In the third panel discussion on the series, Why Bans Are Not Best For LMICs, the focus remains on Latin America, with Senior Correspondent Dom Garrett moderating the conversation surrounding the tobacco industry and harm-reduction products. Joining him was Dr. José Manuel Mier, M.D., Ph.D., and Tomás O’Gorman.
Dr. Mier is the Director of Minimal Invasive Thoracic Surgery Institute at Angeles Lomas Hospital and the Coordinator of the Lung Cancer and Thorax Tumors Clinic. His work ties him near the topic, knowing that lung cancer is the number one cause of deaths every year and works with lung cancer patients day in and day out. Despite his work in treating these patients, he understands the limits of his job in only impacting 200-250 patients every year, which is why he is participating in this discussion. He is quick to assert that the most vital problem is not lung cancer; the most vital problem is smoking cigarettes.
O’Gorman brings a consumer perspective to the table, as he used to smoke but stopped within a matter of weeks after trying safer nicotine products. His ability to quit cigarettes so quickly sparked his decision to get involved with tobacco harm-reduction efforts. He was invited to become a co-founder of Pro-Vapeo Mexico, where they are working to spread the word of other choices and alternatives, which reduce harm significantly. O’Gorman emphasizes the fact that there are millions of people who would benefit by switching to these safer alternatives.
“It is proven that e-cigarettes produce 95% less toxins for the body”, says Dr. Mier.
He says that the lack of regulation on these safer nicotine products also promotes the illegal market and not complying with minimum sanitary rules. This could all be avoided by the regulation of these harm-reductive products. Smoke and tobacco are the first cause of death worldwide, killing an estimated 7 million people every year.
Senior Correspondent Dom Garrett states the number of smokers in LMICs is around 800 million, out of 1.1 billion worldwide. Therefore, the impact of harm-reduction products could potentially have, particularly in LMICs, is significant.
Garrett asks for the panel’s first thoughts when they read the position paper by The Union, and O’Gorman referred to it as “the product of a dystopian nightmare.” He goes on to say, “I can’t believe they are proposing to ban safer alternatives in countries where 80% of the smokers live.”
The argument of the paper, according to O’Gorman, is that LMICs are weak and not strong enough to enforce anti-tobacco policies; therefore, they cannot regulate safer nicotine products. His frustration centers on the fact that the countries and people who would benefit the most from adequate regulation of these products would be the inhabitants of LMICs.
O’Gorman refers to a survey done in Mexico to illustrate his point. “In 2011, the percentage of people smoking tobacco between the ages of 12 and 65 was 17%,” he says. “In 2016, it was 17.6%.”
Dr. Mier refers to the UK case as an ideal collaboration on how to handle the regulation of tobacco. He said the UK has a roundtable discussion to deliberate the anti-tobacco products, papers being published about these products, the regulations, etc. Then they discuss the science, discuss the problems, discuss the possible solutions, and put it into a practical plan with a strategy.
And the proof is in the data. In the last 10-12 years, says Dr. Mier, the UK has reduced the number of smokers by 10%.
Senior Correspondent Garrett asks him whether the medical community within Latin America is behind this idea.
“The medical community in Mexico and Latin America, many of them share the same opinions,” Dr. Mier states. “The problem is that they cannot publicly express their opinion because many of my colleagues are working in National Public Health. If you are working in the National Public Health, you can lose your work if you are in opposition.”
The solution, according to Dr. Mier, is education. Not only knowledge with the health authorities but the medical community as well.
O’Gorman adds to this sentiment and stresses the misinformation spread about these safer alternatives in tobacco harm-reduction products. “Society must receive truth and scientific-based information regarding these alternatives,” he states. “These harm-reduction products should be seen as an opportunity, not as a threat.”
The analogy Dr. Mier uses is being in the same battle but with different weapons. He clarifies by saying he only wants to put other options on the table, options that won’t cause harm or damage to his patients. They only want to offer alternatives.
As the stance of the World Health Organization begins to surface, O’Gorman states, “If the WHO is really worried about the health of the society and the people, they should acknowledge that harm-reduction products are a safer alternative, it’s a scientific fact.”
Dr. Mier admits that the FDA is beginning to understand the problem and recognize harm-reduction products. He is convinced everyone needs more time to understand the problem and how it might be solved.
Garrett points out that many of the same principles that worked for issues like drugs and HIV would be applicable in reducing harm within the tobacco industry.
One part of the solution, O’Gorman believes, is bringing tobacco harm-reduction products and issues to legislators for them to be regulated.
“Legislators in Mexico and the rest of Latin America should not fall in the trap of believing a blanket ban will alleviate the problem,” states O’Gorman. “Especially when these products are part of the solution.”
He goes on to question the grounds of the paper published by The Union, asking if The Union supports its recommendation that LMIC authorities are weak and unable to enforce anti-tobacco policies. How will they deal with the negative consequences of a blanket ban? These consequences include dealing with the black market with a lack of regulation and a lack of quality control.
“Legislators should not be dictating how people live, they should be giving them choices,” O’Gorman concludes.
When asked how they would like to see these products regulated, both panelists agreed that the regulation on harm-reduction products should differentiate from regular tobacco.
Tobacco products cause cancer, cardiovascular and respiratory diseases, and the taxes need to reflect those problems, believes Dr. Mier.
“This should be a regulation that does not conflate its products with smoking,” states O’Gorman. “It should be a proportionate risk regulation, and the products should be regulated according to the impact of their harm.”
Dr. Mier places emphasis on the right to choices among treatments is a fundamental medical principle, allowing patients to choose their own treatment.
“We are on the right side of history,” says Dr. Mier. He concludes with a positive note, “I’m convinced in the next few years, we will have a legal market and legal options for all of the patients we are treating.”