The massive criticism directed at the Foundation for a Smoke-Free World (FSFW) has not kept it from working with the best scientists in the field, according to its founder and president Derek Yach, the former director for noncommunicable diseases and mental health at the World Health Organization (WHO).
The foundation has been embroiled in controversy largely due to receiving major funding from tobacco giant Philip Morris International (PMI), at $80m a year for 12 years starting in 2018.
Members of the organisation, including Yach, were not allowed to attend a tobacco control conference in Cape Town earlier this month, and a number of research bodies have declined to accept money from the foundation.
Yach has been described as “a pariah” in the tobacco control field – but he remains defiant. “We’re certainly not wavering,” he says.
He tells ECigIntelligence that the FSFW anticipated controversy, but that the only impact may be an acceleration of its plans.
Yach sees the arguments against the foundation as two-fold. One, incredulousness that millions of dollars from PMI won’t in some way affect research. Two, discomfort with the foundation’s focus on harm reduction.
On the first point, Yach claims that despite PMI’s support the organisation has a very independent structure and he hopes this will become apparent as it moves forward.
On the second, he emphasises that the foundation will increase that focus “unashamedly” as it views harm reduction as important to advancing global health.
In March, billionaire media mogul Michael Bloomberg announced the setting up of a group to counter tobacco-funded research, to be called Stopping Tobacco Organizations and Products (STOP).
For Yach, STOP and groups like it have no effect outside the small and insular world of traditional tobacco control. Stepping back for the big picture, he says: “Most scientists are generally unaware of Bloomberg’s platform, and are not from traditional tobacco control backgrounds.”
The new frontier
Yach, a former professor of global health at Yale University, was deeply involved in the development of the WHO Framework Convention on Tobacco Control (FCTC) as head of the organisation’s Tobacco Free Initiative. “I’ve spent a lot of my life in the traditional tobacco control world,” he says.
But he believes the next “big frontier” is in “innovative product design”. And he says the top researchers in this world come from places like Silicon Valley, where they are less likely to be engrossed in that world.
Despite the antagonism, he views the goals of the FSFW and STOP as essentially similar. “Take a look back and ask if it’s really in the interest of global health [that they clash],” he says.
Asked about the the US Food and Drug Administration (FDA)’s advance notice of proposed rulemaking (ANPRM) on flavours, Yach said it was a “knee-jerk reaction” to say that e-cigarette flavours are bad and merely attract kids. The evidence, he says, is more complex.
According to Yach, quoting a recent study by Yale researchers John Bucknell and Jody Sindelar in the National Burea of Economic Research, there is clear and solid data that menthol in e-cigs, as opposed to combustibles, will probably help smokers switch.
Follow the evidence
That study estimated preferences for flavours and attempted to predict demand for tobacco products, given alternative bans on flavoured and menthol tobacco products. It concluded that the ban proposed by the FDA before the recent ANPRM would have increased consumer preference for combustible cigarettes. It also highlighted that a ban on menthol in combustibles would “result in the greatest reduction in smoking of combustibles”.
The regulatory approach from a broad-based perspective is to differentiate between combustibles and reduced-risk products to encourage switching. The subsidiary question is kids, according to Yach. And he doesn’t believe the “gateway” thesis is supported by the evidence.
“If a kid wants a gummy bear, the kid’s going to eat a gummy bear, not vape,” he says. He adds that for kids already smoking combustibles, flavours like menthol could actually help them switch.
“I think it’s premature to decide policy without evidence,” he says.
The FSFW will be represented by Charles Gardner, its director of health science and technology, at the Next Generation Nicotine Delivery event in Atlanta, Georgia on 24th and 25th April.
– Daniel Mollenkamp ECigIntelligence staff