The rendez-vous that did not take place with Richard Peto

Below is the content of the email I sent to Richard Peto on April 11, 2019.

 

Hi Richard,

 

First, great to hear your April 9 interview with BBC Radio 4 and that you are in good health.

 

Second, one regret about a few questions you were not asked: what do you think about vaping? do you see potential/real health benefits (as a way to switch from smoking combustibles to a less dangerous product) or potential/real health risks and dangerous addiction to nicotine?

 

Where I presently live (in the US) the debate is raging with threats of prohibition.

Considering the emphasis you have put on quitting and how vaping seems to have helped and still helps millions to quit, it would be great to know where you stand.

 

Third, who am I to dare emailing you?

My name is Philippe Boucher, I edit the blog THR-rendezvous about tobacco control and tobacco harm reduction issues. 

 

The format is simple: I email 6 questions (see below), if you agree you email back the answers and I post the interview on the blog and via twitter.

I hope this short format, that reaches out to people from many different countries help clarify the ongoing debate about tobacco harm reduction and what today's priorities should be.

I know it's a short format so don't hesitate to mention things you consider important that I did not touch.

 

I remember the last time I tried to interview you, during the 13th World Conference on Tobacco or Health in Washington DC in July 2006 after I had recorded your presentation and posted it on the Globalink radio blog: unfortunately the recording (and all the others) were lost when Globalink disappeared without any effort to transfer the work that had been posted and I did not think to duplicate. I had planned a post-presentation interview with Judith Watt but it did not work out: I got stuck and missed the appointment. 

 

I remember regretting the failure but also being skeptical at the time about the emphasis you were putting on the necessity to convince people to quit. I agreed it would be great  to increase cessation rates but I could not see how to make it happen as there did not appear to be any way to quickly make many dependent smokers quit. I think that like many others I wrongly dismissed snus and I had never heard of e-cigarettes. They only caught my attention much later when I started to view numerous online  testimonies of people telling how they had quit smoking thanks to vaping. I found them very touching and convincing, not only mere anecdotal evidence.  Having seen the level of controversy that divides the tobacco control community, I decided to relaunch cyberinterviews with advocates, hoping to better understand what's happening and what can be done.

I know a very long time lapsed before my asking again for your comments but I thought I would try anyway. I was shocked when I reached out to several people I had last cyber-interviewed almost twenty years ago!

 

Thanking you for your contribution to the field I hope you'll agree to answer those few questions but I'll understand if you don't. 

If you do, feel free to expand as much as you want, including aspects that don't directly relate to the questions but you judge relevant to address.

Thanks

Philippe

 

Here are the questions:

 

Q1. You always stressed the importance of quitting before 40 or earlier as it reduces the risk of death associated with continued smoking by about 90%. 

You also insisted on the dose-response relationship: smoke 5 cigs/day and you have a 2 fold excess risk of lung cancer, smoke 25/day and you have a 20 fold risk! Are those key ideas enough underscored and understood today? Is the message difficult to carry? 

 

Richard Peto:

 

Q2. 'Smoking remains one of China burning problems', was the headline of an article in the Financial Times on September 13, 2017: it focused mainly on the increase of smoke-free workplaces. The most recent study I could find about the prevalence is CTSU's based on the findings of the 2010 national survey (published in 2016). It concludes: stronger and more efficient tobacco control is urgently needed. A China Tobacco Cessation Alliance has been created in 2016, relying essentially on health professionals, but in March 2018 his President called for help to better enforce regulations. What should China do? Do the same recommendations apply to India that has the second biggest number of smokers?

 

Richard Peto: 

 

Q3. In a previous rendez-vous with Karl Lund, we looked at the situation in small Norway, where a very significant drop in smoking prevalence linked to the rise of snus has taken place, following what happened in Sweden: in both countries the prevalence is much lower than anywhere else in Europe but nobody seems willing to draw any conclusions (as reported by Karl) that would lead to a change of attitude toward snus. What is your assessment?

 

 

Richard Peto: 

 

Q4. People invoke the continuum of risk, as described by David Abrams to argue for less taxes and less regulations for less dangerous products. You did not sign any of the letters sent in 2014 by two different groups of tobacco control advocates pro and against,  to then WHO's Director General Margaret Chan about 'tobacco harm reduction'. What is your position today on tobacco harm reduction?

 

Richard Peto:

 

Q5.  What priorities would you assign today to the tobacco control movement? Are they the same as 20 years ago? Does the arrival of non combustible nicotine delivery products can change the picture? How to bring change?

 

Richard Peto:

 

 

Q6. Is there anything you would like to add?

 

Richard Peto:

 

Thank you very much.