Tobacco control: ideology versus public health

The Framework Convention on Tobacco Control not only negatively impacts tobacco farmers, tobacco companies and tobacco retailers, but also harms smokers themselves, in several ways.

Superficially, the goal of the Framework Convention on Tobacco Control (FCTC), which is to gradually reduce and ultimately eliminate tobacco consumption, seems noble and laudable. After all, tobacco is undeniably unhealthy.

So are many other things, though, that are not subject to rules drawn up by unaccountable public health experts at the World Health Organisation (WHO).

Ahead of the 9th Conference of the Parties (COP9), due to be held in Geneva, Switzerland, where the smell of old money permeates the streets, we really ought to understand how the FCTC works, and why it is a real problem that only those with a bona fide anti-tobacco stance are permitted to attend.

An international conclave of public health officials making rules for billions of people, without any consultation with affected parties or any accountability to national legislatures, is incompatible with the basic principles of participatory democracy.

Besides tobacco companies themselves, and millions of farmers and retailers are victims of draconian anti-tobacco legislation hatched at these gatherings, where besides the public health experts, only anti-tobacco NGOs are permitted entry.

Smokers themselves also suffer harm.

Illicit trade

One oft-discussed effect of FCTC-style suppression, especially through high excise taxes, is the growth of an illicit market in untaxed products. Greatly exacerbated by the inexplicable prohibition on tobacco during South Africa’s first lockdown, the illicit market for tobacco is now well developed.

Illicit trade now accounts for over half of South Africa’s cigarette market, compared to 37% in 2019. Even though the tobacco prohibition was lifted over a year ago, market shares have not returned to normal, and a hefty increase in sin taxes has made things worse, not better.

Black market products are far cheaper than legal, fully taxed tobacco, which makes them highly attractive to skint consumers. However, these illicit products are often of poor quality, and pose a risk of contamination.

The illicit market also siphons money away from the legitimate market, which reduces their economic viability and cuts into government revenue. Estimates of lost revenue due to unpaid excise duties have doubled to R20 billion from their pre-pandemic levels of around R10 billion.

While it may seem relatively harmless to entertain a black market in tobacco products, one should never lose sight of the fact that organised crime gangs, which have now added tobacco to their portfolio, use those profits to support truly shady business, ranging from kidnapping, extortion, protection rackets and armed robbery to hard drugs and modern slavery.

Taxing the poor

Smoking is unpopular among wealthy elites nowadays. It remains very popular among the poorer classes, however. That makes taxing tobacco an invidious tool for public policy. The demand for tobacco is relatively inelastic; due to its addictive nature, people tend to pay whatever they have to for their fix.

I myself once said I’d quit smoking when the price of a packet of Camels hit R5. When I eventually did quit, a packet cost over R50. Price sensitive, I was not, even though I’ve often struggled financially.

Excise taxes on tobacco are highly regressive. They hit the poor the hardest. What they are required to spend on tobacco tax they could have been spending on better nutrition or better healthcare for them and their families.

One could, of course, callously argue that their own poor choices cost smokers so much money, but from a public health perspective, taxing the poor for smoking is a very counter-productive intervention.

Harm reduction

One would expect the overarching objective of the public health campaign against smoking to be about, well, public health. That is, once the matter of second-hand smoke has been dealt with, the concern should be about the health of smokers.

In fact, the obsession of the ideologues that are allowed to attend FCTC COP meetings is not the health of smokers. They couldn’t care less about smokers. Their ire is directed at tobacco companies. They want to punish tobacco companies and drive them out of business, no matter what they actually do, say or sell.

So, for example, in a very lengthy report on the scientific basis of tobacco control, you’ll find lines such as these: ‘Tobacco control experts warn that increased marketing of [smokeless tobacco products like snus] may have an adverse impact on population health by appealing to young, new users or by inciting current smokers to maintain their nicotine dependence.’

What is harmful about smoking is largely the products of combustion. Burning tobacco produces the same toxic ingredients as burning any vegetation, such as your cosy wood-fired hearth. The only difference is the concentration of the smoke you inhale.

Nicotine is itself relatively benign. It is highly addictive, of course, but as a stimulant, it poses health risks comparable to those of caffeine. It is not listed by the International Agency for Cancer Research as a potential carcinogen, and studies that claim otherwise are largely weak, speculative and unquantified.

De-demonise nicotine

For every study about the potential harms of nicotine, there is a study about its potential benefits, including in preventing Alzheimer’s disease, delaying the onset of Parkinson’s disease, and reducing susceptibility to SARS-CoV-2 infection.

