Something about getting off a plane makes me wants to vape. There is a certain pleasure in taking a moment to settle after the hustle and bustle of the airport, but the more obvious reason is that I wanted some nicotine. I stood outside with a handful of smokers, vaping for ten minutes or so and becoming acutely aware that I was not dressed for the Warsaw summer weather, which was about as hot as a busy kitchen operating out of the depths of hell.
For many people, the smokers and I will have looked like one and the same. Vaping just seems like smoking in a different form. Shocking numbers of people think it’s just as dangerous. And, most importantly for many people, we were all “addicted” to nicotine. Nicotine, of course, is a Bad Thing. Being addicted is a Bad Thing. We stand outside because the good, morally superior people need to be kept away from our toxic emissions.
But it’s not really that simple, is it?
That’s why the theme of the sixth Global Forum on Nicotine (GFN) is “We Need to Talk About Nicotine.” The perception that nicotine is the devil is pervasive, to say the least, but vaping, snus, heat-not-burn and other tobacco harm reduction products shine a spotlight on how untenable that idea is. Outside of smoke, nicotine is loosely comparable to coffee, and switching to a reduced-harm alternative – like I did seven years ago without ever really intending to quit smoking – undoubtedly reduces your risk of a premature death.
This conflict, between the reality that vaping is substantially safer than smoking and the widespread perception that all nicotine is unquestionably evil, is really why the GFN exists. Advocates, researchers, policy experts, consumers and other interested parties have been gathering for six consecutive years to discuss the latest research, regulatory barriers to reduced harm alternatives to smoking and the challenges posed by advocacy.The conference sold out for the first time, and with over 80 speakers over the three-day event – including some huge names in the world of tobacco harm reduction – I was ready for a busy few days of learning from experts in the field. So here’s a run-down of what happened.
13th of June – Satellite Events and Michael Russell OrationThe majority of the first day was kind of a pre-conference event, with the Michael Russell Oration in the evening before the inevitable over-indulgence at the mixer.
The Consumer Advocacy Alignment MeetingKey Points
- The WHO’s oppositional stance to vaping is impacting regulation in much of the world
- Advocates need to focus on networking, clear messaging and telling their stories with passion and positivity
Tomás O’Gorman spoke about the common anti-vaping arguments being widespread in Latin American countries, including his home country of Mexico. In Africa, Joseph Magero stressed that people don’t have the information they need to make informed decisions about their nicotine use, and advocacy is time-consuming and expensive.
In the Netherlands, Eveline Hondius pointed out that there is no harm reduction policy, with the focus solely being on prohibition and complete abstinence, even from vaping. The message is very much that the alternatives don’t work, and they want to be completely smoke-free by 2040. And it’s not much of a surprise that Australia presents many issues, Fiona Patten (a politician and leader of the Reason party) pointed out that the Australian Medical Association supports supervised injection centres for heroin users but is completely against harm reduction for smokers.
David Sweanor really summed up the issue with policies like those in Australia – where vaping is banned but cigarettes are readily available – in a pithy quote, likening it to saying: “We don't want people to play tennis, but it's ok if they toss bombs back and forth.”
It’s pure madness.
So what are the answers? How do advocates move forwards?Clive Bates had a well fleshed out, blog-post-y five-point list of tips, which ties in with a lot of what the other panellists advised:
- Advocacy is 80% perspiration, 20% inspiration: Network and get contacts, get organized, have fact sheets at the ready and put in the work. The occasional moments of genius are nothing without this.
- Don’t try to be too clever. As a consumer advocate, your story is one of the most powerful tools in your arsenal, much more so than scientific waffle.
- Networking and inclusivity is key. An interesting question on this topic asked about the divisions within THR, for example vapers not supporting heat not burn or snus. The truth is that we are all in this together, so being inclusive in your advocacy is vital. Clive answered, “The key distinction is between combustion and non-combustion (...) As consumer advocates, you’re advocates for all consumers, not just yourself.”
- Be concise. People – especially politicians and regulators – are pressed for time and don’t want to listen to a lecture. Get to the point and don’t bore people to death.
- Don’t agonise over your principles, just start doing stuff. Focusing on irrelevant details just takes time away from practical and useful action you could be taking.
The Michael Russell Oration: Ronald Dworkin – Interests and Ideology in Harm ReductionThe Michael Russell Oration this year was a highlight for many people. Ronald Dworkin came at the issue very much as an outsider, but the perspective he brought to the topic was very refreshing.
