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Monday
Sep212015

Pork chop at a bar mitzvah – reflections on GTNF 2015

I was in Bologna last week for the Global Tobacco and Nicotine Forum at the Palazzo Re Enzo (above).

As older readers know I've been going to GTNF for several years and there's always something to enjoy, not least the often stunning locations. See Bangalore (2010), Antwerp (2012), Cape Town (2013) and West Virginia (2014).

Since it was launched in Rio in 2008 as the Global Tobacco Network Forum there's been a gradual evolution to the point where the predominant theme is now harm reduction.

Like any sane person I welcome harm reduction and I recognise it's a sensible strategy for the tobacco companies to adopt.

Nevertheless, as a representative of a group that has spent 36 years valiantly defending the freedom to smoke, it feels strange being a slightly peripheral figure at a tobacco industry supported event.

Don't get me wrong. I didn't feel unwelcome – there were far too many friendly or familiar faces – but one moment sums it up.

On a coach to the closing reception at the Enzo Ferrari Museum in Modena I sat beside a very nice American who has spent 20 years testing smoking cessation products including patches and, most recently, electronic cigarettes.

Hank (not his real name) gave up smoking around the same time he began testing alternative nicotine products and I gathered that he sees it as his duty to improve public health and help others quit too.

We chatted amiably throughout the 30-minute journey. I was interested to know more about his work but when it came to explaining what I did he was polite but clearly found it bizarre that anyone would defend smoking.

We didn't fall out but at that moment I felt like a pork chop at a bar mitzvah.

In contrast Hank would have felt totally at home at GTNF and for that I must congratulate the organisers who once again attracted a remarkably eclectic group of speakers, many of them from the public health or harm reduction communities.

In fact I can't think of another event where public health and tobacco industry stakeholders can meet and talk without rancour or suspicion and in a spirit of mutual cooperation.

Credit where credit's due, I respect public health campaigners who are prepared to engage with the tobacco community despite fierce opposition from some of their colleagues. We may have strong differences of opinion but at GTNF I've discovered it's possible to share a platform – even a drink – with anti-smoking campaigners without feeling uncomfortable. That alone is a significant step forward.

If governments, the World Health Organisation and other anti-tobacco bodies are genuinely interested in public health they must follow suit. Nothing good will come of ignoring the tobacco industry. Burying your head in the sand and sticking your fingers in your ears are the actions of a five-year-old child. Declaring industry representatives to be persona non grata is not a credible policy.

If I have a problem with GTNF it's the fact that those who don't want to quit smoking are ever so slowly being excluded from the discussion. Others may disagree but that's my interpretation.

The other issue is logistical. There are so many break-out sessions (19 over two afternoons) the ones you would most like to attend often clash.

Hence I missed what by many accounts was the stand-out session, a vigorous debate about heat not burn (HNB) vapour products.

The panel included rival tobacco company scientists and if the tweets I read are accurate there was a polite but fundamental disagreement about the efficacy of HNB in comparison to e-cigarettes.

Personally I'd like the consumer to be offered as wide a range of tobacco and vapour products as possible. As long as government doesn't interfere too much the consumer will ultimately decide by voting with their wallets.

The concept of HNB intrigues me because I like the fact that some tobacco companies are still trying to find a 'safer' way to consume tobacco. E-cigarettes may mimic the act of smoking but they don't contain tobacco so where does that leave consumers who want the real stuff, albeit in a less potentially harmful device?

Common sense suggests that in terms of risk HNB vapour products come somewhere between cigarettes (high risk) and e-cigarettes (low risk).

Unfortunately some advocates of e-cigarettes seem to view HNB as a threat because the direct association HNB has with tobacco could split the vaping 'movement' and alienate potential allies in public health and government.

I see it differently. Depending on who you believe, there are currently 8-10 million smokers in the UK and an estimated 2.5 million vapers (many of whom are dual users).

What those figures tell us is that the vast majority of smokers don't want to switch to e-cigarettes – not yet, anyway.

There are several reasons for that but the elephant in the room is blindingly obvious – millions of people enjoy smoking tobacco and have no plans to quit because, for them, a more satisfying alternative doesn't yet exist.

If therefore you believe in harm reduction, HNB devices must be given a chance. They may not be as harmless as e-cigarettes but there's a very high chance they are significantly less harmful than smoking.

So the message to government has to be, regulate according to the known risk and let the consumer decide between a wide range of nicotine delivery products.

