Absolutely outstanding. That’s my carefully considered assessment of the Global Forum on Nicotine in Warsaw that I was fortunate enough to attend two weeks back. I say this despite the mosquito bites and the fact that the weather was rather warm for me. The event was one of those that provide a buzz and an energy that comes back to the workplace with you. This was fuelled by an outstanding array of speakers and a vibrant audience mix. Discussion and argument were not limited to the auditorium or breakout rooms, but instead could be heard throughout the venue, over lunch, during coffee breaks. There were attendees from every continent (well, ok, I didn’t actually meet anyone from Antarctica). Academics, clinicians, researchers, harm reduction advocates, retailers, product developers, policymakers, and- most importantly - vapers and users of other tobacco harm reduction products, all mixed together sharing views, experiences, and- as we should expect- differences of opinion. It certainly lived up to the conference strapline Its Time to Talk About Nicotine and the rich promise of a genuinely horizontal approach.

For me some of the highlights were sessions that looked at vulnerable groups: those who are homeless, experience mental health problems, or have substance misuse problems. These are individuals who are so often left behind by the health improvements that the rest of society benefit from. As one presenter starkly put it “my clients don’t get cancer from smoking, they don’t live long enough”. The direct health gains and engagement potential of helping people switch from smoking is massive. If we had a means of reducing the harms from alcohol or heroin in anything like the magnitude offered by vaping or snus, we’d be wildly celebrating one of the great public health gains of the last 50 years. The reality is a number of excellent small-scale projects but a failure of systems to grasp the massive potential to transform lives and health costs.

Peter Hajek pointed out the often-overlooked history of the use of oral tobacco, including for crews of submarines, and outlined the concerns of many whose objections to alternative nicotine products were hinged on concerns about young people. Many speakers considered the issue of competing science and research, and how this was relayed in the media. There is no doubt that many individuals continue to smoke because they have read scare stories on the “dangers” of vaping. Ronald Dworkin delivered the Michael Russell oration, with a powerful critique of public health systems that often seem to lose sight of the reality of being human. He also outlined the use, and potential abuse, of science and the value of professionals being humble in dealing with individuals’ adversity.

The issue of science, evidence and its application was one of the recurring themes of GFN, hardly surprising in one of the most contested and polarised areas of current health debate. Funding dictates a great deal and it is something of a tragedy that we lack a vigorous, independent framework that can assesses and analyse research, be it from the tobacco or nicotine industry or from those whose funding or ideological positions predetermine their opposition. As Dr David Abrams put it, we need to overcome belief and convictions. It fell to a “pure scientist”, Dr Roberto Sussman, GFN’s resident Theoretical Cosmologist, to sum it up neatly - most of those resisting tobacco harm reduction approaches don’t “see themselves as authoritarian nanny staters, but rather as warriors and crusaders for the greater good, fighting the evil tobacco industry”. And how can we blame people for seeking to punish Big Tobacco? My thoughts on this are that if you can jump in your time machine (Roberto can possibly assist with the theoretical aspects) then by all means go back and punish them. What we should not be doing is fighting that war now, when the price is not paid in reduced profits, dividends or salaries of big tobacco but in the health and lives of our most vulnerable citizens. We do not protect young people from nicotine by allowing their parents and carers to die prematurely of avoidable smoking related disease. You benefit no-one (other than cigarette manufacturers) by establishing regulatory systems that make it easier to buy smokable tobacco than safer alternatives.

Back in London I am looking to try and help those reaching out to spread tobacco harm reduction and deliver real and achievable gains for individuals, their families and communities. We have a great opportunity and we can overcome the obstacles. I am also starting to think about the next event which adopts the same kind of approach to delivering an enriching event: City Health International Melbourne, 3 and 4 October 2019. Hope to see some of you there, just as soon as I can work out which London underground line it’s on….