Tag: World Health Organization

  • WHO Alarmed Over Youth Vaping in Europe

    WHO Alarmed Over Youth Vaping in Europe

    Photo: Ethan Parsa from Pixabay

    Despite an overall decline in tobacco use among young people in Europe, several countries of the region observed an increase in tobacco use prevalence among young people in the latest round of the Global Youth Tobacco Survey.

    While cigarettes remain the most used form of tobacco products, young people are turning to e-cigarettes at what the World Health Organization (WHO) describes as “an alarming rate.” In some countries the rates of e-cigarette use among adolescents were much higher than those for conventional cigarettes, according to the new report. In Poland, for example, 15.3 percent of students smoked cigarettes and 23.4 percent used electronic cigarettes in 2016.

    Some countries that monitor e-cigarette use among young people have shown marked increases over the years. In Italy the prevalence of current e-cigarette use increased from 8.4 percent in 2014 to 17.5 percent in 2018. In Georgia it increased from 5.7 percent in 2014 to 13.2 percent in 2017, while in Latvia it was 9.1 percent in 2011 and 18 percent in 2019.

    Contrary to health advocates who acknowledge the tobacco harm reduction potential offered by new “tobacco” products, the WHO views e-cigarettes and heated tobacco as a tobacco industry ploy to preserve and expand its markets.

    “However, with good guidance, research and a rigorous implementation of the WHO Framework Convention on Tobacco Control, a path can be built towards a tobacco and nicotine-free future,” the global health body wrote on its website.

  • Feet to the Fire

    Feet to the Fire

    Photo: Alexey Novikov |Dreamstime

    Five questions for the Framework Convention on Tobacco Control as the treaty marks its 15th anniversary

    By George Gay

    This year marks the 15th anniversary of the entering into force of the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC), but I won’t be sending a card. I’m sure the parties to the FCTC will understand. It’s nothing personal. It’s just that it’s unwise, especially for somebody of my age, to make unnecessary trips to the shops and post office just now because, while the WHO had its eyes focused firmly on tobacco smoke, a colossal, deadly pandemic arrived on the doorstep, seemingly without very many people in the global health community noticing. Or, if they did notice it, perhaps they didn’t like to make a big deal of it straight away, presumably because they didn’t want to make a fuss and alarm people unnecessarily.

    Nevertheless, I guess that the pandemic has put a bit of a damper on the FCTC’s anniversary celebrations, which kicked off on Feb. 27, two days after the WHO’s coronavirus timeline described the director-general of the organization, Tedros Adhanom Ghebreyesus, as having “repeatedly called for ‘solidarity, not stigma’ to address Covid-19.” So at least one good can come out of this mess. We can assume, I suppose, that the WHO, which has spent 15 years using the FCTC to urge national governments to stigmatize smokers, has now realized that stigmatizing certain groups of people is discrimination at its most ugly and grossly unfair.

    The elephant in the WHO’s smoke-filled rooms wasn’t even called a pandemic—such a nasty word—until March 11, but, about 10 months on, Covid-19 has been responsible for the premature deaths of more than a million people, huge social upheavals, domestic and international political rows, and catastrophic economic damage that is causing untold hardship, especially among the financially worse off. I believe the virus that causes Covid-19 is thought to have become endemic in some areas. Still, let’s not get into a blame game. After all, anybody can make a mistake.

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    Ruling out harm reduction

    I have long found it difficult to understand why a global health organization would become obsessed with tobacco smoking, which is legal and a lifestyle choice for some perfectly respectable people, but seemingly be less bothered about devastating health threats that can sweep across national borders and that the person in the street has almost no defense against. Let’s not pretend that the current pandemic could not have been predicted and that it caught everybody by surprise.

    I can be sure of two things, however. Nobody will be held to account for this mess, and the parties to the FCTC will continue to pat themselves on the back for “saving lives.” Of course, in reality, not one life has been saved in the physical sense. Some lives might have been extended but without the FCTC asking the people concerned whether they wanted to have their lives extended. The view of this point from Geneva will, after all, be different to that from, say, some of the world’s many war zones.

    I have from time to time also wondered why the WHO feels compelled to stick it to smokers alone, and my curiosity was roused once again by a number of recent comments from respected members of the health community who have suggested the WHO has lost its way with tobacco. These comments suggest the WHO is ignoring what is currently the most promising tobacco harm reduction tools by, de facto, ruling out the use of innovative nicotine-delivery products produced by the tobacco and nicotine industries to transition cigarette smokers to far less risky habits.

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    Picking on smokers

    So I decided it was time to take a fresh look at the FCTC treaty text, and I didn’t have to read far to find what probably is the answer to part of my query. The very first item in the preamble to the treaty says the parties to the convention are determined “to give priority to their right to protect public health.” It jumps out at you, doesn’t it? The words “their right.” What exactly do they mean by “their right”? Do they believe this right has been divinely bestowed and that their mission is to save lives at a spiritual level? It seems unlikely in this day and age, but you have to wonder when you observe some of their inquisitional-style tactics, such as putting smokers on the tax rack, geared up with the Protocol to Eliminate Illicit Trade in Tobacco Products, which came into force in September 2018, despite the fact that, even now, it has only attracted the support of 58 parties out of the FCTC’s 181.

    And how is it that the parties to the FCTC assume that their rights override the right of smokers to smoke? I would willingly concede that the parties to the FCTC, in so far that they represent governments, have an “obligation” to protect the public, which is part of the democratic contract between voters and governments, but I get nervous when rights are invoked. Obligations tend to make people set to work; rights tend to cause people to forget their obligations, mount their high horses and launch moral crusades. And let’s face it, you cannot mount a moral crusade against an invisible virus—you just look silly. If you want to mount a moral crusade, you need to do it with panache, and that needs an identifiable enemy. A windmill, perhaps, or better still, a smoker.

    But even if the WHO needs an enemy it can point at, why did it pick on smokers and smokers alone? It was a conscious choice and one of which it is proud. One of the first sentences of the anniversary website proclaims that the FCTC is the only international treaty negotiated under the auspices of the WHO. There is, in other words, no treaty aimed at stigmatizing drinkers, polluters and the other groups of people involved in harmful activities that affect other people as well as themselves. This is odd to my way of thinking because it is becoming clear that pollution is causing far greater damage to people’s health than smoking, especially in the case of young people.

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    The questions

    So what is the FCTC about? It’s difficult to say because it’s a shadowy organization that shuns publicity, save that contained in the controlled announcements it puts out. Attendance at its meetings is strictly controlled so that, I guess, everybody present is in agreement about stigmatizing smokers before these events get under way. And in such circumstances, the only way to find out about this organization is to conduct an “interview,” using a modified version of what I understand is the five-point questionnaire devised by the late Tony Benn for interrogating the powerful:

    1. What rights do you, the FCTC, believe you have in respect of involving yourself in the lives of smokers?
    2. From where did you get these rights?
    3. In whose interests do you use these rights?
    4. To whom are you accountable?
    5. How do we get rid of you?

