Posted on October 3, 2023 By Colin
EMERITUS PROFESSOR SIMON CHAPMAN AO recently wrote a blog titled “Two parallel universes for Big Tobacco”, in which he dismissed the aspirations of some tobacco companies to transition away from combustible cigarettes to reduced risk nicotine products. He also misrepresented and derided my statements on nicotine and vaping. This is my response to correct the record.
Professor Chapman’s attitude to the tobacco industry remains stuck in the tobacco wars of the past. There is no doubt the tobacco industry has an appalling record of selling addictive and deadly products, lying about the health effects of smoking and obstructing tobacco control.
However, consumers are driving a profound market transformation by opting for reduced-risk, non-combustible nicotine products. These innovative products threaten tobacco companies, much like digital cameras did to Kodak and electric cars do to petrol vehicle manufacturers.
The major multinationals are embracing transformation to varying degrees. PMI has gone furthest so far, spending USD 10.5 billion since 2008 in research, development, and commercialization of safer alternatives to smoking. It now earns 35% of net revenue from reduced risk products, aiming for over two-thirds by 2030. The transition to safer products is a huge positive for public health and should be encouraged rather than obstructed.
Some skepticism is justified. Tobacco companies continue to oppose tobacco control policies and promote the sale of cigarettes. However, the transformation would be faster if activists like Professor Chapman ceased resisting it. Industry transformation would have substantial benefits for public health. Obstructing it will maintain the deadly annual toll of 21,000 deaths from smoking in Australia and more than 8 million deaths worldwide.
The push by the tobacco industry is not driven primarily by public health concerns but is a response to commercial realities created by consumer preferences. For some companies, it's an opportunity to exit a deadly and reviled industry while benefiting the company, shareholders, consumers, and public health.
In referring to safer alternatives as “so called” reduced risk products, Professor Chapman demonstrates a lack of understanding of the clear benefits of tobacco harm reduction. There is universal agreement among credible scientists that vapes, heated tobacco products, snus and nicotine pouches are far safer than smoking and have the potential to substantially improve health at an individual and population level.
Vapes are contributing to dramatic declines in adult and youth smoking in countries where they are available, unlike in Australia where smoking rates continue to stagnate.
Heated tobacco products made by tobacco companies have been associated with an unprecedented decline in combustible cigarette sales in Japan of about 50% since 2015. PMI’s iQOS was approved by the US FDA to help addicted adult smokers transition away from combusted cigarettes and significantly reduce their exposure to harmful chemicals. Surely this substitution is a good thing?
The primary goal of tobacco control should be to prevent smokers dying from cancer, lung and heart disease. Instead, Professor Chapman remains obsessed with his life-long battle against the tobacco industry, something that cannot be destroyed, only reformed and reshaped. This goal ignores the fact that selling cigarettes is a legal business, that public companies have fiduciary obligations to shareholders and that there is a strong demand for cigarettes. His campaign to destroy Big Tobacco has failed overall. Despite decades of anti-industry campaigns, tobacco companies continue to thrive from selling deadly products.
Professor Chapman falsely states that I “believe nicotine is virtually a wonder drug”. I have never said or thought this. However, I agree with many health authorities that nicotine is a relatively benign stimulant with many scientifically well documented benefits. For example, the UK Royal College of Physicians states that “Use of nicotine alone, in the doses used by smokers, represents little if any hazard to the user”. the UK National Health Service says “Although nicotine is addictive, it is relatively harmless to health”. Nicotine does not cause cancer or respiratory disease and has only a minor role in cardiovascular disease.
People use nicotine for pleasure and stimulation, to modulate mood, stress and anxiety and for a range of cognitive benefits. It may also help manage various health conditions, such as attention deficit hyperactivity disorder, schizophrenia, Parkinson’s disease and ulcerative colitis.
Nicotine has been a popular drug in human society for thousands of years and almost 1.5 billion people around the world currently use it. Surely it is better for people to use nicotine in reduced risk products than in deadly smoking.
Professor Chapman states incorrectly that I have “long embraced vaping theologies that vaping is all but 100% benign”. My views are in line with the recent comprehensive review by England’s Office for Health Improvement and Disparities that concluded that vaping is not risk-free but “poses only a small fraction of the risks of smoking”. This is also the view of the UK Royal College of Physicians, the US National Academies of Sciences, Engineering and Medicine and the New Zealand Ministry of Health, to name just a few reputable, independent bodies.
My view has never been “that there’s almost nowhere that vapes should not be sold”. I have repeatedly stated that vaping should be strictly regulated as an adult consumer product sold from licensed retail premises with stringent age verification. It should be at least as widely available as combustible products as a safer alternative for adult smokers.
Professor Chapman also mocks me by saying that I think vaping is “peerless as a quit smoking route”. He seems unaware that vaping actually is the most effective quitting aid available, according to many authorities, including the latest Cochrane review and a systematic review by the prestigious UK National Institute for Health Research. Vaping is also the most popular aid for quitting and reducing smoking in Australia and many other western countries, and has the potential to reach far more smokers and reduce smoking rates more than any other intervention.
Professor Chapman also incorrectly says that I believe that concerns about vaping by kids are unwarranted. I have repeatedly said that kids should not vape or smoke. The reality is that some kids will vape whether we like it or not, however, concerns about youth vaping are wildly exaggerated. Most use by non-smoking youth is experimental and short-term, frequent vaping is rare and so far there is very little evidence of serious harm. Importantly, vaping and smoking are substitutes and vaping is diverting young people away from deadly smoking overall. This is not to endorse vaping for kids but is a reminder that we need to keep vaping in perspective.
A small number of young vapers, many of whom are former smokers, are dependent on nicotine. Compassionate and supportive approaches need to be found which recognise their needs and the difficulty of managing this problem at schools. I have suggested some possible solutions to address the reality we currently face. Professor Chapman provides no alternative solution for this problem.
Professor Chapman’s resistance to the tobacco industry’s transition obstructs progress. By dismissing these products outright he is inadvertently supporting the very thing he should be trying to eradicate – combustible cigarette sales.
This stance overlooks a pragmatic opportunity to engage with a transitioning industry to accelerate the decline in smoking. In the public health arena, it's crucial that we remain open to new evidence-based strategies even if they challenge traditional anti-tobacco narratives.
Professor Chapman demonstrates a failure to understand the huge public health benefits that vaping and other tobacco harm reduction products could deliver. He misrepresents my views with no opportunity to respond and correct the record.
Today, I am again issuing a challenge to Professor Chapman for a courteous, public debate on this important public health issue. Perhaps our two parallel universes can find some common ground and refocus on the main concern of tobacco control – to prevent death and illness from smoking. I look forward to his response.