The passion pit

Stakeholders talk nicotine in Warsaw

By George Gay

Just before the start of the consumer advocates meeting, which was one of three parallel sessions that kicked off the Global Forum on Nicotine (GFN) in June, one of the panelists asked another, “Who’s in charge?”

It was to prove to have been a good question. Although the meeting was well-run (in Euro 2016 football competition terms, say, the referee let the game flow), there was always a sense that anarchy could break out at any moment—an anarchy born of passion. Of course, there was plenty of passion to be found elsewhere at the forum as scientists showed their frustration at having to counter the media stories emerging from the publication of poorly designed and misleading studies into noncombustible tobacco and nicotine products, and as tobacco control advocates expressed dismay that some of their colleagues refused to embrace the concept of smoking harm reduction. But such academic passion is not on the same scale as the passion stirred in people who believe that various authorities are trying to ban or restrict products those people see as lifesaving and, indeed, life-enhancing.

In fact, though the 2016 GFN, which was held in Warsaw, Poland, had as its theme “Evidence, accountability, transparency,” a subtheme was surely passion. And there should be no surprise here. This year’s GFN, the third such meeting, attracted 350 participants—including 40 speakers—from 55 countries, which put it a little over capacity. It attracted consumers, scientists, regulators, manufacturers, distributors, public health professionals, policy analysts and media representatives. And, crucially, these participants came in different shapes and sizes; so, unlike at some conferences, they weren’t all in agreement.

Lack of vision

In fact, the passion was there from before the start of the formal sessions on June 17 and June 18 because, prior to the forum’s social event on the evening of June 16, participants had the opportunity to attend a viewing of A Billion Lives, a documentary by Aaron Biebert that traced the history of the tobacco industry and the emergence of lower-risk products, mainly vapor products. The documentary showed, with a passion that film can provide so well, how the promise of these new lower-risk products was in danger of being squandered by some of those with vested interests in their not being successful and by those too set in their ways to embrace this new phenomenon. And clearly there are a lot of people with such vested interests and with such lack of vision.

Step forward the World Health Organization with what one forum participant described as its policy-based evidence, and its secretive offspring, the Framework Convention on Tobacco Control with its bizarre—given that it is purportedly committed to harm reduction—insistence that smokers consume licit cigarettes rather than illicit cigarettes—or, heaven forfend, vapor products.

Step forward the EU Commission and its revised Tobacco Products Directive with its vapor product provisions seemingly aimed at nagging these products out of existence. And step forward the U.S. Food and Drug Administration (FDA) with a perfect demonstration of the science of obfuscation. The FDA has taken a long look at vapor products and turned what is a simple concept into an incredibly complex one. If the courts don’t rein in this agency, it will strangle these products in gobbledygook, which should be the subject of prominent, graphic health warnings. The irony is that in the one area where consumers could use some help—the area of exploding batteries—the relevant agencies seem to have completely failed.

If these organizations cannot help consumers, they should be removed from this field. Consumers are perfectly capable of navigating their way around vapor products. And as one forum participant suggested, vapor products are simply not risky enough to spend energy and resources on regulations beyond those to do with their construction.

Passion and compassion

But perhaps the forum’s passion subtheme should be expanded. One of the participants said that she had been hugely encouraged by the passion and compassion that she had seen displayed during the event. And her observation was spot on. A vapor advocate who spoke made the point that while the vapor sector had made alliances with various groups, including with public health, smokers had tended to be sidelined. He asked whether it wasn’t time to invite smokers—whom he described as the nine-tenths of the smoking/vaping iceberg still submerged—to take part in the debate. That is worth thinking about from two perspectives: from the perspective of whether this isn’t a good idea in itself, and from the perspective of how a person fighting against the odds to advance the cause of vaping still had enough energy, courage and compassion to speak out on behalf of those who so far have continued to smoke.

He wasn’t alone. A number of speakers made the point, one way or another, that while smokers should be encouraged to quit their habit, they shouldn’t be bullied into doing so by being marginalized socially or being ground under foot by unconscionable levels of taxation. In fact, the word “quit” seems to be becoming something of a dirty word. Smokers shouldn’t be encouraged to quit, it was said, but to shift to less risky products.