An anaesthesiologist by training, he started by talking about how crude tools (like ether) were replaced by more targeted medicines in his own field. Similarly, alcohol is a crude tool for dealing with complex issues like depression and anxiety, again there are now more targeted interventions for these issues. In the same way, vaping distils the key pleasurable element out of tobacco, offering something more focused where there was once only a crude tool.
He spoke about seeing a doctor outside at a conference smoking. The man had issues – like everybody does – and cigarettes offered him some comfort, and pleasure through difficult times. Public health people he told the story to first assumed that he can’t have known the risks – which, as Dworkin pointed out, he definitely did – or that he obviously had some sort of problem. He clearly needs to see a counsellor, they said.
But what if he didn’t? Is using nicotine or light drinking to cope with these issues really a “problem” in the way public health type people often see it?
His point was that people hate vaping and (light) drinking because there are no proven risks, so they can’t come down hard from a place of moral superiority, but people want to do them because public health’s “solutions” are oversimplified and don’t work for everybody. They are simply fun. And fun is not something we should be ashamed of.He said that the future of vaping is to be enjoyed by many people, just like beer.
14th of June – Talking About Nicotine, Parallel Sessions and Funding MattersFriday the 14th was when the conference officially opened, with introductory speeches from Dave Sweanor and Aaron Biebert of A Billion Lives fame.The main challenge for everyone on Friday was choosing what to see from the wide range of presentations on offer, with the second and third sessions of the day having four options each, including presentations, panels and a film track in each block.
Science Plenary: It’s Time to Talk About NicotineThe first block of talks hit right on the core theme of the whole conference, and thankfully for indecisive people like me it was the only option for the morning sessions.
- Nicotine offers improvements in some areas of attention and working memory, but downsides when it comes to stress and mood.
- The potential risks of pure nicotine are broadly theoretical, with only dependence being well-established.
- Alternative sources of nicotine help smokers quit, but always attracts opposition.
Are the improvements in things like processing visual information after using nicotine actual benefits (i.e. improvements over “normal” performance) or do they just look like it because nicotine-deprived smokers are impaired?
Lynne Dawkins addressed this issue by looking at evidence on smokers not in withdrawal and at non-smokers. A review of 41 studies concluded that nicotine genuinely improves fine motor abilities and aspects of attention and memory, showing benefits on six of the nine areas considered.
However, long-term effects – particularly later in life – suggest that smoking is linked to (although doesn’t necessarily cause) worse cognitive functioning over the long term. There are also downsides of smoking when it comes to stress (smoking doesn’t reduce stress, as many people assume) and mood (with a link to depression, which appears causal because people improve after quitting).
Long Term Effects of Nicotine
Neal Benowitz gave a presentation on the long-term effects of pure nicotine, rating each potential risk.
Addiction was the only “definite,” and cardiovascular (i.e. heart-related) issues were classed as “probable,” and others such as the commonly-claimed adolescent brain development issues and cancer were merely called “possible.” Cancer is a strange one, because nicotine is generally not considered a cause, however there are some effects of nicotine (e.g. promoting cell growth) that could theoretically lead to cancer.
Unfortunately he didn’t get to address the “adolescent brain development” part in his talk, but in the Q&A session before the break he gave a fairly detailed response. He said rodent studies suggest that it delays the maturation of the brain (but doesn’t permanently “damage” it) and that it is more behavioural effects than anything more severe.
Peter Hajek – clearly sceptical of this whole argument (and having covered it in his talk) – pushed to pin him down on specifics. What specific effects would this cause? The response was essentially being more prone to use drugs and more likely to have car accidents. For Hajek, these effects should be visible in population-level data. Have teen drug use rates declined alongside teen smoking? Are there fewer accidents?
Using Nicotine to Help People Stop Smoking
Peter Hajek broke his talk on using nicotine to help smokers quit into two “chapters,” the first of which is all about NRT, while vaping is at the centre of the second.
Some familiar objections surfaced when the idea of nicotine gum was first proposed. For example, “won’t it addict non-smokers? After all chewing gum is a kids’ product.” This push-back was quite mild, though, and Hajek links the ease with which it was quashed to the strong medicalisation of NRT and the low dose, as well as warnings and other factors.
As we all know, the second chapter involves a lot more of the same. Hajek pointed out that the “nicotine damages teen brains” claim didn’t originally feature in the many, many discussions of the risks of smoking, and yet now it’s one of the most common arguments you see in the US in particular. He pointed out that there are many countries where teen smoking is largely confined to men – wouldn’t these countries show sex differences in mental health issues, if the claim was true?