    What worries me, in respect of the first question, is that the FCTC might be laboring under the misapprehension that ethics and rights are linked: that taking what it sees as an ethical, nose-in-the-air stance on tobacco smoking in itself confers on it the right to encourage regulations opposed to such smoking. This is nonsense. It is quite possible to be opposed to something ethically but be willing to uphold other people’s rights to avail themselves of that thing. I would imagine that just about every government in the world claims to be ethically opposed to tobacco smoking but nevertheless does not introduce legislation aimed at ending it anytime soon.

    I cannot answer the second question because, as far as I am aware, there has been no divine intervention. And if that right was bestowed by some nondivine being, and given the fact that smoking is legal, you get into a circular argument about who gave that being the right to bestow such a right …

    I know the answer to the third question, however. It is present and future generations. The anniversary website tells us, “The aim of the convention is to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke.” This is all very noble, if one is willing to concede that the parties to the FCTC have the right to act in this way, but it still raises numerous questions. One is why is there no protection from alcohol consumption, which almost certainly is playing an indirect part in increasing the spread of Covid-19, and no protection from pollution? After all, there is no point acting to protect future generations from tobacco consumption and smoke if, because of pollution, climate change and environmental breakdown, there aren’t going to be many future generations as currently seems likely. Another is why is there no stigmatization of those who consume alcohol? Down at my local supermarket, I can choose from row upon row of alcoholic drinks, some of them flavored, but none of the bottles or cans that contain these drinks show graphic warnings stigmatizing drunks with pictures depicting them beating their partners to death, urinating in their pants or choking on their own vomit.

    To whom is the FCTC accountable—or more pointedly, beholden? I guess it’s those who hold the purse strings, though it is clearly the case that they are not holding the organization to account. A better health outcome could be achieved by doing away with the FCTC’s meetings and giving the considerable amounts of money saved to the world’s poorest to spend as they see fit. This would have the added benefit of saving the environment from the considerable damage inflicted by flying representatives of the 181 parties to and from the meeting venues.

    Finally, question five. How do we get rid of you? Simply by having governments, which best understand how their societies operate, take full control of their own tobacco policies. There is no need for a supranational body to oversee the demise of the tobacco industry. The industry is supplying the tools to do the job, and all that national governments have to do is aid that process by allowing sensible, truthful advertising of the new products and by keeping an eye on those products. If the WHO wants a role, it should concern itself with ensuring that tobacco growers, especially those in Africa, are given the tools to transition away from tobacco and into other, more lucrative operations.

    And if the FCTC wants to maintain a role, it should change its ways by treating smokers as ends in themselves not as a means to an end.

    George Gay is Tobacco Reporter’s European editor, but his territory spans the globe. Based in London, George has covered the tobacco industry since 1982, initially for a U.K.-based publication and since 2004 for Tobacco Reporter. George’s understanding of industry issues, combined with his keen sense of observation and dry wit, have earned him a loyal following among Tobacco Reporter’s readers.
  • Turning the Tanker

    Turning the Tanker

    Now would be a good time for the World Health Organization to change direction without abdicating from its tobacco responsibility.

    By George Gay

    A few lines from a song by the late Warren Zevon have taken up residence in my head of late: “You can dream the American Dream / But you sleep with the lights on / And wake up with a scream.” Whether or not they buy into the idea of the American Dream, a lot of people around the world, I imagine, are feeling that level of fear because of the Covid-19 pandemic. Take me, for instance: I have been waking with a scream brought on by a recurring dream in which, with the world in the grip of a post-Covid-19 pandemic, I am trying to discover whether the U.K. government has managed finally to get its head and technology around the concept of contact tracing. The answer is no.

    But it’s not all bad news, I’m told. The government is now able to inform me of the whereabouts of every pack of cigarettes in existence, nationally or internationally. There is even some talk about how it might have been able to game Heisenberg’s uncertainty principle since, by using a track-and-trace system developed at the behest of the World Health Organization (WHO) that works in real time, even during deliveries, it is aware of both the position and momentum of each pack. It is at this point that I wake up screaming.

    Why has building a track-and-trace system for cigarette packs apparently been seen as more important and more urgent than developing a globally adaptable, fast-to-implement and efficient contact tracing system for people during times of pandemics? I don’t know, but I can guess at a number of reasons, one of which was playing out across the world as I wrote this piece in June when many of those in authority were demonstrating once again the relative importance they attach to the preservation of people (low) and property (high). 

    In addition, as far as I can see, the cigarette pack track-and-trace system is in place to ensure that those who choose to smoke and thereby risk their health pay the full price for their cigarettes. The “free” market, which the WHO clearly supports, demands that a proper level of profit and tax revenue should be squeezed out of the products that make people sick and that a proper level of profit should be made in treating that sickness.

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    Dismantling the arguments

    But whereas it’s easy to see why some businesses dealing in tobacco and health would appreciate what they would see as the benefits of such a system, I struggle to understand why the WHO would find it advantageous. So let me take a guess about what we might be told if the WHO were, with the help of a nosegay, able to bring itself to answer questions from a representative of the tobacco industry. Firstly, though, it is necessary to understand that the WHO believes that the implementation of its track-and-trace system will reduce—it actually uses the word “eliminate,” but that is the stuff of dreams—the sale of illicit cigarettes and therefore smoking. Given this, I imagine it would say the consumption of tobacco causes the deaths of 8 million people a year whereas Covid-19 has so far (see below) caused the deaths of 430,241, so tobacco is by far the bigger threat.

    There are a number of problems with this argument. The main one as I see things is that whereas tobacco has been around for a long time and therefore has to be subjected to control measures, there is still time to build robust preventative measures to combat the thousands of potential viruses that are lining up to devastate lives and economies around the world. And in the eyes of all but the most virulent free market supporters, prevention must be preferred to control, so a people contact tracing system should be regarded as being way more urgent than a cigarette pack track-and-trace system.

    Another problem with the above argument is that it is based on two figures that are clearly wrong: one being ludicrously rounded, the other being ludicrously precise, even though they are both WHO figures published this year. The 8 million figure was published on May 26 without even the qualification of an “about” while the 430,241 figure was published in respect of the period of the Covid-19 crisis up to June 15.

