The WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2021 - Addressing new and emerging products lays bare the significant and inappropriate influence exercised by Bloomberg Philanthropies over WHO policy. The report is undeniably biased and reminiscent of tactics and pseudo-science employed by the US tobacco industry after the formation of the Tobacco Industry Research Committee in 1954, albeit worse because of the abuse of the public trust that the WHO is endowed with.
Tobacco Industry TacticsIn January 1954, US tobacco companies jointly funded an advertisement entitled "A Frank Statement to Cigarette Smokers" to counteract the public cancer scare and decline in cigarette volumes that ensued after an article in the December 1952 edition of Reader's Digest called "Cancer by the Carton". The story highlighted a growing body of research linking ever-increasing lung cancer cases to smoking.
Source: USDA, FTC, Alcohol and Tobacco Tax and Trade Bureau
The "Frank Statement" aimed to cast doubt on research that suggested smoking and lung cancer are linked. It stated that:
- Experiments showing this were inconclusive,
- that medical research indicated many possible causes of lung cancer,
- that there was no agreement among authorities what the cause was,
- that statistics linking smoking with the disease could apply equally to many other factors, and that many scientists were questioning the validity of these statistics themselves.
It went further, saying that the industry believed its products were safe and that past attempts at blaming tobacco for various diseases had failed due to lack of evidence. Notwithstanding this, the industry would not dismiss these concerns out of hand but aid and assist the research effort into tobacco and health by establishing the Tobacco Industry Research Committee (later known as the Council for Tobacco Research). The committee was to be headed by a scientist of "unimpeachable integrity and national repute", with an advisory board of scientists "disinterested in the cigarette industry".
What followed was a multi-decade, well-funded public relations campaign that amplified the views of sceptical scientists to create doubt in the public's minds regarding evidence of the health risks associated with smoking. Not only were the volume declines recorded in 1953 and 1954 entirely reversed by 1956, but industry volumes increased some 66% by 1981 and only declined to below the 1954 level by 2005.
Bloomberg Philanthropies and the WHO
In his keynote address, "Why has the WHO FCTC failed to reduce adult smoking and its impact?", at the 2021 Global Forum on Nicotine, Derek Yach, who was instrumental in establishing the FCTC, said (about the tobacco industry campaign) that "No amount of PR obfuscation could hide the devastation caused by tobacco in the long term." This is undoubtedly true, but it worked for decades and contributed to a significant increase in smoking and tobacco-related deaths.
Now, nearly 70 years after the formation of the Tobacco Industry Research Committee, a new form of PR obfuscation has taken hold, and it is potentially just as lethal, if not more so. This time, most of the tobacco control community has shifted its focus from reducing deaths from smoking to ending all nicotine use, regardless of the associated health risks. Not only does this approach potentially deny millions of smokers access to reduced-harm alternative nicotine products, but to justify the abstinence-only approach, lower-risk nicotine products have been demonised to the extent that a large proportion of smokers and would-be smokers believe they are at least as harmful as cigarettes.
According to ASH, nearly a third of adults in Great Britain believe that vaping was equally or more harmful than cigarettes. This is notwithstanding Public Health England's position that vaping was at least 95% less harmful than smoking and a generally supportive UK government and health bodies approach.
Source: ASH UK
The chart above shows how perceptions of the relative risk of vaping worsened in Great Britain from 2013 to 2016, whereafter it stabilised until 2019. Media coverage of the so-called EVALI outbreak in 2019 markedly impacted public perceptions of the relative health risk of vaping. "E-cigarette, or vaping product, use-associated lung injury" (EVALI). Even though the cause of the outbreak was identified as vitamin E acetate used to adulterate THC containing e-liquids, it was widely attributed to vaping in general.
At the peak of the EVALI-related hospital admissions in the US in September 2019, Bloomberg Philanthropies and the Campaign for Tobacco-Free Kids launched a $160m campaign to end the "Youth Vaping Epidemic." During the first year of the initiative, eight US cities and states banned flavoured e-cigarettes. Congress raised the federal minimum age for all tobacco products, including vaping products, to 21 and anti-vaping messages permeated society.
Bloomberg Philanthropies has been the most prominent financial supporter of tobacco control, having invested some $1bn over the past decade. As such, it can influence policy to align with its extreme views that call for the elimination of reduced-harm products. Its generous contributions to the WHO have earned its founder, Michael Bloomberg the role of, "WHO Ambassador for Noncommunicable Diseases and Injuries". Developing such a relationship with the ultimate global health authority is something that the tobacco industry wouldn't dream of in years gone by. It creates a dangerous platform for Bloomberg to have his extreme views promoted by a health organisation endowed with a significant amount of public trust.
Bloomberg's influence and the glaring conflicts of interest for what is supposed to be a neutral international organisation are all too evident in the recently released WHO report on the global tobacco epidemic 2021: addressing new and emerging products. Rather than merely disclosing that the report received funding from Bloomberg, it proudly states on the title page, "Made possible by funding from Bloomberg Philanthropies".
In his foreword, Michael Bloomberg states, "Since WHO launched the first report 13 years ago, cigarette sales had been steadily climbing for decades, and in most of the world, there were no measures in place to protect the public. Driven by the spread of MPOWER tobacco control measures, global cigarette sales began declining in 2012 and have continued ever since, even as the global population has grown." The irony of this statement is that 2012 was also when e-cigarettes started to emerge as a disruptive threat to the cigarette industry.
The report is a showcase for obfuscation and is undeniably biased. It claims, among other things, that:
- There is growing evidence of the harmful effects of ENDS (electronic nicotine delivery systems). This section starts by saying that ENDS are being promoted as safer alternatives to conventional cigarettes, but then, rather than discuss relative health risks, it points out that these products are not harmless. The most comprehensive research on the relative risks of vaping, published annually since 2015, comes from Public Health England (PHE), who continues to conclude that vaping is at least 95% less harmful than smoking cigarettes. If consumer goods were required to be harmless, very few presently being ingested by humans would have seen the light of day.
Nicotine is deleterious to adolescent brain development and poses risks during pregnancy. Whether this statement is true is irrelevant given that nicotine replacement therapy (NRT) is recommended as a smoking cessation aid for smoking cessation. Furthermore, users of ENDS do not consume more nicotine than they would have smoking cigarettes.
- Other e-liquid components can also be harmful to health. Once again there is no quantification of the potential risk associated with these components. Nearly half this section is devoted to EVALI, even though the authors acknowledge the source as vitamin E acetate in cannabis vaping products (which they incorrectly describe as ENDS that contain cannabis).
ENDS use among children and adolescents increases the chances they will use conventional cigarettes and other tobacco products. There is clear and likely deliberate confusion about the difference between causation and correlation. It is more likely that adolescents who experiment with either smoking or vaping will experiment with the other, rather than one leading to the other.
- Evidence on the potential role for ENDS in cessation is still inconclusive. This claim is made notwithstanding acknowledgement of the Cochrane Review, which concluded that e-cigarettes were likely nearly twice as effective as NRT to help people quit smoking successfully. A neutral organisation aiming to reduce smoking-related deaths would have welcomed the findings and committed resources to establish the veracity of the findings.