To the 1.3 Billion People Who Smoke Cigarettes: We’re Very Sorry.

A Formal Apology from Public Health

Preamble

This apology letter is sent on behalf of the global public health community. It may seem a little presumptuous of me to take this on, but I have been around long enough to recognize a catastrophic blunder when I see one. To be clear, this is not a personal apology letter but one written on behalf of all public health institutions around the world, including the World Health Organization (WHO). No individuals, institutions, or organizations have endorsed or even asked me to write this letter, but someday they will appreciate it. History will not be kind to those who tried to impede access to the “cure” for the biggest preventable health crisis in the world. I urgently need to get this letter out to the 1.3 billion people who consume tobacco. If you could kindly pass this on to at least one person, it would be a great start. Here goes.

Dear friends and global citizens who smoke cigarettes:

It is truly embarrassing and inexcusable the way you have been treated by the public health community. By their actions, they are basically telling you all to drop dead. I would understand fully if you just ripped this letter up or lit it on fire (I know you carry a lighter), but I sincerely want to make things right. I don’t want you to prematurely suffer and die for no good reason. You have things to do, places to visit, jobs to finish, stairs to climb, books to read, festivals to attend, and grandchildren to play with.

The great news is that you can now have nicotine without getting sick and dying young. It’s true! All the benefits of nicotine without all the horrible health consequences. Vaping, heated tobacco, and nicotine pouches can all work to get you off cigarettes without sacrificing the pleasure. Compared to cigarettes, all these products carry a small fraction of the risk and there is no reasonably informed person who should be telling you otherwise.

It is astounding and unethical that the public health community doesn’t want you to know this. In fact, you are being systematically denied access to products that could dramatically improve your health and ultimately save your life. You have been exposed to massive and well-funded disinformation campaigns that have deliberately created uncertainty and fear. This has not only generated confusion for you, but also among the non-smoking public, health care providers, and policy makers.

We have known for over 50 years that cigarettes directly kill half of the people who use them and cause disability and suffering to most of the rest. It is estimated that over 8 million people die every year from tobacco. For this reason, public health organizations have focused their attention and resources on reducing smoking rates. In fact, we often congratulate ourselves on our progress as smoking rates have fallen – at least in high income countries – where fewer young people are starting to smoke and there is a steady and predictable die-off of current smokers.

However, celebrating success on the backs of people dying is hardly a reason to take a victory lap. The focus should be on getting people who are already smoking to quit, and we have done a very poor job at that. The medical community has offered a range of treatments, including nicotine patches and some pills, but they help less than 10% of people who try them.

But now, the outlook for people wanting to quit has dramatically changed with a range of safer nicotine alternatives. These are not only extremely effective ways to quit smoking cigarettes but provide alternatives that have major advantages for the consumer, bystanders, and society at large. Tragically, public health leadership has not caught up and under the pretence of “precaution” and “doing no harm” have created massive harm by lying to you about their safety.

The approach to vaping and other new nicotine technologies have essentially been added to the old tobacco control playbook which was already failing. Instead of using proven public health approaches like empathy, engagement, and harm reduction, we have chosen shaming, isolation, and prohibition. These strategies have disproportionately impacted the poor and the marginalized who are unlikely to ever quit. These policies have also directly led to a burgeoning and violent illicit tobacco market, that fills the streets with unregulated and potentially dangerous cigarettes and nicotine products. A total disaster from a public health perspective.

To deflect blame and provide cover for poor decisions, we have identified a villain. The tobacco industry. Here is a group of companies that have presided over a highly profitable global experiment in human suffering by manufacturing and promoting cigarettes over many decades. Safer nicotine products were never their idea. In fact, such disruptive technology is the last thing that these companies want. However, if people are switching to safer products, they have adjusted their business accordingly and have added alternative nicotine products. In fact, some of the largest tobacco companies plan on phasing out their cigarette business altogether which is amazing. It is ridiculous to deny you life-saving products because some are manufactured by companies that also make cigarettes. Who cares who makes safer nicotine products, just get them out there.

This apology letter would not be complete without acknowledging the outsized financial contributions from Michael Bloomberg Philanthropies who offers unlimited funding to any organization who wants to ban nicotine products. It seems incongruent with his other global public health initiatives – polio eradication, road safety, and obesity reduction – but he got terribly confused around safer nicotine products. He is now funding organizations that only serve to protect tobacco companies and prolong the global cigarette epidemic.

I realize that this apology is too little, too late for the millions of people who have been denied life-saving nicotine alternatives. But it is not too late for you to act. Become educated about the cure for cigarettes and give vaping, heated tobacco, and/or nicotine pouches a try. Demand that political leaders grant you access to regulated, accessible, enjoyable, and safe nicotine products. Live better and healthier lives.

Sincerely,

Mark Tyndall MD ScD FRCPC

Concerned Public Health Activist and Change Maker.