Wasted Time

Time has not been used effectively to lower smoking rates using proven THR policies.

By George Gay

No truer statement about tobacco harm reduction (THR) could ever have been made than this: “Too much time has been wasted.”

This blunt assessment was attributed to Jacek Olczak, CEO of Philip Morris International, in a September press note heading that had him challenge “governments across the globe to embrace smoke-free alternatives to end cigarettes faster.”

I take it that what Olczak was referring to is the time that has not been used by societies to good effect to bring down tobacco smoking rates using proven THR policies. But he might well have had in mind, too, the cumulative time cut from the lives of individuals said to have died “prematurely” from smoking-related diseases—diseases that could have been avoided by employing THR strategies.

The press note includes much that is interesting, but my eye was particularly drawn to a passage where it was said that, according to a new international survey conducted by independent research firm Povaddo for PMI, 82 percent of respondents agreed they would be somewhat or very angry, frustrated or upset to learn that a breakthrough that could help address a societal issue was not made available to the public due to government inaction.

Even very angry doesn’t cut it for me, partly because we are not talking only about government inaction but about government action in undermining such breakthroughs. Later in the press note, Sweden was said to have one of the lowest smoking rates in the developed world, at just 5.8 percent, largely due to the availability of snus, which Swedish men began switching to decades ago. “… The Swedish Snus Commission (SSC) estimates that more than 350,000 smoking-attributable deaths among men could have been avoided each year if the other EU countries had matched Sweden’s tobacco-related mortality rate,” the note said.

If the SSC is correct, and given that the EU has banned snus outside Sweden since 1992, we must reluctantly accept that about 10,500,000 men have, because of the action of the EU authorities in banning snus and then their subsequent, continuing inaction in not unbanning it, died prematurely in about a 30-year period.

OK, so 10,500,000 might be something of a stretch because the EU was smaller in 1992 than it is now, and I don’t know whether the 350,000 annual figure is an average or is based on a single year. But it is clear that we are talking about a big number and that no such number would have been allowed to have occurred in a 30-year war. A truce would have been called long ago and compromises made. But not in respect of the war on snus, and yet nobody will be called to account over what has occurred in the EU because of the ban on snus.

And the question arises as to whether such a calamity, such an outrage, would have been allowed to go almost unnoticed, unremarked in any other field. I think not, but I struggle to understand why this is the case, and the only reasons I have managed to come up with so far are that 1) smokers tend to be financially less well-off than the average person and to have little or no public voice or power, and 2) smokers have been deliberately denormalized by anti-tobacco activists. They have been placed beyond societal norms, so the problems they face are not regarded as being societal issues. People will not be very angry, or even upset, if governments don’t take the problems of smokers seriously.

These are not wholly convincing arguments, are they? And I must be concerned when I cannot even convince myself. I mean, individuals, companies, organizations and governments do worry about smokers, don’t they? At the first opportunity, everybody with the closest or flimsiest connection to tobacco or nicotine will lament that, according to the World Health Organization, 8 million smokers die prematurely each year because of their habit. Ask yourself how many times you have seen that statement written or heard it articulated.

PMI says it used WHO data, estimates and methodologies, along with third-party data, to calculate the potential public health impact of the world’s smokers switching from cigarettes to less harmful, smoke-free products.

“The hypothetical model shows that if smoke-free products are assumed to be 80 percent less risky than cigarettes and if people who currently smoke were to switch to them completely, then over their lifetime, there’s a potential for a tenfold reduction in smoking-attributable deaths compared with [those that would have occurred under] historical tobacco control measures alone,” the press note said.

This is impressive and worthy of note, but the problem here is that in using and, dare I say it, extolling the data and, especially, the methodologies of the WHO, PMI rather shoots itself in the foot.

“For over a decade, PMI has championed a smoke-free future,” Olczak is quoted as saying. “Having invested more than $10.5 billion to scientifically research, develop and commercialize smoke-free products—which today account for more than a third of our total net revenues—we are living this future. Yet, inexplicably, there are countries stuck in the past where smokers can easily access cigarettes—the most harmful form of nicotine consumption—but not the better option of smoke-free alternatives.”

This situation is not universally inexplicable. Imagine for a minute that you are the health minister in a country whose economy does not allow major investments to be made in nation-specific health research. When the WHO comes knocking and tells you that your country has a smoking problem that is draining its finances and that THR is not the way to address it, what are you going to do?

You might notice that PMI is advocating THR, but you also notice that it is relying on WHO data and methodologies. That is, the methodologies are the same, the only difference is the interpretation of the data, so who are you going to believe, the international health organization or the international tobacco/nicotine company? It’s a no-contest.