    Does it matter that these figures are wrong? To my mind, yes. It’s a matter of trust. We seem to have reached a situation whereby any information dumped on the unsuspecting public, no matter how distorted, can be justified on the grounds that it is meant to bring about the most advantageous result, seemingly defined as the result best suited to the ideologies of those putting that information out. And once people and organizations start to believe in this way of carrying on, especially as in the case of the WHO, if they refuse to engage with those of the outer dark, they become reckless. For instance, in recent times, the WHO’s annual tobacco-related deaths figure seems to have been playing 1 million unit leapfrog with its pollution-related deaths figure.

    But it is not only the hyperinflation of these figures that make them look suspect. Given that many people who die of tobacco-related or pollution-related deaths will die from, say, lung disease, how is it possible to accurately ascribe these deaths to their rightful causes? If a smoker living in a flat adjacent to a city’s main diesel bus parking and servicing depot dies, is her death put down to pollution or to smoking? No prizes for correctly guessing the answer.

    The end result of all this will surely be that no thinking person will trust such figures and, by extension, the individuals and organizations that pump them out with the further consequence that various people will be wringing their hands because the person in the street has become fed up with experts. It is necessary to remember that if you publish dodgy information, as it is passed down the line it will become further distorted until the point where it becomes drivel.

    Take the 430,241 figure. In a story in my newspaper, the writer or editor, presumably concerned that it was not possible to justify such an exact figure, rendered it as “more than 430,000,” which sidesteps one problem but runs into another. What does “more than” mean here: 430,001, 4.3 million, 4.3 billion?

    Meanwhile, a recent note by the British Heart Foundation (BHF), which claimed that “contrary to headlines suggesting that nicotine protects against Covid-19, smokers are more likely [presumably than nonsmokers] to contract the coronavirus.” It makes this claim, even though it quotes a WHO note that says, in part, “There are currently no peer-reviewed studies that have evaluated the risk of SARS-CoV-2 [the virus that causes Covid-19] infection among smokers.”

    But not content with this nonsense, the BHF goes on to say, “Even if smoking did have a small protective effect against Covid-19, this would still be hugely outweighed by the well-known harm that smoking causes.” How can this be justified either at a personal or a smoker-population level, especially when no timeframe is mentioned? To make any such claim, you would firstly have to know what is the level of this so-called “small” protective effect, and this is not known. Then, on an individual level, you would need to know a good deal about the smoker’s personal details, including such things as her age and general state of health. And, as time goes by and we learn more about this novel virus and the disease itself, we would probably need to know more. After all, from my reading of some of the latest findings, the unprecedented damage done to the lungs and other organs while Covid-19 is active in the body far outweighs the damage done by smoking over a similar period.

    The point is, we don’t know enough about Covid-19 to be handing out anything but the most basic advice about such things as hand washing and social distancing. And if we don’t know, we should say we don’t know. We should not be extolling the efficacy, nor the dangers, of nicotine in the fight against the virus unless we are fairly certain that we are right.

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    Wanted: New direction

    And, to give it its due, the WHO took a more balanced view than the BHF in this regard. In fact, despite the above, I’m very much in favor of having a health organization with global reach, but the WHO desperately needs to change the direction set by the previous director general. It has to change its focus from addressing those health issues that individuals can tackle on their own and that are far from existential in nature, such as tobacco and nicotine use, to addressing—and here I mean preventing in preference to controlling—those health issues that the person in the street has no or little control over and that could be existential in nature, such as species-jumping viruses.

    Given the state of unpreparedness that the world found itself in when the Covid-19 virus started crossing borders, it is simply ridiculous that the WHO has held eight international conferences under the auspices of its Framework Convention on Tobacco Control, including more recently its meetings of the Parties to the Protocol to Eliminate Illicit Trade in Tobacco Products. It takes 40 years or so to die from a smoking-related cause—40 years during which the smoker provides an inordinate amount of revenue to the exchequer and, yes, derives pleasure and, perhaps, solace from her habit. It takes three weeks to die of a Covid-19-related disease, and just the threat of the disease causes economic mayhem.

    The good news is that now is an ideal time for the WHO to change direction without abdicating from its tobacco responsibility. Businesses have been and are providing a string of innovative products that can help cigarette smokers switch to these much reduced-risk products, including vapor devices, snus, nicotine pouches and alternative nicotine-delivery devices. The WHO doesn’t have to endorse these products; however, it does need to stop pretending that they are not highly useful products in the fight against smoking—certainly more useful than the sorts of pharmaceutical products that it seems willing to endorse.

    But it’s going to be a hard job turning the WHO tanker around. To coincide with World No Tobacco Day 2020 at the end of May, an international group of independent experts with no conflicting links to the tobacco or vapor industries sharply criticized the WHO for its backward-looking approach to innovation and new technology, such as vapor products. A press note, put out under the Iowa Department of Justice’s Office of the Attorney General, made the point that these experts had become exasperated by the WHO’s dogmatic hostility toward new technology and feared the U.N. health agency would squander the opportunity to avoid millions of premature deaths that will be caused by smoking.

    The attorney general, Thomas J. Miller, the longest-serving state attorney general in U.S. history, who played a leading role in the 1998 Master Settlement Agreement, claimed the WHO had lost its sense of mission and purpose. “It’s as if the WHO has forgotten what it is there to do—to save lives and reduce disease,” he was quoted as saying. “We can do that by helping and encouraging consumers to switch from cigarettes to lower risk products. This means being honest about the much lower risks and by using smarter regulation to make switching more attractive.”

    To my mind, honesty is vital. But it needs to be extended to other institutions—the U.S. Food and Drug Administration and the EU Commission spring to mind—and to governments. It is vital too, to keep in mind that the aim is “to save lives and reduce disease,” though I would like to once again put in a plea here that “reducing disease” should in the first instance focus on prevention and only after failure in that aim to controlling disease. It is necessary to keep banging on about prevention because it is the logic of the free market and of many of the authoritarian and would-be authoritarian regimes around the world that if we had a global health organization that managed through prevention alone to eliminate all diseases in the world, its funding would be cut to zero.

    George Gay is Tobacco Reporter’s European editor, but his territory spans the globe. Based in London, George has covered the tobacco industry since 1982, initially for a U.K.-based publication and since 2004 for Tobacco Reporter. George’s understanding of industry issues, combined with his keen sense of observation and dry wit, have earned him a loyal following among Tobacco Reporter’s readers.
  • Setting Priorities

    Setting Priorities

    Photo: PixaBay

    The WHO needs to target more of its resources at communicable diseases.

    By George Gay

    Since it was suggested that the wellbeing of nonsmokers could be negatively affected by secondhand tobacco smoke, smoking has been banned in an ever-increasing number of public places, including workplaces, in more and more countries; and, in this way and to a large extent, the perceived problem has been solved while retaining most of the economic benefit the tobacco industry delivers.