‘We need to de-demonise nicotine,’ a professor of tobacco addiction told Scientific American in 2015. For decades, it has been accepted wisdom that ‘people smoke for the nicotine, but die from the tar’.

‘Should we really be that bothered about addiction in and of itself, if it doesn’t come with any other substantial harms?’ another expert asked the Scientific American reporters.

The FCTC technocrats will have none of it. To them, nicotine addiction by itself is just as bad for your health as smoking tobacco, and must be treated as equivalent.

Ironically, they hold this view even while advocating for nicotine-replacement therapies (NRT). Perhaps that is because NRT is typically sold by pharmaceutical companies under medical supervision. In the battle for profit between Big Tobacco and Big Pharma, where might the interests of public health technocrats lie?

What is smoke?

What exactly constitutes smoke occupies two pages of a document to be presented at COP9. The intention is to conclude that any vapour or aerosol produced by any product, such as a heated tobacco device or even a vape, should be classified as ‘smoke’ for the purposes of tobacco control regulations.

It thereby conflates a variety of thermo-chemical processes with combustion. By the same logic, if they were regulating food safety, they might have considered cooking food equivalent to burning food. Even though burning food produces far more carcinogens and toxins, tobacco-style control would condemn merely heating food, too, and would prohibit claims that cooked food is less harmful to your health than burnt food.

This is non-sensical. Any scientific approach would attempt to quantify the risks of, say, heated tobacco products (HTPs), when compared with conventional combustible tobacco products like cigarettes. It stands to reason that by eliminating the toxic byproducts of combustion, and retaining only the by-products of heating, HTPs must be to some degree less harmful than cigarettes.

The problem is this: in its latest report on the scientific basis of tobacco product regulation, the FCTC explicitly recommends ‘[putting] the burden of proof on manufacturers to support claims about the products, and prohibit unsubstantiated claims about the relative risk or harmfulness of HTPs relative to other tobacco products’.

Until then, the FCTC technocrats recommend regulating heated tobacco products on an equal basis with combustible tobacco products (unless they are already banned and such treatment would relax restrictions on them). It also recommends prohibiting claims of reduced risk without conclusive evidence to that effect.

However, it also explicitly rejects any research or representation made by anyone who has links to, or receives money from, the tobacco industry.

So the only way to ever obtain sufficient evidence to support reduced-harm tobacco products would be if some benevolent third party, with no interest in the matter whatsoever, were to fund and conduct independent research.

The FCTC knows full well this is unlikely to happen, so its pre-judged rules and regulations, made in what they admit is an absence of evidence, are immune from challenge.

Vaping myths

That the FCTC is not at all interested in public health, but only in destroying the tobacco industry, is even clearer when it comes to vaping. It is heavily biased against electronic nicotine delivery systems (ENDS), even though it recognises their potential to reduce risk, compared to cigarette smoking.

It strongly emphasises the potentially toxic components of ENDS vapour, spending an entire chapter trying to characterise the potential risks of ENDS and electronic non-nicotine delivery systems (ENNDS, or vapes that don’t contain nicotine). Yet it can only speculate about potential health effects.

It briefly refers to ‘single cases of lipid pneumonia’, without disclosing that those cases were all related to fatty oils (vitamin E acetate) used in black-market, psychoactive cannabis oils, and not to the liquids used in commercial vapes.

Besides this inconsequential factoid, the FCTC report is unable to present any evidence whatsoever of documented real-world harm caused by vaping, almost 20 years after their first introduction in the market.

It is obsessed over the minutiae of ‘nicotine flux’, which is the rate at which the devices deliver nicotine. According to the worthies at the FCTC, users can absolutely not be trusted to adjust settings and select nicotine concentrations for themselves. This, they argue, must be regulated in fine detail.

It says that ‘ENDS use by previously nicotine-naïve individuals is inconsistent with public health goals’, but that is trivially false if that individual would otherwise have taken to smoking tobacco.

It is also rare for non-smokers to start vaping in the first place, contrary to the FCTC’s fears. The notion of a youth vaping epidemic is simply false. In South Africa, the Vaping Products Association of South Africa (VPASA) has run a national campaign against youth access to vapes, which the organisation continues to support, even in the absence of legislation, by holding its members accountable to industry-imposed standards.

Quitting smoking

The FCTC seeks to medicalise the use of vaping for smoking cessation. ‘Under certain circumstances, such as in the context of intensive behavioural counselling, ENDS that deliver nicotine effectively might help some smokers to quit combustible smoking, with positive public health effects,’ its report says. ‘Most of these individuals, however, continue to use ENDS, with uncertain individual health consequences and thus an uncertain public health impact.’

