October 15th, 2015

WHO’s Director General’s casual irresponsibility promotes death and disease through protecting the cigarette trade

I’m always wary of calling a new low in public health, given the competition down in its murkiest, most depraved depths, but here is a strong contender…

Today I saw an article about e-cigarettes in China in which Dr Margaret Chan, Director-General of the WHO called for national governments to ban e-cigarettes.

“Margaret Chan, the WHO’s director general, expressed concern and urged caution. “E-cigarettes will prompt young people to take up smoking. I recommend that national governments ban, or at least regulate, them” she said. Tough controls urged for e-cigarettes in China – China Daily (p2)

Dr Chan is the most senior health official in the world. Assuming she was reported correctly, this is the most despicable and casually irresponsible thing I have ever heard from a senior official in public health. And that’s a high bar. This statement will cause thousands of needless deaths if governments do actually follow her advice and ban e-cigarettes – let’s hope they have more sense. The term for the causal pathway between a bureaucrat’s statements or actions and a premature death that happens as a consequence is ‘desk killing’.

Fact: Dr Chan does not call for banning actual cigarettes, products that are 20-100 times more dangerous than e-cigarettes and kill 1 in 2 long-term users and maybe a billion people in 21st Century, according to, er, WHO. Nor should she, and it would be futile to try – the reality of prohibition is inevitably miserable failure.

Fact: the world e-cigarette market is about $6 billion, though growing rapidly, whereas the world cigarette market is about $800 billion retails sales (Euromonitor). She would like to kill off a disruptive technology in its earliest stages and leave the huge and still-growing cigarette market intact.

Fact: 49% of men in China smoke and China accounts for about one-third of world cigarette consumption

Fact: most of the world’s e-cigarettes are made in China

Fact: there is no evidence anywhere that e-cigarettes ‘prompt young people to take up smoking‘ or cause any material harm at all. They do however offer very good options for smokers who wish to radically reduce their risks, but not give up some of the harmless things they like about smoking. Why does the head of WHO know so little – or care so little about facts? Note: the recent papers in JAMA and JAMA Paediatrics provide no such evidence; see here and here.

Fact: there is no ethical justification for restricting Chinese, or any, consumers to only the most dangerous ways of taking nicotine. Nor is there any obvious justification for protecting the Chinese national tobacco monopoly from competition from innovative pro-health alternative businesses, including from other firms in China.

Fact: Dr Chan is almost completely unaccountable and bears no responsibility for the consequences of statements like this, even if they are factually wrong and highly likely to cause harm to health, damage good businesses and violate ethical and legal principles. Poor accountability is the only way that statements like this can be explained.

Fact: Dr Chan is in her second term and we are likely to be blessed with her leadership until 30 June 2017.

But really? What is the point of WHO if it carries on like this? WHO needs to see the huge opportunities rather than be obsessed with theoretical threats. And it needs to stop propping up the cigarette business right now – it’s not that hard to understand how banning e-cigarettes might just do that.