As part of my preparation work for the next Global State of Tobacco Harm Reduction report, which is due out in November, I was reading Professor Virginia Berridge’s book Demons: Our Changing Attitudes to Alcohol, Tobacco and Drugs, published in 2013. I was surprised to read that back in the 1970s, the anti-smoking warriors objected to medical help for people who wanted to stop smoking.
They “attacked the idea of treatment because of its doctor focus and in general the public health movement from the 1970s saw abstinence through self-control as the answer not medicine”. I would argue this is a perverse interpretation of the idea that public health should enable people to take control of their own health with nobody left behind. Unfortunately, many of those old-timers are still around, pushing failed abstinence policies while dripping poison about tobacco harm reduction into the ears of any politician or legislator willing to listen.
For sure, many people have given up smoking just by quitting, whilst others have had some success using over-the-counter nicotine patches and the like. Increasing numbers have taken control by switching to safer nicotine products. There are however millions of smokers across the world who, while not necessarily regarding themselves as ‘patients’ who are ‘sick’, nevertheless need a helping hand. This can come either from stop smoking services or at least from doctors with a decent grounding in tobacco harm reduction and the chemistry of nicotine which, as the UK Royal Society for Public Health says, is no more dangerous than caffeine. Sadly, help of any kind is in short supply.
The WHO admits that 70% of smokers have no access to stop smoking services. This is the weakest part of the MPOWER tobacco control monitoring tool, where O = Offering help. So you could be forgiven for expecting Bloomberg Philanthropies to step into the breach and use some of its staggering wealth to help fund these programmes, rather than do untold damage to public health by funding anti-tobacco harm reduction antics. You would be wrong.
The grant application for the latest round of Bloomberg Initiative grants to ‘reduce tobacco use’, published in January, specifically states: “The grants program does not fund basic research, academic studies, prevalence surveys or cessation services.” (emphasis added). Why should that be?
Both Bloomberg Philanthropies and the Gates Foundation are run on business lines - they want to see quick returns and demonstrable bang for buck. In the realm of tobacco control, this means using proxy agencies to push through demand reduction laws, especially in LMIC legislatures. Never mind that most of this legislation is unenforceable either through political apathy, fragile health care systems or conflicts of interest over tax revenues. Cessation programmes on the other hand are expensive, hard to evaluate in the short-term, may work for some and not others, and generally don’t deliver the grip and grin photo ops with the WHO Director-General that mega-rich philanthropists crave.
But when the WHO offer only quit or die options to adult smokers, it is hard not to imagine that the thread of abstention still runs through the ethos of the global tobacco control establishment. Demand reduction has a patchy history. Taxation is held up as the gold standard intervention, except it only impacts on the poorest people who smoke the most and who will readily turn to the illegal market for affordable supplies.
There is no political or financial capital for the neo-colonial anti-THR NGOs to gain from trying to help adult smokers off the smoking highway. They use kids as a human shield to keep the cash flowing and to hide their morally bankrupt abstentionist policies. If the WHO are serious about reducing death and disease from smoking, they need to be promoting all and every means of assisting 1.3 billion smokers away from the most dangerous ways of consuming nicotine. The fact that they actively push an abstentionist agenda (or ‘acceptable’ medical use of nicotine supplied by Big Pharma), while campaigning against harm reduction using tainted money, demonstrates an organisation not fit for purpose.