Later this month the Conference of Parties of the Framework Convention on Tobacco Control (FCTC) will meet in Geneva. Those who won’t be allowed in the room are advocates of tobacco harm reduction, like Derek Yach and Mark Tyndall whom I interview in this podcast (available above as well as on Spotify and Apple).
Recent modelling by Derek has shown that 100 million lives could be saved by 2060 using tobacco harm reduction. One thing is for sure — there is a battle here between ideology and science.
The ideology stems from a provision in the FCTC that claims a “fundamental and irreconcilable conflict” between the interests of tobacco companies and public health. This was indeed true 20 years ago when the FCTC — which has saved millions of lives through its provisions on taxes and advertising and more — entered into force, because the tobacco industry made only one product that killed people.
However, as Derek points out in the podcast, innovation on the part of the industry on tobacco harm reduction products — like vapes, heated tobacco, snus, and e-sheesha — means this is no longer the case.
Nevertheless, the taboo persists. As Mark points out in the podcast, he has been treated as a “pariah” by his colleagues. Why? For bringing his expertise, passion and courage in HIV and drug addictions harm reduction to tobacco. His recent book, “Vaping: Behind the Smoke and Fears,” details this story and the evidence behind harm reduction. It’s worth a read.
I met Derek decades ago when, he was WHO Executive Director under Dr Gro Harlem Brundtland. Ironically, Derek was responsible for developing and shepherding the FCTC to approval. He was always intellectually honest and refreshingly non-bureaucratic. When WHO staff threw reports we had written on Genomics and Global Health into the trash because they didn’t have proper authorization to be handed out at the World Health Assembly, Derek retrieved them and delivered them to the hotel where the Health ministers were staying.
When I met Derek in Geneva during my recent stint as Special Advisor to the Director General — even after he had stepped down as CEO of the Foundation for a Smoke-free World which was funded by the tobacco industry — I felt I needed to wear a fake nose and eyeglasses to disguise myself. It was as though he had a big ‘T’ branded onto his chest, reminiscent of the 1850 Nathaniel Hawthorne novel The Scarlet Letter.
In this podcast, we cover questions such as What is tobacco harm reduction? What is the epidemiology of smoking related deaths and the potential for tobacco harm reduction to save lives? What is the evidence of benefit and also related to potential harms such as providing a gateway for young people to start smoking? How does Derek see the current situation from his perspective as a pioneer of the FCTC? How does Mark see it from his standpoint as an academic and public health expert in harm reduction in other contexts? What countries have the right approach? What does the future hold?
For me, the overarching question is one of intellectual honesty. Science relies on open debate and engaging with alternative views. The opposition to tobacco harm reduction struck me more as religion than science. That is why I wanted to explore it in this podcast.
It’s also an issue in impact. More than 1 billion smokers are dying at a rate of more than 7 million each year from smoking-related causes. The 100 million lives saved through 2060 figure is about 3 million lives saved per year. That’s the same scale of magnitude as childhood vaccination, hypertension control, GLP-1 access, and possibly pandemic preparedness. I know of no other health intervention that can save more lives (of the 60 million or so deaths each year).
I can also think of no other public health issue where ideology and potential benefit point so strongly in opposite directions. I would be very happy to interview on my podcast colleagues (many of whom are friends) who might wish to debate what Mark and Derek have to say, ideally engaging with them as well.
There are few public health issues where the stakes of intellectual honesty are so high. Paraphrasing a well-known quotation, ‘A few million lives saved here, a few million there, pretty soon you’re talking alot of lives!’
