For more than 70 years we know that smoking is detrimental to health and that the best approach is never smoking, and the second best is quitting smoking. But what about the hundreds of million smokers worldwide who cannot quit? 1,3 billion people still smoke.
All speakers of the 5th Scientific Summit on Tobacco Harm Reduction, in Athens Greece (29/9), agree that smokers who are not able to quit smoking should not be abandoned to their doom when safer products can reduce the hazard to their health!
The main challenge today is to generate sufficient and strong data to inform accurately consumers, doctors, regulatory authorities, and politicians about all products and their comparative risks.
The main outcome of this Summit is the need to unite forces to advocate for THR. “We must persuade politicians and regulators by informing them about the evidence because although there is mounting scientific data that innovative tobacco products are less harmful, invariably the argument used by government authorities is that the data is not yet adequate”. Nonetheless, there are obstacles to conducting research to build further evidence. This is against the principles and values of scientific ethics. The experience of the Covid-19 pandemic showed us that collaboration amongst countries is key to rapid accomplishment. We need to develop common study protocols and develop ongoing comparative studies; to record, analyze and evaluate the effects of innovative products.
WHO’s agenda is very dogmatic and the fight against smoking becomes a fight against nicotine… THR products don’t have zero risk, but they significantly lower risk that can save lives! SCOHRE, the International Association on Smoking Control & Harm Reduction, advocates for more data to be generated and for further discussion and invite the THR organizations and experts to collaborate on the drafting of an advocacy statement at the conclusion of this Summit.
It is an irony that autonomy and justice were two principles of bioethics that were protected by WHO, which in 1986 stated that “we need to provide all the means and all the information to people to take control of their own health”, Professor Konstantinos Farsalinos reminded us. The “we know better for you than you” approach, which has been adopted by WHO as it concerns smoking and THR, goes against that statement and prevents people from being autonomous. As David T. Sweanor said “unfortunately, in the field of nicotine and tobacco, we have a clear failure on issues of ethics. There is a tendency within public health to tell noble lies, to lie to people because they think it is for their good, and this way the public health authorities have destroyed their credibility.”
Lion Shahab, in his keynote speech, concluded that there is clear evidence that e-cigarettes (but also snus and other reduced harm products) are beneficial for existing smokers with little evidence of gateway effects. Of course, to engage smokers and youth correctly, we need accurate information/legislation, favoring e-cigarettes over cigarettes, while reducing lifestyle appeal.
Marewa Glover, Director of the Centre of Research Excellence: Indigenous Sovereignty & Smoking, NZ, interestingly said that countries that want to reduce smoking-related harm will face the following challenges: i) a campaign of disinformation about the relative risk of nicotine, ii) loss of academic freedom, iii) the rise of “liberal paternalism”, and d) diminishment of human right to autonomy, dignity & right to consent, e.g., to medical intervention. She cautioned that countries should beware of the lies & propaganda campaigns demanding prohibition and of the policies for which there are no real-life scientific trials that record their adverse effects and consequences. Long-term monitoring and evaluation are vital.
Fernando Fernández Bueno (Platform for the Reduction of Harm due to Tobacco Consumption, Spain) said traditional cigarettes and THR products are considered the same, the current government in Spain refuses to dialogue with stakeholders, and doctors and scientists who defend THR are actually suffering harassment and coercion by the authorities. This must change: the public and the doctors must be provided with accurate information about the actual differences between the products.
Charles Gardner Executive Director of INNCO representing 112 million adults worldwide who use safer nicotine to avoid toxic forms of tobacco, emphasized that today that there are safer alternatives to traditional combustible cigarettes it is pure “negligent homicide” not to be recommended to people who need them. As David Sweanor stated, many years back we sued the tobacco industry because they didn’t appropriately inform smokers about the risks of smoking to their health and now, we have governments and authorities that prohibit the flow of information about the less harmful or potentially less harmful tobacco and nicotine products to the public.
ETHRA (European Tobacco Harm Reduction Advocates) representative, a European advocacy group representing approximately 27 million users across EU, supports the accessibility of THR products to smokers since they enhance their ability to quit. Regulation must always consider the minimal risks of harm-reduced products versus the large risks of smoking, Tom Gleeson of ETHRA explained, and it is extremely important to evaluate THR products compared to combustible cigarettes and not the fresh air.
Vassilis Kontozamanis, previous Health Minister in Greece, stressed that governments should adopt a pragmatic public health perspective; whilst monitoring the use of novel tobacco products and further studying the long-term effects, we must take care of all those who are smokers and do not want or cannot abandon the use of nicotine.
“Better informed doctors make better-treated patients,” said Manuel Pais Clemente, representative of the European Medical Association. Emil Toldy-Schedel, (Hungarian Scientific Association for Harm Reduction and Environmental Diseases, Hungary) proposed that campaigns should be conducted in every country.
The common goal for SCOHRE and the other THR organizations that participated in the 5th Scientific Summit is to start an open and constructive dialogue for a better approach to containing the global burden of smoking, and to provide stakeholders with science-based and balanced information on the effects of nicotine, to raise awareness on existing knowledge on Tobacco Harm Reduction, to benefit from already existing solid expertise in many countries and bring THR higher in the agenda of politicians and regulatory authorities.
All new products must be properly evaluated and regulated Ignatios Ikonomidis (President of SCOHRE) commented, but you cannot compare the novel THR products with fresh air· they should be compared with cigarettes. Thus, we need comparative studies between THR products and combustible cigarettes.