There was, in fact, a general groundswell of sympathy for smokers, who tend to be relatively less well-off financially. It was pointed out on a number of occasions that these smokers, especially those living outside the developed countries, but in some cases indigenous people living in developed countries, would find it difficult if not impossible to access vapor products, given the initial outlay necessary. And in the future, of course, it is possible if not likely that vapor products will, like cigarettes, be taxed.

If this is starting to make the forum sound like a late 1960s love-in, that’s probably because it was to some extent. And, of course, there are dangers here. As Mr. Lebowski was all too keen to point out: “Condolences! The bums lost!” But while there are similarities with the late 1960s, there are differences, too. The dreams of the 1960s were summoned up partly by the consumption of illicit products, whereas the movement in evidence in Warsaw is based partly on—in most places at least—a licit product. Also, importantly, in the 1960s the “straight” community was still in thrall to the existing social, economic and political structures, whereas now it is looking at structures fracturing in the realization, post-2008, that they are, if not rotten, in need of considerable remedial work.

Division

I have to step a little carefully here because I have introduced a division between licit and illicit products, and the GFN was most decidedly not about division. One speaker made the point that the use of heroin blighted lives, not because it was inherently dangerous but because its categorization as illicit often led to the use of contaminated equipment to deliver a degraded product obtained from criminals.

But there was one division that I noticed, and that was in A Billion Lives, where there were no interviews with the major tobacco manufacturers about harm reduction. I can understand why this was the case, but I think it was a pity. Say what you like about the major tobacco manufacturers, but, after a late start, they seem in general to be trying to advance the cause of harm reduction. It might be the case that independent suppliers of vapor products are more consumer-friendly and more innovative, and it might be the case that the major tobacco manufacturers are seen to be being handed an advantage because of their ability more easily to meet regulatory demands, but it has to be acknowledged that the bigger manufacturers have the financial and intellectual resources to make an important contribution.

To my way of thinking, the film dwelled too long upon the undoubted misdeeds of tobacco manufacturers in the past. These are generally well-known. What we need to focus on—as indeed the film did—is the one thing that matters: helping those smokers who want to do so to shift from tobacco cigarettes to less risky cigarette substitute products. This is certainly not, to my mind, an argument for increasing the participation of the major tobacco manufacturers at the GFN; they can all too easily take over such forums. And I don’t think that anybody should take their eyes off these companies’ lobbying and competitive arrangements. But it is undoubtedly the case that their scientists have an important contribution to make to debates surrounding harm reduction.

I should point out, however, that while the film sidelined the major manufacturers in respect of harm reduction, the GFN and its participants didn’t. At the start of the consumer advocates meeting, attendees were asked to explain who they were, and one person, representing a major manufacturer, added that he was sitting at the back in case the other attendees tried to kill him. But I can report that the man left the session unharmed.

Which is how it should have been. The forum, after all, was largely about harm reduction. Journalists were told during a press conference before the opening that the number of smokers was increasing worldwide and that during this century 1 billion people were expected to die prematurely from causes related to smoking. But while there were available nicotine-delivery devices whose consumption was 90–95 percent less harmful than was smoking, some people and organizations were discouraging their use through the application of bad science, scaremongering and poor legislation, often concocted behind closed doors. As one person said, people had been lied to—they had been told that vaping was as harmful as was smoking.

The encouraging thing is that in some jurisdictions at least consumers are savvier than they are perhaps given credit for. The point was made well enough that, for some people, e-cigarettes made giving up smoking enjoyable, which is presumably why 6.1 million people in the 28 member states of the EU are said to have quit smoking using vapor products. (It is necessary to say “quit” here because some of those who stopped smoking might also now have stopped vaping.)

But consumers have to be given a fair go. It is worth mentioning that the severity with which some countries treat people involved in the e-cigarette trade is difficult to comprehend, given that all but the one-eyed must admit these products have the potential for delivering huge public health improvements. It was mentioned during the advocates meeting with which this piece starts that people in Australia and India had been treated with what I could only describe as irrational vindictiveness. It makes you wonder who is in charge of such matters in these countries.

The GFN presentations are at: https://gfn.net.co/2016-presentations.