Perspectives from GFN24 – Day 2

Friday’s Keynote Speech

Opening the day with the keynote speech, Dr Garrett McGovern, the Medical Director of the Priority Medical Clinic in Dublin, spoke about the over-reliance and misinterpretation of the precautionary principle when it comes to nicotine use.

“On the surface, the precautionary principle is sensible - and there are times when it is valid to follow it, but, when misapplied in public health, it has caused unnecessary harm and death. That's what's going to happen with electronic cigarettes,” he said.

Dr McGovern reminded the audience that smoking tobacco products is a deadly activity. In contrast, vaping is not deadly.

“We're over 20 years in, and we're not seeing those harms,” he pointed out. “We know that if we stop people using electronic cigarettes, many of them will otherwise smoke.”

McGovern spoke about how smokers have tried multiple times to quit using traditional approaches and products and, for almost all, it ends in failure.

“And then they hear someone on the radio saying very authoritatively that they are no better off using electronic cigarettes than smoking. That angers me,” Garrett continued.

Rather than adopting the precautionary principle, he believes, these public health “experts” are “practising harm reduction denialism.”

“Harm reduction is the cornerstone of everything we do in medicine. There's not very many things in medicine we can cure - all we can do is reduce symptomatology. And in medicine, we shouldn't make that difficult. But with this, for some reason, we're making it difficult.”

“Given the unequivocal support the World Health Organization has given to drug harm reduction, its deeply negative stance on e-cigarettes is bizarre, bereft of evidence and increases the risk of harm to people who smoke.”

Then, during a discussion following a session, the theme of tobacco harm reduction continued to be explored.

“I am very disappointed in the stance that the WHO has taken on harm reduction” – Professor Tikki Pangestu

Tikki Pangestu, a Visiting Professor at the National University of Singapore, addressed the subject of the World Health Organization’s involvement. This was pertinent as Tikki is a former Director of Research Policy and Cooperation at the WHO: “I am very disappointed in the stance that the WHO has taken on harm reduction, especially because many LMIC look to the WHO for guidance, lacking capability to objectively assess the evidence and make their own policy decisions.” 

“The WHO gave birth to the Framework Convention on Tobacco Control and like any parent, they will protect it at all costs. But the question of resources is more important. The TFI and many tobacco-related activities are sponsored by one man.” 

“The only thing that will make the Director-General sit up is if member countries demand change. Progressive countries like the UK, like New Zealand, like Japan and other smaller countries, must collectively say to the Director-General that a more open, objective discussion around this issue is needed. At the last COP10 in Panama, we were beginning to see some countries agitating for something like this to happen. All of us must work together to move this along until we reach that tipping point.”

Harm reduction expert Clive Bates continued: “The precautionary principle is a symmetric thing, looking at both the consequences of action and inaction. It isn’t a one way bet against innovation - you must consider what happens if you don’t have the innovation. So, if you don't have e-cigarettes or low risk products because you act on the basis that you think residual uncertainties in the future are overwhelming, what are the consequences of doing that? You let an epidemic of cigarette smoking go unchecked.”

Alex Wodak, drug law reform advocate and physician, added some words of hope: “We should always be mindful of wildcards. The country with the most smokers in the world is China. The world's biggest tobacco company is the China National Tobacco Corporation (CNTC), producing something like 40% of the world’s cigarettes. Currently, China is against tobacco harm reduction. But vaping is not uncommon in China, and the CNTC has the world's largest collection of tobacco harm reduction patents. Acquiring that portfolio must have cost billions of dollars and couldn't have been done without the approval of the Chinese Government, which owns the CNTC outright. It only needs Beijing to switch from being against to being pro tobacco harm reduction and this whole debate’s over.”

Relying on China to change its mind? Maybe hope is the wrong word because legislation in the UK used to be evidence-based, now we are seeing a shift in focus. This was covered by Clive Bates during the second panel discussion of the day.

“You can't assume or you shouldn't assume the regulation is inherently justified. It limits what people can do. It limits everything,” Clive said. “Regulation has to be justified on its own merits. And those are sometimes simply illusion.”

“Children are used to create emotive campaigns, to create a sort of moral panic and to justify things that would not be justifiable if they were done to adults. There are 18 times as many adults using nicotine products as there are young people in the UK, but all of the political focus is on the small number of young people who are vaping.”

“The needs of those adults are served by a legal supply chain, responsibly and proportionately regulated with acceptable risk. That should constrain the prohibition instinct, which has seen the rise of a big illegal and unauthorized market in Australia and the United States.”

Law professor David Sweanor added that laws are not something that should be used to control behaviour, as “people can only make as good a decision as the information and the options available to them allows. It has to be a consumer offer that makes sense to them.”

He noted that all traditional approaches to tobacco-related public health is coercive, forcing people to change – but “what if we told them the truth? What if we gave them better products?”

Dave Cross

Journalist at POTV

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Dave is a freelance writer; with articles on music, motorbikes, football, pop-science, vaping and tobacco harm reduction in Sounds, Melody Maker, UBG, AWoL, Bike, When Saturday Comes, Vape News Magazine, and syndicated across the Johnston Press group. He was published in an anthology of “Greatest Football Writing”, but still believes this was a mistake. Dave contributes sketches to comedy shows and used to co-host a radio sketch show. He’s worked with numerous start-ups to develop content for their websites.