Tobacco harm reduction advocates have accused the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) of lies and despotism, asserting that the organization controls the narrative on smoke-free products and seeks to alter the definition of smoke.
"They are guilty of despotism. They won't let consumers take part in discussions. They won't allow consumers to watch the event. They won't let us speak directly with delegations. Delegations almost all ignore messages sent to their governments on harm reduction,” said Martin Cullip, an international fellow at the UK-based Taxpayers Protection Alliance's Consumer Center.
Cullip made these remarks as delegates from 183 countries with diverse interests, including the Philippines, participate in the 10th Conference of the Parties (COP 10) at the Panama Convention Center, organized by the WHO FCTC, an international treaty which has been in effect since 2005. Smoke-free novel and emerging tobacco products are among the key topics under discussion.
"The WHO should adhere to scientific truth," said Cullip, citing the WHO FCTC's efforts to redefine smoke. "The science overwhelmingly supports tobacco harm reduction, so advocacy should be unnecessary. However, when they disregard science, we are compelled to speak out, only to be ignored."
Clive D. Bates, director of Counterfactual, a consulting and advocacy group focused on a pragmatic approach to sustainability and public health, said the WHO FCTC's unscientific approach is depriving 1.3 billion smokers of options.
“WHO and tobacco control activists have been instrumental in denying millions of smokers access to life-saving, low-risk alternatives to cigarettes – this has occurred through prohibition, regulation and misinformation – for which there is no scientific or ethical basis,” Bates said.
He particularly criticized two WHO FCTC papers that exclude science and consumer input from the discussion and attempt to misclassify heated aerosol as 'smoke'.
"In summary, the primary aim of these two papers is to argue that heated tobacco products are smoking products that do not offer harm reduction benefits and therefore should be regulated similarly to cigarettes. However, this narrative is false and dangerous. These products are, beyond any reasonable doubt, far less harmful than cigarettes and, in some countries, have triggered a dramatic decline in smoking,” he said, referring to Sweden, the UK and Japan.
Bates said heated tobacco products (HTPs) do not involve combustion and are chemically different from tobacco smoke. He highlighted the significant reduction in harmful chemicals emitted by heated tobacco products compared to tobacco smoke, citing findings from investigations into their function.
“In general, HTP emissions contain far fewer compounds than tobacco smoke and exhibit, on average, a 90-percent reduction in HPHCs (harmful and potentially harmful chemicals). The TPM (tobacco particular matter) of HTPs is dominated by water and has a high volatile content, whereas the TPM of tobacco smoke is mostly composed of low-volatile droplets and solid particles,” he said.
Bates also referred to court cases in Germany and Sweden where heated tobacco products were not classified as smoking products due to the absence of combustion. He criticized the WHO FCTC Secretariat paper for failing to acknowledge these rulings and the rationale behind them.
The court explained that the distinction between a “smoking tobacco product” and a “smokeless tobacco product” is based solely on whether a tobacco product is consumed with or without a combustion process; and it is irrelevant whether smoke occurs when the tobacco product is consumed.
Bates said the WHO FCTC Secretariat paper does not mention these cases and the technical and legal reasoning behind the rulings. “The paper also aims to suggest a false and misleading equivalence between HTP aerosol and tobacco smoke, presumably to bolster its argument against tobacco harm reduction and to support regulation of these products as if they were as dangerous as cigarettes, which is far from the case,” he said.
He said that toxic exposures with heated tobacco products are significantly lower, likely reducing health risks for smokers who switch to these products, as recognized by no less than the US Food and Drug Administration. “WHO fails to mention the 2-million-page application and in-depth analysis by the FDA in reaching its authorizing decisions,” he said.
He said WHO FCTC’s recommended extreme bans on communications related to tobacco and alternative nicotine products without sufficient justification.
“WHO has never provided a justification or evidence for this policy (banning a much safer product while allowing cigarettes to be available everywhere). Given ENDS [electronic nicotine delivery systems) are substitutes for cigarettes, we would expect this measure to increase smoking, promote illicit trade in ENDS, and increase harm to health and welfare,” he said.
Regarding claims by the WHO that there is insufficient evidence showing that these products displace smoking at the population level, Bates said there is ample evidence from various sources indicating the opposite.
“There is a wide range of evidence from randomized controlled trials, observational studies, population trend data, quasi-experimental economic studies, market observers and user testimony, all showing that ENDS use displaces smoking. Also, we would expect that innovation with new, safer products should displace incumbent dangerous products,” he said.
Tobacco harm reduction advocates also warned that banning smoke-free alternatives would only exacerbate the underground market for these products.
“India decided two or three years ago to ban cigarettes. What was the outcome of that? From a very small market which was at that time unregulated but not illegal, they illegalized the product and they ended up with a huge 100-percent black market of illicit electronic cigarette products that are available virtually in every corner in all major cities in India with no quality criteria, no quality control, no regulation, no oversight from the government, no rules on marketing and promotion, no one knows where they come from,” said Dr. Konstantinos Farsalinos, a cardiologist and research fellow at the Onassis Cardiac Surgery Center in Athens, Greece. “The government now pretends that e-cigarettes don't exist because they banned them.”
“It's a perfect example showing that regulation can sometimes be much worse than just leaving everything alone and applying no regulation at all. Hopefully one would expect countries to learn from these mistakes. They don't because first of all they don't admit the mistakes despite the obvious and well understood outcome,” he said.