Smokers’ population rises to 1.3 billion despite global tobacco control treaty


The population of smokers globally increased to about 1.3 billion today despite the strict implementation by the World Health Organization (WHO) of a tobacco control accord that prevents them from using smoke-free alternatives, according to public health policy experts.

Dr. Konstantinos Farsalinos, a cardiologist and a leading researcher on tobacco harm reduction (THR), blamed the WHO’s Framework Convention on Tobacco Control (FCTC) and other national health authorities for ignoring the merits of THR and excluding scientific and technological advancements in policy discussion.

“We are literally preventing people from quitting smoking through the use of alternative products by demonizing these alternative products just because they contain nicotine,” said Dr. Farsalinos during the THR Summit Spain held recently at the Universidad Rey Juan Carlos in Madrid.

Dr. Farsalinos said a successful tobacco harm reduction strategy could save millions of smokers, “and we need to apply the same principles in terms of legislation as we apply them in every other daily aspect, which is a risk proportionate regulation. 

“We don’t need any complex rulings or any complex laws. We need something which is simple. We need to understand, first of all, the level of risk difference and to encourage in reality people to use these products instead of smoking,” he said.

Renowned public health authorities earlier described the FCTC as an example of a global public health agreement that is no longer fit for purpose as it continues to ignore views of key stakeholders and refuse to acknowledge latest scientific developments.

Dr. Michael De Luca, a Disaster and Operational Medicine Fellow, Department of Emergency Medicine, The George Washington University and Dr. Mario L. Ramirez, an Emergency Medicine Physician, Department of Emergency Medicine, Inova Fairfax Hospital warned that the WHO’s proposed pandemic treaty is doomed to fail if it will be patterned on the FCTC.

Referring to smoke-free products such as e-cigarettes, heated tobacco products and snus which, according to voluminous scientific studies, are far less harmful than traditional cigarettes, Dr. Farsalinos said, “You don’t need to be a scientist in order to understand the vast difference in the risk between smoking tobacco cigarettes and using electronic cigarettes. On one side, we have tobacco cigarettes which are burning organic matter at temperatures that go up to 800 degrees Celsius when a smoker takes a puff. On the other side, we have a device which uses electricity to heat a coil and to evaporate a liquid, which is subsequently recondensed in temperatures of less than 300 degrees Celsius. Just hearing this, a non-expert, a non-scientist can understand that these are vastly different products.”

“The level of risk difference is tremendous, and we have seen that repeatedly in lots of studies over the last 10 years. I’ve offered many of them, but all the studies converge basically. I don’t think there is any disagreement. We now see scientific societies accepting the substantial lower level of potential toxins in electronic cigarette aerosol compared to tobacco cigarette smoke,” he said.

“Unfortunately, all our medical products to quit smoking are not very effective. That’s why most smokers are going to end up using these alternative products. We need clinicians to provide this option to the smoker, instead of misinforming and scaring them,” Dr. Farsalinos said.

Dr. Farsalinos is known as the author with the most peer-reviewed publications on e-cigarettes worldwide.  He presented the latest scientific evidence on harm reduction products that continue to argue—with more evidence than ever—that alternative products are much less harmful than smoking.

He is among the panelists during the THR Summit Spain which discussed the impact that harm reduction strategies can have in the area of smoking.  It served as a forum to contribute to the generation of new proposals for tackling the problem of smoking, providing new points of reflection for scientists, professionals, technical and political decision-makers.

He said that unfortunately, the global campaign against smoking focused mostly on politics, ethics and moralism, with very little attention on science and public health.  

“So, a public health issue about smoking-related disease has turned into a moral issue of whether it’s ethical and appropriate to use or not use a substance,” he said. “We need to go back to what public health is, and public health is not a moral issue. It’s an issue of smoking-related disease when we discuss about smoking.” 

He said that while the WHO initially endorsed the harm reduction approach and the harm reduction strategy in the FCTC, they later moved to a war on nicotine instead of a war on smoking.  “That’s how all the governments, all the officials and a lot of scientists, unfortunately, have been misinformed. They live on misperception, with inability to differentiate smoking from nicotine as well as misunderstanding of the difference between harm and the need globally to reduce smoking-related diseases,” he said.

“No one realizes that this is causing harm. It’s not a matter of not advancing public health. It’s a step backwards. They are actively causing harm to many people despite having the best of motives because I believe that legislators, liberal scientists have the best of motives. But the level of bias coming from this predisposition, this prejudice, this dogmatism against nicotine is unprecedented,” he said.

Mr. Clive Bates, former director of Action on Smoking and Health UK and former advisor to British Prime Minister Tony Blair, said the WHO should be held accountable by its shareholders.   “It’s an international non-governmental organization, a branch of the United Nations, and it has member state countries which sit on its board. They should be holding its feet to the fire. But what they’re doing with smoking is that it’s almost as if the World Health Organization was advising people not to use vaccines for Covid, because they think there’s some risks. It is in almost in the same mental space as anti-vaccine,” he said.

Harm reduction advocates said countries should support a debate on how to advance the fight against smoking, and not to stigmatize those who think differently from the WHO.

The latest review by the UK Department of Health and Social Care, its eighth so far, confirms that in the short and medium term, vaping represents a small fraction of the risks of smoking and that there is significantly less exposure to harmful substances from vaping compared to smoking, in biomarkers of cancer, respiratory and cardiovascular diseases. 

Dr. Farsalinos said smokers should be aware of the truth.  “And the truth beyond any doubt is that yes, there are uncertainties over the long-term effects as with almost anything that medicine develops or even new consumer products that are being released in the market. But we have very, very strong evidence on the lower-risk potential. We have to communicate this to the smoker and let them decide, provide them with all the tools available to quit smoking starting from psychological support and medications, but finishing with nicotine-containing alternative products,” he said. 

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