The Heart of the Matter
I would recommend that anybody interested in questions surrounding tobacco harm reduction take a look at these videos, but I shall draw attention to just two. I am not saying that these are the best of the bunch; I have, after all, listened to and watched fewer than half of them. But these two videos contained significant messages in my view. One, by John Oyston, a retired anesthesiologist, sought to answer the question of why many people working in the medical profession have not fully embraced the idea of tobacco harm reduction using electronic cigarettes, and made suggestions about how they might be brought on board in the future. It wasn’t that Oyston said anything new, but he brought to his presentation the insights and authority of a retired medical professional who had boiled down the salient points into a five-minute talk that, unlike some of the more data-filled presentations, got to the heart of the matter in a way that could be understood and appreciated by anybody. It deserves a wide audience.
There was something a little disturbing about Oyston’s presentation, however. This was the eighth annual GFN, and we are still apparently in a position where we are casting about for ways to get medical professionals on board. Indeed, we are still trying to get many health professionals to understand that nicotine doesn’t cause cancer. And we still seem to be in the situation where we leave each annual conference with the same words ringing in our ears—we need to refute the bad science being put about so that the messaging changes and a large majority of people accept the idea that nicotine is not the problem and can be delivered in ways that are far safer than is the case with tobacco smoking. In fact, one of the messages that came across a number of times was that science was losing out to politics and ideology, with the result that nicotine was being shoehorned into the evil empire where tobacco dwells.
This has to raise the question: do we need a plan B? Given that the object of the exercise is to encourage smokers to quit their habit, not necessarily the promotion of alternative nicotine-delivery systems, do we need to look at things again? At what point do we have to accept that, however wrong they might be, the people at the WHO and others opposed to THR have won?
One of the disheartening aspects of the conference was to see on one of the panels an unusually subdued Konstantinos Farsalinos, a physician and senior researcher at the University of Patras and the University of West Attica’s National School of Public Health in Greece. Farsalinos’ work in demonstrating the validity or otherwise of THR science has been invaluable for the nonscientists among us. But in a recent piece on Qeios, he explains how a report by journalists in the BMJ had confused his work on an aspect of Covid-19 with unconnected THR research, and had wrongly accused him of the nondeclaration of interests. But worst of all for Farsalinos, I think, was the fact that he was not allowed a right of reply in the same journal.
The next question that inevitably pops up, I guess, is outside the scope of the likes of GFN conferences. It concerns how it might be possible to encourage smokers to quit their habit without the use of nicotine alternatives. And here I mean “encourage.” What passes for “encouragement” among much of the tobacco control community is, to my way of thinking, “bullying.” It is largely about raising taxes to levels that render poorer the already financially impoverished. And in this respect, I was gladdened to hear one panelist point out that piling taxes and stigma on smokers is not ethical; indeed, it is reprehensible.
And there was some encouragement here from my other choice of videos. This one, narrated by Kevin McGirr, concerned an observational study targeting tobacco-using individuals with substance use or mental health disorders—people who make up a disproportionate amount of smoking populations. What I particularly liked about this study was its humanity—the way it has been constructed to allow the researchers to work with smokers, not work on them. Participants, who have to have shown some interest in altering their smoking habits, might not have abstinence as their final goal, which they set themselves. The researchers do not even use the term cessation.
