The biggest victims of WHO’s anti-harm-reduction efforts are in India

by Carl V Phillips

Tobacco harm reduction supporters and vapers have been (rightly) incensed by the World Health Organization’s (aka The Organization WHO Must Not Be Named) recent disinformation about e-cigarettes and proposed policies that would inappropriately restrict them. But there is good news for >99% of those of you speaking up about this: You live in a country where an extremist cabal at the WHO has limited influence. Not so for the unfortunate citizens of India and neighboring countries.

England has already explicitly stated that they will not ban vaping indoors in spite of the WHO calling for that. It is difficult to imagine that they, France, Germany, and especially the United States would yield to such diktats (i.e., recommendations) from WHO. That is not to say that WHO’s lies and bad recommendations do not cause harm in those countries. They still provide fodder for fellow extremists and can trick policy makers. But no more so than the pronouncements of extremists and liars at universities in California and Bath.

This is not the case for India and other South Asian nations (nor for much of Africa, or Canada and Russia for that matter, but those are topics for another day). In India, the public health apparatus is pretty much beholden to WHO due to a combination of limited domestic resources and expertise, massive WHO expenditures (which buy both useful services and beholden people), and the revolving door (officials do not want to annoy the organization that might one day hire them for an overpaid job in Geneva). After the WHO calls for a near-ban on e-cigarettes, India is likely to comply.

This is actually a relatively minor problem for the people of South Asia compared to WHO’s war on smokeless tobacco (ST), which earned WHO the third spot in last year’s anti-THR liars of the year, even before their attacks on e-cigarettes had risen to more than random chatter. Oral dip products used there — gutka, paan, and others — are very cheap and widely used. They are far more popular than smoking in many places and may be even worse for the user’s health (in particular, because serious problems occur at a much earlier age), though the epidemiology is so lousy and fraught with propaganda that it is hard to be confident about that conclusion. These products are not ST, as I have explained at length — they may (or may not) contain tobacco as one of their ingredients, but it is clearly not what is causing the harm.

Gutka (along with similar products) presents an even more obvious role for ST in THR than does smoking. Smoking is sufficiently different from dipping that a lot of people would not consider making such a change (thus, e-cigarettes). But dipping tobacco instead would be a natural transition from gutka. It would not be as potent and probably would be somewhat more expensive, which could be a problem for many extremely impoverished gutka users. But it could be produced entirely domestically and so could presumably be made cheap enough for many to afford, probably cheaper than cigarettes (which are unaffordable to the poorest) and a lot cheaper than e-cigarettes. A product that is roughly as low-risk as Western smokeless tobacco could thus replace a lot of use of a product that is roughly as harmful as smoking.

And I do mean a lot. The number of people there using gutka and such is in the order of a hundred million. It dwarfs the number of people using e-cigarettes or smokeless tobacco and is a substantial fraction of the total number of smokers in the world.

So why is no one trying this? Because the same moralizing anti-harm-reduction activists that attack THR in the West dominate — particularly via the WHO — discourse and policy there. Moreover, that same cabal, intent on demonizing the use of snus and chew in the West, wants people to believe that the South Asian products are smokeless tobacco and thus believe that ST is harmful to a measurable degree. Even some people who are ostensibly supporting THR fall for this trick. These propagandists are willing to throw Indians under the bus in order to advance their disinformation campaign in the West. The result is that India officially declares these products to be smokeless tobacco and even requires warnings about tobacco use on them (though driving the product to the black market in many jurisdictions may have hampered such efforts for obvious reasons). There are no such warnings about the ingredients that actually cause the harm. The press tends to repeat the lie that these products are harmful because they are tobacco. Thus, few have any idea that they could substitute low-risk tobacco for this high-risk product; they are told it is tobacco.

This is not to say the WHO’s lies about e-cigarettes are not hurting Indians too. The growing middle (and even not-dirt-poor) class can afford cigarettes, and so there are a lot of smokers too. Many of them can also afford e-cigarettes. (Correspondents have told me they are rather hard to acquire; the article quoted below claims otherwise, which means this might have changed recently — or it might be another lie in the article.)

But it is even easier to lie to the masses in places like India than it is in the West, and there is apparently little incentive to not do so. In the West, even WHO flacks would be hesitant to say this, which appeared in the major newspaper, The Hindu, today:

Dr. Vinayak Mohan Prasad, project manager for Tobacco Control in WHO in Switzerland told The Hindu that smart marketing and inadequate information on the nicotine content in e-cigarettes has created a false impression that these devices are not as harmful as regular cigarettes.

Just in case some readers might not interpret that in a strong enough manner, The Hindu made sure by saying, in the first sentence of the article,

The World Health Organisation (WHO) has red flagged the growing market for e-cigarettes in India, underlining that the use of the devices is no less harmful than traditional cigarettes.

Naturally, the article has a few more of the usual lies, but the lie that e-cigarettes do not help people quit smoking hardly matters when you are already lying that they are just as harmful as smoking.

The Westerners who are active in promoting THR tend to focus on Western countries. This is understandable and probably the best strategy (better to win here where we can, and create a good example to imitate, rather than try to bang our heads against the wall in countries where the WHO and associated liars basically own the place). But we should not forget quite how big the world is, and especially not that WHO is hurting people elsewhere a lot more effectively than they can hurt us.