Africa: Interview with Dr Kgosi Letlape - Globlal Forum on Nicotine- June 6, 2015 Warsaw 2015

12 June 2015

Dr Kgosi Letlape is a South African ophthalmologist and health care leader. He is the current president of the African Medical Association, former chairperson of the South African Medical Association (SAMA), past president of the World Medical Association (WMA). He also serves as a member of The Global Hygiene Council in South Africa..
In past years he has served as Chairman of South African Medical Association (2001–2009) as well as President of World Medical Association (2005–2006).
He made history by becoming the first black person to qualify as an ophthalmologist in South Africa during the apartheid years, and was the first black person to be elected as WMA President. His interest in health care for South Africans sees him participating in various health committees and task teams, including advocacy for antiretroviral treatment to HIV positive patients.

Good Morning Dr KGOSI LETLAPE and before we start, All Africa would like to thank you for accepting this interview. What are the reasons that motivated you to attend the Global Forum on Nicotine? We were not expecting a doctor and a non-smoker to support smoking in any kind. Instead, we were expecting you in the opposite side

It’s interesting why do you think doctors are expected to be in the opposite side?

Well, it is the public opinion

I was raised in a culture of being useful to others and making people lives better. And being qualified as a doctor, my oath means helping patients and improving the quality of their lives and doing no harm to them. So even when they harm themselves, if there is an opportunity to help them reduce harm to themselves, because sometimes you can’t make people stop harming themselves. As you have heard, it’s difficult to get people to stop smoking, just in like HIV and AIDS, and it’s very difficult in Africa to get people from being re-infected and infecting others. So you embark on trying to help reduce harm to them. In essence, in retrospect, all we do as doctors is to reduce harm in many aspects. So my interests in it have been about knowing about the degree of harm that combustible cigarettes do. When something comes along that will be better for those that smoke, that can’t stop for whatever reason, I felt it would be important to an advocate of them. So what brings me here is the fact that, you know the old adage of ‘’people are addicted to the nicotine but they die from the tar’’. So if there are safer ways of delivering nicotine, I have a duty as a doctor to bring those to the attention of society and my patients.

Do you consider e-cigarettes to be alternatives?

It’s not a magic bullet. But it’s part of safer ways of delivering nicotine. And it’s not the only product. For me, what brings me here at the Global Nicotine Forum that parent products that needs to be discussed is tobacco itself. So it can’t be outside the discussion. It’s the first time I attend this forum and what I found fascinating was the notion where the nicotine forum seems to demonize cigarettes. Instead of seeing it as ‘’this is a forum about understanding of how people get the nicotine delivered to them’’. And coming from Africa, in particular, I have come to understanding for a very long time, tobacco is going to be the easy way of people that are addicted to nicotine getting their fix.

Can you talk about the difficulty of Africans to quit smoking? Do they succeed on giving up on tobacco?

You know, there are a lot of smokers in Africa. Otherwise, there would not have jobs in Africa if there were no smokers. So there is a market and there are jobs. And it’s a huge market. There are even other aspects of tobacco. In that harm, there are also on the line, jobs that are created. But coming specifically to this question about the difficulty of Africans to quit smoking and how prevalent smoking is, smoking is prevalent. In Africa, you see new trends where they are more young females taking up to smoking. Smoking among young boys is still as high as before, they still want to experiment and part of the challenge in Africa is that counterfeit cigarettes are on the increase. So the issue about safe products becomes an issue but the prevalence of smoking in Africa is just like the general trends in the world, in South Africa, the prevalence is down because of all the measures that have come out of FCTC, advertising public spaces bans, health warnings, etc… Those things have had an impact you see smoking coming down. And what people do not realize is that the issue about banning advertising, the other effect is that you stop glamorizing it because when people advertise, there are the soccer stars that are worshipped by the society. That part has also helped reduce the incidence of smoking but is still quite significant and the rate of disease is still high and the impact on health system is still severe.

So you do consider e-cigarettes as alternatives. Would you suggest these alternatives to the government?

Oh yes. But there is a product portfolio. E cigarettes are not the only thing that is available. There are other things too, like smokeless tobacco. There are other forms like inhalers. It shouldn’t be like it’s only e cigarettes. People need to understand that there is a product portfolio. The most popular, the one that is in the public eye, in the media is e cigarette but e cigarette is not the only product that is less harmful than combustible tobacco. There are even tobacco products that are not combusted but have a much lower risk profile than the combustible cigarette.

So the combustion is the problem?

The major but not the only one. Because incidents on cancers tend to be higher. So it’s not like it’s without problems it’s much reduced harm than what combustible do. It’s banning the tobacco that’s causing the problem

What laws or policy would you suggest?

Well I would promote an intense education campaign about the alternatives to combustible cigarettes and people need to be educated about the whole spectrum that is available. Because understand that smokeless, snus tobacco has a lower disease profile than combustible cigarettes. And in Africa, in particular, you may find that access to smokeless tobacco might be easier than access to e cigarettes. So you have to mindful that we are a developing nation and there are issues of access so you don’t know when to create the impression that e cigs are the only way to go and when people can’t have access to e cigarettes they are not made aware that they are other alternatives that are less harmful. What I would propose for the government to embrace the fact that there are reduced risks products that e cigarettes and they should actually be talking to cigarette manufacturers to encouraging them to switch reduced risk products and creating incentives for the companies to make the switch. And that’s what responsible governments should be doing. They should make it more attractive for the companies to switch from combustible to reduced risk products but the challenge that we have to navigate is the fact that the banning of advertising we’re going to find creative ways of how to disseminate the information and how we create the necessary public education of the issue of the risk continuum of reduced risk products and what is available right now. Also encouraging young people to come up with innovative solutions and create funding for e cigarettes. We should keep it an open mind because somebody from South Africa, for example, come up with an even more accessible way for people to access safer nicotine. The main issue is about safe nicotine delivery that reduces the harm associated with current nicotine delivery mechanism.

Something else you wish to add?

Remember that not to create the impression that I am promoting smoking or vaping. I think it should not be lost on people that the best that you can do for yourself is not to do neither. So we should not go out there creating the impression that vaping is desirable. People should not lose focus that we are comparing here and that’s why I’m a hard reduction advocate. People should understand that harm reduction does not equal harmless. People should remember that the best thing you can for yourself is to quit, and quitting is not easy because of social trends and all other things. Even if you stick to one partner use a condom so the fact that you have one partner does not say you should abandon safer sexual practices. It’s the same thing here. The key issue is people should take their responsibilities and they can do that once they have the information. What I’m here for and will work for is to remind them of the responsibilities to make the information available and they have the responses to do that. We have to navigate it around the limitations of not advertising but we also need to educate them about the fact that they should not find excuses. There’s a big difference between infomercials and commercials.

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