PS. On the return journey from Modena I found myself sitting next to an investor in tobacco.

He was one of several investors I spoke to during the conference and as a group they were the most pragmatic and least judgemental on the subject of smoking.

To paraphrase one, "The consumer is king. Harm reduction may be the future but smoking is the present."

It echoed my final words to a session on 'Consumer wants and needs' when I made this oft-repeated appeal to the tobacco industry:

"Embrace harm reduction, embrace e-cigarettes, embrace other new technologies including heat and burn and others that have yet to be invented, but don't forget who your core customer is."

Below: part of the Enzo Ferrari Museum at Modena, Italy, that we visited on Thursday night

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Reader Comments (9)

I've been using the Phillip Morris heat not burn iQOS for 2 weeks now. Barely touched my ecig since. I also haven't had a real cig for a week . Longest time in over a decade. I think ecig makers are the ones who should be worried.

Monday, September 21, 2015 at 15:50 | Unregistered CommenterMark Butcher

Surely the issue here (as you point out) is freedom for the consumer to choose. The only regulation should be centred around harm to others - and that will provide plenty to fight about. That one product is 95% or whatever safer than another has nothing to do with regulation, it has to do with education - and the consumer then makes a choice.

As a vaper and former smoker I have been subjected to the lies and deceits, to the raw power of Tobacco Control, and maybe, naive, have felt the guilt that only a smoker can feel, and much of the hangover remains: There is though a difference between then and now - now, I know for sure that there is no reason for the denormalisation of vaping, for bans, for being the object of the masses unwarranted righteous indignation for vaping anywhere. And as for then? I know now that then I was wrong to allow myself to be duped so easily just because the lies and deceits were so plausible, so unexpected, and I was, like so many others, overwhelmed in the tidal wave of publicity that followed on from the the early discoveries that tobacco smoking caused harm.

But this is 2015. Vaping has arrived. Tobacco Control has been stripped and left standing naked in the snow. But, as for the courageous advocates who fought against the smoking bans, there is still a very important job to be done - Smoking bans went too far; denormalizing programmes went too far, and the education of the public with regard to smoking, has been totally one-sided and so has not gone far enough - the damage has to be rolled back, has to be undone, and this I say accompanied by a feeling of discomfort.

Why?

Will I be damaging the vapers' case by "being seen in the company of 'smokers?'"

The answer is irrelevant - the question is, which public bodies told the lies in the first place and how should I respond to this?

Monday, September 21, 2015 at 17:04 | Unregistered Commenterrobert innes

@ Mark Butcher

How do these iQOS compare price-wise with normal fags and e-cigs? The concept is intriguing, but my gut feeling is that they will be taxed out of the market very fast if they actually use tobacco, just as TC are trying to do with e-cigs, although e-cigs are a bit more problematical as they don't actually use tobacco.

However, I have every confidence that TC will manage to lie and lobby as they always do, and get e-cigs taxed as tobacco products eventually. Either that, or get them medicalised so most of the producers will be driven out of the market. The thought that someone might be enjoying something they don't like is anathema to them.

Monday, September 21, 2015 at 19:21 | Unregistered Commenternisakiman

Thanks again for being a voice of reason Simon.

Speaking of the iQOS (which I cannot get here in the U.S....arghhh), here is a little something that I saved on my 'puter a few months ago:

---------------

Average reductions in toxicity compared to levels measured for the 3R4F reference cigarette. Measured using Neutral Red Uptake, AMES and Mouse Lymphoma Assays-

Cytotoxicity- ≈ 90% reduction

Bacterial Mutagenicity- Under conditions of test, iQOS
aerosol not mutagenic as opposed to smoke from reference cigarette

Mammalian Genotoxicity- ≈ 95% reduction

Heat not Burn Products: Scientific Assessment of Risk Reduction

-----------------------


As someone who switched over to vaping entirely via tobacco vaporizer(s) (Ploom modelTwo and now the PAX), I can honestly say that there is nothing that (for me) comes close to the taste and effect(s) of actual tobacco. Don't get me wrong, I like my advanced e-cig/PVs too, but if not for HnB I would most definitely still be smoking.

There is massive potential for HnB.....no doubt about that.

I sure wish that the U.S. would get with the program with regards to tobacco vapor technology. The fact that the iQOS (nor the Ploom modelTwo any longer) is not currently available here in the U.S. tells us a lot about how behind we are in the field of harm reduction over here in the States.

