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A wrong target on smoking

Public health authorities must not conflate nicotine addiction with tobacco (or E-cigarette) use.

Nov 12,2012
When the World Health Organization’s (WHO) tobacco control group meets in Seoul this week, it risks harming smokers who need help quitting. The group will consider bans on less harmful alternatives to cigarette smoking such as Swedish-style smokeless tobacco, or snus, and E-cigarettes. These products have been shown to help smokers stop smoking. The type of regulation applied to these products is especially important to Korea, which has among the highest rates of cigarette smoking within the OECD.

The Conference of the Parties to the WHO Framework Convention on Tobacco Control (FCTC), will consider two especially egregious reports on these matters. The group sets guidelines for countries who are parties to the tobacco control treaty.

The papers, prepared by unnamed WHO bureaucrats, employ specious arguments and agenda-driven science that represent a radical departure from the group’s original and well-intentioned mission to fight the deadly harm from tobacco use around the globe.

Cigarette smoking is by far the most dangerous, and according to the WHO’s own analysis, “the most dominant form of tobacco use.” Therefore, cigarette smoking should be public enemy number one when it comes to reducing the harm done from tobacco use.

But the FCTC is now urging its members to consider bans on lower-risk forms of nicotine use, such as snus and E-cigarettes, which are promising tools for “tobacco harm reduction” (THR), a strategy which employs less harmful forms of nicotine consumption to help smokers quit. If the FCTC nannies get their way, some of the least harmful forms of nicotine would be banned while cigarettes would remain legal.

Parties to the FCTC should take note of critical language in a draft guidance just published by the United Kingdom’s National Institute for Health and Clinical Excellence which states that, “most health problems are almost entirely caused by other components in cigarettes, not by the nicotine.”

Because nicotine is the addictive, but not particularly harmful component in tobacco, public health authorities must not conflate nicotine addiction with tobacco (or E-cigarette) use. In fact, recognizing the difference is critical to understanding the value of THR. Harm reduction, widely used effectively in public health (methadone, clean needles and condoms), helps smokers as well. THR can be a life-saver, especially for those who have failed to quit using widely known and highly ineffective approaches, including cold-turkey, medical nicotine replacement therapy (gum and patch) as well as counseling.

One report, “Control and prevention of smokeless tobacco products,” attempts to make believe that THR simply doesn’t exist. The report doesn’t spend even a sentence on the established literature, international reports and case studies about the promise of snus in harm reduction. Yet it lingers on, citing some of the most implausible and discredited studies about possible dangers of various smokeless products. This is important because in order to establish sound THR practices, public health authorities and smokers alike need credible science about the comparative risks of different forms of tobacco use.

In addition, the report properly acknowledges the vast variances in risk between classes of different smokeless tobacco products, with snus being among the least harmful. Yet at the same time, it fails to acknowledge the tremendous gap in risk between snus and cigarettes. That’s like admitting the important differences between roses and tulips, while ignoring the fact that roses are very different from crocodiles.

While the FCTC report on smokeless tobacco is misleading, its paper on E-cigarettes, is flat-out preposterous. The report argues, for instance, that more research must be conducted regarding E-cigarette marketing claims such as that they are an “alternative to smoking.” If E-cigarettes aren’t a (much safer) alternative to smoking cigarettes, what are they?

Perhaps the most imaginative justification for WHO’s global ban on E-cigarettes is the argument that since parties to the FCTC have “an obligation to undertake a comprehensive ban of all tobacco advertising, promotion and sponsorship,” it should ban E-cigarettes, since they “can be considered as promoting tobacco use, either directly or indirectly.”

The reports are chock-full of unsupported assertions against less harmful cigarette alternatives, while they ignore the growing body of evidence that THR is effective, especially given the public health community’s abject failure to address a fundamental tobacco control challenge: helping cigarette smokers quit.

Yes, there’s still room for improvement of THR products, both in terms of even further reduced risk, as well as increased satisfaction, so smokers will be more likely to switch. But the FCTC secretariat’s absolutist attitude would stifle this very innovation public health requires in the real world. They’d prefer a “quit or die” approach that is completely unrealistic and lacks compassion for smokers.

If the FCTC bureaucrats’ ideology goes unchecked, the result would be counterproductive worldwide government policies that harm those they should be helping, by leading to just one form of tobacco use: the most deadly. Cigarettes would still be the nicotine product of choice, and any nicotine product except historically ineffective medicinal forms would be banned.

Parties to the FCTC should firmly reject these anti-science approaches and demand that the treaty remain bound to its original public health mandate.

* The author is a senior fellow at the National Center for Public Policy Research in Washington and heads its risk analysis division.

by Jeff Stier



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