Tag Archives: who

Letting Africa take the hit

Recent WHO-FCTC declarations regarding restricting tobacco flavorings (and other additives) have raised considerable concern in the African burley growing countries (burley tobacco tends to be processed with additives). Their justification in their own words is

One major cause for concern is flavourings and additives being widely used in cigarettes and other tobacco products to increase their palatability and attractiveness – particularly among young people.

Though no one supports the creation of unwilling users, there is certainly some concern about deliberately making a legal pastime enjoyed by millions less enjoyable. Though this is business as usual when it comes to the treatment of tobacco users, there really is no precedent in any other area of consumption.

There is also no evidence that this will do anything other than reduce the enjoyment of smoking. Surveys have shown that kids do not usually start with flavored products (they start with whatever is at hand). At some level of engagement, people are pretty resilient. (Even very particular coffee drinkers will settle for substandard products rather than forgo their drink and most people knowingly eat sub-par food quite regularly.) Smokers who do not have their brand available will usually buy another; at the extreme smokers in prison have been known to roll up patches and smoke them. So all flavor restrictions are likely to do is make tobacco users (because this will affect smokeless tobacco users too) less happy.

Outside of tobacco control, that is known as sadism.

But let’s say just for a minute that the evidence is all wrong and this could really change the world and fewer people would smoke. Given that the developed world is most attuned to quality products, one would expect the greatest drops there. (As a rule, the more money you make and education you have, the less likely you are to smoke and if you do smoke, the more likely you are to quit.) So you have a “reasonable” justification that fewer people will smoke as a result.

And let’s say that this destroys the market for burley tobacco. That is, it is no longer a viable crop for African farmers. Though the FCTC and anti-smoking NGOs suggest they should just take up alternative crops the problem here is that while they are globally competitive in burley, they would be at a disadvantage with any other crop, not to mention that given the characteristics of the soil, only certain crops will grow there in the first place. (Tobacco is a plant that flourishes under conditions where many other plants do not.)

And would the FCTC even dare to proceed in this fashion if this were a developed world industry (this smacks of global paternalism in the worst way). Consider that in Malawi (just one of the nations that would be affected) that burley production comprises 60% of its export revenue and a full 13% of its economy.

Removing (or adjusting to) that portion of the economy of even a strong nation would be momentous but in the case of Malawi where 70% of the nation are already below the poverty line, and where the unemployment rate is a staggering 95% the results of this would be catastrophic.

Even if a burley ban is only a worst case scenario, it is a threat to a country that already is a worst case scenario.

And it seems somewhat immoral to scrabble to add a few more years onto the already long Western average lifespan at the expense of Malawi where the lifespan is under 50. The greatest threat to health is being poor so we could expect a trade here which would result in an even lower average.

What everyone seems to forget in this whole rush to eliminate smoking related disease is that it is actually a sign of great success when smoking related causes lead. What it means is that you have removed high infant mortality, diarrhea, diptheria, cholera, typhoid, and malaria; it means that you are living longer than 50 when most of these luxury conditions kick in.

So as a result of us beating those horrible conditions Malawi is still prey to, we will ask them to bite the bullet so that we can outlive them by even more than the 24 years we already do.

– Paul L. Bergen

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Biggest public health advance of the century: new nicotine products could virtually wipe out smoking related disease!

If a doctor’s obese patient starts exercising a little and eating less, and losing some weight, that doctor will be pleased. And if they have a smoker who has cut their smoking in half, they will praise that patient. And if on a national scale obesity levels dropped by half, it would be cause for drinks all round. But though smoking has dropped as much the news and public health authorities have portrayed this positive turn of events as some sort of failure.

There could be good tobacco related news every day but all the good news is given a negative spin and any bad news is exaggerated. And this is why this column ends up being so argumentative all the time; those of us active in tobacco harm reduction are faced with this unending grimness, this little pocket of health where the traditional approaches and philosophies are all discarded in favor of prohibitionism.

Just once, I would love to see a headline like the one above followed by an article highlighting quotes from some of the big names in public health saying something like:

You know I’ve always hated tobacco and I always will but the fact is that whenever smokers switch to snus or e-cigarettes they are cutting their disease risk dramatically. We are happy when people take in a little less sugar, when they exercise more, and we should be happy about this We should get behind this and encourage it because damn it, it means people will be living longer and better.

If we can get everyone behind these products it could be the greatest advance in public health since the discovery of insulin. If most smokers switched to snus or electronic cigarettes, we could end up recategorizing tobacco associated illness as almost negligible and use those billions of dollars we have been using to war against these panaceas for other more worthwhile causes.

But you know they could have had those same kind of headlines about the drop in smoking rates but somehow that did not qualify as momentous. For a more recent example when Katherine Heigl appeared on Letterman and showed how she had finally quit smoking, most of the news after was not to congratulate her, or to praise the now higher profile of this safer alternative but to question her method and her motives. It seems that political correctness matters even when you are trying to quit smoking.

Well, it is unlikely that there will be any sea changes in the near future when the dark forces have managed to convince most everyone that their death maintaining policies are in the public interest, that safer products are actually more dangerous than the harmful one and that smoking is the prime threat to everyone’s well being.

It does not bode well when you have Sweden, a country with the lowest tobacco related disease rates in the developed world, not coincidentally since their dominant form of tobacco use among men is snus, and even there, anti-tobacco sentiment runs high within the public health authorities. In 2008, Gunilla Bolinder was recognized by WHO for her efforts to restrict domestic and international availability of snus -rather bizarre when you know that she comes from a country that has strong population level evidence that snus substitution for smoking has resulted in many saved and healthier lives.

-Paul L. Bergen