The remainder of the talk addressed more of the second chapter of objections, in particular concerns about dual use (dual users who regular vape substantially reduce their toxin intake, not increase it) and claims like those from Stanton Glantz – that vaping actually lowers quitting rates – are based on shoddy evidence.He concluded by saying that, unfortunately, the battle against these same bad ideas will take a lot more time to win this time.
Parallel Session: Regulation of NicotineKey Points
- The FDA is starting to acknowledge the huge potential downsides of their approach
- The situation with both the World Trade Organisation rules and the WHO’s Framework Convention on Tobacco Control is in need of legal clarification
- The way the TPD is applied varies substantially between EU countries
Patricia Kovacevic ran through the basics of the FDA’s deeming regulations, litigation updates and where we are now, but in particular focused on a recent FDA admission of something vapers and advocates have been pointing out for years. Mitch Zeller finally acknowledged that suddenly losing tons of vaping products “would cause significant public health concerns,” which, frankly of course it would but the admission is at least progress. Additionally, she pointed out that no PMTAs are currently under review for vaping products, with the ones being sent so far being insufficient to accept or even file.
Taming the Schrödinger Cat
Both Lukasz Gruszczynski and Marina Foltea’s presentations spoke about international issues primarily around interpretations of more generic rules in the case of e-cigs. Gruszczynski discussed the Schrödinger’s cat-like, multiple-things-at-once situation vaping finds itself under based on the WHO’s FCTC. Since it wasn’t created with vaping in mind, they could arguably fit into four categories, and different countries could interpret the rules in different ways. A decision at COP could overrule this, though, “taming” the Schrödinger cat.
The World Trade Organisation and Vaping Products
For Marina Foltea’s presentation, the key issue was whether e-cigarettes are “like products” to cigarettes (in a legal sense) under World Trade Organization rules. If so, it will be difficult to treat vaping differently to cigarettes under these rules, and given that the legal “tests” for likeness revolve around whether the products are competing on the market, it’s more than possible that they would be. In this situation, bans could be considered discriminatory by the WTO unless there is a science-based justification (spoiler: there isn’t). While this sounds good, in the Q&A session, it was pointed out that it could also open the door to harsh restrictions on vaping, because it would mean they’d need to be treated in a similar way.
The TPD Across Europe
After a basic introduction to the TPD, Michal Dobrajc focused on the transpositions of the law in the UK, France and Germany and the differences this has created between the countries. For example, in the UK, the 2 ml limit on tanks is considered to apply to all tanks, whereas in France and Germany, it only applies to disposable cartridges with nicotine. Similarly, the UK and France haven’t listed any extra “forbidden ingredients,” whereas Germany has created an extensive list, so a liquid legal in the UK and France could easily be illegal in Germany.
Developing Testing Standards for Vaping ProductsFinally, Gene Gillman closed out the session with a discussion of CORESTA and the work they’re doing to establish standards and protocols for testing vaping products, a key part of jumping through regulatory hurdles. From a purely consumer perspective this wasn’t the most useful talk, but it’s incredibly important for researchers and companies.
Parallel Session: Beliefs and Practices: New Evidence on Real World Use of Electronic CigarettesKey Points
- Collaboration between healthcare professionals and the vaping industry could help in the fight against smoking
- Evidence continues to emerge that shows the effectiveness of vaping for quitting smoking
- Claims about “particulates” in vapour are unhelpful and betray an ignorance about everyday sources of airborne particles
- The NYTS data from America don’t support the “epidemic” claimed, and vaping by never smokers could be largely explained by marijuana vaping
Emma Ward presented the results of her interviews of vapers about the potential for collaboration between vape shops and health professionals in the UK.
The research covers several possible methods of creating this partnership, ranging from basic information displayed in-store to things like voucher schemes, smoking cessation training for vape shop staff and “pay per quit” programs for staff. Most respondents were in favour of partnership in general, commenting that it would make people feel reassured about potential health risks of vaping products and it could help to make vaping products more affordable. Whereas others felt that vaping should remain a personal choice, or even that it was “unethical” to fund vaping devices.
Using JUULs to Quit Smoking
The research Christopher Russell presented focuses on JUUL, with a big sample of over 15,000 vapers who used a JUUL for six months. The results showed that 20.3 percent of participants were smoke free both at three months and six months after the start of the study. Interestingly, he pointed out that vapers who used mint or mango flavour pods had a bigger chance of successfully quitting (relative to Virginia Tobacco).
