Huge disruption has been caused by the evidence that non-combustible vaping and heated tobacco products and Swedish-style snus can have a game-changing impact on reducing death and disease from smoking. The advent of these products has disrupted industry thinking while governments have been trying to play catch-up with often knee-jerk and harmful revisions to tobacco control policies. But the disruption has been most keenly felt within the global public health community.
Organisations have been founded, professional careers and reputations built, and millions of research dollars acquired based on the immutable division between the devils of Big Tobacco with their lethal products and the angels of public health. The tobacco wars were fought on the premise that there were irreconcilable differences between these warring factions.
And then along came safer nicotine products. For some, they have been the exit ramp from smoking towards abstinence. But for most, these products have enabled those consumers who wanted to continue using nicotine to carry on doing so with relatively little risk. This was something many in the public health community could not stomach. They refused to accept that once you took the nicotine out of the cigarette, it was a whole different public health ball game.
Nor has there been any reflection that the global effort to reduce death and disease from smoking was (and is) failing. Predictions two decades ago that deaths would reach 8 million by 2030 have already been reached; smoking is set to increase in some countries while falling rates in other countries have begun to level out. Claims by the WHO that billions of people are ‘protected’ by anti-smoking laws are delusional.
Rather than stepping back and taking a mature approach to reviewing tobacco control policies to embrace new product developments, the WHO has led the charge ably assisted by NGO allies and funded by private money to conduct a campaign driven by fear, uncertainty and doubt (FUD).
Given the quasi-religious mania underpinning much anti-tobacco harm reduction rhetoric, it is no surprise that the origins of FUD can be found in 17th century theological arguments about the value of the death-bed repentance. In modern times, the term is more usually associated with attempts by established companies, especially in the computer world, to use FUD as a means of persuading existing customers against switching to some new-fangled bit of kit or software proffered by a new kid on the block. Stick with us, you’ve been with us for years, our products are tried and tested unlike these new products which might wreck your systems etc etc.
And indirectly this is the same dangerous game being played out by opponents of tobacco harm reduction. They spread fear by making claims, unsubstantiated by credible data, about vaping epidemics, gateway effects of vaping, death and disease caused by vaping, damage to adolescent brains, the spectre of addiction, and other health harms caused by nicotine. When desperate, come the claims that vaping causes everything from erectile dysfunction to depression.
As a frightening number of doctors and other health professionals think the most dangerous element in a cigarette is the nicotine, the fear-mongers are playing to an audience already softened up by years of unchallenged assumptions. Fear naturally causes uncertainty and doubt among smokers (“Should I switch?”) and among health professionals (“Should I encourage patients who smoke to switch?”). Surveys among smokers and doctors show that negative views about vaping are increasing.
Of course, the purpose of fear campaigns is not to keep people smoking, but this is often the net result. If smokers are being told that vaping is at least as dangerous as smoking, if not more dangerous, why should they switch? When it comes to tobacco harm reduction, the WHO remain a tragically trusted source of information from which health ministries, medical agencies and individual health professionals take their cue. So if there is a tsunami of white noise from trusted sources about the alleged dangers of alternative products, smokers seeking help will be poorly served. If for one moment, the anti-vaping lobby could peer out from a veil of propaganda, it might come to realise that in their war against safer products, there will only be one winner. No guesses as to who that might be.
The next edition of the Global State of Tobacco Harm Reduction report, “The Right Side of History”, will be published in November.