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The Global Forum on Nicotine (GFN) was in Warsaw again last week, and once again proved to be one of the most thought-provoking events on the tobacco harm reduction (THR) calendar, though it has to be said that – like all of its kind – it runs the risk of becoming an echo chamber.
One pro-THR activist told me he thought the reduced-risk nicotine world was divided more than ever into “them and us” (the antis and the pros). And while there may well be truth in this, as long as both sides are just standing in their own corners shaking their fists at one another, we’re not going to get anywhere.
Still, that’s a much bigger problem which can’t be laid at the door of the GFN specifically, and there were certainly some noteworthy themes and ideas emerging. Here are some of the thoughts I took away.
Regulation can be part of the solution
Regulation is part of the solution, not just part of the problem. (This may seem obvious, but to some in the more vociferous pro camp, it isn’t.) While “regulate to eliminate” is clearly a danger whenever new rules are proposed, regulation does provide protection for consumers (as the ever-quotable Clive Bates put it, it covers their “information acquisition costs”; in other words, governments learn about risk and safety so that consumers don’t have to).
Regulation that permits products to be marketed legally enables environmentally sound practices; who can imagine a recycling programme for illicit products? It makes crises easier, not harder, to deal with; recalling legal products is far less difficult than stamping out dangerous illicit products. Regulation can also communicate risk and comparative risk both explicitly (for instance, through health warnings) and implicitly (cigarette advertising bans, for example, don’t just remove ads from view – debate around them also reminds consumers that combustibles are risky products).
Regulation that allows responsible manufacturers to supply their products, coupled with efficient enforcement, can at least reduce the involvement of organised crime, for which illicit disposable vapes and similar products are attractive. And enforcement against illicit products also makes it easier to market safe ones.
Similarly, while a world of mom-and-pop retailers and cottage-industry suppliers may have some emotional appeal, the sector needs big corporates (including but not limited to Big Tobacco). They have the resources to make significant product innovations, the reach to distribute to whole populations, and the structures to deal with problems if they do arise.
The takeaway: Effective regulation and corporate involvement may be instinctively unappealing to some activists, but markets without them risk being small, messy and dangerous.
Prohibition doesn’t work
Tobacco regulators should learn from the War on Drugs, where the failure of the prohibition/total abstinence approach is (mostly) well-established, and so is harm reduction. Banning THR is more like banning needle exchanges than banning the drugs themselves, one speaker suggested, and it’s an excellent point.
It was observed, too, that teens often have good access to illegal drugs – very likely better than their parents. Excessively tight restrictions on novel nicotine products, in the interest of keeping them away from kids, run the risk of creating a situation where non-smoking youth can get hold of them and adult smokers can’t. (Or maybe they have to ask their children, in a quiet embarrassed way.)
The takeaway: Prohibition? Just say no. Even if you’re anti-THR.
Misinformation is still a big problem
Misinformation, in particular misperceptions of nicotine and conflation of nicotine with tobacco, remains a major problem. One panellist even suggested that the effects of misinformation can amount to a partial de facto ban, if it’s so pervasive that health professionals start advising against THR, for example. This may be particularly true if government authorities encourage such misinformation.
Another speaker pointed out that the “tobacco endgame” strategies of many countries are in danger of becoming a “nicotine endgame”. Nicotine has become tarred with the brush of combustion when in reality it’s a pretty benign substance in the kind of doses actually taken; as Bates (again) pointed out, nobody thinks of wine aficionados as “ethanol drinkers”.
This confusion isn’t a new phenomenon, but it’s getting worse and it’s hard to counter, in part because for so many decades nicotine, and tobacco products such as combustible cigarettes, were in practice the same thing. You couldn’t have one without the other until recently.
Others pointed out that there is a persistent, historically long-standing demand for stimulants and relaxants (though I’m very sceptical of the argument put forward at GFN that nicotine itself has been as historically/culturally universal as alcohol; that’s pushing the comparison too far). Cigarettes are a relatively recent arrival on the scene, and more importantly they are only a delivery mechanism; the nicotine itself, not the cigarette, is the “benefit” for the user, so eventually reducing their use to minimal levels, at least, is very likely achievable. Wiping out nicotine is not only unnecessary, but would only result in the use of other nicotine-like substances.
The takeaway: Both the THR movement and the novel nicotine sector need to continue educating policy-makers, health professionals and other stakeholders on the tobacco/nicotine distinction. It won’t be quick or easy, but it may well prove to be just as important as the youth usage issue.
The importance of consumers in the equation
Consumers are sometimes forgotten, but they matter. This point recurs frequently at THR conferences, but it’s worth repeating because it’s so easily overlooked: theory is important, but practice is what matters in the end. For example, wanting to be a non-smoker is not the same as disliking the act of smoking, yet much tobacco-control theory fails to take account of this.
And it permeated the GFN, too. A speaker from one Big Tobacco company talked about its impressive “co-ideation” programme in which the product development team has contact with consumers throughout their development process. Other speakers reminded us that harm reduction has to be accompanied by desirability (very few people want bitter-tasting medicine).
The takeaway: Ultimately, substituting less risky products for more risky ones is something that individuals do. The THR movement, the industry, regulators and others can all help, but they can’t force it if they don’t take those individual perspectives into account.
– Barnaby Page TobaccoIntelligence staff
Photo: Global Forum on Nicotine
