Ignoring science and innovation in nicotine regulation perpetuates smoking, warns Global Forum on Nicotine
Imagine a parallel universe where people consume their nicotine without combustion, but smoke tea leaves to get their caffeine fix. If someone offered to teach people how to brew tea, would we say “Oh my God, think of the children!” What if they are attracted to drinking tea? What if someone who has completely stopped smoking tea leaves starts drinking tea? What if there were flavors for these teas and people found this tea more acceptable? They might even drink more! » We would laugh at this situation and we should laugh at similar arguments made today about nicotine.
This striking argument is an example of the original thinking and willingness to challenge conventions that characterized the Global Forum on Nicotine 2024, held in Warsaw. It comes from Professor David Sweanor, chair of the advisory board of the Center for Public Health Law, Policy and Ethics at the University of Ottawa in Canada. Active in tobacco and health policy issues since the early 1980s, Sweanor is one of many health professionals, legal professionals and other experts who have participated in debates about how the scourge of smoking could be eradicated if only politicians and regulators were willing to listen to the science – and to listen to adults who want to stop taking the health risks associated with smoking.
Forum participants felt that too often it is the member states of the European Union, as well as other countries around the world, that seem to be entering a parallel universe. Harm reduction products, developed to help smokers get their nicotine much safer, are banned, taxed or restricted, leaving cigarettes as the only product still available.
David Sweanor, however, welcomes consumer resistance. “Part of the reason we'll see change is that it can't be stopped,” he told me. “Innovation, disruptive technology, there is no stopping it now, because with the Internet to obtain information, social networks to share it and international trade to obtain the product, we cannot prevent consumers from moving. We can shape this market, but we can’t stop it.”
Nowhere is the desire to shape the market stronger than in the European Union, one of the first regions in the world to regulate tobacco harm reduction products, particularly e-cigarettes, many other products not being available when the regulations were established in 2014. Today, health ministers are discussing restricting or banning new tobacco and nicotine products, such as flavored vapes, through the EU.
Konstantinos Farsalinos, a physician and senior public health researcher at the University of Patras and Western Attica in Greece, has conducted extensive research on smoking, tobacco harm reduction and vaping. He told me that many member states have already introduced new restrictions, ignoring evidence from countries that have taken a different direction.
The most notable case is Sweden, where smoking has fallen to 5,6% of adult men, according to the latest data. It is by far the closest EU country to reaching the World Health Organization's definition of a smoke-free country, which is to fall below 5%.
For many Swedish ex-smokers, the solution has been snus, a traditional smokeless tobacco product placed under the lip. “Snus is the only harm reduction product with indisputable long-term epidemiological evidence showing that it is almost harmless,” said Konstantinos Farsalinos.
But it is banned in the European Union, with the exception of Sweden, although the EU is "a region where the sale of the deadliest nicotine-containing product, tobacco cigarettes, is absolutely legal, available everywhere ". The ban on snus, from which Sweden obtained an exemption, was the result of a health scare campaign, claiming that certain scientific studies had found a link between the product and cancers of the mouth and gums.
None of this data exists, but regulators at the European Commission's DG SANTE have never withdrawn the claim. They also did not learn from their mistake. “They are trying to add new restrictions, they think for example that if we ban flavors, children will not use e-cigarettes,” said Konstantinos Farsalinos, saying that the history and experience of all countries having introduced bans have been a complete failure.
He cited the remarkable example of India, where “e-cigarettes were so rare that you couldn't find them; we didn't see anyone vaping. But they wanted to follow the rules and recommendations of the World Health Organization, so they said 'we ban them'.
“The market has exploded. Products can now be found on every street corner, in every major city. Everything is on the black market, illicit, entering the country illegally. Nobody knows where they come from, what they contain... and of course the black market attracts the most vulnerable population, namely young people.
“This is a direct harm to public health and now European governments are becoming obsessed with flavors. There is so much research evidence that the flavors are intended for adults. The flavors increase the chances of quitting for adult smokers, yet authorities insist the flavors are only there to attract children.
“Of course, ideally all smokers should quit on their own, but we have 1,2 billion smokers worldwide and eight million deaths a year. We avoid the example of Sweden. Sometimes it's so depressing that it feels like there's no common sense. It's not just science, it's like there's no common sense. Either way, let's be optimistic! »
Optimism was abundant at the Global Forum on Nicotine. David Sweanor said we are seeing a fundamental change. “Rather than being bullied by regulators, consumers are finding solutions for themselves… often using products that governments have not authorized, have not encouraged, and that anti-smoking groups have discouraged.”
“Not long ago the only country you could name was Sweden, but now we can name Norway, Iceland, Japan, New Zealand and even countries that have really worked hard to prevent this, like the United States which banned virtually all alternatives to cigarettes...non-combustion products took 20-40% of the nicotine market in just five years.
“In Japan, cigarette sales have halved in just seven years. In New Zealand, they halved smoking rates in five years. So we are seeing this major change despite opposition. How quickly could we eliminate smoking if we really tried? »
The price of inaction is paid first by smokers who do not give up cigarettes, with disastrous consequences for themselves and their families. But David Sweanor also warns of "the decline of trust in government, the decline of trust in authority which is a huge global problem, accentuated by this kind of action to prevent consumers from obtaining information truthful, to obtain the products, to take responsibility for managing their own health.
Another speaker in Warsaw, Clive Bates, former director of Action on Smoking and Health (ASH) in the UK, identified a fundamental flaw in much of the current regulatory approach. “You cannot assume – or you should not assume – that regulation is justified on its own. It limits what people can do. It limits everything.
“Regulation must be justified on its own merits. And these merits are sometimes simply illusory... children are used to create emotional campaigns, to create a kind of moral panic and justify actions that would not be justifiable if applied to adults. There are 18 times more adults using nicotine products than young people in the UK, but all the political attention is on the small number of young people who vape.”
Michael Landl of the World Vapers Alliance also identified the same cause of many problems. “To exaggerate slightly, I would say that if there was not a single child vaping in the entire world, we would still have a problem with youth vaping, because perception is more important than reality in formulating policy. policy and regulation in this sector.
“We live in a really strange time where it's actually tobacco companies that are more positive about helping people quit or switch to a less harmful product than public health organizations and the WHO ".
It may seem strange, but no one should be surprised that the industry is best positioned to transform the way people consume nicotine. Over the past decade, there has been a proliferation of new no-burn products that are better alternatives to smoking.
It is the market that provides the solutions, with consumers seeking harm reduction products and businesses investing in the innovation that provides hope for a world without cigarettes. Market-driven solutions may be difficult for regulators to accept, but politicians must take responsibility, avoid moral panic and insist that citizens have the right to choose the solutions that are right for them, especially when their health is at risk. game.