Adding Vaping to Quit Smoking Treatment
Karolein Adriaens’ study was smaller, but the results were in line with those from Christopher’s study. It specifically looked at the impact of adding vaping products into the standard quit-smoking treatment from tobacco counsellors in Belgium. The results showed that vapers were more likely to have quit at the end of the study compared to people using NRT, and vaping also seemed to reduce the risk of relapse. One interesting finding was that the people who chose cold turkey quitting smoked less (11 for cold turkey quitters vs. 17 for non cold turkey quitters), which could explain why quit rates with no aid were quite high in the study too.
Patterns of Vaping to Support Long-Term Abstinence From Smoking
Sarah Gentry spoke about her survey with a one-year follow up that focused on the impact of different choices when it comes to device and nicotine level on the risk of relapse to smoking. They found that vapers using tanks and vape pens were less likely to start smoking again than people using cigalikes, and higher nicotine strengths also made relapse less likely. Unsurprisingly (for vapers), the vapers in the study tended to move towards mods, fruity and sweet flavours, and lower nicotine strengths over time.
“Particulates” and Second-Hand Vaping
Roberto Sussman gave a very unique and energetic talk that put concerns about second-hand vaping into context. He pointed out that vapour dissipates quickly, because it’s composed of liquid droplets that readily evaporate. Unlike smoke, which is composed of solid particles and lingers for a long time. However, both of these are indiscriminately referred to as “particulate matter” as if that’s the only relevant factor. He illustrated this point beautifully by showing higher particulate levels from having a lit candle in the room, grilling meat and even vacuuming. This led to one of my favourite quotes of the whole conference:
“If harsh interventions are needed to protect the public from e-cig sub micron particles, then we need even harsher interventions to protect them from candles, grilling meat and vacuuming.”
The “Epidemic” of Youth Vaping
Finally, Konstantinos Farsalinos closed out the sessions with a rational look at the data from the 2017 and 2018 US National Youth Tobacco Survey, widely claimed to show an “epidemic” of use. But as soon as you look at the data in more detail this interpretation starts to fall apart. He broke the data down into infrequent and frequent use (defined as over 20 days of the past 20), and while use at all frequencies did increase, the vast majority of youth vaping was and still is infrequent use. For teens who’ve never smoked, only 0.5 percent of them had vaped each day, and another 0.4 percent had vaped on over 20 days but not every day. The “epidemic” is less than 1 percent of never smokers, at best.The most interesting result concerns the question about vaping marijuana, though. The NYTS results show that 60 percent of frequent vapers who’ve never smoked have used marijuana in an e-cig. This presents the interesting question: how much of the “epidemic” really stems from teens vaping marijuana? There is no answer at present, but it has the potential to seriously undermine the current panic.
Debate: Funding MattersKey Points
- Funding has to come from somewhere. Transparency about the role of a funder is more important than the perceived “cleanliness” of the source.
- Non-financial conflicts of interest can and do distort the science.
Marewa Glover spoke second but the pictures she used as props perfectly set the stage for the conversation that followed. They were four illustrations showing the perception of different funding sources: industry funding was represented by a toxic sludge, and the most pure funding (literally, in the picture) falls from the sky. Ironically though, if money is taken through taxes and “laundered” through the government, it’s seen as “purified” despite the exact same source. The hypocrisy was shown so clearly and creatively through just four images.
Moira Gilchrist pointed out how IQOS was approved by the FDA on the basis of the evidence, but that very evidence is consistently dismissed as “PR.” She argued that scepticism is healthy but only if it’s followed by genuine inquiry into the issue. She added that the narrative of tobacco control hasn’t changed in decades, but the companies, the products and the personnel at Phillip Morris has.
Clive Bates really hit the nail on the head: “The funding issue has been weaponised.” It’s mentioned purely to suppress findings tobacco control doesn’t like. Unfortunately – and also very accurately – he points out that “virtuous” funders who could support the crucial work simply don’t find the issue attractive. There isn’t much sympathy for smokers, and really that is sorely needed.Clive also pointed out the issue of non-financial conflicts, but David Abrams spoke about this in more detail. He argued that everyone is biased. People with “clean” money can also distort the science, and he used Truth and the Campaign for Tobacco Free Kids as examples of this. The real test is – and should always be – the data and scientific integrity, not who is footing the bill.
