the English proposal causes discussion in Italy

Imagine a generation of non-smokers: ban cigarettes for life from 15 years onwards. And then to rise progressively, every year, until only the elderly are left to smoke. The proposal – which is the one on which the English Parliament has been called to vote in these hours, amidst a thousand controversies – everyone in Italy likes. Where “everyone” stands for “the small clique” of independent experts on smoking, as they like to define it Silvano Gallus, always on the front line with the Mario Negri Pharmacological Institute (of which he is laboratory head for Lifestyle Research) in the battle against tobacco.

The news from London heartens him after the disappointment of the failure of the major campaign launched in collaboration with the Italian Tobacco Society (Sitab), within the broader European initiative promoted by the Spanish NGO Nofumadores, with the aim of raising one million of signatures and see a petition approved that would ban the sale of tobacco and nicotine-based products to all European citizens born after January 1, 2010. More or less what Prime Minister Rishi Sunak is asking of his country, «only that we had no funding or even support of any kind” explains Gallus. Because, let’s face it, the fight against smoking in Italy is not exactly at the top of the list of priorities. Any examples? A pack of cigarettes costs between 5 and 6 euros compared to 15 in England (and loose tobacco even less); the ban on smoking outdoors, or in crowded places, is the result of some sporadic and courageous local initiative (Turin took it this Tuesday, Milan in 2021, Bibione has experimented with a smoke-free beach in the past); primary prevention is almost completely non-existent; the anti-smoking centres, almost entirely concentrated in the Pneumology departments of hospitals, have reduced by a third after the pandemic, going from 300 to a hundred (and with a haemorrhage of professionalism). «And, last but not least, Italy is one of the countries in the world where “interference” between the tobacco industry and the government is highest – continues Gallus -, which means that the tobacco industry participates in and supports certain public initiatives with its own funds». Which, for the most mischievous, would explain why the meritorious announcement at the start of the mandate by the Minister of Health Orazio Schillaci on the need to review the Sirchia law in a restrictive sense was hastily buried by his government colleagues (starting with Salvini), so as not to be never brought up again.

Yet smoking among very young people is an emergency here too, if possible worse than in England. According to Hbsc (Health behavior in school-aged children) data published on the website of the Higher Institute of Health and referring to the year 2022, Italy is the first country out of the 75 taken into consideration for the percentage of smokers among adolescents: 40% already use normal cigarettes at 17 and 25% use electronic ones. The trend is impressive if we go down to 15 and 13 years of age: in the first age group there are almost 30% of cigarette smokers and 20% of electronic cigarettes, in the second age group (we are talking about middle school children) almost 10% for both. “It’s a shame that no one would ever think of such a ban” concludes Gallus, who recalls that not even the bare minimum has been done, i.e. updating the Sirchia law by banning the smoking of electronic cigarettes and heated tobacco cigarettes in public places. And, perhaps, raise the ban on the sale of tobacco to 21 year olds: “Which wouldn’t discourage 17 year olds from trying to buy anyway, but 15 year olds would.”

These are the same reflections as Roberto Boffi, head of Pneumology at the Tumor Institute of Milan and director of the historic anti-smoking center linked to it: «The intervention on the Sirchia law, which dates back to 2005, when “vaping” did not exist, would have been and still will be the most logical, simplest and most incisive thing to discourage smoking, combined with the certainty of sanctions and the increase in taxes” he explains, describing himself as disarmed by the possibility of electronic cigarettes being smoked peacefully in restaurants and by the spread of heated tobacco devices in the shopping arcades of shopping centers or airports among bookshops and toy corners. «The truth is that we in Italy no longer talk about smoking, on the contrary. And our country has become a land of conquest for the large tobacco multinationals, with the large Philip Morris factories in Bologna and British American tobacco in Trieste.” Boffi is less convinced about the English ban than his companion in many battles Gallus: «Let’s create a generation of non-smokers and then? Then everything else is needed – he explains -, education, prevention are needed, people need to know the harm of cigarettes but also of electronic cigarettes, which independent research shows has the ability to cause cancer like others. My colleagues also need to be more trained on this, so that the young pulmonologists who are now returning to our hospitals to specialize understand how important it is to prepare for prevention.”

A tobacconist – Ansa

And then the great limitation of the London proposal, for the pulmonologist, is precisely that of stopping only at old cigarettes: «For teenagers they no longer exist» explains Boffi, recalling a book written 15 years ago with a package-like cover «which today seems like an heirloom. The kids have never seen those old packages, they don’t even know what shape they have. There are poof (disposable cigarettes), the i-Qos device (with the microcigarettes that are heated inside them), the snus (i.e. nicotine salt bags to put in your mouth and suck like candy). Smoking is a trend, nowadays spread by social media and advertised by influencers, with the big difference compared to the past that smoking has become good, due to the flavors of mango and blueberry which are often combined with new products and which allow young people not to smell, not to be discovered by parents, to vape even at school and not to cough.” “Good” smoking, thus, increasingly resembles a game «so much so that some experts, also convinced that electronic cigarettes are the lesser of evils compared to tobacco ones, have started talking about “risk reduction” instead than “harm reduction”. A sensational mistake, given that the damage is demonstrated for both the former and the latter.” But also a useful deception, if you look at it from a business point of view, given that those who produce tobacco (Philip Morris, Bat, Japan Tobacco) are also those who produce what should do less harm than tobacco and replace it: «A little ‘as if those who produced and sold the drugs were also those who produced methadone” Gallus underlines again. Which is the story of the English anomaly: London, which today would like to ban cigarettes, is the country that has most ridden the wave of “replacement” with the less dangerous (on paper) electronic ones with its experts «so much so that 4 out of 5 smokers started smoking them before the age of twenty, convinced that they were not harmful – he finds the president of the Italian Society of Environmental Medicine Alessandro Miani – and then become frame smokers and remain so forever.” Miani, according to whom London’s proposal “is captivating”, would like serious smoking bans in public areas for our country, with specific fines, and education in schools starting from primary school.

Those who, on the other hand, do not demonize the use of electronic cigarettes at all, considering the approach of their colleagues “too restrictive”, are Riccardo Polosa, professor of Internal Medicine with specialization in Pneumology at the University of Catania and director of the Research Center on Harm Reduction (CoEhar), a structure that has come under the scrutiny of part of the scientific community in the past for its alleged conflicts of interest with the tobacco industry : «English law can certainly be useful, but it is completely anachronistic – explains Polosa -. All the data tells us that we are moving towards an almost total abandonment of tobacco by the new generations. Smoking, which has now become a technological phenomenon, is linked to a spasmodic updating of the devices that allow it, in 85% of cases produced in China. You buy the latest vape released like the latest smartphone.” As for e-cigarettes «we are convinced, this is what we try to demonstrate with our research and publications, that they represent a significant reduction in harm, especially for those people who do not want or are unable to stop smoking and for whom in our country, as in many others, no type of health policy exists. We will never say, obviously, that vaping is like breathing in the Matterhorn area. But yes, this habit lowers the risk compared to that of traditional cigarettes. And we believe we are objective.” Since 2019, CoEhar has collaborated on some funded projects by the American organization Foundation for a smoke-free world allo spin off called Eclat, salso from the University of Catania. The Foundation for a smoke-free worldcommitted on paper to the fight against smoking, was economically linked to Philip Morris until 2023.