Working with consumers to end tobacco’s death toll

With many global challenges, the solutions are a troubling combination of uncertain, disruptive, expensive, and lengthy. But sometimes we have the good fortune to be able to rapidly deal with problems, such as those that can be addressed through measures such as sanitation and vaccination. Add tobacco’s toll to that list.

Cigarette smoking vies with air pollution as the globe’s leading cause of preventable death. The health catastrophe could be solved without significant government expenditure and while reinforcing consumer freedoms. We need only focus on science and facilitate the use of existing technology.
Tobacco products are used to obtain nicotine by well over a billion people, roughly 300 million in India alone. To understand the potential we have, one needs to understand that the nicotine itself at the dosage people seek has relatively small risks. It is the way it is obtained, primarily by the inhalation of smoke but also from unnecessarily toxic mixtures in some other forms of tobacco products, that causes the harm. The problem is the delivery system.

We have encountered similar issues with contaminated drinking water, unsanitary food, and cooking and heating with open fires; situations where we can empower people to have far healthier lives through interventions that reflect science and available technologies.

Not surprisingly, most major cigarette companies and businesses producing other toxic tobacco products are not enthusiastic in pursuing efforts that could kill their exceedingly lucrative existing businesses.

But ironically these corporate interests are assisted in perpetuating the lethal status quo by national and global health bodies that seek to limit or prohibit any product substitution. Their actions are as misconstrued as, say, environmental groups opposing replacements for fossil fuels. Such abstinence-only approaches repeat a longstanding pattern of seeking to use the power of the state to impose one’s moral views on the behaviour of others.

As we have experienced on alcohol, access to contraception, and many other issues, such policies are a fundamental denial of rights, ignore science, and are invariably disastrous.

But in this case, the groups pushing an abstinence-only agenda on alternatives to lethal nicotine products are redirecting time and money that could be driving down the use of toxic products. It is like attacking sanitary food while leaving widescale availability of contaminated alternatives. Their abstinence-only agenda only applies to the far safer alternatives.

Countries including India have banned low-risk products, like vaping, etc. that heat rather than burn tobacco. Worse, the World Health Organisation, which used to be at the forefront of efforts to reduce smoking, gave an award to India for a policy that protects the cigarette business. How could they have gone so far wrong? Why would the WHO actively oppose far safer products for such an enormous number of people?

Well, follow the money.
The WHO is financially stretched and accepts money and partnerships from non-government entities such as those funded by ultra-wealthy Americans. Where the goals of those multi-billionaires coincide with rational public health policies the world benefits. But in the case of tobacco that funding, complemented by a tsunami of cash to other entities, comes from Michael Bloomberg and is strongly focused on a prohibitionist approach to alternatives to cigarettes.

This is done while ignoring the tremendous success of product substitution as a key part of a rational strategy to reduce tobacco’s toll. A strategy that has given Sweden by far the lowest smoking rates and tobacco-caused disease rates in the European Union, that allowed Norway to cut smoking in half in just a decade and that has played the key role in Japan reducing cigarette sales by a remarkable 40% in just last five years. Countries attacking product substitution have failed to come anywhere close to reducing smoking.

Japan merely allowed into their market products that heat tobacco without creating the toxic stew that comes from burning it. Sweden and Norway used a very low-risk oral product. This raises the key question of just how rapidly a country could drive down the use of lethal tobacco products. Policies meant to discourage smoking can be joined by ones that facilitated change by making many more low-risk alternatives available, used risk-proportionate regulation of all tobacco/nicotine products, and communicated honestly with consumers about relative risks.

We are on the precipice of a public health revolution of historic significance. We can empower people to improve their health rather than merely trying to coerce behaviour changes that so many are not reasonably likely to make. We can limit the role of foreign entities with unscientific moralistic agendas. We can do what has worked so well for so long on so many other public health issues. It merely requires us to embrace science, reason, and humanism. Simply put, when opportunity knocks, answer the door.

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