    Since almost everybody in the world has been under some level of threat of contracting Covid-19, the disease caused by SARS-CoV-2, people have been banned from an ever-increasing number of public places, including workplaces, in more and more countries; and, in this way and to some extent, the spread of the virus has been slowed, though those measures have caused, are causing and will cause for an as-yet-unknown time untold social problems and a reduced economic output such that, according to at least one headline, the world is going bust—whatever that means.

    It takes about 40 years for a smoker to die of a smoking-related disease. It takes about three weeks to die of Covid-19.

    And yet … it’s tobacco that seems to be uppermost in the mind of the World Health Organization (WHO). The Conference of the Parties to the WHO Framework Convention on Tobacco Control (FCTC) and the Meeting of the Parties to the Protocol to Eliminate Illicit Trade in Tobacco Products was due to be held in November, according to a note on the FCTC website dated Feb. 5 and still current well into April. But there was no mention of the Conference of the Parties to the WHO Framework Convention on Pandemic Prevention and Control, or of the Meeting of the Parties to the Protocol to Eliminate Trading on Markets Known to Present a Significant Risk of Zoonotic Diseases.

    It’s true that, on April 27, the joint meeting was postponed until November 2021, but not, as one might have expected, because the WHO needed to have all hands to the Covid-19 pump, but: “In light of the COVID-19 global pandemic and its impact on the conduct of international global conferences and travel…” But surely, it cannot go ahead even then. I cannot believe that the countries that normally fund this event are going to put up the money for the ninth meeting of the Parties—not at this time. Not when their treasuries are in hock and it is clearly time to focus attention on a few of the health threats that, unlike the threat of tobacco, people cannot deal with themselves: pollution, pandemics and poverty, for instance.

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    Spectacularly unprepared

    It is staggering that the world was as ill-prepared as it was for the onslaught of SARS-CoV-2 (hereafter referred to as the coronavirus). Representatives of most countries have come together for eight international conferences to discuss tobacco and latterly the illegal trade in tobacco, which you have to perform intellectual somersaults to view as a health issue. Did they not come together to discuss what to do in the case of a coronavirus outbreak?

    It seems as though they didn’t since the world proved spectacularly underprepared despite the fact that the coronavirus is generally assumed to have arisen from the midst of a type of “wet market” (one that sells both live and butchered animals, some of them exotic) that is known to be one of the major risk factors for such virus outbreaks. It was underprepared despite the fact that the operation of this market was taking place within China, a country that plays a major role in the global market. And many countries were underprepared because they had fallen for the idea that the “free” market was sovereign. They had allowed to be outsourced their manufacturing capabilities, including those producing the personal protective equipment (PPE) that is vital during the sort of pandemic that has ensued, they had run down stocks of such equipment, and they had failed to put in place workable plans to ramp-up quick and local manufacturing of such PPE in the event of an emergency.

    In other words, we are dying from a perfect storm of markets: wet, global and “free.” Or rather, we are dying from a perfect storm of these markets plus the effects of the interference in two of them once the going got tough. Once the authorities in some countries realized that they had been left exposed in respect of PPE and ventilators, globalization lost its sheen, border gates were slammed shut and the “free” in free market was taken a step further so as to include the “hijacking” of PPE.

    The wet market in question was being operated in Wuhan, though it would be misleading to give the impression that if these sorts of wet markets were eliminated in China, the world would be safe. Similar markets are operated in other countries, and the risk of coronaviruses arises from many other sources, including the sorts of factory farming that supplies most of the meat consumed in the U.K., where I live. And while the problems caused by the coronavirus were exacerbated by China’s system, which tends to suppress what are viewed as negative messages, such systems are being taken up in other countries. In the U.K., we are building a cult of leadership—albeit one that is looking a little shaky at the moment—and have recently voted in a government that is itching to control the media, the message and, as a backstop, the courts. Given the narrowness and brittleness of the U.K. government’s ideology, it is not surprising that it has proved to be one of Europe’s most incompetent in the face of the coronavirus.

    Change ahead?

    But we shouldn’t despair. I keep reading how, after we come through this pandemic, things must change. For instance, it’s said that inequality must be reduced significantly. This is a nice idea, but given what happened after the 2008 financial crash, a little naive, I think.

    One of the changes that is much touted has it that a lot of people whose jobs are now undervalued and underpaid will henceforth be recognized for the essential work they do and will be paid accordingly. Of course, this predicted change concerns mainly healthcare and other workers without whom basic services cannot be maintained, but let’s look at the tobacco industry. Will this brave new way of looking at the world change the lot of the tobacco grower, who, by definition, is an essential worker when it comes to producing tobacco products? I don’t think so. They will continue to live on a pittance while those performing nonessential jobs and those performing no jobs will snap up the big tobacco money. 

    But let’s look on the bright side. Perhaps one of the changes will deliver a different type of advantage. Perhaps we will try to hang onto the environmental benefits that have seen pollution reduced over many cities partly because people have been making fewer journeys during lockdowns. Again, it’s a nice idea but unlikely. Such change would require bold political and business leadership at a time when many of the countries of the world are led by people who have so little imagination that they cannot see we have a problem or who are so in hock to the current system that they daren’t change direction. In a scene that reflects the end of the film, Dr. Strangelove, some airlines, for instance, are jostling for public money so that they will be able to take to the skies again en masse once lockdowns are lifted. You can laugh at the idea of a “mineshaft gap” only when it’s part of a film.

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    Ramping up pressure

    In fact, very little changes. Anti-tobacco crusaders have used the coronavirus to try to scare smokers (and, in some cases, vapers) into quitting. At a time of high anxiety, they have ramped up the pressure on smokers by putting forward the idea that they are at especial risk if they contract Covid-19. Looked at from one direction, this is common sense. Smoking affects the lungs—organs that the coronavirus attacks. But the one thing that we know about Covid-19 is that we know very little about it; so, I would suggest that it behooves anti-tobacco activists to take this into account before speculating. Indeed, it might be wise from their own point of view to exercise a little caution. They are going to look rather daft if, as seems possible at the moment, it is found that smoking and, more particularly, nicotine, is a defense against contracting the coronavirus.

    I’m sure that some of the people using the coronavirus as a means of scaring smokers half to death are well meaning. But I cannot say the same for those who have been putting forward the idea that tobacco is not an essential item and so should not be on sale during lockdowns, especially since in many countries tobacco products are available at the sorts of shops that are open anyway because they sell food. This idea, I take it, comes from what must be the puritanical fringe. But the puritans too should exercise some caution—on two counts. They need to bear in mind that one crucial aspect of a lockdown is that you keep as many people on side as is possible. And they need to be aware of the fact that they, also, are going to look more than a little daft if smoking and nicotine turn out to comprise a defensive weapon.

