THR-Rendez-vous 1 - Wednesday October 11, 2017
Jean-François Etter, PhD in political science, is professor of public health with the Institute of Global Health, at the Faculty of Medicine of the University of Geneva.
Q1. Our previous rendez-vous took place in January 2001 (more than 16 years ago!). It ended with your mention of a project about the effectiveness of Nicotine Gums to quit smoking. That was before the e-cigs era. In 2013 you published a book titled in English "The electronic cigarette: an alternative to tobacco?" and in French, La vérité sur la cigarette électronique where you presented the e-cig as an ongoing revolution. How do you assess today the state of the harm reduction strategy? What role can the e-cigarettes play?
Jean-François Etter: E-cigarettes and other new vaporizing technologies actually represent a revolution in our field. In the UK, the e-cig is by far the most frequently used aid during attempts to quit smoking. In Japan IQOS already represents 10% of all the tobacco market, which is quite impressive if you consider the products was launched only 2 years ago. Elsewhere, the situations varies greatly from country to country.
Q2. There is still a wide divide between the advocates who support the development of non combustible products and those who very much oppose them. How do you explain the divide and the vehemence of the debate?
Jean-François Etter: There is a very nice paper, Minors, Moral Psychology and the Harm Reduction Debate, by Lynn Kozlowski that explains this, his explanation (link to the full text) relates to moral psychology. The state of science has little to do with it, and this divide will not fade away even if we produce more of the best science.
Q3. The violence of the debate has been particularly visible when Derek Yach announced the launch of the Foundation for a Smoke-Free World, funded by millions of dollars from Philip Morris International. What's your personal take on this story? How did it play in Switzerland where PMI is headquartered, as is the World Health Organization?
Jean-François Etter: WHO’s FCTC secretariat issued a very negative (and not very well informed, I think) press release about this Foundation. Derek Yach had a lot of courage, but I am not sure that he explained enough or communicated enough about his project, and many people do not understand it. Actually, it will take a lot of effort to explain why (and make people accept that) PMI at the same time continues its efforts to undermine FCTC and supports this Foundation.
Q4. Mike Siegel who is in favor of e-cigarettes (like Derek Yach) chose to decline collaborating as a consultant with the Foundation for a Smoke-Free World. Have you been asked to work with them? How do you feel about Derek Yach's claim of independence? Do you think the public health community will obey the call for ostracism given by the World Health Organization?
Jean-François Etter: I have not been asked to collaborate with this Foundation, but my Institution’s (University of Geneva) rules prohibit to accept money from tobacco companies, and for the moment all the Foundation’s money comes from PMI. WHO is very influential and there is no doubt that many people will follow WHO’s advice. This Foundation should nevertheless be given a chance, and it is probably a mistake to shoot at it without listening to Derek’s arguments first.
Q5. You have criticized the way the new European Directive on Tobacco Products and the way it wants to regulate e-cigarettes. Can you explain what it does and what basic principles you think should rule new regulations for non combustible products?
Jean-François Etter: The e-cigarette industry survived the TPD, but the TPD has many negative aspects, in particular the enormous waste and unnecessary pollution created by the 10mL bottles (you need 3 time more bottles than if you had 30 mL bottles), the excessive anti-advertisements rules, and the unworkable and costly declarations system.
Q6. I am very new in this territory but I have the feeling many people who 'vape' are very enthusiastic and committed about their practice and ready to organize to defend it at a very grassroots level with an active use of the internet tools and films (like "Beyond the cloud", "A billion lives") or videos like "The truth about vaping". Are 'vapers' going to play or are already playing a role in defining the issues and the eventual solutions?
Jean-François Etter: Vapers are organized and are politically influential in some (e.g. France), but not in all countries. There is a core of very enthusiastic vapers, but instead of focusing of the preferences of this group (e.g. big clouds of vapor, sophisticated devices), the industry should instead focus on would-be vapers, i.e. the large numbers of smokers who would switch to vaping if they had access to good entry products (easy to use, delivering a satisfactory dose of nicotine and good flavors). I am not sure that this need is satisfied, and this may explain why relatively few smokers switch to vaping.
Q7. Is there anything you would like to add?
Jean-François Etter: The success of heated tobacco products and the enormous investments of the tobacco industry in these new technologies (billions with a B$) suggest that in the future, heated tobacco may surpass e-cigarettes and may substantially reduce the market for combustible cigarettes. I am not sure that public health experts are ready to accompany this change intelligently.
Thank you very much Jean-François for taking the time to answer our questions.
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