As the first global state of tobacco harm reduction report is now in the tender care of the copy editors, time to cast an eye once again on the wacky world of THR.
Taking time out from the intellectual tour de force that is a Dan Brown novel, (Me? Jealous?), I turned my attention to Time to Deliver the recent WHO status report on how member states are doing to tackle noncommunicable diseases (NCD) in pursuit of the UN Sustainable Development Agenda goal of reducing NCD by a third by 2030. In shock news, the world is nowhere near achieving that and received a sharp slap on the wrist from the WHO – ‘must do better’ said the headmistress’ report. One way of doing better says the WHO is to engage with the private sector, although of course as the report is at pains to point out, this specifically excludes the tobacco industry. Yet when it comes to the alcohol industry, “Governments could also encourage economic operators in the area of alcohol production and trade (as opposed to those who give alcohol away free of charge??) to consider ways in which they could contribute to reducing the harmful use of alcohol…”.
Now it is fine that the alcohol industry gets a seat round the table, but this is a product which when consumed to excess over time does more damage to the vital organs of the body than heroin, causing over three million deaths a year worldwide from alcohol-related diseases plus is a major factor in road deaths (up to half of all road deaths in some countries) and in domestic and community violence. Some estimates for alcohol-fuelled domestic violence in the UK are as high as 70% and check out any bar anywhere in the world just after closing time. So, I’m struggling here. Maybe the get out of jail free card for Big Booze is that they just shrugged their collective corporate shoulders in effect saying, ‘knock yourself out’ and didn’t spent umpteen millions of dollars and several decades denying their product was harmful. And while you can drink more safely, there is no safe limit for smoking. Which brings us back to the role of safer nicotine products in reducing smoking-related NCD. It is time to deliver – time for the WHO to deliver on tobacco harm reduction to tackle those millions of preventable smoking-related deaths happening every year and start engaging with all those who can make a difference.
Which takes us seamlessly onto the recent and disappointing Lancet editorial ‘Progress towards a tobacco-free world’. Firstly, a tobacco-free world is a deeply naïve aspiration much like the UN’s’ A drug free world. We can do it’. No, you can’t. The editorial made great play of the regulation wins to implement smoking bans and plain packaging. But if you look at a huge tobacco market like India, second largest tobacco producer in the world with 12% of the world’s smokers, the vast majority of tobacco consumers don’t smoke branded cigarettes, they use an endless variety of locally-derived and equally dangerous varieties and a whole range of smokeless products many of which are also dangerous to health. India desperately needs tobacco harm reduction and could benefit equally, or even more, from snus as from other forms of safer nicotine products. Yet, regarding these safer options, Indian state and national authorities are becoming increasingly proscriptive probably in part (or even mainly) to safeguard the tobacco economy but also to demonstrate what wonderful FCTC partners they are.
Furthermore, the editorial declared “Scaling up tobacco control with global and national legislation and legal approaches is admirable and a crucial step forward, but such progress does not warrant complacency given the continuing global tobacco epidemic and huge gap in the full implementation of the WHO FCTC in many countries”. The problem here is that while the FCTC does not demand a ban on all safer non-combustible tobacco products, it gives three cheers for any country implementing such a ban. Ultimately the WHO would like to see an end to all recreational use of nicotine, smoked or not, but this is based on a moral objection not public health evidence. The real emphasis needs to be on where the most harm resides, which is not tobacco per se, but what happens when you set fire to it in a cigarette. There was not a single mention of tobacco harm reduction in the editorial, which, for a medical journal published in a country whose public health officials have fully endorsed the concept, is pretty depressing.
The bullshit-o-meter swung off the scale at the statement by Tobacco Free Finland that snus is just as harmful as cigarettes and leads young people to smoke. Quite remarkable when in neighbouring Norway, smoking among women is down to 1%, but still around 15% of women use snus while in Sweden, snus has helped Sweden outshine the whole EU in terms of smoking-related death and disease.
And here’s another – this article from health24.com relates to ten myths about smoking, most of which are accurate, but then this,
'I only smoke hubbly bubbly or e-cigarettes'
“The truth is, inhaling smoke from anything is extremely dangerous as it contains high concentrations of toxins and cancer-causing chemicals. The dangers of e-cigarettes have been researched over the years….”
So those reliable people from health24.com can’t tell smoking from vaping and leave their readers with a massive unreferenced ‘MYTH’ about the danger of e-cigarettes.
Given the ludicrously and inexplicably diverse range of quotes I received for renewing my car insurance, I am not surprised that there is no consistency among British insurance companies as to whether or not vapers will be counted as non-smokers. But at least this article reveals that UK vapers have a choice of where to put their money.
OK. It’s officialI, forget cancer, gateway effect, addiction and popcorn lung, the horrible truth about vaping is…your teeth might get stained. How did we miss that?
Two good reads for you – one from Martin Dockrell of Public Health England on wise words from his mum;
The other is from The Spectator referencing a report from the Adam Smith Institute highlighting an issue about trying to appeal to more women about vaping;
“Adverts targeted towards young women have the potential to be the most effective. And it is young women’s lungs that are most blackened by the Tobacco Products Directive, as women are much less likely to switch to vaping than men. While 8.9 per cent of young men vape, for women it is just 2.6 per cent. Women are however continuing to smoke with nearly 16 per cent of women aged 16-24 smoking”.
“Women haven’t been adopting vaping products in the UK. Perhaps this is due to their chunky appearance compared to a cigarette; their fiddly nature makes it more Airfix than Audrey Hepburn. American women, however, have been using small, skeek (sic?) available in the States, which resembles a USB stick, rather than a Hornby train.” [Probably a reference to Juul]
Apparently South Africa’s oldest man (114) wishes he could give up smoking. He doesn’t smoke cigarettes simply rolls tobacco in newspaper. Somebody should introduce Mr Fredie Blom to e-cigs on the basis that ‘it’s never too late, buddy’
And finally….forget e-cigs ‘re-normalising’ smoking. Thanks to Trump, Brexit and the prospect of everyone in the UK being issued with a haz mat suit, we are all back on the fags;