At the start of the year, the storm clouds of anti-tobacco harm reduction (THR) were darkening, threatening as ever the lives of smokers looking to switch or stop. But in the bleak mid-winter, rays of reason have shone a light on those that needed to be called to account.
In his book Velvet Glove, Iron Fist: A History of Anti-smoking (referring back to the time when life was so much easier for anti-tobacco activists – Goodies vs Baddies), Chris Snowdon quoted arch anti-tobacco nemesis Stanton Glantz at an anti-tobacco conference in 1992 about the way he conducted his research: “If it comes out the way I think, will it make a difference? And if the answer is ‘yes’ then we do it, and if the answer is ‘I don’t know’ then we don’t bother. Okay? And that’s the criteria” (p.167).
Even in support of underlining the danger of smoking tobacco, one might question the ethics of simply embarking on a blatant research programme of confirmation bias. However, when indisputably safer nicotine products came along, life got a whole lot trickier for anti-tobacco researchers. What do they do? Stick to the same old playbook, swerving round some awkward truths – for example, when it was clear that vaping was not a gateway to smoking, the new enemy was nicotine itself, warping the brains of young people and turning them into drooling nicotine addicts. Funnily enough, there were no official and well-publicised evidential concerns about adolescent brain damage through all the previous decades of cigarette smoking. But hey, why let evidence get in the way of a media soundbite?
And nobody is better at this than Glantz, the media go-to person for the anti-THR comment – youth in peril, a Big Tobacco plot, everyone who supports THR is a Big Tobacco shill, blah, blah. Since he switched to undermining THR, his research has been roundly criticised by a slew of independent researchers demanding retractions from academic journals. In an article published last June in the Journal of the American Heart Association, Glantz and Dharma Bhatta claimed that vaping caused heart attacks – a story lapped up by national media as you might expect. However, tobacco researcher Brad Rodu quickly picked up that the study cohort had suffered attacks before they started vaping. This prompted demands to the journal demanding a retraction which finally – and grudgingly – happened last month. True to form, Glantz moaned that the journal had been pressurised by “e-cigarette interests”. Damn straight, researchers interested in calling out junk science in the interests of public health.
Similarly robust objections were lodged against the European Respiratory Society (ERS) when they published this position statement on THR from their Tobacco Control Committee last May which in summary said that THR strategy:
- incorrectly claims that smokers cannot or will not quit smoking;
- is reliant upon undocumented assumptions that alternative nicotine delivery products are highly effective as a smoking cessation aid;
- is built on incorrect assumptions that smokers will replace conventional cigarettes with alternative nicotine delivery products;
- and is ignorant to the lack of evidence to show that alternative nicotine delivery products are safe for human health.
In response eight researchers and public health experts including Deborah Arnott, CEO of ASH, signed a letter, published last month, which contained a detailed, evidence-backed rebuttal of every point in the ERS statement and in particular called the authors out on their claims that THR lacked evidence.
And so to smears. Back in the day, tobacco companies were able to publish research in mainstream academic journals which aimed to dismiss research demonstrating the damage caused by smoking. While the current peer review process leaves much to be desired, overall the level of scrutiny across the academic world, including conflict of interest declarations, makes that level of smoke and mirrors now virtually impossible.
At one level, and because of the scrutiny that would now be brought to bear, it is actually to the detriment of THR product research that companies find their in-house studies impossible to publish. These days, peer reviewers and journal editors would be highly sensitised to bias in tobacco industry research. As it is, valid scientific and clinical research around THR probably remains hidden.
Worse still, though is the climate in which reputable researchers are smeared by essentially offering an alternative evidence-based narrative to the Holy Writ of anti-THR. Rather than simply road testing the science (which any credible researcher would do) and then engage in healthy debate where disagreements emerge, THR researchers are simply libelled and shut out.
One of the most egregious examples of recent months has been the disgraceful treatment of Professor Marewa Glover from New Zealand, an internationally respected social scientist and campaigner for smokers within minority ethnic communities and their right to health through access to THR products. Off the back of claims that her work is influenced by the tobacco industry, she has been effectively barred from speaking as event sponsors pull out, and was the subject of a cowardly whispering campaign to have her nomination for New Zealander of the Year withdrawn.
Much smearing tends to be done through word of mouth, phone calls and so on with no evidence trail. However Ashley Bloomfield, New Zealand’s Director General of Health, wrote to all public and district health bosses, specifically telling them not to have anything to do with Professor Glover because some of her work had been funded by the Philip Morris-backed Foundation for a Smoke Free World, without offering a shred of evidence as to how this funding has influenced the outcome of Professor Glover’s work.
In a circulated New Zealand public health newsletter, Dr Prudence Stone, CEO of the Public Health Association, claimed that Professor Glover had made false statements to the NZ parliamentary select committee considering amendments to the Smoke-free Environments (Prohibiting Smoking in Motor Vehicles Carrying Children) Amendment Bill. At least in this case, Professor Glover received a public apology: “Dr Stone and the PHA retract these comments and unreservedly apologise to Dr Glover for the comments made”.
