5 reasons Amy Khor’s answer to Leon Perera is bad, bad science

Mar 04, 2017 01.03PM |
 

by Daniel Yap

SENIOR Minister of State for Health Amy Khor’s answer to WP Non-constituency Member of Parliament (NCMP) Leon Perera’s question about heated tobacco products exposed a weakness in the Ministry of Health’s policy on alternative tobacco products, and its approach to science. Smoking is a big risk for our healthcare system, and if alternative products can lower that risk, then perhaps we need to consider them more carefully.

Heat-not-burn tobacco may be strange to Singaporeans because it is banned here, but it accounts for more than five per cent of the tobacco market in Japan after being on the market for just two years, and is catching on in many major markets worldwide. Its popularity is due to rising fears of the effects of second-hand smoke and also smokers’ desire to quit or reduce harm to themselves and their families.

But since Singapore plays host to research and development facilities of tobacco companies, it’s odd to think that we know so little.

How Philip Morris International's iQOS system works
At least we know how Philip Morris International’s heat-not-burn iQOS system works

Plus, since we are at war with diabetes (of which smoking is a major risk factor), it behooves us to be interested in even preliminary studies of products that claim to reduce risks, including e-cigarettes and heat-not-burn products.

I have family and friends who smoke and I would like to know whether this product (or any other, like vaping) could reduce the harm they are doing to their bodies (and to mine). I would think every smoker’s family does.

It takes time, of course, but Dr Khor did not say that studies were underway. Are they? I know the budget is tight, but this is a budget for the future, isn’t it? Why not spend a few million now to potentially reduce future healthcare costs by billions of dollars?

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1. Don’t know means don’t know, not “no”

Dr Khor’s reply sounds like a defence of the G’s policy of banning heat-not-burn products, along with e-cigarettes and non-smoking tobacco. If a lack of information exists for an issue as important as smoking, then it is the duty of the G’s scientists to go and find out more.

If we don’t know, we should be open to trying. I’m not saying we should completely legalise alternative products to all and sundry. Even Mr Perera’s suggestion to start with giving these products to smokers trying to quit will be a start.
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2. Citing nicotine levels as a reason why heat-not-burn is bad

Mr Perera was asking about the overall risk of heat-not-burn products. Dr Khor answered with how nicotine levels were comparable to regular cigarettes. This answer is strangely off-track.

Smokers are addicted to nicotine but killed by tar and other chemicals. Shouldn’t the answer be about tar and carbon monoxide instead? Or at least one of the many other chemicals in cigarettes that could harm your body?

And if lower levels of other chemicals are detected in heat-not-burn products, then the same level of nicotine would be a good thing because it would be easier for addicts to switch products because they get the same high while causing less harm to themselves and others.

We practise “reduced harm” policies for other vices. If heat-not-burn products and e-cigarettes reduce harm, we should allow them, and the health authorities should commit to this and then go research it.
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3. Criticise the research, not (just) the researcher.

Dr Khor is a little too dismissive of the research done by tobacco companies when she says “while there have been claims that such tobacco products are less harmful…these claims are made by the tobacco industry”. It is one thing to know that a person or organisation is an interested party in a study or has lied in the past, but that isn’t what makes a study true or untrue.

Research done by tobacco companies on heat-not-burn stretches back to 2008. And it is extensive, with publicly available methodology. Philip Morris, for example, has submitted a two million-page dossier to the US Food and Drug Administration on the effects of heat-not-burn. If heat-not-burn is as harmful as cigarettes, as Dr Khor presumes, then we need to dive into the research, not ignore it.

Since there is currently no research to disprove the tobacco companies, why not peer review their studies? Why not attempt to replicate them? Why not conduct independent studies? That is how one refutes (or proves) another’s research, not by a mere claim that the other party is an interested party. That’s what we do with big pharma, so apply it across the board.

Good science was responsible for linking cancer, diabetes, heart disease and a host of other ailments with smoking. We need to drop the lazy rhetoric and do the hard work of science.
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4. “There is no safe level of tobacco use”

This was the answer Dr Khor gave to Mr Perera’s query about trialing reduced-risk products to help smokers who have registered for smoking cessation programmes quit.

Not only does it fail to answer Mr Perera’s question, the answer hides behind a truism. Of course there is no safe level of tobacco use. There is also no “safe level” of particulate pollution. There is no safe level of red meat consumption. But we know that a PSI below 50 is considered “healthy”. We know that one can eat a moderate amount of red meat and not be considered “at risk” by doctors or insurers.

We want to know whether heat-not-burn is safer than cigarettes, not whether tobacco is bad for you. Big tobacco is claiming that heat-not-burn is safer. There are no claims that it is safe.
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5. The “gateway effect” and other “evidence from other countries”

Dr Khor says that “evidence from other countries” shows that heat-not-burn products have emissions that are not too different from cigarettes. However, a November 2016 Ontario Tobacco Research Unit report on heat-not-burn products comes to this conclusion:

“To date, we have not found new independent science that has assessed the harm reduction potential or the acceptability of the current generation of heat-not-burn products… If independent science finds that the new heat-not-burn products do indeed considerably reduce harm and are widely acceptable to smokers, an opportunity would arise for eliminating the sale of the higher risk combustibles.”

So other “evidence from other countries” so far is a well-documented seven-year-long and counting study by UK health authorities disproving Dr Khor’s “gateway effect” fears, and showing the exact opposite.  Dr Khor mentioned the study but didn’t have the time to explain why she didn’t accept its findings.

Instead, her evidence backing up the “gateway effect” is only half a story – that adolescent e-cigarette use in the US is growing quickly (ten-fold since 2011). The other side of the story, which she left out, is that there was a sharp decline in conventional cigarette use over the same period. I’ll not be one to confuse cause and correlation, but telling only one side of the story robs us of the facts.

Add to that the fact that the UK government has concluded that e-cigarettes are definitely less harmful than regular cigarettes and you’ve got to ask: Could the Ministry of Health, in their over-zeal to protect Singaporeans from “potential harm”, also be holding us back from potential benefits? All I know is that we can’t justify our policy positions with bad, bad science.

 

Featured image by Flickr user Vaping360. (CC BY 2.0)

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