Nearly 700 people participated online when the THR Summit Spain 2023 was broadcast live on Thursday evening. Doctors met researchers, activists and health scientists in a discussion on e-cigarettes and the role of technology in smoking cessation and harm reduction.
THR SUMMIT SPAIN. "You don't have to be a doctor to understand the difference between smoking and using an electronic cigarette. Smoke is smoke, vapour is vapour. It's all about temperatures and heating. There is no doubt that vejpning is a safer way to use nicotine. The question is rather HOW much safer? We can't answer that until we have epidemiological studies," the cardiologist said. Konstantinos Farsalinos, during the discussion at the THR Summit Spain.
Worrying developments for smokers
The theme of the conference centred around e-cigarettes and the relative risks of harm, but also how doctors can use the technology to help smokers quit. The debate on vejping has been going on for a long time across the EU, not least in Spain where smoking rates are among the highest in Europe. At the same time, few official institutions have highlighted harm minimisation as a strategy to reduce the harms of smoking.
"This is very worrying. Smoking takes many lives every year. And despite the fact that we introduced strict anti-smoking laws almost 20 years ago, there is no significant reduction in smoking in Spain. It is therefore of utmost importance that we discuss alternative ways to break this pattern. E-cigarettes are one of several methods we need to discuss." noted Dr. Fernández Bueno, surgeon at the University Hospital of Madrid in his opening speech.
Unacceptable to stifle discussion
At the same time, opposition to the technology is huge, especially from anti-tobacco groups and pharmaceutical companies, but also from the World Health Organisation (WHO). The conference was originally scheduled to take place in the Juan Carlo University hall in Madrid. However, the Spanish public health authorities and representatives from the WHO urged universities to withdraw from the collaboration at the last minute. The Tobacco Harm Reduction Summit Spain became an online meeting instead. Despite the turmoil, nearly 700 people participated online. Far more than had previously registered their interest.
"We have seen completely unacceptable behaviour from our authorities. Just because their officials have a different opinion on an issue, it is not ok to try to stop a scientific debate. Ironically, this has led to more people attending today than if the conference had taken place in person," said Dr Fernández Bueno.
Anti-tobacco movement attacks e-cigs
Clive Bates, a consultant in the field of harm minimisation and sustainability, said that the debate on e-cigarettes is really about something other than public health.
"There is no doubt that e-cigarettes have the potential to replace cigarettes in the market. We also know that harm minimisation works; a proof of concept is Sweden, where snusing has displaced smoking in large parts of the population. The result is significantly fewer deaths from smoking-related injuries. But this challenges the fundamental ideas that have guided the anti-tobacco movement since its inception. A consumer-driven revolution does not favour them or their funders. That's why we're seeing their gun turrets now targeting e-cigarettes and nicotine instead of the real problem: smoking." said Clive Bates, who chaired one of the seminars at the conference.
"Must look at the best interests of the patient"
Josep María Ramón Torrell, a doctor and professor of medicine, noted that the open battle over e-cigarettes is affecting both smokers and doctors in Spain. Currently, as a doctor, he is not allowed to recommend the products as a smoking cessation tool.
'As a doctor, I have to look after the best interests of the patient. If the patient is a smoker, it is my job to get him or her to stop. Today we have access to nicotine medicines, which work for some but far from all. Really bad smokers will not quit just because they are prescribed a tablet and some counselling. Smoking is part of people's everyday life, their social life. That's where e-cigarettes come in. I have seen hopeless cases of heavy smokers switching to vejping and staying smoke-free without any major problems. Therefore, it is of utmost importance that our politicians regulate these products wisely, in the same way as they regulate nicotine medicines," he said. Josep María Ramón Torrell, during a discussion with Spanish doctors and health scientists.
More smokers in Spain
At present, between 29 and 32 per cent of the population in Spain. The EU average is 20 per cent. In Sweden, the proportion of smokers is close to 6 per cent - according to EU Barometer this is probably due to the replacement of snus by smoking among men aged 26-46 in Sweden.
The proportion of vejp users in Spain, as in the rest of the EU, is 1-2 per cent of the population. In the UK, where vejping is recommended as a substitute for cigarettes, the proportion of vejp users is just over 7 per cent (smoking has declined from 20 to 13 per cent since 2011).
The same trend we see in Sweden although, thanks to snus, we started at a much lower level.
The last % smokers are incredibly difficult to get rid of if you only use restrictions, punitive taxes and threats/intimidation as weapons.
In the last 10 years, the number of smokers in Sweden has decreased by almost exactly the number of e-cigarette users we have today. You could say that harm reduction has, despite the authorities' reluctance, accounted for all the reduction over the past 10 years.
Time for politicians to wake up from their hard core denial strategy and realise that e-cigs, snus and nicotine pouches are the only way to eradicate tobacco smoking from our society.