Commentary

“Common Ground” on E-Cigarettes: Perhaps Not

David Bareham*
Community Respiratory Services, Louth County Hospital, UK


*Corresponding author: David Bareham, Community Respiratory Services, Louth County Hospital, UK


Published: 14 Feb, 2017
Cite this article as: Bareham D. “Common Ground” on E-Cigarettes: Perhaps Not. Ann Pharmacol Pharm. 2017; 2(4): 1024.

Commentary

Current debate regarding the potential positive and negative effects of e-cigarettes is widely recognised to elucidate “controversy” [1]. Specific issues within this debate, which are ostensibly “shared ground” between opposing “factions” [2], could present more positive scope for discussions and agreement. One such topic, which it could strongly been argued should represent one key area of commonality, would hypothetically be the importance of upholding and respecting the World Health Organisation Framework Convention on Tobacco Control (FCTC) Article 5.3 [3]. However, it is noted that a publication from the United Kingdom Centre for Tobacco and Alcohol Studies (UKCTAS) [4], regarding their analysis of the recent WHO position statement on e-cigarettes [5], reveals an analysis from pre-eminent authors that “breaks ranks” with their own, previously convincing and robustly stated beliefs with regard to FCTC 5.3, as identified in the Royal College of Physician’s (RCP) “Nicotine without smoke” review [6]. The UKCTAS piece is authored by John Britton, IlzeBogdanovica, Ann McNeill and Linda Bauld, all of whom contributed significantly to the highly influential RCP “Nicotine without Smoke” review, with John Britton, indeed, being the Chair of the Tobacco Advisory Group of the RCP. The document provides, overall, excellent sections on the aims and strategy of the tobacco industry’s involvement in e-cigarettes. For example, ostensibly, the majority of this statement in the RCP Review appears entirely reasonable:
“Tobacco companies make their money by selling tobacco, and the industry’s recent programme of investment and acquisitions in e-cigarettes perhaps indicates recognition that these products represent a disruptive technology that should be harnessed to protect the core business of selling tobacco, exploited to expand tobacco markets or developed as an opportunity to make nicotine products attractive to non-smokers. There is little likelihood that the industry sees e-cigarettes as a route out of the tobacco business, but it is highly likely that e-cigarettes will be exploited to enhance claims of corporate social responsibility, and to undermine implementation of Article 5.3 of the World Health Organization Framework Convention on Tobacco Control. There is no firewall between a ‘good’ tobacco industry that is marketing harm-reduction products in the UK and a ‘bad’ one that promotes smoking, or undermines tobacco control activities, in low- and middle-income countries.” (my emphasis) Moreover, the following key arguments are postulated:
“The recognition of a fundamental conflict between public health objectives and tobacco industry interests has become a central tenet of tobacco control, epitomised by Article 5.3 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), which requires countries to protect the setting and implementation of tobacco control policies from the industry’s commercial and other vested interests. The emergence of a distinctive model of health governance, centred on minimising engagement with the industry, has led to tobacco companies experiencing increasing political marginalisation and difficulty obtaining access to policy elites.”


Furthermore, The Report Wisely Highlights That

“Tobacco companies’ interest in the concept of harm reduction increased markedly following a 2001 Institute of Medicine report, driven by recognition of a dual opportunity to both ‘(re-) establish dialogue with and access to policymakers, scientists and public health groups and to secure reputational benefits via an emerging corporate social responsibility agenda’.”


