaths – of millions of smokers in the process. One of their current weapons of choice is the selective application of Article 5.3 of the WHO Framework Convention of Tobacco Control to mute any discussion of anything that threatens their cause. This article was designed to ensure transparency in governmental dealings with tobacco companies, but is now used with the alacrity of Donald Trump claiming anything that incurs his displeasure as ‘fake news’.

Such extremism might charitably be attributed to lack of progress in challenging the industry and no impact on reducing smoking rates. However this would be to ignore the major developments in technology that have made new, safer nicotine products available, which have had a profound influence in enabling people to enjoy nicotine in a safer way. These products have, in many places, fundamentally reduced rates of smoking.

Unfortunately the response from tobacco control is aggressive, shifting the focus of their zeal onto nicotine generally. I won’t dwell on this, save to say that nicotine is recognised as a drug that is no more harmful than caffeine and also shows some therapeutic effects for conditions such as those associated with ageing.

As has been said, the first casualty in war is the truth and sadly this is true in the case of tobacco control’s war, with their refusal to acknowledge the growing body of evidence that supports a more reasoned stance, rooted in reality and driven by the desire to reduce harm.

To justify their war tobacco control cites the historical wrongs of the tobacco industry. Nobody doubts that these were very real and that the hiding of the dangers of smoking came at a high price in terms of human life. However in order to progress and achieve change there is a requirement to acknowledge, process and move on from historical wrongs (real and/or perceived). Evidence for this comes in the examples of the ‘Truth and Reconciliation Commission’ in South Africa and the Good Friday Agreement in Ireland. Both the examples required the acknowledgement of the conflicted parties that they had to seek a settlement that would enable them to stop the harm caused by endless conflict. Whilst the situation concerning tobacco control and the tobacco industry is unique in and of itself, there is little likelihood of either entity disappearing in the near future, which makes at least some dialogue essential, once again to prevent the collateral damage mentioned above.

One major feature of the conference was the sustained attack on the new Foundation for a Smoke Free World. On its website the Foundation states that it was formed ‘to help the world’s billion smokers quit and reduce their risks from smoking, which remains the leading cause of preventable disease and death. The purpose of the Foundation is to improve global health by ending smoking in this generation. Our mission is also to address the consequences of the global reduced demand for tobacco on smallholder tobacco farmers and to help them transition to alternative crops and livelihoods’.

Something I think everyone would support, in its balanced approach, mindful of both health and economic consequences of reduced demand for tobacco. The issue for tobacco control is that the Foundation received initial funding from Philip Morris International. Despite the statutes and governance of the new organisation explicitly forbidding any interference in its work from funders, or any other external body, the mere fact of the donation was sufficient to send tobacco control into a frenzy. The most appalling manifestations of this were the relentless ad hominem attacks and slurs on Derek Yach, the Director of the Foundation and previously one of the architects of the WHO Framework Convention on Tobacco Control, and the holding of a session during the conference to trash the Foundation, without the courtesy of allowing someone from it to respond.

I won’t address the pros and cons expressed in relation to the Foundation, nor the attacks on Derek, as these have been dealt with in others’ writings – notably by Clive Bates https://www.clivebates.com/foundation-for-a-smoke-free-world-the-mindless-mob-behaviour-of-tobacco-control/. Suffice to say, if ever there were cause to be sceptical about the possibility of a peaceful conclusion to tobacco control’s war, this was it.

Not content with its current strategy of non-engagement with the ‘enemy’, tobacco control is now boosted with a grant of $20m from Michael Bloomberg, to establish Stopping Tobacco Organizations and Products (STOP) ‘a global tobacco industry watchdog will aggressively monitor deceptive tobacco industry practices to undermine public health’. Essentially a ‘war chest’ for tobacco control to pursue its campaign to destroy the tobacco industry.

The ‘endgame’ for tobacco control has shifted now to one of prohibition and the destruction of the tobacco industry. We have seen how such ‘wars’ have played out in relation to alcohol – with prohibition in the US, in the 1920’s – and the on-going ‘war on drugs’. Both resounding failures.

All wars either endure, to nil effect other than continued suffering and death, or conclude with annihilation, capitulation (usually leading to residual hostility and a later conflict) or negotiation and compromise (truces and treaties). Casualties are usually are greatest among non-combatants – in this instance smokers and vapers.

Benjamin Franklin once said ‘there never was a good war, or a bad peace’ . Those in tobacco harm reduction stand ready to discuss in good faith, without pre-conditions all the options available to ensure a ‘good peace’. I wonder whether the same will ever be true of tobacco control, or will they carry on regardless with their crusade?

To return to the opening of this piece, the film closes with a long slow pan out that ends in a dizzying aerial view of countless soldiers' graves, a most evocative image and one we should all think of in relation to the new ‘war on nicotine’.