    And there are aspects of this idea that simply don’t make too much sense. We are told that smokers are addicted to their habit and find it nearly impossible to quit. So, what do politicians think is going to happen when they cut the official tobacco supply to addicted smokers, especially if those smokers suspect that smoking could be a defense against contracting the coronavirus? The likelihood is that there will be an increase in the illegal trade, which won’t, because of the nature of that trade, be observing social distancing. And it is a racing certainty that tax revenues will fall—at a time of special need for such revenue.

    Targeting resources

    But let me flip back to the beginning of this piece because I might have given the wrong impression. I support the institution of the WHO and do not think that the president of the U.S., Donald Trump, was wise to threaten to cut his country’s funding for the organization, though I can understand why he is feeling a little cross with it.

    As is stated above, however, the WHO needs to target more of its resources at communicable diseases such as the coronavirus that is now running amok across the world. It can backpedal on tobacco. The tobacco and nicotine industries, with their ever-improving, new-generation products can do a better job than the WHO in reducing and, eventually, eliminating smoking. This is the sort of area where the “free” market does work.

    What the WHO doesn’t need to do is be the cause of thousands of people flying around the globe to come together in November 2021 to discuss a problem that others can solve. Holding the FCTC meeting will cause pollution and, even at that time perhaps, before the world has figured out how to interact with nonhuman animals in a civilized manner, send out the wrong message about bringing people together for major international meetings.

    Finally, it needs to be remembered that tobacco, unlike novel viruses, cannot pose an existential threat to civilization. For the WHO and its members to concentrate on tobacco is reckless.

    George Gay is Tobacco Reporter’s European editor, but his territory spans the globe. Based in London, George has covered the tobacco industry since 1982, initially for a U.K.-based publication and since 2004 for Tobacco Reporter. George’s understanding of industry issues, combined with his keen sense of observation and dry wit, have earned him a loyal following among Tobacco Reporter’s readers.
  • WHO Criticized for ‘Backward-Looking’ Approach

    WHO Criticized for ‘Backward-Looking’ Approach

    Tom Miller | Photo: David Parker

    Marking World No Tobacco Day, an international group of independent experts has criticized the World Health Organization (WHO) for its “backward-looking” approach to innovation and new technology, such as vaping products.

    The experts say they are exasperated by the WHO’s “dogmatic hostility” towards new technology and fear the U.N. health agency will squander the opportunity to avoid millions of premature deaths that will be caused by smoking.

    Iowa State attorney general Tom Miller said the WHO has lost its sense of mission and purpose. “It’s as if the WHO has forgotten what it is there to do—to save lives and reduce disease,” Miller said.

    “We can do that by helping and encouraging consumers to switch from cigarettes to lower-risk products. This means being honest about the much lower risks and by using smarter regulation to make switching more attractive.”

    The group of experts criticizing the WHO include David Abrams of the School of Global Public Health, New York University; Tikki Pangestu, visiting professor, Lee Kuan Yew School of Public Policy, National University of Singapore; John Britton, professor of epidemiology at the University of Nottingham; Rajesh Sharan, of North-Eastern Hill University, Shillong, India; David Sweanor, Centre for Health Law, Policy and Ethics, University of Ottawa; and Clive Bates, director of Counterfactual Consulting.

  • Turkish Leader Blasts Tobacco Industry

    Turkish Leader Blasts Tobacco Industry

    Photo: Gerd Altmann from Pixabay

    Celebrating the World Health Organization’s World No Tobacco Day, Turkey’s president Recep Tayyip Erdogan on May 31 blasted the tobacco industry, saying it entrapped millions of young people in addiction.

    “The tobacco industry has been filling its own pockets for decades, depriving the freedom of millions of young people, imprisoning them to a life of addiction,” Recep Tayyip Erdogan told Turkish youth via videoconference at an anti-smoking event in Istanbul.

    Erdogan said temporary closures of hookah-smoking and entertainment venues introduced to curb the spread of the novel coronavirus would remain “for a while longer.”

    In February, Turkey banned the import of e-cigarettes and related products. Asserting that the tobacco industry had tried to find new customers for the “poison” they produce, Erdogan accused the industry of propaganda and manipulation.

    Turks consumed a record 119.7 billion cigarettes and spent TRY78 billion ($11.4 billion) to sustain their habit in 2019, according to data released by the country’s health ministry.

    The figure exceeds the previous record, set in 2018, of 118.5 billion sticks, and comes despite a long-running anti-tobacco campaign.

    Registering at up to 87 percent of retail price, Turkish cigarette taxes are among the world’s highest, following a series of hikes to tobacco taxes since the beginning of 2019.

    An estimated 14.5 million adults and 252,000 children use tobacco every day in Turkey, according to Tobacco Atlas.

  • Rehumanize Yourself – The WHO’s Backward Priorities

    Rehumanize Yourself – The WHO’s Backward Priorities

    In the fights against smoking, the World Health Organization appears to measure success in bureaucratic rather than human terms.

    By George Gay

    As I get older, I have a growing problem whereby my thought processes move into circular orbits around my head. For instance, I have been reading the 2019 World Health Organization’s (WHO) tobacco report and, while you might expect it to contain much food for thought, just about the only question that is doing the rounds in my mind is: Why does the report contain so many pictures of children (and to be clear, I’m talking about preteen children)? There are so many such pictures that I gave up counting less than halfway through the 200-page online version of the WHO report on the global tobacco epidemic 2019, by which time I had totted up 50 smiling children.

    Don’t get me wrong, such pictures, with their air of joy and hope, can brighten the darkest days even for an old cynic. But there is a time and a place, and I thought that mixing such pictures with tobacco was a no-no, unless overwhelming evidence could be presented to support the idea that such juxtapositions would have a significant positive outcome for children in general.

    So, perhaps I wouldn’t have questioned the placement of the pictures if the underlying theme of the report had been the prevention of smoking initiation among children, but it wasn’t, and the use of the pictures seemed gratuitous. The theme was “offer help to quit tobacco use,” a seemingly tortuous effort to justify the ‘O’ in ‘MPOWER,’ which was said in a foreword by WHO Director General Tedros Adhanom Ghebreyesus to encompass six measures to help implement the WHO’s Framework Convention on Tobacco Control (FCTC) using “effective interventions that are proven to reduce demand for tobacco.”

    To my mind, this foreword is a strange piece in which “success” seems to be measured in bureaucratic terms—in respect of how many countries have been encouraged to implement MPOWER measures—rather than in human terms—the number of people who quit smoking, which doesn’t get a mention.

    It seems a strange thing to say, but the FCTC doesn’t seem to do humanity. Rather than try to get to the bottom of why people smoke and help address the issues they have, it encourages governments to threaten them with graphic images of diseases and tax them until they bleed through the eyes. It seems not to be on the side of the smoker but on the side of some greater calling. It seems to be on the side of tobacco manufacturers, through its Protocol to Eliminate the Illicit Trade in Tobacco, and on the side of governments and their revenues, which many spend not on programs to prevent tobacco initiation among smiling children but on armaments, some of which end up blowing the limbs off those children. I suppose you can’t smoke if you don’t have any fingers.

