Risking Lives of Millions of Smokers Worldwide for Standing in the Way of Smoking Alternatives

Recently a webinar hosted by the Italian cultural and political journal Formiche gathered public health experts, tobacco control professionals, policy makers, scientists and thought leaders to discuss the importance of adopting science-based reasons by the WHO Framework Convention on Tobacco Control (FCTC) to respect humanism, where they emphasized that accessibility to correct data on tobacco harm reduction is a human right.

The discussion ensured that the World Health Organization Framework Convention on Tobacco Control (FCTC) needs to redefine the regulation of the sector to incorporate the new awareness of environmental and health implications and pave the way for the principle of harm reduction, given that twenty years have passed since the launch of the convention and many proven scientific studies have been released since then.

Professor and President of the Advisory Board of the Centre for Health Law, Policy and Ethics of the University of Ottawa, David Sweanor frowned the WHO Framework Convention on Tobacco Control (FCTC’s) approach, describing it as a ‘recipe’ by the WHO for how to define tobacco products neglecting what science says and the role of research and development in the progress of the process. He added that people working on the convention are ill-informed about the real issues as far as harm associated with tobacco is concerned.

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Sweanor stressed that it is difficult to rationalize WHO’s opposition to tobacco harm reduction when the organization accepts the concept in every other area of human health yet denies it for reducing risks associated to smoking.
Professor of Internal Medicine at the University of Catania and founder of CoEHAR, Research Center for Harm Reduction from Smoking, Riccardo Polosa said that there are plenty of studies that prove that smoking alternative products are 80-90% less toxic in comparison to combustibles, which marks them as a clear solution to reducing risks associated to smoking, yet the world seems to be completely blindfolded.
Polosa showcased what some countries are doing in regards of harm reduction adoption and how their practices are recording successful results in decreasing the number of smoking populations in their countries including Japan, the United Kingdom, Norway, and Iceland which categorize smoke-free nicotine products as part of their reduction strategies. He also stated that tobacco control policies today need innovation and need to think in the 21st century mode taking into account the integration of the principle of risk reduction policies and the promotion of non-combustible alternatives for adult smokers.
For her part, Coordinator of Corporación Acción Técnica Social, Colombia, Maria Alejandra Medina faulted FCTC for being unwilling to tell the difference between nicotine and tobacco leading to misinformation about the risk profiles of the different alternative products. Medina added that the current tobacco policies are creating more harm as there is no possibility of a tobacco or a nicotine-free world, which drives the urge of leadership to change the approach to include innovative embracing alternative products.
For her part, MD and Professor of Psychiatry at the Cairo University School of Medicine, Prof. Dr. Rania Mamdouh discussed harm reduction concept and strategies in North Africa, highlighting the nexus between harm reduction and psychiatry. Mamdouh said that 40 million Egyptians were reported to have used nicotine at least once throughout their lives, according to a national survey in 2019.

She clarified that psychiatry has adopted harm reduction programs for 35 years now for their realistic solutions to combat addiction including opioid use disorders and cannabis use disorders saying that many smokers cannot quit smoking despite their awareness of risks associated with smoking due to the addictive effect of the nicotine. Mamdouh stated that not all people change in the same degree and time, so with applying the harm reduction approach, the smokers can still get same or less levels of nicotine but with less risk to their health.

Prof. Dr. Rania Mamdouh also referred to neurobiological studies from Harvard university from pre and post harm reduction approach for nicotine dependent people showing that many of the people that switched to non-combustible tobacco alternatives succeeded to reach a consumption of zero nicotine within a duration varying from 12 to 18 months. From a neurology perspective, Mamdouh stated that that the harm reduction approaches came to solve two problems, the addiction of nicotine and the overall health issues attributed to smoking. She stated that on a daily basis, the Nicotine Clinic in her University receives around 40 patients transferred from the Cardiology and Chest clinics. At first, those patients are instructed to use nicotine gum, patches, and sprays. If the patients are not satisfied and need more nicotine, they are then advised to try the non-combustible nicotine products along side 30 cognitive behavioral therapy exercises.
Prof Rania Mamdouh stressed that non-combustible smoking alternative products are less harmful yet not risk-free saying that long-term studies are required to fully determine their impact on human health just like combustible products which health organizations looked into their impact on human and public health for hundreds of years.