History in the making

A panel event in London, England, yesterday proved the adage that prediction is difficult – especially about the future.
The event, which was staged by the New Statesman magazine in association with Philip Morris International and chaired by Anna Hodgekiss, a freelance health/medical journalist and media consultant, set out to address the question: How long until smoking is history [in England]?
But given that all of the panellists – and possibly most of the 70 guests drawn from the ranks of parliament, the tobacco and cigarette industry, public health, public affairs, think tanks and professional services – seemed to support a harm-reduction rather than a quit-or-die policy, the debate turned largely on how smokers could be encouraged to switch to lower-risk products, such as vapor devices and oral tobacco products.
Nevertheless, Nick Fitzpatrick, an economist and consultant with Frontier Economics, which last year produced a report for PMI entitled: Working towards a smoke-free England, presented some of the findings from that report, one of which had it that the UK government would meet its smoke-free target of reducing the prevalence of smoking in England to five percent by 2040 given the continuation of current taxation policies and regulatory interventions. Fitzpatrick added that the target could be met by 2029 if a number of criteria were fulfilled, including increasing rapidly the number of smokers switching to smoke-free alternatives, such as e-cigarettes.
But these predictions were less important than the debate that they stirred – a debate that PMI has been encouraging since 2016 and one that, while based on an English experience, had universal echoes.
The panellists seemed to agree that there were too many unknowns to predict with any accuracy when smoking might end in England, But there was general agreement that vapor products had made a major step in the direction of encouraging smokers to quit and that they could make a further contribution given that they were the subject of sensible taxation policies that reflected their health impact, sensible, relevant regulation that was not simply moved over from tobacco regulation, and product improvement and innovation.
It would be necessary also to ensure that lower-risk messages were communicated to both smokers and the health care professionals who advised them, many of whom were still reluctant to talk with smokers about using vapor devices, even when those smokers had exhausted other methods of quitting.
The debate threw up the question of what it meant for smoking to be eliminated, and the idea that elimination would have been achieved once the smoking prevalence had been reduced to five percent was questioned. Panellist Mark Littlewood, the director of the Institute of Economic Affairs, pointed out that a five percent threshold, more widely applied, would mean that heroin was not used in the UK. Littlewood pointed out also that the rate of success in encouraging people to quit would be governed in part by a law of diminishing returns as the number of people still smoking was boiled down to a hard core of smokers.
One complicating factor in getting smokers to move to vapor devices was seen as the fact that smokers have different needs. Sarah Jakes, the chair of the New Nicotine Alliance and one of the panellists, told the event that she had switched to a vapor device even though it had not been her intention to do so. She was a smoker who decided to try e-cigarettes so that she could vape while in her car, but she had found that she liked the device to the point where she switched over completely. Littlewood, on the other hand, admitted that he had been unable to find a satisfactory substitute, and while he found heat-not-burn products better than e-cigarettes, he kept drifting back to traditional cigarettes. And another panellist, Dr. Roger Henderson, a general practitioner and smoking cessation expert, in a chilling intervention, told how some diabetics would choose smoking over their legs.
One interesting side issue had to do with the sympathy demonstrated for smokers who did not want to quit or could not quit. Although Henderson was passionate in his opposition to smoking and just as passionate in his support for harm reduction, he believes that in the end a smoker has to decide for herself what she does. If a smoker fully understood the risks she was taking and if she knew what cessation help was available to her but still decided to keep smoking, it was not for other people to tell her how to live her life.