Is public health losing its way? In his 13th presentation at the Global Forum on Nicotine (GFN), Dr. Konstantinos Farsalinos delivers a powerful address on the "ideological war" surrounding tobacco harm reduction.
As supranational organizations and regulatory bodies lean heavily toward dogmatic prohibitions and restrictive frameworks, Dr. Farsalinos argues that the foundational principles of true public health - empathy, compassion, and human autonomy - are being left behind in favor of a moralistic "quit or die" agenda.
Tune in to discover why defending science-backed, safer alternatives isn't just a matter of medicine and epidemiology, but a fundamental fight for human rights and personal freedom.
Transcription:
00:03 - 14:16
[Konstantinos Farsalinos]
Time goes by so rapidly. I mean, 13th year, it's my 13th presentation also here. Who would have known 13 years of GFN? And I think GFN represents the beacon of reason in what I call an ideological war. Defending science, defending compassion and empathy for humans, for citizens, their autonomy, in a growing authoritarian age of prohibition. And that's exactly, I think, the main subject and the main theme of this conference this year and the main issue that we all need to work on. Unfortunately, we are facing the shadow of prohibition in a very arrogant way from the opposing public health community. And that was very evident across all the themes and the presentations, the keynotes, the panel discussions. that really addressed this devastating social and economic cost of product prohibition, bans, whether it's de facto ban on the products themselves or severe restrictions in availability, accessibility, and use. The main focus of the conference is look at the evidence, and it's not only epidemiological evidence, but epidemiology is the epitome of finding the public health impact of any kind of intervention. So through GFN, and I invite everyone to also submit their work to GFN science labs, this was seriously addressed. This is a conference not of personal opinions, but a conference of creating an opinion based on evidence. Unfortunately, we are facing this prohibition cascade coming from supranational, so international organizations, including the WHO, including lately, unfortunately, the European Commission and the European Union. Although this is not a recent event, I remind everyone the prohibition on the sales of snus, the product with the most compelling harm reduction evidence from hardcore epidemiological clinical human studies, and this product has been banned throughout the EU with the exception of Sweden, but tobacco cigarettes are sold legally in every European Union country. This overreaches which is more evident in developing countries, because developing countries who don't have the resources to produce evidence-based policies, they are very much focused on what the WHO is saying, or other regions of the world, including the EU, the US, result in erosion of sovereignty, because these organizations act like pressure points trying to implement their own agenda. And what happens with prohibitive regulatory frameworks is an explosion of the illicit market. There is not a single case of a country that has implemented prohibition where the end result was not the development of a strong criminal activity of an illicit trade. And I'm not talking only about developing countries like India, for example, or several Latin American countries, but also very developed and rich countries, including completely isolated countries such as Australia. It has been a disaster. And consistently, the regulators fail to acknowledge that. They don't want to admit the reality. Within the conference, some other areas which are largely forgotten have been addressed, like Disparities in terms of gender, women, and smoking. Tuberculosis patients, a major, major problem. Smoking is a risk factor for tuberculosis and a risk factor also for an adverse outcome in tuberculosis patients. And of course, marginalized drug users and GFN organizers have a very strong experience in the field of marginalized substance use. So what we see as a prevailing argument is the quit or die dogma. So you will either quit by yourself or with things that we approve to be used in order to quit, rather than giving you all the necessary tools, all the available tools, in order to make your own personal choice. And unfortunately, this is not people-centric, unfortunately, or anthropocentric, to use a Greek word. It is based on ideology and dogmas. The foundational principles of public health are about meeting people exactly where they are, minimizing harm with the best possible way and with all the methods that we have available, and prioritize the improvement in quality of life. Public health is not about morals. is not about liking or not liking the use of any sort of substance. That's not only about nicotine. It's about everything. And unfortunately, in pursuing this dogmatic moralistic approach, there is a staggering lack of common sense in the arguments. And that's why it's extremely difficult to engage into a debate. with the opposite side. And that is why, despite efforts, particularly in the first years of GFN, to invite people with different views, they have systematically ignored the invitations. In some cases, they did not even respond to invitation emails. I remember discussing with Pat and with Jerry during the first or second year of GFN, we wanted to invite Stanton Glantz. And he received an invitation that he could use. whatever amount of time he wanted. He