MOLDOVA || CALL TO ACTION OF THE YOUNG CARDIOLOGISTS SOCIETY OF MOLDOVA: To communicate or to prohibit

SCOHRE would like to express its support in the call to action issued by the Young Cardiologists Society of Moldova. Following the announcement of modifications by the Ministry of Health of Moldova in Tobacco Control Regulation, in order to align the Moldovan Tobacco Control Law with the EU Tobacco Products Directive, one of the changes proposed is to prohibit communication between healthcare professionals and patients. SCOHRE strongly believes that this ban is a major violation of established human rights and agrees with the Society. Any health professional abiding by the Hippocrates oath has the obligation to do whatever is appropriate to protect the life of his/her patients.

We, at SCOHRE, believe that smoking control strategies should be reshaped to include harm reduction through alternative potentially lower risk products use, besides the traditional smoking cessation and smoking prevention measures. SCOHRE includes scientists from all sectors: basic science researchers, medical doctors, policy experts, behaviourists, legal experts, academics, and professionals, human rights advocates. Our purpose is to provide stakeholders and regulators with science-based balanced information.

SCOHRE works to better inform all stakeholders of the existing evidence corroborating that harm reduction in smoking should be implemented to counterfeit the detrimental effects of smoking, when smoking cessation fails or is not sought. We need to raise awareness on existing knowledge, benefit from already existing solid expertise in many countries, and create more opportunities for education of health policy experts, regulators, and the public.

In SCOHRE’s recent 10 public health proposals, which were published during the “7th Summit on Tobacco Harm Reduction: Novel products, Research & Policy”, SCOHRE re-established its core values: (1) awareness and informed decisions, (2) bioethics & human rights, (3) health literacy (education), (4) network & collaboration, (5) prevention, (6) robust regulatory framework (legislation) to ensure fairness, (7) evidence-based policy, unobstructed research & transparency in scientific data, (8) smoking cessation as the steppingstone to fight smoking, (9) differential taxation to drive behavioural change, and (10) tobacco harm reduction – a mainstream strategy for public health protection.

Cigarette smoking is a huge cause of death and disease in Moldova, and we know it is the inhalation of smoke rather than the use of nicotine that is causing this carnage. We also see that the availability of alternatives has been leading to extraordinary declines in cigarette use in an ever-growing list of countries.

To seek to respond to this technological innovation by disadvantaging or banning the low-risk alternatives and banning truthful information from health professionals seeking to save lives is an attack not just on health but on human rights and free speech. It is also a gift to criminal organisations that will facilitate an illicit market.

Banning accurate information on relative risks in an environment where cigarettes are massively more toxic than viable alternatives sustain cigarette smoking by keeping consumers misinformed. It is a truism that people can only make as good a decision as the information available to them allows. Limiting the communication of critically important life saving information perpetuates cigarette smoking, at the cost of lives and health.

Further, the ban on accurate information protects the cigarette business from entities that would otherwise seek to inform consumers that they are selling far less hazardous alternatives. Thus, protecting cigarette companies from competition that would be good for public health.

Also, such a ban protects the cigarette business from any legal action (tort law, consumer protection law, trade practices law, etc.) that obligates the marketers of products to ensure their consumers are not misled. If accused of failing to ensure their consumers were able to make informed decisions and of not communicating the nature and extent of relative hazards, the companies have been handed a ‘get out of court free’ card. They merely say it was illegal to tell consumers the truth. The cigarette business is absolved of responsibility. Such a law is hugely protective of the cigarette industry at the cost of the rights and lives of the people of Moldova.

SCOHRE would like to state that there is no reasonable doubt that a variety of products are significantly less hazardous than smoking cigarettes. In the case of snus (and, thus, nicotine pouches) that risk is minimal. With vaping and HTPs the difference is also huge.

There is a vast difference in risk. Plus, consumers have been shown to be very capable of moving in large numbers from cigarettes to non-combustible alternatives. We now see irrefutable proof of this in an ever-increasing number of countries.

This gives us a route to one of the greatest advances ever achieved in the history of public health.

It is in that context that a ban on truthful and non-misleading information is a violation of human rights and irresponsibly protective of the cigarette industry.

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Further bibliographical references

1. 1. Balfour DJK, Benowitz NL, Colby SM et al. Balancing consideration of the risks and benefits of e-cigarettes. American Journal of Public Health. 2021;111:1661-1672. https://doi.org/10.2105/AJPH.2021.306416
   2. US Food and Drug Administration. The relative risks of tobacco products. (Current as of 4/16/2024.) https://www.fda.gov/tobacco-products/health-effects-tobacco-use/relative-risks-tobacco-products
   3. O’Leary R, Polosa R. Tobacco harm reduction in the 21st century. Drugs and Alcohol Today. 2020;20(3):219-234. https://doi.org/10.1108/DAT-02-2020-0007
   4. Beaglehole R, Bonita R. Harnessing tobacco harm reduction. The Lancet. 2024; Feb. 1. https://doi.org/10.1016/S0140-6736(24)00140-5
   5. Fagerstrom K. Can alternative nicotine products put the final nail in the smoking coffin? Harm Reduction Journal 2022;19:131. https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-022-00722-5
   6. Hajat C, Stein E, Selya A et al. Analysis of common methodological flaws in the highest cited e-cigarette epidemiology research. Internal and Emergency Medicine. 2022;17(3):887-909. https://link.springer.com/article/10.1007/s11739-022-02967-1
   7. Polosa R, Farsalinos K. A tale of flawed e-cigarette research undetected by defective peer review process. Internal and Emergency Medicine. 2023;18:973-975. https://link.springer.com/article/10.1007/s11739-022-03163-x
   8. Sussman RA, Sipala R, Emma R, Ronsisvalle S. Aerosol emissions from heated tobacco products: A review focusing on carbonyls, analytical methods, and experimental quality. Toxics. 2023;11(12):947. https://www.mdpi.com/2305-6304/11/12/947
   9. Royal College of Physicians. E-cigarettes and harm reduction: An evidence review. 2024; April 18. https://www.rcp.ac.uk/policy-and-campaigns/policy-documents/e-cigarettes-and-harm-reduction an-evidence-review/
   10. Cummings KM, Roberson A, Levy DT, et al. Transformation of the tobacco product market in Japan, 2011–2023. Tobacco Control Published Online First: 29 October 2024. doi: 10.1136/tc-2024-058734
   11. Tuisku A, Rahkola M, Nieminen P, Toljamo T. Electronic Cigarettes vs Varenicline for Smoking Cessation in Adults: A Randomized Clinical Trial. JAMA Intern Med. 2024;184(8):915–921. doi:10.1001/jamainternmed.2024.1822