15th of June – Vulnerable Populations, Emergent Evidence and Final ThoughtsThe Saturday’s schedule thankfully didn’t involve parallel tracks, and all of the sessions were packed with excellent speakers and scientists to end the conference in style.
Safer Nicotine Products and Vulnerable and Hard to Reach PopulationsThe four speakers in the morning session all spoke about different groups, but there was a strong common thread underlying all of the talks: vulnerable populations are highly affected by smoking, and vaping could make a difference where nothing else has.
- Homeless people, people with mental health issues and those with substance issues smoke and high rates, and vaping could make a difference where little else has
- Indigenous communities are best helped by community-led projects
Sharon Cox spoke about smoking in homeless people, who have smoking rates estimated to be anywhere from 70 to 90 percent. Contrary to many people’s expectations, a randomised controlled trial focused on homeless people found a quit rate of 9.3 percent, right in line with the general population.
Her group’s survey of homeless smokers found a strong desire to quit and a substantial level of interest in vaping. But it also found a couple of major barriers to quitting. Firstly, over 9 in 10 had daily contact with other smokers, so it’s almost unavoidable, and secondly, the most they can realistically afford is £5 to £10, way less than the cost of an average starter kit. The research group is now looking at the effect of providing free starter kits for homeless people.
Smokers with Mental Health Issues or Substance Use Disorders
The key themes from the homeless smokers talk really repeated themselves through the session. Sarah Pratt spoke about the challenges for smokers with mental illness, for whom smoking rates are high and smoking is almost encouraged, being used as a reward in some situations. Deborah Robson found essentially the same thing for people with substance use disorders, except because of their addiction, treatment providers don’t even offer support to quit smoking – it’s seen as a lesser issue.
In both cases, vaping could help. For people with mental illnesses, a pilot study showed promising results and a larger one showed almost 40 percent of the group reducing to five cigarettes per day or lower at 8 weeks. Similarly, integrating a tobacco treatment unit into a substance abuse treatment facility showed little uptake at first, but this improved when vaping devices were incorporated into the service.
Smoking in Māori CommunitiesThe final talk from Rebecca Ruwhiu-Collins was on a different type of vulnerable group, the Māori community in New Zealand, who smoke at about double the rate in New Zealand overall. Rebecca created Vape2Save in part to address this, but the key idea in her approach was for it to be community led. Incorporating Māori culture into her approach, she’s making waves with a group traditional approaches can easily miss.
Pushing the Pace: Emergent Evidence in Nicotine ScienceKey Points
- Bad science on vaping is ubiquitous, but can be rebutted by attacking the repeated errors rather than every individual claim
- There is ample evidence to show that smokeless tobacco has a massive potential for reducing smoking-related harm
- Nicotine use in pregnancy isn’t perfectly OK, but encouraging switching when quitting isn’t possible could immediately reduce risks
- Second-hand vaping releases fewer particulates than smoking, but this varies by the type of device
Riccardo Polosa addressed the ubiquitous issue of bad science around vaping, but with the optimistic message (delivered with his usual infectious positivity) that “bad science can be effectively fixed.” He pointed out that the same mistakes are repeated time and time again. For example, cell studies (“in vitro” research) is frequently conducted using unrealistic vaping protocols and with little concern for realistic dosing. With animal research, the issue is similar: mice, for instance, despite their minuscule weight are often given human-like doses of nicotine. The fact that these mistakes are repeated shines the light on a solution: rebut the recurring issues and you can take down tons of bad research in a single point.
The Science on Smokeless Tobacco
Brad Rodu gave a solid run-down of the evidence on the risks of smokeless tobacco. In a nutshell, while dry snuff does appear to have risks (albeit smaller risks than something as common as driving a car), snus and smokeless tobacco are effectively safe, with the only detectable risks relating to smoking history rather than use of smokeless products. Smokeless tobacco has huge potential for reducing disease and death from smoking.
Nicotine Use in Pregnancy: What the Data Says
Marewa Glover went through her work reviewing the evidence on using nicotine (without smoke) while pregnant. She looked at 22 studies in detail, but the broad conclusions were that preterm birth is probably linked to nicotine use and reduced birth weight could be, but there is no evidence of other forms of risk. This opens up a huge potential avenue for preventing harm.
