At the recent Global Nicotine Tobacco Forum (GTNF) in Seoul, South Korea, BAT's global head of business communications, Jonathan Atwood warned that a lack of knowledge and education surrounding tobacco harm reduction was hampering its progress. He expressed that while more must be done to educate people about the science, smarter regulation and strong enforcement were also needed to ensure that the media could not demonize products like e-cigarettes.
During the summit, a panel session under the title Talking Nicotine: Perception vs. Reality spotlighted the impact of misperception and misinformation are having on the nicotine industry. David Sweanor, professor of Law and an avid Tobacco Harm Reduction (THR) advocate moderated the panel opened the discussion by highlighting misperceptions surrounding nicotine posing a very frustrating issue.
Globally, the World Health Organisation (WHO) estimates that 8 million people die from smoking combustible cigarettes annually, and approximately 1.3 million non-smokers are exposed to second-hand smoke. Around 80 percent of the world's 1.3 billion tobacco users live in low- and middle-income countries.
The general sentiment is that people who smoke die from nicotine despite scientific evidence having proven that it is the tar emitted during combustion that leads to morbidity and mortality associated with smoking. Because of the information gaps and the general fact that people don't know, the desire to switch to lower-risk nicotine products is also compromised.
Sweanor said the lack of adequate information was hindering smokers from switching to lower-risk nicotine products and people were dying from that ignorance.
"There is a truism that people can only make as good a decision as the information available to them allows. If people have inadequate information, they make poor decisions and then there is a tendency to blame them for having made a poor decision. Somebody continuing smoking or a legislator pushing a law that is counterproductive has a negative bearing on people's health," said Sweanor.
He added that nicotine wasn't the problem. It was the delivery system (combustion) that needed to be addressed.
"We have seen examples from places like Sweden where people have moved from combustible products and now have disease rates that are massively lower than what you see elsewhere. How do we deal with the fact that nicotine is not the problem but people think it is? How do we deal with the fact that people are not changing to lower-risk products because they don't know and they are dying from that ignorance?"
He said legislators are pushing a narrative that harms the change and cigarette companies are benefiting from the commotion as their profits are coming from the cigarettes.
In countries like Australia, the regulation requires smokers to get a prescription from a General Practitioner before buying a Vape or E-Cigarette.
Dr. Carolyn Beaumont, an Australian General Practitioner and founder of Smoker Health Telehealth and Medical Nicotine scripts said Vaping had proven to be an effective smoking cessation tool in Australia. She however said that conflicting narratives in public health and lack of adequate information could derail Tobacco Harm Reduction gains.
"In Australia, we are talking of years and years of being smoke-free once one changes to vaping. However, many ex-smokers are scared that they will go back to smoking if they no longer have access to vapes. The next generation of general practitioners needs to be targeted, giving them proper education about smoking cessation and tobacco harm reduction." said Dr. Beaumont.
Recent studies have shown that misinformation around Public Health issues was the biggest killer. Dr. Beaumont further explained that the longer nicotine misperception continues, the more people will die.
Dr. Delon Human, the president of Health Diplomats, a global health consulting group specializing in strategy, access to healthcare and harm reduction, said the WHO's failure to differentiate between tobacco and nicotine, combustibles, and non-combustibles, has caused a wave of confusion among the organisation and further afield.
"We are wasting lives unnecessarily. We are allowing the misperception of nicotine to lead to diseases. This is a time when we absolutely have to engage stakeholders who can change perceptions. In terms of the scale of nicotine perception, it is quite useful to think of the wide ecosystem of stakeholders as state players and non-state actors," said Dr. Human.
He added that state actors like the intergovernmental agencies such as the World Health Organisation, the United Nations and the non-state actors, the non-governmental organisations, health professionals and key stakeholders like philanthropists' aid in the misperception of nicotine.
"If you look at the scale of misconceptions at that level, let's just look at WHO. If you read WHO documentation, even the documentation for COP10 in Panama, you find that there is almost a schizophrenic relationship with the understanding of Nicotine. On the one hand, nicotine is part of the WHO lists of essential medicines (nicotine replacement therapy for smoking cessation). On the other hand, there is an all-out war on nicotine."
Dr. Human suggested some of the ways these misperceptions can be corrected. He argued that doctors' training needs to be updated, so they are aware of the facts surrounding nicotine and the benefits of tobacco harm reduction. Human called on the industry to make a firm commitment to stop marketing to children, and to also continue with research and innovation. He asked for the industry to align their interests with the interests of public health so they could work together to correct misperceptions.
Apart from Sweden, Japan has also recorded a 15 percent reduction in smoking prevalence. Smoking is the biggest cause of disease and premature death in Japan, ahead of other prominent causes such as hypertension and diabetes. In 2010, 157,000 people in Japan died from smoking-related diseases, including malignancies and respiratory afflictions.
Dr. Hiroya Kumamaru, a cardiovascular surgeon and vice director of AOI International Hospital in Kawasaki, Japan, said despite the reduction in smoking prevalence in Japan, misperceptions around nicotine were rife among general practitioners and physicians.
"General practitioners think nicotine is quite harmful itself and we have to educate them. I tried engaging physicians and the media a few years ago around Tobacco Harm Reduction but it was very difficult. The industry needs to think about how best to educate these people to accept the new data," said Kumamaru.
Japan's overall smoking rate continues to decline. Phillip Morris International's (PMI) data shows that less than 0.1 percent of new smokers started because of its HTP product, IQOS, in 2017.
Meanwhile, Dr. Mohamadi Sarkar, a fellow of scientific strategy, analysis and regulatory affairs at Altria Client Services said scientific data shows that nicotine is not carcinogenic.
"Despite the evidence, we have this disconnect between what physicians and consumers think. In the United States of America, the Population Assessment of Tobacco and Health (PATH) has shown that 75 percent of people who smoke actually think nicotine causes cancer and 80 percent of people who smoke believe that e-vapour products are equally or more harmful. That needs to be fixed," said Sarkar.
He argued that evidence shows that vapes contain significantly less harmful chemicals than cigarettes. Sarkar called for there to be a unified voice from all stakeholders to communicate with and educate consumers to change these misperceptions. The industry according to him should also continue to innovate and generate science to fulfil the requirements of authoritative bodies, so they can play a vital role in education.