Back in 2018, Professor Gerry Stimson helped organise a Global Forum on Nicotine mini-event in Vancouver to promote the key messages of THR. In an attempt to get the event cancelled, a public health official at Vancouver Coastal Health (VCH) libelled Professor Gerry Stimson to her colleagues.
She succeeded and the event was cancelled. Among the bizarre claims she made was that the Global Forum on Nicotine, which holds the annual international THR conference, was in receipt of a grant of $960 million from Philip Morris. If only!
Professor Stimson complained to VCH about her conduct, including that if she were so free with evidence then she should not be entrusted with the health of Vancouver citizens. After an astonishing 22 months, Professor Stimson has finally received a written apology and a donation of $5000 has also been made to the Portland Hotel Society, the leading harm reduction agency in Vancouver, who will use it to introduce e-cigarettes to their clients.
But it's not over yet. Professor Stimson made a Freedom of Information request for details of further emails, which were not disclosed: 22 months later and Vancouver Coastal Health still resists releasing the emails and the case has now gone to the highest level of adjudication with the Office of the Privacy Commissioner.
And finally, two unexpected developments:
Last year, a Bill snappily titled Reversing the Youth Tobacco Epidemic Act of 2019 was introduced into the US Congress aimed at tackling the highly questionable ‘epidemic’ as it relates to the actual evidence-based prevalence of regular vaping among young people at a population level. Among its provisions was a general ban on flavours and online retail sales of vaping devices. Essentially, a Bill to kill off the vaping industry with severe collateral damage to smokers wanting to quit smoking.
But in a surprise move the White House says it won’t support the Bill on – wait for it – tobacco harm reduction grounds. Part of the statement read:
The Administration cannot support H.R. 2339’s counterproductive efforts to restrict access to products that may provide a less harmful alternative to millions of adults who smoke combustible cigarettes. This includes the bill’s prohibition of menthol e-liquids, which available evidence indicates are used relatively rarely by youth. It also includes the bill’s approach to remote retail sales. At this time, problems surrounding such sales should be addressed through the application of age verification technologies rather than, as this bill would do, prohibiting such sales entirely.
Before I get to the last bit of good news, another incident which relates to what comes next. Last year, I was invited to speak at an invitation-only seminar in Lisbon. The event was held in the Portuguese equivalent of the FDA building and one of the attendees was the Portuguese equivalent of the FDA Commissioner. The topic was harm reduction and one of the speakers was the architect of Portugal’s much praised drug policy. I was due to be joined on the platform by an eminent clinical researcher in THR. But sitting in the plane at Heathrow, waiting to take off, I received a text from him to say that he had been ‘advised’ not to go by a higher-up in his organisation. Why? Because PMI had an involvement in the event. I just wonder what the snowflakes of the tobacco control and research industry are so concerned about? Do they not trust free thinking researchers to be immune from corruption by consuming a Big Tobacco sandwich? Maybe they could allow meetings between researchers and tobacco scientists so long as the researchers self-isolate for 14 days on returning home.
But the more serious point about the WHO Article (of Faith) 5.3 which builds walls between the tobacco industry and everybody else was an article published in an unexpected source. The article, authored by Joe Nocera, was headlined “E cigarette opponents do more harm by snubbing Big Tobacco”, and the unexpected source was Bloomberg Opinion – because Bloomberg Philanthropies, who over the years have poured millions of dollars into global tobacco control, have become the wallet that keeps giving for those very THR opponents criticised in this article. The article focuses on a conference hosted by Bloomberg-funded Vital Strategies. Despite the title “Hope Meets Reality: E-Cigarettes, a Public Health Harm or Harm Reduction?”, the event, says Nocera, “Was a one-sided assault on e-cigarettes”.
Part of the entertainment (possibly the only entertainment) at the biennial meeting of the delegates to the Framework Convention on Tobacco Control is for anybody even remotely connected to the industry, to be publicly named and shamed before being shown the door. One of those registered for the Vital Strategies event was Moira Gilchrist, PMI’s scientist responsible for harm reduction. However, she never made it through the door as her registration was revoked. While acknowledging the obvious scepticism around industry intentions regarding safer nicotine products, Nocera notes Gilchrist’s point that the industry and public health want the same things, like keeping the products out of the hands of young teenagers while at the same time reducing the disease and death toll from smoking. And so he concludes, “The only way we’re going to solve the e-cigarette conundrum…is if the two sides sit down and start talking. I think the public health officials would see…that those on the other side genuinely want to find a solution. At that point, the two sides could fairly easily come up with proposals that would work for everyone. The refusal to engage with the tobacco companies is actually harming public health”.