“Hostile and allied forces” are facing each other and “influencing the transition to low-risk alternatives to smoking.” Clive Bates, an expert who heads Counterfactual Consulting, a policy consultancy organization, calls them the “new tobacco wars.” And, speaking at the ‘Virtual E-Cigarette Summit UK 2021’, he highlighted the need to strip the reflection on the new technologies available and on the strategies to combat cigarette smoking “of all the underlying noise”.
To explain what he is referring to, the expert gives some examples: “Someone has found an association between ‘vaping’ and bone fracture. And this automatically becomes a press release showing that there is a causal link. But when examine the limits of the study, it is clear that they are significant “. In this case “we are faced with an abuse of correlation and causality”. Another example is “advertisements about something that is proposed as a fact, but which in reality is not”. Bates talks about “big lies”. And still speaking of “noise”, he quotes some claims: “Nicotine equals poison for the brain. Or: vaping is as safe as parachuting without a parachute”.
For the expert, reflection must be stripped of contradictions not based on evidence. And the tobacco control strategies implemented so far should also be analyzed in the light of their effectiveness in practice. There is the category of prohibitions. In this regard, Bates observes: “Prohibition has been seen to never work.” And he cites the case of Bhutan, where since the early 2000s there has been an absolute ban on smoking and the sale of tobacco, citing the passage of a focus on the current situation in the country which “is now facing a greater challenge: that of traffic. illegal tobacco and its products “, of an” illicit market that has expanded “over time and,” as studies indicate “, focuses on” young Bhutanese “.
Among other measures examined by Bates, is the taxation of vaporizers: “Scientist Michael Pesko pointed out that a federal tax on vaping would result in an increase of half a million young smokers and that for every e-cig capsule eliminated, they would be sold more than 5.5 packs of cigarettes. Who can think this is a victory? “asks the expert, who invites us to overcome cultural and institutional inertia, to overcome punitive and stigmatic logic, and to consider without prejudice the contribution that could come from new technologies.
“New technologies – he explains – are often met with opposition. In my opinion, the question is: are they an opportunity or a threat? The assumption that they necessarily carry an unknown risk guides part of the debate and this aspect is often amplified to levels that they overshadow the dangers of known risks “. Bates mentions the Evali case (lung lesions associated with the use of e-cig and vaping products) and the alarm in the US related to the alleged “vape epidemic”, which then reports by the health authorities have shown to be related to the use of liquids containing Thc and mostly coming from the illegal market. “Nothing to do with nicotine,” he points out.
The consistency of the Evali risk was also taken into consideration outside the borders of the States. For example in GB, as recalled by Craig Copland, E-Cigarette Unit Manager – Vigilance and Risk Management of Medicines, of the British regulatory body Mhra. The expert explains how notification processes in the UK work after Brexit and shows data from the ‘Yellow Card’ scheme, the system through which adverse reactions are reported from a variety of products, not just e-cigarettes. In a decade, according to the data cited, there have been around 150 reports of vaping. For comparison, the MHRA receives 40,000 notifications of ‘yellow cards’ annually. In describing the activity conducted on the Evali risk alert, the expert explains that in the UK “a total of 275 reports of adverse reactions have been received”, certainly not Evali. Of the total, 36% came from the public, 19% from sanitary ware and 45% from industry. In short, market surveillance is rigid, assures Copland.