there , and their legal products were the devils . The angels were over here – the doctors , the clinicians , the public health people and so on . And there was clear blue water between them . But then the waters got extremely swirled up and muddy .’
Despite all the evidence on the efficacy and safety of the new products , many of the tobacco control organisations could not entertain the idea that safer nicotine products could play a part in reducing death and disease , and resorted to perpetuating ‘ fear , uncertainty and doubt ’. Perhaps rooted in moral and ideological objections , there was a complete unwillingness to consider that people could use nicotine recreationally outside the context of nicotine replacement therapies .
Their negativity had a serious impact , sowing doubt among health professionals . People coming forward looking to switch from smoking were likely to be met with ‘ junk science ’. Instead of being reassured that vaping was a safer option , they were more likely to be encouraged to go ‘ cold turkey ’ instead , which felt impossible for most . As Shapiro points out , ‘ this plays straight back into the arms of the tobacco companies who are still making millions of dollars a year selling cigarettes .’
SLOW PROGRESS As a public health social scientist as well as KAC ’ s director of research and policy , Professor Gerry Stimson is extremely frustrated by the slow progress and unwillingness to act on evidence .
‘ Here was an opportunity to massively reduce the burden of premature death and ill health caused by cigarettes – the potential of vaping products and snus was obvious and exciting to us ,’ he says . The consumer interest and activism around vaping seemed as if it could consign a massive global health issue to the history books , and at virtually no cost to governments . ‘ So we started our work on tobacco harm reduction with some cautious optimism .’ His colleagues were used to difficult issues – they worked in drugs
A STORY OF SMOKE AND SEDUCTION …
The story of tobacco began with Christopher Columbus and crew encountering people putting rolled up leaves in their mouths , setting fire to them and inhaling the smoke . This was in 1492 in what is now known as The Bahamas , and as it spread throughout Europe it became used in the form of tobacco powder ( snuff ), chew , pipes , hookahs and cigars .
James I of England wanted to ban tobacco , but his short-lived prohibition turned into taxing it heavily instead to fund a round of expensive wars , triggering a thriving trade in tobacco smuggling .
The soldiers of the Crimean War and American Civil War took to hand-rolling cigarettes to get a quick nicotine hit . Then came three crucial developments – the development of flue-cured tobacco ( milder , sweeter , with a relatively high nicotine content ); production of the first safety matches ; and the invention of the mechanical cigarette-rolling machine , which could turn out 70,000 cigarettes a day .
Cigarette advertising proved effective propaganda as smoking became a symbol of success , emancipation , and even robust good health , with smoking doctors appearing in adverts . By the end of the Second World War , nearly half of Americans aged 18 and over were smoking at least a pack a day .
During the 1950s evidence of the link between smoking and ( previously very rare ) lung cancer began to emerge , and by the mid-1960s there was strong enough evidence to show that smoking caused cancer .
A range of safer nicotine products have established both an evidence base for reduced harm in comparison to smoking cigarettes and consumer popularity ... But divisions within both the public health and political worlds are blocking progress . harm reduction , HIV and AIDS , the criminal justice system , homelessness , mental health – but they hadn ’ t estimated the extreme challenges of working in the area of tobacco control and reduction .
FAILURE TO LEAD Realising the overnight revolution wasn ’ t going to happen , they prepared for a long uphill struggle . ‘ My enthusiasm as a public health scientist wasn ’ t matched by the enthusiasm of my public health colleagues ,’ says Stimson . Making matters worse , philanthropists who believed nicotine in all its forms was bad , were actually throwing money at preventing safer nicotine products from reaching their target market . It ’ s resulted in ‘ a pretty dismal lack of progress ’ over 20 years in reducing the statistic of 1.1bn smokers .
While realistic that it takes time to change consumer behaviour and patience for governments to work through regulations , he
also understands the equation for tobacco companies . Why would they rush a transformation to new products while they continue to profit so handsomely from selling combustibles ? His anger as a public health expert is directed at WHO and their failure to lead on this . Why are they not using their role – and the evidence – to shift people away from smoking ? He says there needs to be an urgent review of WHO leadership in tobacco control .
Despite the challenges he is determined to remain optimistic about good products and consumer demand , demonstrated by an estimated 80m vapers globally . ‘ This is a major disruptive force ,’ he says . ‘ For me it ’ s not whether safer nicotine products will predominate over combustibles , but when .’ DDN
Read the three reports on the global state of harm reduction , including The right side of history at : https :// gsthr . org / resources / thrreports /
B Christopher / Alamy
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