    As usual, the United Nations is protecting us from things we can protect ourselves from, but leaving us exposed to those that we cannot

    The closest the director general comes to talking about getting smokers to quit their habit is when he suggests that due in part to countries implementing MPOWER measures, “many tobacco users now want to quit, and we know how to help them.” To my mind, the lack of urgency and ambition in this statement beggars belief. But then I guess it’s easy to get used to failure. Part of the summary of the report has this to say: “Unfortunately, only 13 new countries have started providing comprehensive cessation programs since 2007. There are now 23 countries protected by this measure, up from 10 countries in 2007.” At this point, you start to wonder whether the children are pictured because this report is meant to be read by them—or, more likely, only by the very youngest among them. After all, I assume that adults and most children would not need to be told that if a number has increased from 13 to 23, the original number was 10.

    The forewords by Michael R. Bloomberg, WHO global ambassador for noncommunicable diseases and injuries and founder of Bloomberg Philanthropies, and Vera Luiza da Costa e Silva, head of the WHO FCTC Secretariat, also seem to measure success in getting countries to implement FCTC policies, and the nearest they get to talking about the numbers of people who have quit—or who would have quit if only—is when the latter says, “If tobacco cessation measures had been adopted at the highest level of achievement in 14 countries between 2007 and 2014, 1.5 million lives could have been saved.” I’m sure that if they could speak, those 1.5 million people would want to thank da Costa e Silva for her encouraging words.

    The three forewords run to about 1,750 words, and, despite the number of pictures of children in the report, the word “children” occurs only once in those forewords when da Costa e Silva claims the tobacco industry doesn’t want anything to change, but “for the sake of public health, and in the interests of our children and future generations, things must change.”

    Ah, change; it’s all very well, but you do have to be careful what you wish for. In his foreword, Bloomberg highlights some of the WHO’s most important gains, one of which has occurred in Brazil, which “is now the second country [after Turkey] … that has passed all MPOWER policies at the highest level.” It’s true. Policies in Brazil do seem to have changed to ensure that fewer of its children will die of tobacco-related diseases, but mainly, I would suggest, because they will firstly fall victim to the effects of climate change-induced environmental disasters, in which, in fairness, many other countries will be complicit.

    As usual, the United Nations is protecting us from things we can protect ourselves from, but leaving us exposed to those that we cannot: climate change, environmental breakdown, pollution, poverty, globalized viruses and those endless bombs sold, according to the logic of the market economy, to any lunatic group with the money to buy them. There is little sense that we should be in preventative rather than reactive mode. When I see the pictures of the WHO’s smiling children, I cannot get out of my mind the faces of children I see in my newspaper: terrified, dirty faces above malnourished, shabbily clothed bodies wandering among rubble-strewn streets a million miles and years from a school, an inspiring teacher and the prospects of a better life. But at least they’re too poor to be using tobacco.

    Success in South America

    This is not to say that children should not be protected from tobacco and any other products deemed to be suitable only for adults. And Brazil has seemingly done a good job in bringing in measures said by the WHO to encourage people not to start smoking or to quit if they have already done so, starting, according to the WHO report, from 1981 when the Ministry of Health set up the Commission for the Study of the Consequences of Tobacco. In 1999, Brazil also set up the National Commission on Tobacco Control to support the country’s role in negotiating the FCTC, which it signed in 2003 and ratified in 2005. And in 2018, Brazil also ratified the Protocol to Eliminate Illicit Trade in Tobacco Products.

    Since 1989, Brazil has taken increasingly stringent steps against tobacco advertising and promotion and introduced bans on smoking in enclosed public places. The country has introduced increasingly graphic health warnings on tobacco packs and integrated cessation treatments into its public health system. And, of course, it has increased tobacco taxes, which, as of 2018, were said to represent 82.97 percent of the retail price of the most popular brand.

    One of the more amazing—and rounded, it has to be said—figures to come out of Brazil’s efforts appears outside the special section on the country where, it is said, “when Brazil became the first large country to include its national quit line number in graphic health warnings on cigarette packaging, the quit line received unprecedented call volumes—reaching up to 6 million calls in the first year, and more than all other quit lines globally at that time.” Given that we live in a time of fake news, I should point out that “up to 6 million” could legitimately mean one. Just saying.

    Whether due to these measures wholly or in part, adult smoking prevalence in Brazil was said by WHO to have declined from 35 percent in 1989 to 18.5 percent in 2008, the year the MPOWER measures were introduced, and to 14.7 percent in 2013. Adult cigarette smoking was said to have decreased in capital cities from 15.6 percent in 2007 to 10.1 percent in 2017.

    But the smiling children didn’t do so well. “Despite declining smoking rates among adults, smoking prevalence among youth remains stable at around five percent, with 19 percent of boys and 17 percent of girls experimenting with smoking during their school years, according to PENSE [National Adolescent School-based Health Survey] 2015,” the report said.

    Rather than try to get to the bottom of why people smoke and help address the issues they have, the FCTC encourages governments to threaten them with graphic images of diseases and tax them until they bleed through the eyes.

    Brazil is not the only country of South America featured prominently in the report. There is a piece on Colombia that describes how, from 2016 to 2017, tobacco taxes there have been increased hugely. But again, success is measured not against how many people quit smoking because of these increases but on the grounds that civil society groups were able to counteract the tobacco industry’s argument that tax increases would create an unmanageable surge in illicit trade and because Colombia managed “the highest level of achievement under the raise taxes on tobacco MPOWER measure.”

    There was also a piece on Ecuador that focused on its integration of tobacco cessation strategies into its health system. But here, at least, we get a glimpse of what should be the focus of the WHO’s efforts: people quitting smoking. “From mid-March to mid-November 2018, 3,916 tobacco users were identified and given advice on quitting,” the report said. “Among the 2,069 patients who completed a follow-up at four months, the seven-day self-reported abstinence rate was 57.2 percent, and of the 968 who completed a six-month follow-up assessment, the self-reported abstinence rate was 48.9 percent.” So, my interpretation of these interventions suggests that just over 470 people are believed to have not smoked for a while. What can you possibly say? It’s a start?

    Of course, it is impossible not to set Brazil’s success against the fact that the country is the biggest exporter of leaf tobacco. While Brazil is praised by the WHO for its MPOWERing, it is a major contributor to fueling what the WHO characterizes as the “global tobacco epidemic.” And this raises a number of questions.

