I, along with other colleagues from Knowledge-Action-Change, have just returned from Australia on a trip to showcase the Global State of Tobacco Harm Reduction report and to support our friends in that country battling against monolithic political intransigence fuelled by smears and whispers from ‘public health’ flat earth activists over tobacco harm reduction. I was honoured to speak at two sessions in both the parliaments of Victoria and New South Wales and engaged anybody and everybody prepared to listen, enjoying very welcome support from Melbourne MP Fiona Patten who chaired that session.
I was going to start by highlighting some of the telling points made by Professor Marewa Glover from New Zealand, a passionate advocate for the health rights of indigenous and first nation people. I still am, but following the awful events in Christchurch, all I can say first is deep condolences to all those caught up in this murderous horror and hoping that all of our friends and their friends are safe.
In her presentation, Marewa made three key points. The first was that the primary focus of policy at both a national and an international level was now more to do with destroying the tobacco industry than reducing the harm from smoking. It sounds dramatic, but it makes sense to me as the only explanation for the short-sighted and wrong-headed approach to controlling safer nicotine products in countries across the world. The stupidity of this is that some seem to believe that you can sound the death knell of Big Tobacco by doing everything you can to ban the safer products. Like Don Quixote charging the windmill with a feather duster. Of course, you could just ban cigarettes and watch government finance officials do ‘pistols at dawn’ with their colleagues from health.
Her second point referred to the court case where Phillip Morris was taken to court by the New Zealand government for importing HEET sticks for use in IQOS heat not burn devices. The judge threw out the case saying, in short, how can you have legislation that aims to reduce the harms of smoking and then ban the very products helping to achieve that ambition? Which led me to wonder if governments who professed such aims in their tobacco control legislation could be taken to court for contravening or undermining their own laws.
And her third point was to quote an African proverb, “When two elephants fight, it’s the grass that suffers”. And that points to her direct concerns over the collateral damage caused to Maori and other indigenous and vulnerable groups who are denied access to safer products while battles are fought for legislative change. That is the most telling point of all; how can those who profess to be determined to reduce the harms from smoking not realise that nobody supporting tobacco harm reduction is trying to subvert or replace current tobacco control interventions. The reason we need safer nicotine products is that for whatever reason, all the other interventions are not enough. E- cigarettes simply sit alongside other measures to help smokers switch or quit. And if anybody thinks they can tax their way out of a smoking epidemic then just look at the popularity of the illegal, untaxed loose tobacco in Australia called chop-chop. It is estimated in May 2018, that in Australia about 864 tonnes of chop-chop is sold each year which is about 40% of the total legal Australian market of tobacco of 2,150 tonnes a year.
So the fight against truth decay (damn those sweet flavours) continues, especially when faced with this piece of tired nonsense where the past misdemeanours of tobacco companies are dredged up as a reason for trying to crack down on e-cigarettes.
Another tedious trope is that it is the nicotine in cigarettes that does the damage. This nice article nails that one.
But the moral absolutists have been doing a great job of making the world more dangerous for smokers by the drip feed of adverse publicity which puts smokers off from switching.
A recent study over 16 years found that the belief persisted in Norway that snus presented around 80% of the risk of smoking cigarettes whereas all the evidence pointed to a risk level below 10%. This was especially concerning that this level of misconception existed among heavy as well as non-smokers.
The authors point to the WHO insistence on the rights of citizens to accurate health information.
“The World Health Organization (WHO) has emphasized that the public has a right to accurate information on the harms of tobacco and that “countries have a legal obligation to provide it”. However, the vast majority of studies (including ours) demonstrate that the health risk posed by smokeless products is consistently overestimated relative to the risk of smoking cigarettes”.
“In countries where tobacco/nicotine products are legally sold, and also differ greatly in disease risks compared to cigarettes (e.g., snus and e-cigarettes), science-based, comprehensible, and actionable health information on differential risks should be available”.
Which takes us back to the tempting notion of class actions by smokers against those governments who make it as difficult as possible to access safer nicotine products.
And on the same gloomy theme, this from northern England:
Half of smokers and ex-smokers living in Yorkshire and the Humber would NOT try vaping – with many believing it is just as bad for you as cigarettes, a study found. Researchers found tobacco users are ‘suspicious’ of e-cigarettes and have no desire to give vapes a go - despite health professionals urging them to do so. Commissioned by Yorkshire Cancer Research, the survey of 844 smokers and 1,156 ex-smokers across the UK also found that two thirds have attempted to kick the habit at one time or another – four times on average – but to date they haven’t managed to stop for good.
But to end on a much more positive note. The very forward-looking McKell Institute in Australia has published a new report, Legalising Vaping in Australia, by Colin Mendelsohn and Alex Wodak. Certain people kicked off about this report, which is all to the good as it shows a potential shift in the balance of influence reducing the nay-sayers to underhand measures like trying to deny Marewa Glover a place in the nomination list for New Zealander of the Year.
The authors conclude:
“Vaping provides another quitting strategy at no cost to the public purse. Smokers who switch to vaping can expect substantial improvements in health as well as large financial savings, of special importance to low-income groups. Fears of vaping being a gateway to youth smoking, renormalisation of smoking and uptake by non-smokers have not materialised to any significant extent in over 10 years of overseas experience so far. Legalising vaping has enormous potential to improve public health, particularly for disadvantaged smokers who are disproportionately affected by smoking-related diseases. We recommend that vaping products should be primarily regulated as consumer goods rather than as a therapeutic, medicinal or tobacco product. Regulation should aim to maximise the benefit for adult smokers while reducing any potential risks to users and harm to the wider population, especially young people who have never smoked. Regulation should be proportionate to the risk of vaping”.
And more power to Australian tobacco harm reduction efforts from the University of Melbourne where the authors of this article strongly recommend the ending of the de facto ban on vaping to improve the nation’s health:
And whoever might be reading this with influence in the legislative and policy arena – don’t give up on the people who can’t give up.