The involvement of the tobacco industry will be crucial if a new international society on nicotine studies is to make a contribution to the public health and regulation debate – but that will bring its own problems, delegates heard at a conference in Warsaw today.
Openness would be a goal of the new association, and among its goals would be to remove the “taboo over tobacco”, said founder Konstantinos Farsalinos of the Onassis Cardiac Surgery Center in Athens, one of the best-known scientific researchers into e-cigarettes.
“We are not in favour of combustible products. We are in favour of other forms of tobacco, non-combustible,” such as snus and e-cigs, he said, adding that “we don’t want to be involved only in e-cigs”, as “even more inventive products” could be developed in the future.
The tobacco industry would only be involved indirectly in the proposed group, Farsalinos said; for example, tobacco company members would not have voting rights. E-cigarette companies would be similarly treated to avoid the appearance of treating tobacco as taboo.
The association’s goal would be to provide a science-based aid to regulation. For instance, this could include recognising that because conventional nicotine replacement therapy (NRT) cessation products do not work for the majority of smokers, “we have an obligation” to provide non-combustible alternatives, that are more acceptable to users, and find a “delicate balance between the level of harm achieved by one product and how much the smokers like this product”.
Some from the audience at the First Global Forum on Nicotine warned, however, that openness to corporate interests could bring complexities. Sandra Costigan-Dijkstra, principal toxicologist for Nicoventures, agreed that the pharma sector needed to be included – but cautioned that it might be unwilling to participate if tobacco does, because the association could be viewed as an advocacy group.
The conflict-of-interest issue was also raised by Linda Bauld of the University of Stirling and UK Centre for Tobacco and Alcohol Studies, who pointed out that researchers are criticised for industry links and funding.
How much is enough?
The level of scientific data really needed to classify a product as acceptable-risk, rather than risk-free, was also debated.
Farsalinos said that 15 years of information was required to show “evidence beyond doubt on the population effect” of products such as e-cigarettes, and that although some net harm reduction could be assumed in the meantime as smokers moved away from combustible tobacco, it could not be quantified. But others at the meeting said that it is already clear that the risk of products such as snus is so much lower than that of cigarettes, “nitty-gritty details are beside the point”.
Scientific conclusions may not be the end of the story, in any case. Another society founder, Lars Ramstrom of the Institute for Tobacco Studies in Sweden, said many regulators ignore science, and a third agreed: “It’s very disheartening to produce good science for years and find that this good science is to no avail,” said Riccardo Polosa of Italy’s University of Catania.
And is science even the ultimate need?
“It doesn’t require science,” argued Farrell Delman, president of the Tobacco Merchants Association in the U.S. “It requires regulators who are prepared to make calculations that may not stand them in good stead with the anti-tobacco, anti-e-cigarette crowd,” for example on the net public health benefit of various alternatives to smoking such as e-cigs and snus. He suggested that, for example, it needed to be objectively considered whether one new user taking up smoking was outweighed by 50 tobacco users switching to e-cigs.
“Any work done that would address the public health standard at this level would be of great value,” he said, and more useful than narrow health-impact comparisons of cigarettes with tobacco cigarettes.
The new society, if it goes ahead, will form an alternative to the 20-year-old Society for Research on Nicotine and Tobacco (SRNT), a U.S.-based but international organisation with more than 1100 members.
What This Means: Tobacco and pharma have vested interests in how nicotine is delivered – of course. But they are also in very strong positions to influence how its delivery is achieved, and if new methods really do promise significant public health benefits, it may be a pointlessly high-minded gesture to exclude them from the table.
Whether the openness to truly all stakeholders called for in Warsaw today will be embraced by other bodies is far from certain, however, and the discouragement of engaging with the tobacco industry given by the Framework Convention on Tobacco Control (FCTC) of the World Health Organisation (WHO) will deter many.
– Barnaby Page ECigIntelligence staff
Photo: Manuel Martin Vicente