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Cigarette smoking continues its rapid decline in Japan while the upward trajectory of smokers seeking alternative nicotine products shows no signs of slowing down. According to PMI a small percentage (calculated variously at between 5—15%) of their IQOS customers are dual users, but the rest have fully converted. The access to the market for companies like PMI afforded by the Japanese government plays a big part in this; advertising is seemingly allowed in any ways the imagination can conceive and is just as ubiquitous as the most aggressive cigarette advertising. Tobacco regulators around the world may choke on the vapour here, but the experience in Japan strongly suggests that putting obstacles in the way of e-cigarette and HNB marketing simply prolongs your cigarette problem.

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s2smodern

The heat and dust continues to swirl around the Foundation for a Smoke Free World https://www.smoke-freeworld.org/leadership.

Whether the negativity continues will very much depend on what it actually does, although suspicion will always dog its tracks no doubt. The WHO have weighed in with a statement urging all governments and public health bodies to steer clear and refuse any collaboration: https://www.cnbc.com/2017/09/28/who-tells-governments-to-reject-philip-morris-funded-smoking-foundation.html

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As you can see, this is blog number 33 and so I hope I am not repeating this little anecdote, even though it does bear repeating.

There used to be a BBC TV political comedy called Yes Minister in which the senior civil servant Sir Humphrey Appleby was consistently trying to derail any initiative by his Minister Jim Hacker, which might not be in the interests of the civil service. One failsafe tactic, should the Minister suddenly announce such a move, would be for Sir Humphrey to say, ‘That’s a very brave decision, Minister’ At which point Hacker would turn pale and instantly drop the idea. Because no politician who is actually in power wants to be regarded as ‘brave’ as that invariably means a risky enterprise which could end in the sack, reshuffled to some low-level post, a loss of votes or even the loss of a parliamentary seat entirely.

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Harry Shapiro Director DrugWise

No guesses as to the big story of the moment – the announcement that PMI are funding a Foundation for a Smoke-Free World to the tune of $80 million annually over the next twelve years. The interim president is Dr Derek Yach, former WHO director for noncommunicable diseases and mental health where he led the development of the Framework Convention on Tobacco Control. Eyebrows have shot skywards at this appointment leading to inevitable claims that Dr Yach has been won over to the Dark Side.

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Harry Shapiro Director DrugWise

There is a new Holy Grail within the world of tobacco control – the reduced nicotine cigarette which proponents claim will make cigarettes so unattractive that smoking tobacco will be eliminated. This was the thrust of a recent commentary from Scott Gottlieb and Mitch Zeller in the New England Journal of Medicine http://www.nejm.org/doi/full/10.1056/NEJMp1707409#t=article and is likely to become a major tobacco control policy goal internationally. Scientific evidence is being presented that this works; the Gottlieb commentary cited the FDA-funded study by Eric Donny which has been challenged by Dr Brad Rodhu. No doubt ‘methodologies at dawn’ will be played out in the medical press in the coming months.

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Harry Shapiro Director DrugWise

Two contrasting items this week about the idea that celebrities who are either seen to be endorsing drug use or actively campaigning against it, have any influence on decision-making among young people.

The first is an opinion piece by Guy Bentley in the Washington Examiner about the continuing controversy over movie stars smoking on-screen. It was prompted by this report, which showed the use or implied use of tobacco in top-grossing movies rose 72 percent from 2010 to 2016. In PG-13 movies these "tobacco incidents" rose 43 percent, and there was a 90 percent increase for R-rated movies. The researchers included e-cigarettes in their category of tobacco incidents, despite the total lack of tobacco in an e-cigarette. It will therefore come as no shock that one of the authors of this report was one S. Glantz and Bentley goes on to describe why this kind of causal relationship research is deeply flawed.

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Harry Shapiro Director DrugWise

The Washington Post has published a letter from the vice chair of the American Thoracic Society’s Tobacco Action Committee attacking the FDA for its more neutral position on new nicotine technologies, accusing the agency of promoting a switch from one addiction to another, underlining an ideological trope that lies at the heart of much of the response from many national and international so-called ‘health’ agencies.

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Harry Shapiro Director DrugWise

There has been much hum on the wires about the FDA seeming to put reduced nicotine cigarettes (or Very Low Nicotine Content -  VLNC) front and centre of its revised tobacco control strategy. Invariably there are arguments for and against. So here is my brief take on the debate.

VLNC advocates argue that a VLNC will stimulate quitting because the cigarette will not be delivering its essential ingredient – nicotine. There is a hope too that if young people take up VLNC cigarettes, they are less likely to become lifetime smokers again because the product will not be satisfying. And VLNC may be a pathway to quitting perhaps in the same way that moving heroin users onto methadone and then gradually reducing the dose of methadone does help some people become free of drug use altogether.

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Harry Shapiro Director DrugWise

Tobacco harm reduction is on a roll right now – and I don’t mean a roll-up. Let me count the ways.

The big one of course is the announcement by Scott Gottlieb on the FDA’s revised approach to THR. Here is the full FDA news release

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm568923.htm

The FDA has shifted to a more neutral position on e-cigarettes and similar products through a recognition of the role that THR plays in reducing the harms of using nicotine via cigarettes. It is saying that adults who want or need nicotine can get it from much lower risk products; that there will be rules and standards for e-cigarettes; that the Center for Tobacco Products will reconsider aspects of deeming of reduced risk products while pushing back the compliance period for e-cigarettes from 2018 to 2022.

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Harry Shapiro Director DrugWise

Since attending the 2016 GFN Conference in Warsaw, I have heard all sorts of dark tales about the Framework Convention on Tobacco Control (FCTC), the Framework Convention Alliance (FCA) and the Conference of the Parties (COP). The FCTC adopted by the 56th World Health Assembly held in Geneva, Switzerland on 21 May 2003 came into force in 2005 and seeks "to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke”. The FCA is an international civil society consortium of around 500 organisations, mainly NGOs who act to support the maintenance and development of the FCTC. The COP is an annual gathering of FCTC signatories, the FCA and other observers.

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Harry Shapiro Director DrugWise

This week some further reflections on the links between drug and tobacco harm reduction.

There are many interventions from a public health or health and safety perspective that could be called harm reduction – seat belts, crash helmets, speed limits, safer drinking levels, smoking bans. But as Ethan Nadelmann was at pains to point out at the GFN conference, harm reduction is not just another name for public health or health and safety. It sits at the intersection between public health on the one hand – and human rights and civil liberties on the other.