would choose whether to accept questions or not. He would choose the subject of his presentation, and he didn't even respond to the email, let alone reject the invitation. Unfortunately, what we're seeing is a blunt and disregard of evidence and cherry-picking a very, very small part of the available evidence. Today, you know, it's not 2013 when the TPD2, the currently implemented TPD, was based on basically lack of evidence and only common sense. Today, we have a lot of evidence, but still no common sense. And that results in sacrificing health and compassion for people in order to pursue our own dogmas. And unfortunately, that's not the philosophy of public health. So unfortunately, this discussion concerning tobacco harm reduction is no longer a scientific debate. It is a puritanical ideological debate. It's a political case with predetermined restrictive policies which are punitive for smokers. And it involves suppression of available evidence or even targeting evidence that doesn't fit the dogmas and the ideologies. So on one side, we have the biological medical health war, because health is not only about biology, it's about also psychology, it's about sociology. And the target is smoke-related diseases. It's not the choice of someone to use nicotine or not. It's not to become ill and not to die from it. And the method should be evidence-driven and pragmatic. But unfortunately, there is very little discussion about it from the international organizations and health associations. On the other side, we have the ideological war with a demonization of nicotine and users of nicotine, unfortunately. It's not only about the substance, it's about the people who use it. They're completely marginalized. They are considered as doing something sinful, doesn't make any sense, but that fits their own decisions. There is a deliberate suppression of data. I mean, listen to the recent statements by DG Santer of the European Commission, who said that non-combustible nicotine products are associated with comparable risks to smoking. not only that they are harmful, but they are comparably harmful to smoking. It's an unprecedented, unscientific statement. It doesn't make any sense. But this is the global reality today, even in the developed world. But it's not only about the biology, it's also about human rights. Harm reduction for everything, including nicotine, is about defending freedom, personal autonomy, self-determination. And adults have the right to make informed choices to their bodies. And they have the right to access to reliable, balanced information, because even within the ethics code of medicine, it's always about free, informed decisions. It's never about implementing what I feel is good or better for you. So denying access to safer alternatives is not just a manipulation of science. It's also a human rights violation. And this, I think, should be further emphasized in future events. Now, GFN has been criticized as being an echo chamber. There is only one side of the story being expressed. And yes, it's a closed system. It has become a closed system, not because we wanted it to be, because there is no other way. However, we need to understand the value of this echo chamber. All of us who are on this side, on the harm reduction side of the story, we are experiencing such intimidation such lack of common sense and reasoning in the global debate about harm reduction that it gets really disappointing. You know, for many times, especially recently, I have considered abandoning this field at all. I thought it's not worth it. It creates such emotional and psychological stress. And GFN has always been the... shelter for us has always been the inspiration to continue working in this field. And we need to make sure that this continues every year and perhaps not just on an annual basis, even more recently. And that's a very important role for an echo chamber GFN. It doesn't matter if it's an echo chamber or not. It has to be sustained and it has to grow year after year. Because we need to find the public health compass again. We need to focus on evidence-based information, on human rights, on empathy and compassion, And we need to be the drivers of the debate in the near and far future. We are far from the end, unfortunately, unreasonably far from the end. So we need to keep on fighting. So there is no point being silent. We have to stand up. We have to react to this tide of misinformation. And we need to take care of people, their personal, but also public health interests. Promote true public health, defend human rights, and fight for the well-being of everyone. So thank you for being here. I hope you will be here again, not just you, but many more next year and every year. And because there is a fight right now in the European Union, a fight for the access to harm reduction products, I will invite everyone to submit their feedback. I'm not talking only about scientists. I'm talking about users, consumers, potential users, that is smokers, They need to provide their feedback to the European Union, preferably using a PDF document, because the European Union does an excellent job in discouraging everyone from submitting comments. They have a 4,000 character, not word, character limit, which is basically useless. But fortunately, they give you an opportunity to attach a PDF file with your view comprehensively expressed. So I invite everyone, whether an activist, a scientist or an advocate to submit as many comments as possible in order for common sense to prevail. Thank you very much.