It’s hard to believe that a global public health treaty dedicated to stopping smoking — and saving millions of lives in the process — could lead to more unnecessary disease and premature death. But that’s what may happen if the World Health Organization has its way.
This week, India is hosting a major meeting focusing on the WHO’s Framework Convention on Tobacco Control (FCTC), a landmark 2003 global treaty on tobacco control. The most controversial issue under discussion will be the treatment of electronic cigarettes.
The debate could not be more polarized. On one side, the WHO has taken a relentlessly hostile approach to electronic cigarettes, seeing them as a threat to individual and public health. On the other side, a large group of experts in nicotine science and policy point out that using electronic cigarettes is much less risky than smoking tobacco cigarettes, and the new products provide an opportunity to reduce smoking and related diseases.
The Royal College of Physicians of London, relying on toxicological studies, has estimated that the health risks of electronic cigarettes are “unlikely to exceed 5 percent of those associated with smoked tobacco products, and may well be substantially lower than this figure.” Electronic cigarettes don’t burn tobacco, so they don’t produce carcinogenic tar and other toxic products of combustion.
The opening shots have been fired already. Officials at the WHO published a literature review of electronic cigarettes in August. Late last month, an expert group at the UK Center for Tobacco and Alcohol Studies published a detailed and damning critique of the WHO’s work. It argued that the WHO “fails to accurately present what is already known about e-cigarettes … it positions e-cigarettes as a threat rather than an opportunity to reduce smoking.”
Faced with these dueling reports, what should delegates at the FCTC meeting actually do? Here are six pieces of advice:
First, delegates should read the conflicting reports and decide for themselves based on evidence, not on politics or ideology. The WHO should be at least as concerned with squandering a tangible opportunity to save lives through safer alternatives to smoking as it is with controlling hypothetical risks.
Second, the treaty should not be changed unless and until more of the controversy is resolved at the country level. This means that the FCTC should call for more research and a more professional assessment of the evidence. So far, the WHO has failed to provide any meaningful assessment of the risks and opportunities of electronic cigarettes in comparison with tobacco cigarettes.
Third, the WHO should stop endorsing outright bans on the sale and manufacture of electronic cigarettes in its member countries. How can it make sense, ethically or scientifically, to ban a safer alternative when the dangerous product, tobacco cigarettes, is available everywhere?
Fourth, the FCTC should go back to public health basics and recognize that the role of government is to help citizens make informed choices in their own interests. This means giving people access to all the possible options to control their health risks, along with high-quality information to help them decide what is best for them. Instead, the alarmist rhetoric emanating from the WHO and some anti-tobacco activists is creating a climate of fear and confusion that will leave smokers sticking with the devil they know rather than trying something new and much safer.
Fifth, the FCTC meetings must be more diverse and inclusive. In the guise of excluding the tobacco industry, the WHO and FCTC have excluded just about everyone who may disagree with their approach. This includes smokers and vapers, and the many electronic cigarette businesses that have never had anything to do with the grim history of Big Tobacco. Strikingly, the opposite approach has been taken with other UN initiatives such HIV/AIDS, where the slogan “nothing about us without us” hangs over the convention meetings.
Sixth, the WHO and the FCTC should focus on their obligation to “first do no harm” by avoiding misguided interventions into this new market. Almost any regulation of electronic cigarettes has the potential to backfire if it causes vapers to return to smoking tobacco cigarettes or never switching away from them in the first place.
Regulations that make electronic cigarettes less accessible, less palatable, more expensive, less consumer friendly, and less satisfying, or that slow down innovation, will tilt the market back in favor of tobacco cigarettes. If that happens, the result will be more cancer, heart, and lung disease, and premature deaths.
We hope the FCTC delegates have a successful and productive meeting. But we urge them to carefully consider all the options, because lives are at stake. Making unwise and premature decisions about e-cigarettes could add to the burden of ill health instead of reducing it.
Clive Bates is a public heath commentator and former head of Action on Smoking and Health in the United Kingdom. Sally Satel, MD, is a resident scholar at the American Enterprise Institute.