Second-Hand VapingFinally, Maciej Goniewicz spoke about the evidence around second-hand vaping. The focus was on particulates (in a bit of a clash with Roberto Sussman’s talk the previous day), but overall the research shows that vaping products are better than smoking even with the arguably unhelpful focus on “particulates” without reference to their specific composition. He also showed that there is quite a bit of variability depending on the specific vaping devices used.
If it's Time to Talk About Nicotine – What Have We Missed?Aside from the reflective, concluding session, the last panel was very much an open forum discussion. There were many great moments, but one set of responses really stood out.
Clive Bates asked the panel what they thought the reason for the opposition to vaping is, and the responses were all really good.
Greg Conley spoke about Michael Siegel’s three explanations: ideological elements (vaping looks like smoking), their conflict of interest (since they’re ultimately dependent on industry revenue) and that they didn’t come up with the solution, so the industry would get credit rather than them.
Cecilia Kindstrand-Isaksson pointed out that they need a clear enemy, and while the advent of safer alternatives should really give them cause to bring some nuance into their view, the desire to keep a simple “bad guys vs. good guys” framing means they can’t even acknowledge obvious shades of grey.
Saul Shiffman said it’s become a moral crusade. They regretted being fooled by low tar cigarettes, and they don’t want to be fooled again. As for the moral crusade element, he also mentioned the important distinction between addiction and dependence. Without harm, it is not addiction. You aren’t “addicted” to coffee, although you may be dependent. But the language around smoking – and how I must have looked to people heading off for a vape as soon as I got off the plane – leads people to view it unsympathetically, even if they have their own dependence too. He said “whether you need to keep vaping is not even a public health issue.”
Finally, Fiona Patten likened it to a prohibition on pleasure. It’s precisely because vaping is enjoyable that people dislike it. If it was harder – if there was pain, rather than just pleasure – people would have an easier time accepting it as an approach.
A couple of comments from Greg Conley and Clive Bates are a great place to finish.
Greg said: “It’s a moral imperative, if people are doing something that is harmful to their health, they deserve access to accurate information [about safer alternatives].”And Clive characterised the public health opposition to vaping as an “illusion of control.” People in the field incorrectly believe that they can funnel smokers into the “right” way of quitting. But this leaves no space for personal choice or even agency. It is flagrantly disrespectful to treat people like that.
Wrapping UpNeedless to say, there was tons of interesting information presented over the few days of talks, and even this very long post can’t do justice to it all. But overall a couple of themes really stuck out to me.
The big challenge for everyone in this area is how to tackle the constant stream of misinformation. This can be exhausting and succeeding is difficult – in fact, many speakers argued that realistically, we’re losing – but there is still hope. First, Dave Sweanor spoke about the power of ridicule. This might seem like an unimportant point but it hits on something more powerful. The anger people (justifiably) feel when faced with this information can really put people off. Ridicule comes with humour, and while it can be devastating to an argument, it will always come with a positive overtone.
It ties in with a comment Clive Bates made in the consumer advocacy panel: “You will never lose by being polite and respectful, but you can lose by being too aggressive.”
The way forward when it comes to rebutting misinformation seems to be doing it with a smile, having fun with it, resisting aggression but encouraging ridicule, and as Riccardo Polosa advised, focusing on recurring errors rather than playing whack-a-mole with individual claims.
The second point is arguably more important. The opposition to vaping in the US in particular centres around “the children,” and this works because it’s a (pretty blatant) appeal to emotion. But they aren’t the only ones with a potential emotional message. We too can win hearts as well as minds. As many people commented, consumer’s biggest assets are their personal stories. Everybody knows smokers, and we need to remind people – as often as possible – that we are proud to have made a decision that means we’ll be more likely to remain around for our loved ones.
On top of this, the talks on Saturday about vulnerable populations are another emotive message that we don’t use often enough. What about all the schizophrenic smokers, the homeless smokers and the indigenous communities with high smoking rates? These people matter and existing approaches aren’t working for them. These are yet more stories and arguments we can use to win hearts as well as minds.
And to finish, a great comment from Dave Sweanor’s closing speech really hits home. It’s hard to keep fighting when it feels like there are more challenges, more restrictions and more nonsense hitting the front pages each week. But Dave likened it to climbing a mountain. It might feel like you’re never going to get to the top, but it’s important to turn around once in a while and look how far you’ve already come.
Because even though the challenges are ongoing, the THR community has achieved a lot so far. And we can achieve more in future.
Are E-Cigarettes Harmful? Dec 2018, Cancer Research
Nicotine without smoke: Tobacco harm reduction, April 2016, Royal College of Physicians