    Older readers will remember the arguments put forward in the past that EU farm subsidies should not go to supporting leaf tobacco growing, some of which had merit. But some cleaved to the ludicrous claim that if you stopped leaf production in the EU, you would stop smoking there, seemingly forgetting that the EU was a relatively small player in tobacco production and a major leaf importer. Brazil is not the EU, however. If Brazil stopped leaf production overnight, it would MPOWER the WHO’s activities like nothing else. And, of course, it would impoverish a lot of people, especially those in Brazil.

    I would not advise such a course of action. As one reformed supporter of globalization once said, the basic responsibility of governments is to maximize the welfare of its citizens not to pursue some abstract concept of the global good.

    But what is the WHO’s view? In its eyes, is impoverishment an acceptable side effect of curing the tobacco epidemic? Of course, I cannot know the answer to that question, but something tells me that it would be “yes.” If you look closely at the children whose pictures were chosen for publication by the WHO, most of them seem to be living in or close to poverty. I can assume only that, from the lofty heights of Geneva, Switzerland, poverty seems quite quaint.

    George Gay is Tobacco Reporter’s European editor, but his territory spans the globe. Based in London, George has covered the tobacco industry since 1982, initially for a U.K.-based publication and since 2004 for Tobacco Reporter. George’s understanding of industry issues, combined with his keen sense of observation and dry wit, have earned him a loyal following among Tobacco Reporter’s readers.
  • Trump Threatens to Permanently Defund WHO

    Trump Threatens to Permanently Defund WHO

    Photo: Image by Gerd Altmann from Pixabay

    U.S. President Donald Trump threatened to permanently end U.S. funding of the World Health Organization (WHO) amid accusations that the agency allowed China to cover up the coronavirus outbreak in the early stages.

    Trump stated that the WHO must “actually demonstrate independence from China” and “commit to substantive improvements within the next 30 days,” but Chinese officials claimed that Trump was trying to shift the blame for his administration’s “incompetent response” to the pandemic, according to the Washington Post. 

    The threat to end WHO funding came after Trump stated that he has been taking hydroxychloroquine as a preventative for Covid-19. Experts have continuously urged people not to take this drug outside of hospitals or clinical trials as it can cause heart problems and other side effects, including death, and has not been proven to help prevent Covid-19 infections. The drug is usually used to treat lupus, rheumatoid arthritis and malaria.

  • European WHO members to make ‘tobacco a thing of the past’

    Health ministers from the 53 European member nations of the World Health Organization (WHO) on Sept. 16 agreed to a plan to make “tobacco a thing of the past” within the next decade.

    The member nations—who convened at the WHO’s 65th session of the Regional Committee for Europe in Vilnius, Lithuania—intend to realize this goal by enforcing a series of smoke-free laws and bans on tobacco advertising, promotion and sponsorship, and by implementing new educational initiatives. In addition, the roadmap calls for an end to portrayals of smoking in the entertainment industry as well as training to teach health care and family support workers to deliver smoking-cessation interventions.

    The WHO has urged European governments to set national targets for significant reductions in tobacco use by 2025. Ireland, Scotland and Finland aim to have smoke-free populations by 2015, 2034 and 2040, respectively.

    Zsuzsanna Jakab, the WHO’s regional director for Europe, said, “The generation growing up now cannot comprehend that people used to smoke on airplanes, buses, in restaurants or in offices,” and that “the dream of a Europe where tobacco control has succeeded is not unrealistic.”

  • Fight against flavor

    Fight against flavor

    The tobacco industry braces for the fallout of “Uruguay” and the recommendations about to be issued by the FDA’s tobacco products committee.

    By George Gay

    In a report to the executive board of the World Health Organization earlier this year, Director General Dr. Margaret Chan said the organization was not performing well enough across all of its activities because it was overextended and needed to trim the scope of its operations.

    In fairness, this mea culpa took up only a small part of the report, and Chan talked also of instances where the WHO had enjoyed considerable success.

    Nevertheless, Chan went on to say she believed that the level of WHO engagement should not be governed by the size of a health problem, but by the extent to which the WHO could have an impact on the problem. Others, she believed, might be positioned to do a better job.

    I would be interested to know whether Chan would include in “others” the Framework Convention on Tobacco Control (FCTC). This body was born of the WHO but is often spoken of as existing independently of its parent. Perhaps it has just grown up and moved on, rather like a student going away to university. In fact, this is possibly a good analogy. The lifestyle choices of both leave something to be desired, and I don’t mean only that they both tend to live beyond their means, or what should be their means.

    This is what British American Tobacco had to say in November in a note posted on its website: “Vague and partial guidelines on tobacco product regulation, including on the use of ingredients, were adopted last week by governments gathered in Uruguay for the World Health Organization’s tobacco control conference—despite the fact they offer little guidance on implementation of these recommendations.

    “Delegates at the weeklong event, known as the Conference of the Parties [the FCTC’s fourth conference of the parties, COP4], were asked to consider far-reaching recommendations similar to legislation recently passed in Canada which bans the use of almost all ingredients in cigarettes—despite the fact there is no scientific evidence which supports the theory that cigarettes with ingredients are any more addictive or attractive than cigarettes without ingredients.

    “Despite objections from many tobacco growing countries across the world, and a highly-charged debate culminating in a ten hour committee meeting, it was decided that the unfinished guidelines on this complex subject be accepted—regardless of the lack of clarification on key aspects and the absence of sound scientific evidence to support them.”

    The Canadian model

    Of course, since these comments came from a major international tobacco manufacturer, many people will dismiss them as just the automatic gainsaying of anything put out by the FCTC. But this would be wrong because BAT has been making strenuous efforts to reach out and publicly debate difficult issues, something that was reflected in a comment attributed within the website note to Michael Prideaux, director of corporate affairs, who said, in part: “However, we are encouraged by the newly included text in the partial guidelines that governments ‘should consider scientific evidence, other evidence and experience of other countries when determining new measures on ingredients of tobacco products’ and we urge governments to do just that.”

    This is essential in fact if chaos is to be avoided. Canadian manufacturers, which serve largely a Virginia cigarette market, have been able to cope with the ban on most additives. But shortly after the COP4 meeting at Punta del Este, Uruguay, on Nov. 15-20, in a move that had been foreshadowed before that meeting, Brazil’s National Health Surveillance Agency (Anvisa) launched a public consultation on whether the country should ban additives from tobacco products. Submissions are due to be accepted until the end of March.

    Despite the lack of evidence against the traditional ingredients added to tobacco products, the agency seems in no doubt about the effect of the use of flavors. “The flavors stimulate initiation of smoking in youth and adolescents and mask the unpleasant taste and odor of cigarettes,” said Anvisa’s manager of tobacco products, Humberto Martinez.

