There exists a bunch of pirates, ostensibly independent NGOs and medical and public health organisations who, flying under a flag of convenience called ‘tobacco control’ are sinking the evidence base for tobacco harm reduction (THR), in the process denying potentially life-saving products for millions of current smokers who can’t or do not want to give up nicotine while knowing full well the damage caused by cigarettes.
These agencies are sweeping broader public health issues overboard in pursuit of a rabid obsession with Big Tobacco interference in the domestic tobacco policies of mainly lower-and-middle income countries (LMIC). Article 5.3 of The Framework Convention on Tobacco Control (FCTC) is devoted to it accompanied by a set of ridiculously over-interpreted guidelines. Nobody would deny the tobacco companies have and do attempt to influence tobacco policies - likewise Big Energy, Big Pharma, Big Mines, Big Food, Big Agri and all the other multinational Bigs seeking out global economic advantage. Therefore, few could argue about the need for transparency in trade negotiations between governments and multinationals. But some of this crew have been at sea for far too long.
The South East Asian Tobacco Control Alliance (incidentally the WHO “knowledge hub” for the swivel-eyed 5.3 Guidelines) ran a competition for young people to create an anti-tobacco warning graphic – or something like that. The terms and conditions for entry were substantial not least the requirement that entrants had to confirm they had no connection with the industry to the ‘fourth level of consanguinity’ – that’s great, great, grandparents and third cousins three times removed. This was a competition for kids remember. Bonkers or what?
Here’s the paradox though; the FCTC was the first multi-lateral health treaty. Consequentially, neither the WHO nor the member state delegations comprising health ministers and officials (often doctors) who attended the negotiating sessions, had any experience of international law or treaty making. They instead relied on the ‘advice’ of experienced US activists such as the Campaign for Tobacco Free Kids (CFTFK) and US Ash. Despite the fact tobacco control (excluding cross-border smuggling for example) is an entirely domestic issue - these NGOs were in a powerful position to influence several countries in shaping an international treaty in accordance with their own agendas. That was back in the early 2000s. This neo-colonial interference is still going on, but now the emphasis has switched to safer nicotine products (SNP).
As the WHO admits, very few LMIC have sufficient resources or political will to get anywhere near full implementation of all the requirements of the FCTC. These requirements are enshrined in the WHO strategy named MPOWER where M = monitoring prevalence; P = protecting non-smokers; O = offering help; W = warning campaigns; E = enforcement and R = raise (taxes).
To reduce smoking prevalence, death and disease, the most important element is O, offering help, getting people to stop smoking. Yet here is where LMIC are failing the most in what the WHO calls ‘the highest level of achievement’. Millions of smokers in LMIC have little or no access to help while NRT and counselling might only be available privately. So it would make public health and humanitarian sense for LMIC health officials to be encouraged to embrace THR to help their communities of smokers. Sadly no.
Recently the CFTFK ran a webinar aimed at LMIC suggesting that countries might wish to immediately ban all SNP until they are fully compliant with the FCTC at the ‘highest level of achievement’ and only then consider regulating SNP as tobacco products knowing full well that many countries will never get to that point for many reasons. If, for example, you were a health minister from an African country battling the whole panoply of infectious diseases, where would your priorities lie?
But that didn’t stop another crew member, The Union (formerly The International Union Against TB and Lung Disease) from rallying all LMIC to ban SNP.
This call was to mark what has quietly morphed from International No Smoking Day to International No Tobacco Day while the WHO conducted an online media session highlighting interference not just from tobacco companies, but also nicotine companies.
The WHO also published more reports about SNP which they claim help bridge the gap between science and policy whereas what they achieve is to further widen the gap between the WHO propagandists and credible independent evidence.
Last December, a WHO official admitted to a group of politicians in the Philippines that LMIC don’t have the resources to make up their own minds about SNP – better just to ban everything. Follow captain’s order and you get a tick and gold star from the FCTC Secretariat and if you are lucky, an award for doing your bit in the ‘war against nicotine’.
In another mood of celebration, the WHO weighed in with their own anti-tobacco ads aimed at young people with a hint of vaping in there as well. Their big picture image is a young girl blowing smoke rings. How cool does that look? Just like those ads from JUUL showing the cool kids enjoying a vape. Ummmm…
I said at the beginning organisations being ‘ostensibly’ independent. On paper, yes, but they populate a tangled inter-dependent web of grantees, sub-grantees, associates and partners including the WHO Tobacco Free Initiative stretching across the world. Follow the multi-million-dollar trail buried in annual reports and financial statements and lurking on websites, and you find most roads lead back to Bloomberg Philanthropies with assistance from Gates. And Big Philanthropy love easy tick box initiatives achieving maximum publicity. Top of the list are campaigns aimed at kids. Except there is no consistent evidence that teen-targeted ad campaigns have any significant impact in preventing initiation or changing behaviour.
The reasons are many, but include:
- Young people think they are invulnerable. Suggest they might die in 60 years from smoking cuts little ice.
- When asked about smoking, young people often say they hate the smell on clothes and breath or going into rooms full of smoke rather than concerns about health.
- Even if young people say ads made them think again, public communications research shows decay time is very steep and ads are quickly forgotten.
- Some advertising just invites ridicule like the US Just Say No anti-drug ad with an egg frying in a pan which apparently is “your brain on drugs”.
- Some research has shown ads might even encourage smoking.
In 2012, UK addictions expert, Professor John Strang and colleagues published an article in The Lancet summarising the effectiveness of a range of drug policies. They analysed many of the education and prevention interventions at both the classroom and community level and for the majority there was no evidence of effectiveness in preventing or delaying initiation into drug use either in the short or medium term.
For a comment piece in the British Medical Journal, one-time White House senior drugs advisor Professor Keith Humphreys and Peter Piot outlined the reasons why scientific evidence is only one arbiter of drug policy. Even so, they stated that where evidence is lacking, the net result “can also lead to a massive waste of public resources (such as the billions of pounds spent worldwide on ineffective youth-oriented programmes to prevent drug use)”.
Many LMIC countries will never have adequate resources to implement comprehensive healthcare measures to help people who want to quit smoking, and like I say, many don’t want to anyway. Far better to allow easy access to SNP, help reduce death and disease and crucially at NO cost to governments. Or you could just betray millions of smokers because nobody wants to rock the pirate boat and lose all those pieces of silver, do they?
My name is Michael Bloomberg, King of Kings:
Look on my Works, ye Mighty, and despair!
Nothing beside remains. Round the decay
Of that colossal Wreck, boundless and bare
The lone and level sands stretch far away.
With apologies to Percy Bysshe Shelley