27 June 2019
By Dr. Jana Olson
This article is part of a series. You'll find my notes from day 2 here and day 3 here.
This is my first year attending the Global Forum on Nicotine (GFN), and it’s been a warm welcome. Literally, because it was over 30 °C all week in Warsaw.
At the first session every single audience member was asked to introduce themselves and say something. I found this to be a particularly pointed way of saying, “It’s time to talk about nicotine” as this year’s tagline states.
The forum is described by its organizers as “the only international conference to focus on the role of safer nicotine products that help people switch from smoking.” The schedule, just like the venue, was packed. The foyer was peppered with various booths hosted by companies and other organizations, including our own, busy with people asking questions.
As I was waiting in line at registration, I overheard a group of people discussing how there are over 600 attendees this year from over 70 countries. That’s so many that the organizers had to close registration or risk overfilling the venue.
This is Dr. Shaun Evans, ready and waiting to answer questions on our products and science.
Better alternatives: focus on technology
The highlight of the first day for me was the ISoNTech sessions. Dr. Erik Auguston from JUUL kicked off with some hard facts on quitting, saying that while around 40% of people will try to quit, less than 5% of quit attempts succeed. At least 28.3% of adult smokers had quit smoking cigarettes completely after using the e-cigarette for 3 months. Further, flavors are an important part of e-cigarette use, as noted by the fact that study participants who exclusively used certain non-tobacco flavors instead of tobacco flavors were around 30% more likely to abstain from smoking a cigarette. These data really highlighted the fact that smokers that don’t quit need options to choose from that can help them switch completely to better alternatives.
Dr. Gizelle Baker, Director Scientific Engagement, presented the story behind our Platform 1 product. Our original heated tobacco products were introduced in the late 1990s and early 2000s with an external heating element, were too bulky for many users, and had an insufficient battery life. Since then, Platform 1 has been redesigned in several ways, including the new heat control blade that heats the tobacco from the inside out, making it smaller and more efficient.
Dr. Tryggve Ljung MD, from Swedish Match, presented data on the company’s tobacco-free snus product, which aims to be a better alternative to snuff and snus products. David Valerie, co-founder of Vapetrotter, described his new website, which serves as a source of market research that is independent of the nicotine industry to further inform evidence-based decision making.
Another new product was also described by Alexandre Scheck from Enovap. Their e-cigarette product contains two different pods, one with nicotine and one without. The device collects data on the vaping habits of the user, and then helps the user to step down their nicotine level over several months.
Achieving change: focus on the people
The last session of the day included the Michael Russell oration, given by Dr. Ronald Dworkin MD, a practicing anesthesiologist. His oration explained why tobacco harm reduction is made more complex because it combines the scientific and the personal.
Dr. Ronald Dworkin, M.D., a practicing anesthesiologist, delivering the Michael Russel Oration during GFN 2019.
"The closer we get to our subject and the more we know, the more the scientific method breaks down," he said.
Dworkin expanded on this point later in his speech, saying “Public health has turned to a realm of ideologies perhaps best illustrated in the way it has turned science itself into an ideology.” He told a story about how a public health professor at a conference had denounced the sexism of the operating room of caesarian sections, where the operating table was always tilted to the left in a way that spilled blood onto only the nurses' shoes, not the male doctors’ shoes.
He spoke up from his expertise as an anesthesiologist, explaining that the tilt of the table prevented dangerous blood pressure drops by avoiding pressing on the vena cava, a major vein. He also explained why the nurses and doctors had to stand in those specific places for the surgery. The tilted table saves lives. Making a change to appease concerns of sexism would have endangered thousands of women.
This story, Dworkin alluded, is comparable to tobacco harm reduction. If experts in public health focus on specific and narrow perspectives, they risk making recommendations that could hinder public health overall. We can’t forget that there are real people and complex context behind the statistics. We need to focus on individuals to truly understand what’s going on, and yet we need to make decisions with the big picture in mind.
To read more about GFN, you can find my notes on Day 2 here.