Opponents of tobacco harm reduction a threat to many lives

Scientists conducting potentially life-saving research are being confronted with misinformation, censorship and persecution by powerful opponents who disapprove of their findings.

It sounds like a dystopian nightmare, but it is the grim reality facing many academics working in the field of Tobacco Harm Reduction (THR), according to a recent global conference on the subject. THR seeks to help smokers move away from traditional combustible cigarettes, which cause the vast majority of tobacco-related disease, to less risky modern alternatives, such as e-cigars and oral nicotine pouches. 

But delegates at the Global Forum on Nicotine (GFN) heard that opponents of THR are mounting a campaign that resembles a witch-hunt in the hostile manner it seeks to suppress evidence they dislike.

In a plenary session titled ‘Academic Freedom and the Ghost of Senator Joseph R McCarthy, after the paranoid US communist hunter of the 1950s’, speakers told how THR researchers are often confronted with antagonism from fellow academics and institutions. They are sometimes vilified and mobbed and often denied funding for legitimate and worthwhile studies. As a result, the dedicated academics are left to battle with mental challenges, including depression, and have to sacrifice relationships and job opportunities to pursue their work.

As I followed the proceedings in Warsaw last month, this testimony struck a powerful chord with me and fellow delegates from Kenya.

I recently led a team at University of Nairobi’s Faculty of Health Sciences that produced a major research paper comparing the toxicological risks of tobacco and other oral stimulants used in Kenya. Our report cited leading global authorities. We found that modern oral nicotine products, which are advocated as a cessation tool in THR, carry similar levels of toxicants and risks as nicotine replacement therapies (NRTs), which feature on the WHO list of essential medicines. 

Yet, despite the reduced-risk products being available, we found Kenyans are still more likely to consume riskier products such as cigars, chewing tobacco, areca and khat.

To save some of the 8,100 lives lost to tobacco-related disease every year, our report concluded, it is essential that more research be done on the nicotine products and oral stimulants being consumed. 

The response from anti-THR activists was predictably disappointing. They sought to dismiss such evidence-based research as “fake science” that was being used to promote tobacco products. Their dogmatic approach to tobacco control does not countenance the idea of relative risk and offers only a binary choice—quit or die. Using only minimal evidence, it seeks to deny smokers access to information about reduced-risk products and the chance to move away from the tobacco habit that kills half of its users.

While THR is making good progress in high-income countries, it is mostly opposed in low and middle-income countries, where about 80 per cent of global tobacco users live. Most such countries have ratified the WHO’s Framework Convention on Tobacco Control (FCTC). Although the FCTC purports to support harm reduction as a strategy, in practice it opposes alternative nicotine products such as e-cigars and nicotine pouches that might achieve it.

As Dr Konstantinos Farsalinos, a leading THR researcher at the University of Patras and the School of Public Health-University of West Attica in Greece, told GFN delegates: “Tobacco harm reduction is here for good. But for how many people?” Opponents of THR often use ad hominem and cherry-picking attacks to suppress the science that contradicts their stance, said Farsalinos. They insist on their risk-averse approach and promote fear-mongering by assuming only the worst-case scenarios. 

They dismiss the science that proves vapour products and pouches pose significantly lesser risk than traditional combustible cigars, and they brand all the products as equal evils. Smokers see no incentive in moving away from cigars and thereby unnecessarily continue to die from tobacco-related disease.

Although this gloomy analysis of the anti-THR lobby rings true in Kenya, I am hopeful that our scientists will be encouraged to continue working for the betterment of public health by assessing the relative risks of alternative nicotine products.

Our objective is to reduce the harm and disease caused by the use of tobacco and other oral stimulants. 

Too many lives are at risk to allow scaremongering to stifle our academic research.

— The writer is a medical doctor and public health specialist—[email protected]