I don’t want to seem to be an anti-expert or a conspiracy theorist, but I believe that we need to rely less on numbers, which are impersonal and which can be, intentionally or not, highly misleading, and more on values when it comes to addressing the problems caused by smoking. There is certainly something wrong with the ways that health data are manipulated by some, and the situation is getting worse by the day. Let me provide a current example from the U.K.

The ruling Conservative Party, nervous of a general election due next year, is reverting to type and aligning with a former prime minister’s reported policy of cutting the “green crap,” supposedly to help it appeal to its older voter base. And as part of this strategy, some are opposing certain policies aimed at cutting outdoor pollution by pointing out that the word ‘pollution’ has appeared only once as a cause of death on a death certificate.

I cannot say whether this is correct, but it wouldn’t surprise me because it could be argued that, for instance, people don’t die of heart attacks caused only by the inhalation and ingestion of pollutants, which is perhaps one factor—one major factor—among others that might include lifestyle choices.

But in conceding this, I must ask myself why people are so ready to attribute deaths to smoking. By the same reasoning, I take it, people don’t die of heart attacks caused only by the inhalation of tobacco smoke, which will be one factor—one major factor—among others that might include lifestyle choices and pollution.

Of course, we know the answer to this. It’s because of the way the system is set up to focus on smoking but not on pollution. There are certain diseases that are defined as smoking-related, and if a smoker dies of one of these, her death is recorded as having been caused by smoking.

The fact that these diseases could also be defined as pollution-related diseases seems to be glossed over. To get an idea of the contribution of pollution to disease and deaths, it is necessary to listen to the information provided by people such as the U.N. secretary-general, Antonio Guterres, who is not afraid to speak out.

Interestingly, Sept. 7 was International Day of Clean Air for Blue Skies, and if you look at the U.N. website, you will see that air pollution is described as a twofold problem:

1. “Health impact: Tiny, invisible particles of pollution penetrate deep into our lungs, bloodstream and bodies. These pollutants are responsible for about one-third of deaths from stroke, chronic respiratory disease and lung cancer as well as one quarter of deaths from heart attack. Ground-level ozone, produced from the interaction of many different pollutants in sunlight, is also a cause of asthma and chronic respiratory illnesses.”
2. “Climate impact: Short-lived climate pollutants (SLCPs) are among those pollutants most linked with both health effects and near-term warming of the planet. They persist in the atmosphere for as little as a few days or up to a few decades, so reducing them can have … almost immediate health and climate benefits for those living in places where levels fall.”

It is good to see this emphasized because air pollution, which is generally invisible and is visited upon everyone, even those, such as children, who don’t cause it directly, is a more insidious risk factor than tobacco smoke, which is visible and largely affects only those who consume it. In fact, my newspaper this morning, Sept. 21, has a heading: “Almost all Europeans breathing toxic air.”

Clearly, the figures of one instance of pollution being recorded on a death certificate and 8 million smoking-related deaths annually are both misleading, but they are allowed to guide us because they point us in the direction that we have already determined we want to go. They provide the comfort of confirmation bias. But what we should be doing is determining that direction based on values, not suspect figures, even though such a quest might lead us into difficult places.

And one of those places is, of course, environmental pollution, which, in my opinion, is still not taken seriously enough by the vaping industry, especially when it comes to disposables. I fail to understand how we might be able to justify the proliferation of disposables on the grounds of values.

How can we justify disposables when, clearly, the conversion of all smokers to the consumption of disposable vapes would not be something we could defend—would not, if you like, be something we would wish to become a universal law unless we are seeking to accelerate the end of humanity. And neither can they be justified on the grounds of the good of most people.

In fact, up to a point, I think the same might be said for nondisposable vapes, and so perhaps the time has come for THR advocates to start winding back on vaping devices and concentrating more on products such as snus and nicotine pouches, which are much easier to justify on the grounds of nicotine-user health, the environment and society at large.

A lot of people, including, probably, most of the readers of this magazine, will not agree with this, and they may well be right in not doing so. But I think it is important to have these discussions. THR fails, in my view, if it does not comprise a progressive signpost.

I said at the start of this piece that, in my opinion, Olczak had made what is possibly the truest statement about THR in saying that too much time had been wasted. But he said something even more important that I quoted above and part of which I shall repeat here: “… We are living this future ….”

He’s right: We need to look to the future, not the past, which can be a guide only for those reactionaries not wanting to face the future.