Greek physician and researcher Konstantinos Farsalinos faults WHO for playing rhetoric on tobacco harm reduction

Renowned Greek physician and senior researcher at the University of Patras and the School of Public Health-University of West Attica in Greece, Konstantinos Farsalinos, has criticised the World Health Organization (WHO) for using rhetoric in the application of harm reduction in smoking.

Farsalinos, in his presentation at the 2022 Global Forum for Nicotine (GFN) in Warsaw, Poland, observed that the application of the strategy has been minimal and largely unacceptable by the tobacco control movement.

“Harm reduction is not just about reducing the harm from substance use, but it is also about addressing stigma, marginalization, criminalization, inequalities and oppression. This is done in an effort to protect health, dignity and liberty, including the liberty of making informed personal choices,” he said.

Konstantinos Farsalinos

Farsalinos has been conducting laboratory, clinical and epidemiological research on smoking, tobacco harm reduction and e-cigarettes as principal investigators since 2011. He authored the first systematic review on e-cigarette safety/risk profile, published in 2014.

Additionally, he has performed research and published studies on heated tobacco products. His findings have been presented in major international scientific congresses and his studies were used in preparing the regulatory framework on e-cigarettes by the European Union.

At this year’s summit, he made a presentation titled: Science, Scientism, Prejudice and Ethics in Tobacco Control. Farsalinos disclosed that smoking rates have been continuously declining, particularly due to the popularity of electronic cigarettes (E-cigarettes).

He stated that during the period of increased E-cigarette popularity, which mainly involved experimentation, especially among adolescents without a history of smoking, the frequency being regular daily use is extremely rare among non-smoking adolescents.

He cited that in the United States of America (USA) the current cigarette use among adolescents is reportedly continuously declining.

Farsalinos criticised proponents of the precautionary – “better safe than sorry” – principle for lacking objectivity in their campaign. He argued that the absence of a well-designed, structured procedure makes decision-making distorted by cognitive and interest-based biases, emotional reactions, ungrounded public perceptions and pressures from lobbyists, as well as for popular but unreliable approaches for analysis and forecasting.

“Furthermore, the precautionary principle is asymmetrical because it favours the status quo versus progress, which stifles innovation. It fails to account for the fact that the risks created by inaction and technological stagnation are at least as real as those of action and technological advancement. It leans towards authoritarianism. No use of even the least harmful product is the only acceptable option. It protects people from themselves, denies individuals the freedom to make trade-offs in ways recognized by common-law approaches to risk and harm,” he said.

He added that the principle is vulnerable to corruption because of its vagueness, inconsistency and arbitrariness which appeals to regulators who enjoy expanding their powers and wielding them selectively.

“An increase in corruption and arbitrary regulatory power is further ensured by making precaution and prevention the default assumption, whilst providing a moral background that may be honest, but that may also be dishonest. There is nothing wrong with the precautionary principle as long as it is not used for decision-making or at least as a basis for decision-making,” he said.

In his preamble, Farsalinos disclosed that there are over 1.1 billion smokers around the globe. He described this number as tremendous and a huge problem demanding scrutiny about the outcome.

“Unexpectedly, a growing, overwhelming, authoritarian and restrictive-prohibitory approach, up to the point of equating tobacco cigarettes with lower-risk, combustion-free harm reduction products. We have a clear violation of the principle of risk-proportionate regulation. There is a clearly prohibitory agenda based on risk aversion and (opposed) risk elimination,” he said.

Farsalinos criticized the proponents of precautionary principle, saying they have lost focus by criticizing the behaviour of nicotine use instead of focusing on smoking-related breath harms, and this is moral judgment and outright prejudice.

“The problematic stance of tobacco control is that it’s persistently dogmatic, continuously cherry-picking and frequently misinterpreting evidence; they are attempting to suppress any criticism. They are engaged in a fear mongering campaign based on an application of the precautionary principle, emphasizing potentially devastating future risks and continuous uncertainty – invariably assuming that worst case scenarios are the only possibility. Their fear mongering campaign includes E-cigarettes or vaping use-associated with lung injury,” said Farsalinos.

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