The Report Continues

“A key element of the strategic value of harm-reduction discourse to tobacco companies is its ability to polarise opinions held by those involved in tobacco control policy, fracturing the remarkable degree of political consensus that has characterised the tobacco control movement and been central to its success. PMI’s ‘Project Sunrise’ centred on the recognition of unity as a key strength of tobacco control, and promoting division was seen as critical to combating the movement’s success. The company’s strategy sought to exploit latent tensions between groups that it labelled ‘moderates’ and ‘prohibitionists’, and this finds strong contemporary echoes in the depiction of competing wings of tobacco control comprising ‘pragmatists’ who favour harm-reduction approaches being opposed by ‘idealists’ or ‘zealots’.
This key concept and principle, of the tobacco industry deliberately seeking to fracture and polarise opinions in tobacco control, and driving a “wedge” between groups holding opposing perspectives on the potential role of e-cigarettes in harm reduction and public health policy, is one that would have been highlighted as being one of “shared ground” between these “factions”, as evidenced with the eloquent and elegant, yet robust statements above. However, this premise is, in fact, fundamentally jeopardised by the UKCTAS authors, all key members of the RCP Group, who state that they:
Thank Clive Bates. Konstantinos Farsalinos . . . Riccardo Polosa and David Sweanor for reviewing and commenting on a draft of this report” These individuals have all, controversially, actively engaged in the tobacco industry’s yearly centrepiece, the “Global Tobacco and Nicotine Forum”, in either 2015 or 2016 [7,8], and have, therefore, chosen to dismiss the profound concerns raised in the RCP authors, as highlighted. Arguably, these distinguished experts have, indeed, undermined tobacco control, as the RCP Report postulates, by being scientists and researchers engaging with the tobacco industry, and have disrespected FCTC 5.3. Moreover, in seeking the opinion of these individuals to substantiate and contribute to their analysis, the UKCTAS Group have, apparently, turned a “blind eye” to “a central tenet of tobacco control”, as they themselves have previously characterise it.
Clive Bates, a former director of Action on Smoking and Health England, has, moreover, gone further recently, demonstrating contempt for Article 5.3 [9]. He argues that organisations should engage with the tobacco industry, and that any concerns are entirely misplaced:
“Would you be afraid to have an argument with Big Tobacco and to actually lose it if they are right?” and “You would think [organisations] would want to know how the industry sees its future, what is in their labs, what they want from regulators” Furthermore, in an in-depth personal interview elsewhere [10], he argues that “Disinformation from anti-vaping activists” is “more harmful than from [the] tobacco industry.” This is muddleheaded, at best. The tobacco industry scientifically designed a superbly addictive nicotine delivery device, that it subsequently discovered was lethal; covered up and lied about their discovery, for decades; have continued to make enormous financial profit from the sales of their lethal product, again, for decades; including by deliberately marketing the devices at children [11] “anti-vaping activists”, as Bates calls them, have not. Rather than distancing themselves from these extremist views, the UKCTAS/RCP group authors have actively sought out the opinions and contribution of this individual, and his colleagues, who have currently and previously disregarded and disrespected Article 5.3: which the aforementioned group has previously written so convincingly about. This position, of pure sophistry, appears to be one of: “There is no difference between right and wrong, and we can seek the opinion of who ever to substantiate our analysis, even if they disrespect what we have stated to be fundamental “tenets of tobacco control”. In doing so, they, too, disrespect Article 5.3, however, and even further incongruously claim that:
“This [UKCTAS] report has been prepared in full compliance with Article 5.3 of the Framework Convention on Tobacco Control.” It is, therefore, challenging to identify very many issues, if any at all, related to the toxic topic of electronic cigarettes, that different factions involved in the debate can, or will, agree on. What Bates and others appear, further, to be turning a blind eye to, are the continuing abhorrent multi-million dollar marketing campaigns of some tobacco companies, at least, which even within the last few years, have been identified in Court as deliberately targeting children, in part at least, and encouraging them to smoke tobacco [12].

References

  1. Bareham D, Ahmadi K, Elie M, Jones A. E-cigarettes: controversies within the controversy. Lancet Respiratory Medicine. 2016.
  2. West R, Brown Jamie. Electronic cigarettes: fact and faction. British Journal of General Practice. 2014.
  3. World Health Organisation. Guidelines for implementation of Article 5.3 of the WHO Framework Convention on Tobacco Control on the protection of public health policies with respect to tobacco control from commercial and other vested interests of the tobacco industry.
  4. United Kingdom Centre for Tobacco and Alcohol Studies. Commentary on Who Report on Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems.
  5. World Health Organisation. Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS). 2016.
  6. Tobacco Advisory Group of the Royal College of Physicians. Nicotine without smoke-tobacco harm reduction. 2016.
  7. Global Tobacco and Nicotine Forum. 2015.
  8. Global Tobacco and Nicotine Forum. 2016. Look who’s talking.
  9. Satel S Forbes. Shameless campaign for Tobacco-Free Kids to Censor Researchers. 2016.
  10. Bates C. Vaping Post. Disinformation from anti-vaping activists more harmful than from the tobacco industry. 2016.
  11. Legacy Tobacco Documents Library. Marketing to youth MSA collection
  12. Tobacco-Free Kids. You’re the target. 2014.