Derek Yach, who served as President of the Foundation for a Smoke-Free World until October 2021, has recently responded to criticisms written about him in The Lancet. Tess Legg and Anna B. Gilmore had raised concerns regarding the transparency of a declaration of interests in Yach’s article, “WHO should embrace tobacco harm reduction to save lives,” written in the Correspondence.
Discussing the Foundation for a Smoke-Free World, in their review Legg and Gilmore assumed that the foundation promoted the tobacco industry’s interests and misrepresented science. Yach reiterated that these assumptions mischaracterize the funding relationship between the Foundation and the tobacco company which funded it, adding that measures to ensure the Foundation’s independence from the tobacco industry have been detailed on countless occasions. Moreover, added Yach, in 2023 the Foundation transitioned to Global Action to End Smoking, distancing itself completely from tobacco industry funding, and is now led by Clifford Douglas, a noted anti-smoking advocate.
In their complaint, Legg and Gilmore also challenged the assertion that tobacco companies are moving away from combustible cigarettes, referencing critiques of the 2020 Tobacco Transformation Index report and suggesting the industry believes it has already transformed. Yet, highlighted Yach, the 2022 Tobacco Transformation Index indicates that while some industry changes have occurred, they are inconsistent and slow, supporting the idea that the move away from combustible cigarettes is ongoing but incomplete. In fact early 2024 reports from companies like Altria show declining cigarette sales and increasing e-cigarette sales.
Dangerous bias
Meanwhile, the University of Bath, where Legg and Gilmore are employed, has received significant funding from Bloomberg Philanthropies’ Stopping Tobacco Organizations and Products campaign, an organization which is widely known to support stringent anti-vaping policies. This background, explained Yach, may have influenced their interpretation of his article, which focused on the fact that current tobacco control policies are not adequately supporting adult smokers who cannot quit. Yach reiterated that well-regulated harm reduction is posited as the most effective way to ensure smoking cessation and therefore the quality of life of smokers.
This incident and accompanying arguments may remind some of a recent (unrelated) article by public health expert Clive Bates, which defined the difference between realists and idealists. Bates explained how idealists often obstruct progress with unattainable goals, while realists tend to opt for pragmatic solutions. As an example he referred to the recent case of a medical education program on smoking, tobacco, and nicotine which was shut down due to its funding source, despite its potential public health benefits.
More specifically, the program by Medscape aimed to clarify misconceptions about nicotine and smoking for healthcare practitioners. Despite its success and valuable content, the program was discontinued because it was funded by tobacco giant Phillip Morris International. Activists objected to the funding source on aesthetic grounds, arguing that a tobacco company shouldn’t be involved in ending smoking. No material objections were raised against the course content itself. This exemplifies how idealists, tend to base their decisions on principle and are more concerned with appearances than outcomes. This stance tends to dismantle beneficial initiatives without providing alternatives.
The advantages of an inclusive approach
Experts in the field of smoking cessation have long argued that excluding the tobacco industry from tobacco harm reduction (THR) efforts undermines the potential for comprehensive and effective solutions. Despise it as we may, Big Tobacco possesses extensive knowledge and resources that can contribute significantly to developing and promoting safer alternatives. By engaging with the industry, stakeholders can leverage its research and technological advancements to create less harmful products, such as vaping and heated tobacco products.
Critics argue that the tobacco industry’s involvement is self-serving, and of course they are probably right, but transparent and regulated collaboration can ensure accountability and public health prioritization. In fact, collaborative efforts have shown success in other public health domains, such as pharmaceuticals, where industry and public health experts work together under stringent regulations to develop safer drugs. Hence, many tobacco harm reduction experts believe that applying a similar model to THR could accelerate progress and provide smokers with credible alternatives to deadly combustible cigarettes .
As The WHO Pushes Europe Towards Prohibition, Experts Pull It Towards Tobacco Harm Reduction