That is nonsense. Indeed, its report later admits that it doesn’t know to what extent ‘intensive behavioural counselling’ is required to use ENDS for smoking cessation. Another misdirection is that ‘uncertain health consequence’ is not equivalent to ‘likely significant health consequences’.

It is true that while we have no reason to believe vaping to be substantially harmful, we don’t know exactly how safe vaping is in the long term. Undoubtedly, inhaling vapours is likely to involve at least some health risk (as do so many small pleasures). However, that lack of evidence does not undermine what we do know, which is that vaping is far safer than smoking.

The FCTC might labour under the delusion that smokers are eager to await their instructions on how exactly to quit smoking, but few real-world smokers are going to want to quit ‘in the context of intensive behavioural counselling’.

Vaping is attractive to them because it is a pleasant alternative to smoking, unlike pharmaceutical nicotine-replacement therapies. Trying to medicalise vaping is only going to make it less attractive to smokers, and therefore less effective as a cessation tool.

The FCTC’s claim is also falsified by a great deal of anecdotal and testimonial evidence.

On an online forum, one user said: ‘I smoked between half a pack and a pack a day from about 15 to 30. Switched to the vape because the smokes were hell on my lungs. Haven’t been able to kick the vape yet but feel 10,000x better overall. Haven’t had a cigarette in 3 years and no desire to any time soon, even while out drinking. Tbh I can hardly stand to be around them.’

Replied another: ‘Same. Pack a day from 19-35. Switched to vaping 2 years ago, feel infinitely better in terms of breathing and it shows on my face too. I look pretty much the same now as I looked when I was 25.’

I quit smoking using a vape myself, and can attest to immediately feeling better. I had a chronic cough for three months before quitting, after a bout of bronchitis. A doctor who saw me cough persistently on YouTube suggested it might be early-stage chronic obstructive pulmonary disease (COPD). Within days of switching to vaping, the cough had cleared up, and it hasn’t returned.

I also quit the vape within months, contrary to the FCTC’s belief that vaping is likely to become a permanent habit. Even if people quit smoking and continue to vape for the rest of their lives, however, they will be very much better off than they were as smokers.

Not enough people vape

Public Health England (PHE) completely undermines the FCTC’s views on ENDS as smoking cessation devices. Instead of being worried about people vaping, it is worried that not enough people vape.

It says: ‘As the number of vapers in England plateaus, incorrect perceptions of its relative risks compared to smoking may be discouraging smokers from using vaping to quit.’

These ‘incorrect perceptions’ are exactly the fear-mongering produced in the FCTC reports. Yet PHE discovered that ‘nicotine vaping products were the most popular aid (27.2%) used by smokers trying to quit in England in 2020’, ‘it is estimated that in 2017, more than 50,000 smokers stopped smoking with the aid of a vaping product who would otherwise have carried on smoking’, and ‘using a vaping product as part of a quit attempt in local stop smoking services had some of the highest quit success rates – between 59.7% and 74% in 2019 and 2020’.

The FCTC should be shouting this from the rooftops. It should be advising smokers worldwide to switch to vaping, and recommending national public health authorities to liberalise – and even subsidise – the vaping industry, in the interest of public health and harm reduction.

And instead of deliberately trying to make vaping unattractive, by railing against flavourings and fancy vaping devices, the FCTC should wish to make vaping even more attractive as an alternative to smoking.

Public health

If the FCTC’s concern really was public health, it would be investing time, effort and money in investigating how novel products such as HTPs, ENDS and ENNDS could contribute to their efforts to convince people not to smoke tobacco, and how they could reduce harm.

It is clear that these products have an important role to play, but the FCTC is far more concerned that they give the tobacco industry ‘loop-holes’ through which they could continue to profit.

The FCTC also has no time for people who choose to smoke despite the known health risks, because quitting poses even greater risks to their mental and physical well-being. People with mental health issues, or recovering from drug and alcohol addiction, often rely on smoking to get by. To them, the risk of far-off disease or an early death is far smaller than the very immediate risks of mental breakdown, suicide or relapse.

The campaign waged by the FCTC is an ideological battle against the tobacco industry. Until it becomes a campaign truly focused on public health, it should be resisted.

It admits to lacking evidence on any number of points, yet it prohibits that very evidence from being led at its conferences, because of ‘tobacco interests’. It won’t even listen to the smokers in whose interests it claims to act.

The entire FCTC effort is undemocratic, dictatorial, misdirected and irrational, and has no place in a free world.

https://dailyfriend.co.za/2021/10/08/tobacco-control-ideology-versus-public-health/