    One thing that should be pointed out here is that though the second part of Martinez’s statement seems at first reading to be in line with what some in the tobacco industry might say, it is subtly different and, in my view, wrong. What Martinez is saying is the equivalent of claiming that sugar is used to mask the unpleasant taste of chocolate. In fact, I suppose, sugar is added to cocoa to mask the bitter taste of cocoa, so that it can be made into chocolate. And in the same way, flavors are added to tobacco to mask some of its unpleasant characteristics, so that it can be turned into cigarettes.

    Mane’s Dr. Roger Penn put this more elegantly when he told me that what had to be remembered was that there were only two classical uses for tobacco flavors. One was to help level out the variation in the tobacco base and make a consistent product given variations in tobacco crops. The other was to put a “signature” on a product to create product differentiation on the market.

    Anvisa, meanwhile, evokes the bans imposed in both Canada and the U.S., but it seems to be leaning toward a more extreme Canadian model. Additives are considered to be any substance or compound other than tobacco or water used in processing, manufacturing and packaging of a tobacco product.

    Also, Anvisa is not confining itself to cigarettes. The ban would apply to products that use tobacco and that are smoked, inhaled or chewed.

    One of the problems here is that Brazil’s market, unlike Canada’s, comprises modified blended products, and it seems highly unlikely that Brazilian manufacturers could produce such cigarettes without the use of some additives.

    As Penn put it: “The unfortunate thing about Anvisa in Brazil is that they are advocating a ban, as per Canada, presumably because Brazil has been following Health Canada very closely for quite a few years.

    “If it is a Virginia market, it is easier to sustain without flavorings because they are not used in the majority of products. But if you ban flavors in Brazil, for instance, or Germany, or France, or Switzerland, where there are modified blended products, you will wind up with harsh, irritating products that produce hot temperatures when smoked. People won’t buy them. So you kill that product, but, guess what, you get contraband shipped in from various parts of the world.”

    At this point I asked Penn whether or not he had heard of any other countries planning to ban or regulate additives in tobacco products, and he said he had not. However, he is concerned that, depending on what happens in Brazil, there could be a domino effect.

    Eduardo Berea, of Mother Murphy’s, also believes that Brazil could prove pivotal, at least among the countries of Latin America. Brazil was the first country to add delivery numbers to its packs, he said, and now you could find such information throughout Latin America.

    Berea made the point that it would not be possible to make a reasonable product in Brazil without using casings, since local burleys had low levels of sugars that needed to be compensated for with the addition of casings.

    He said it might be possible in Brazil to make a cigarette without top flavors, but a manufacturer would not be able to create a distinctive pack aroma, and it would be much more difficult to create distinctive products because there would need to be a different blend for every brand.

    A note of explanation is needed here. We all tend to use the word flavor as shorthand, when what we are often talking about are casings, flavors or top flavors, or any combination of these. Casings, Berea explained, were used both in Virginia- and American-blend products, but the functionality was different. With Virginia (flue-cured) blends, the purpose of a casing was mainly to add humectants such as propylene glycol or glycerin—both of which are permitted even in Canada—with the objective of improving the humectation of the flue-cured tobacco, since sugar tended to bind to water and since, otherwise, flue-cured was not able to absorb too much liquid.

    In the case of American-blend products and especially on the burley component, a casing was added that commonly comprised juice concentrates, chocolate, cocoa powder or cocoa extract, licorice and humectants. In this case the main objectives were to correct the sugar/nicotine ratio of the tobacco to make it a smokeable product, and to round—with the cocoa components and the licorice—the flavor.

    Top flavors were used mainly to create a distinctive brand identity not only in the smoke but in the pack aroma as well.

    Following the science?

    Meanwhile, at an international level, Penn is hoping that the scientific argument wins out and that manufacturers continue to be allowed to use traditional tobacco additives. But, if not, he hopes that flavors are not banned but their application levels regulated.

    And as reported by BAT, the tobacco industry’s position received something of a scientific lift when the European Commission’s Scientific Committee on Emerging and Newly Identified Health Risks recently acknowledged the lack of scientific evidence to support the idea that—“bearing in mind the broad meaning of ‘attractiveness’—a specific additive affected the attractiveness of tobacco products intended for smoking.”

    Berea is greatly concerned about the science surrounding the tobacco flavors issue, or rather, he’s concerned with the lack of science. He sees the arguments put out by bodies such as the WHO’s FCTC and the U.S. Food and Drug Administration’s Center for Tobacco Products as being “infected” with the “quit or die” mentality.

    Nevertheless, science is seen by some as the way forward and, in the middle of February, a senior executive of Lorillard—about 85 percent of whose sales are of menthol cigarettes—urged an FDA advisory panel not to lose sight of the congressional and FDA mandate to “follow the science” in developing its report and nonbinding recommendation regarding the use of menthol in cigarettes.

    This sounds all well and good, but to my mind the idea that decisions on menthol can be made on the basis of science is wishful thinking. Congress’ exemption of menthol from its ban on characterizing flavors must have been based on economics and politics. And now, the rationale for that original decision is meeting science in a confluence that can result only in political expediency. This need not be a bad thing as far as the tobacco industry is concerned, however. Politics and economics exempted menthol in the first place, and it seems likely that they can come together with science to keep that exemption in place.

    Currently, the FDA’s Tobacco Products Scientific Advisory Committee (TPSAC) is developing a report and recommendations on the impact on public health of the use of menthol in cigarettes that is due by March 23. And there are a number of aspects of this process that are encouraging. For instance, the FDA has asked tobacco industry representatives who serve on the committee to develop an industry perspective document on the public health impact of menthol cigarettes that will accompany the report.

    Also, the TPSAC intends to discuss draft report chapters at open public meetings before they are finalized, and copies of these chapters are to be made available on the TPSAC website.

    And there is no required deadline or timeline for the FDA to act on the recommendations provided by the TPSAC in the report.

    But there are aspects of what the FDA says that makes me uneasy. For instance, it says that any actions that it might take that lead to restrictions on the sale of menthol products or the establishment of product standards would require formal rule making that would include public notice and comment. It seems to beggar belief that if the science on flavors is uncertain to the point where menthol is not banned, there could be any basis outside of the magic circle for, say, the reduction of levels of menthol in cigarettes.

    But moving back to the international scene, there are other reasons to remain hopeful. Chan in her report made the point that many organizations involved in global health issues were facing serious funding shortfalls. I take no comfort in this where such shortfalls will cut meaningful health initiatives. But, clearly, it would seem to be reasonable that, given the current economic problems in many places, anti-tobacco organizations, like other bodies, should suffer cuts in respect of ideas that have no prospect of improving health and that could lead to severe economic losses in some of the countries least well able to withstand them. The additives issue is one such idea, and, as Chan says, the emphasis should be on what the WHO can achieve, not the
    size—or, presumably, the perceived size—of the problem.