Monday, September 21, 2015 at 20:49 | Unregistered Commenterjredheadgirl

PS...

In case the link that I tried to leave didn't post properly:

https://www.pmiscience.com/system/files/publications/tma_heat_not_burn_scientific_risk_assessment_final_presented_version.pdf

Monday, September 21, 2015 at 21:10 | Unregistered Commenterjredheadgirl

@nisakiman

You have a point. Here in Switzerland (where iQOS has been officially launched) a pack of 20 Marlboro Heat Sticks (as they are called) costs 8 Swiss Francs a pack (£5.30) about the same as a normal pack. But they have a launch offer of 2 free packs if you buy a carton. They also have the standard health warnings on them.

But the (young) man on the promotion stand told me that Phillip Morris are adding the tax and the warnings as they don't really know how to handle them legally yet - so playing it safe. He added that they are talking to the Swiss government about future regulations. The Swiss maybe receptive to being gentle with them in the future as they system was developed here - at PM's research centre in Neuchatel.

So far, no problems about using them in bars (except for the few bars that have already banned ecigs anyway). My only gripe about them is they don't seem to last as long as a real fag - and you have to put the holder back into the battery pack after each one for a re-charge - which takes about 5mins. But I solved that by buying a second unit so I can alternate!

I was talking to an - open minded - doctor friend of mine and she was staggered about the fast moving cigarette technology. Very aware the medical profession is being backfooted by all this. She's convinced ecigs are better and smokers should be encouraged to use them - but also says when she talks to colleagues about this - there's always an argument. The Heat not Burn development will open a brand new debate. Yes, maybe they're not as safe as an ecig. But many ecig users are still dual using (as I was) but the iQOS has turned me into another type of dual user (the iQOS and ecigs - NOT real fags!) After over 30 years of heavy smoking - this is a real change in my behaviour.

Tuesday, September 22, 2015 at 5:57 | Unregistered CommenterMark Butcher

Hi Simon. I attended the hot Hnb session. The point of the discussion was not that "some advocates of e-cigarettes seem to view HNB as a threat because the direct association HNB has with tobacco could split the vaping 'movement' and alienate potential allies in public health and Government".

The issue between e-cigs and Hnb is different. In Italy, where the product has been on sale since november 2014, PMI obtained to get a recognition of "reduced risk" (as stated by Parliamentary docs) and a 50% discount on the tobacco excise. But, if you add this to an absurd equivalence system respect to the traditional cigarettes for both Hnb and e-cigs, the tobacco product ends having an a lot lower tax then the e-liquids (which is now taxed at €4.50 per 10ml).

Furthermore, we heard during the debate that Hnb is not in competition with e-cigs. This is not what's happened in Italy where, on specific request of a big tobacco multinational company, it has been stated in public documents that they both "insist on the same market", and the Minister of Finances' Advisor publicly affirmed that "the e-cig tax cannot be lower otherwise it would wrong foot the Hnb".

BTW, Italy is the same country where there is a 500mn investment on "new generation products" factory and where a total of 500mn until 2015 will be used to buy Italian tobacco.

So, the point is not just about health, but is about competition, given that - thanks to a very well done and strongly (and legally) funded lobby - the Italian Government decided to allow a strong preference to Hnb. All this despite the recent decision of the Constitutional Court that said that e-cigs are not tobacco and cannot be taxed as if they were. But, unfortunately, here nobody cares about health, competition or even justice.

Tuesday, September 22, 2015 at 8:31 | Unregistered CommenterFrankS

Thanks, Frank. I should have made it clear that "some advocates of e-cigarettes seem to view HnB as a threat ..." was based not on what was said in the session but on the comments of one or two vapers who weren't at GTNF but were tweeting about it. Thanks for clarifying. Useful to know.

Tuesday, September 22, 2015 at 9:44 | Unregistered CommenterSimon

My dears. As soon as e cig people begin putting the money into your elected officials pockets that the pharma funded pro ban people do, you will have the respect that they get. E cigs are not going to be allowed to compete with patches as long as the CDC Foundation, partner to the CDC, is funding bans across Europe and Africa and the middle east. All your "charites" are getting money to parrot pro ban propaganda. Your governments were pretty cheap to buy.

Tuesday, September 22, 2015 at 16:04 | Unregistered CommenterSMartin

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