Health experts slam global tobacco control treaty for excluding scientific developments

Dr. Konstantino Farsalinos, a cardiologist and leading researcher on tobacco harm reduction (THR).

MANILA, Philippines — Public health experts have voiced strong criticism against the World Health Organization’s (WHO) tobacco control accord for consistently neglecting scientific and technological advancements in policy discussions. This exclusion effectively denies smokers worldwide access to information about less harmful alternatives available to them.

Dr. Konstantinos Farsalinos, a leading researcher on tobacco harm reduction (THR) and a cardiologist, expressed his concerns regarding the WHO’s Framework Convention on Tobacco Control (FCTC) and other national health authorities’ dismissal of THR benefits. Despite 60 years of accumulated knowledge about the harm caused by smoking, the number of smokers globally has increased to approximately 1.3 billion today.

“We are essentially preventing individuals from quitting smoking by demonizing alternative products solely because they contain nicotine,” stated Farsalinos during the THR Summit Spain at the Universidad Rey Juan Carlos in Madrid.

Prominent public health authorities have previously criticized the FCTC, describing it as an outdated global public health agreement that fails to consider the views of key stakeholders and disregards recent scientific developments.

Dr. Michael De Luca, a Disaster and Operational Medicine Fellow at The George Washington University, and Dr. Mario L. Ramirez, an Emergency Medicine Physician at Inova Fairfax Hospital, cautioned that the WHO’s proposed pandemic treaty would likely fail if modeled after the FCTC.

Farsalinos referred to smoke-free products such as e-cigarettes, heated tobacco products, and snus, highlighting numerous scientific studies showing their significantly lower harm compared to traditional cigarettes.

He explained, “One does not need to be a scientist to grasp the substantial difference in risk between smoking tobacco cigarettes and using electronic cigarettes. On one hand, we have tobacco cigarettes burning organic matter at temperatures up to 800 degrees Celsius when smoked. On the other hand, we have a device that employs electricity to heat a coil and evaporate a liquid, which then recondenses at temperatures below 300 degrees Celsius. Even a non-expert can understand the vast distinction between these products.”

“The disparity in risk levels is immense, and this has been repeatedly demonstrated in numerous studies over the past decade. Scientific societies now acknowledge the significantly lower potential toxins in electronic cigarette aerosol compared to tobacco cigarette smoke,” he added.

“Regrettably, our current medical products for smoking cessation are not very effective. That is why most smokers resort to these alternative products. Instead of misinforming and scaring them, clinicians should be offering these options to smokers,” he stated.

Farsalinos is renowned for having authored the most peer-reviewed publications on e-cigarettes globally. He presented the latest scientific evidence on harm reduction products, further reinforcing the argument that alternative products are significantly less harmful than smoking.

During the THR Summit Spain, which aimed to explore the impact of harm reduction strategies on smoking, Farsalinos participated as one of the panelists.

The summit served as a platform to generate new proposals for addressing smoking-related issues and encouraged scientific, professional, technical, and political decision-makers to contribute their perspectives.

He lamented that the global campaign against smoking primarily focuses on politics, ethics, and moralism, with minimal attention given to science and public health.

“A public health matter concerning smoking-related diseases has been transformed into a moral issue debating the ethics and appropriateness of substance use. We must return to the core principles of public health, which are not rooted in moral judgments. The discussion should revolve around smoking-related diseases,” he emphasized.

Farsalinos noted that while the WHO initially supported harm reduction approaches and strategies within the FCTC, the organization later shifted its focus from combating smoking to combating nicotine.

This misguided perspective has misled governments, officials, and many scientists, leading to misconceptions and an inability to distinguish between smoking and nicotine, as well as a misunderstanding of the global necessity to reduce smoking-related diseases.

“Few realize that these actions are causing harm. It is not merely a matter of impeding public health progress; it represents a step backward. Despite the well-intentioned motives of legislators and liberal scientists, the unprecedented bias stemming from this predisposition, prejudice, and dogmatism against nicotine is deeply concerning,” he cautioned.

Clive Bates, former director of Action on Smoking and Health UK and former advisor to British Prime Minister Tony Blair, held the WHO accountable as an international non-governmental organization affiliated with the United Nations. He argued, “The member state countries sitting on its board should hold it accountable. The way the World Health Organization deals with smoking is akin to advising against using vaccines for COVID, based on perceived risks. It demonstrates a mentality comparable to anti-vaccine sentiments.”

Advocates of harm reduction stressed the importance of countries supporting a debate on advancing the fight against smoking without stigmatizing those who hold differing perspectives from the WHO.

The latest review by the UK Department of Health and Social Care, the eighth to date, reaffirms that in the short and medium term, vaping poses a small fraction of the risks associated with smoking.

It also acknowledges significantly reduced exposure to harmful substances compared to smoking in terms of biomarkers for cancer, respiratory diseases, and cardiovascular diseases.

Farsalinos contended that a successful tobacco harm reduction strategy could potentially save millions of smokers. He urged for a common-sense approach and the application of risk proportionate regulation in legislation, as is done in various daily aspects of life.

“We do not require complex rulings or convoluted laws. We need simplicity. We need to understand the substantial difference in risk and actively encourage people to use these products instead of smoking,” he stressed.

Farsalinos asserted that smokers should be made aware of the truth. “Beyond any doubt, the long-term effects of many medical developments and even new consumer products are uncertain. However, we possess compelling evidence regarding the lower-risk potential of harm reduction products. We must communicate this information to smokers and empower them to decide. We should provide them with all the available tools to quit smoking, including psychological support, medications, and nicotine-containing alternative products,” he concluded.

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