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Fumo, former WHO executive: “Don’t hinder but guide harm reduction policies”

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“The Framework Convention for Tobacco Control (FCTC) of the World Health Organization”, which came into force about fifteen years ago, “has not kept its promises. The missing ingredient in the WHO strategy is reduction. of the damage “. Speaking is Robert Beaglehole, a public health expert who was director of the Department of Chronic Diseases and Health Promotion at WHO for years. Professor emeritus of the University of Auckland, he founded Action on Smoking and Health (Ash) in New Zealand and today, on the occasion of the ‘Virtual E-Cigarette Summit Uk 2021’, he shows what in his opinion would be a real success: “A world without smoke, not a world without nicotine. The enemy is the toxic substances of burnt tobacco, “he warns. Beaglehole turns the spotlight on a public health goal he believes is crucial: “Reduce deaths and illnesses caused in particular by cigarette smoking.” It is estimated “8 million deaths caused by tobacco every year, of which 80% are due to cigarette smoking. There are 20 thousand every single day”. And the WHO, the expert urges, “must be at the forefront in addressing this”. In reality, however, something has not worked so far, he notes. “Bloomberg Philanthropies funded a tobacco intervention (Mpower) for at least $ 1 billion. But where it was fully implemented, such as in New Zealand and other affluent countries, smoking rates have only slowly declined. In other countries they have risen.” , says the expert. For Beaglehole, there are three main reasons why the FCTC has failed to deliver on its promises: “The grip of nicotine withdrawal – he lists – WHO’s failure to embrace less harmful products, attention to juvenile smoking a the detriment of smoking among adults. WHO, at least in the field of tobacco control, has lost its way. The goals set on chronic diseases will only be achieved if the tobacco reduction goals are strengthened “, is the vision of the expert. And for that to happen, the damage reduction piece is missing for Beaglehole. “Sweden – he observes – has shown its value: here ‘snus’ (tobacco for oral use, ed.) Is increasingly replacing cigarette smoke”. Another example is “Japan, where devices that do not burn tobacco have reduced the sale of cigarettes by 30%”. But “WHO has discouraged tobacco harm reduction products. Several countries have banned them, which has resulted in them being rewarded even as smoking rates have continued to rise,” he says. The expert suggests looking at the “lesson from the Covid-19 pandemic: we need a coordinated global response with strong and independent evidence that leaves no one behind, a science-based policy and a transparent discussion of risks and monitoring. progress “. Success will be achieved “if the WHO and the FCTC guide and do not hinder harm reduction strategies; if more countries adopt and achieve reduction goals” of cigarette smoking; “if the tobacco industry will increasingly switch to less harmful nicotine delivery products.” A starting point, continues Beaglehole, “is WHO leadership in this sector”. It will be necessary “to take advantage of the re-election of the general manager Tedros Adhanom Ghebreyesus and ask him about his leadership and that of the organization in this field”. Another point: “Progressive countries” should “work together to reform the WHO and the Conference of the Parties (COP, ed), focus on the urgent goal of reducing smoking and deaths among adults”. Another step should be “the active promotion of low-damage products”. Beaglehole asks the “harm reduction deniers: what if you are wrong? I ask you to consider this possibility.” Today “several high-income countries are making progress in rapidly reducing cigarette smoking and many others are making ambitious plans to accelerate progress. Secondly, many young people in several countries are no longer starting to smoke cigarettes and this is a remarkable achievement. And finally, one reason for optimism is that we have a whole host of harm reduction products “that can be used” to help “quit smoking. One would have to “adapt quickly to changing evidence,” suggests the expert. What can hinder this process? Marcus Munafò, professor of biological psychology at the University of Bristol, tries to explain it, who analyzes how we arrived at such a “polarized debate”. “Even highly skilled scientists are human and can be subject to bias, most of them unconscious, and this affects the way they conduct research and interpret evidence – he analyzes -. Their opinions can also be influenced by structures of incentive “. In theory, “science should correct itself”. But among the factors at play that complicate things, argues Munafò, there is also the so-called “loyalty bias: our loyalty and our personal investment in a topic shape our interpretation of the evidence”. According to him, it is necessary to “try to keep in mind the prejudices that could influence us”, trying to “avoid” being imprisoned in “bubbles” of those who have similar opinions “. And again “respect those who recognize uncertainty. Understanding the nature and impact of these factors will be important if we are to make evidence-based policy recommendations.” “I – concludes Beaglehole – have spoken with epidemiologists, with smokers, with people” who use harm reduction products. “And I was impressed with the personal stories. All of this led me to change my goal: a smoke-free world.”

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