Peter Beckett: Delon Human, welcome to Clearing the Air.
Delon Human: It’s my privilege.
Peter Beckett: Can we get a short introduction of who you are and how you came to be where you are now?
Delon Human: Well, I am a physician first and foremost. I started my career in clinical medicine, but after a few years, I grew frustrated; telling the same story repeatedly to individual patients is valuable, but I felt I could do more systemically. I moved into medical politics, eventually becoming Secretary General of the World Medical Association—the mothership of physicians.
Peter Beckett: Is that the organisation the BMA is a member of?
Delon Human: Precisely. The World Medical Association represents about 12 million physicians worldwide, who exert enormous influence not only on medical practice but on healthcare policy. Physicians have a disproportionately important role in setting that policy. During that time, I learned to develop alliances, helping to found the World Health Professions Alliance—a combination of physicians, pharmacists, nurses, midwives, and physiotherapists. From there, I moved into the interface between policy, science, and the consumer. I started a company called Health Diplomats to help bridge the gap between the private and public sectors and address pressing social and health problems. Tobacco was a major focus; I realised that as an ardent tobacco control activist, I was barking up the wrong tree. My father was a long-term smoker, and I spent years pontificating that he should stop. I only realised how wrong I had been when I studied the Swedish data on snus and calmly considered the evidence. I feel I could have done a better job for someone I love. When I think of people who smoke, I think of people with names, often not told the full story by health professionals who, despite good intentions, are unaware of the “fire escape” available to smokers. Access to healthcare information and services has been another driving force in my career, having lived in a lower-middle-income country in the Southern Hemisphere and now for the last two decades in Europe. Health Diplomats serves as an advisory group focused on improving access in tobacco control, food, pharma, and medical devices. I am at this conference to help accelerate harm reduction methods as part of tobacco control.
Peter Beckett: Tiki Pang said yesterday that the WHO’s Framework Convention Secretariat has become the “anti-vaxxers” in this debate. Is there a particular experience you’ve had that illustrates that in practice?
Delon Human: I would first like to defend the World Health Organization. Nobody enters the WHO with the intention to cause harm; most start with a smile. But after six months, exposure to bureaucracy and ideological barriers creates stress and internal conflict. When the Framework Convention was first developed, I was working for the World Medical Association, and we advocated intensely for a global treaty. I am proud that a tobacco control framework exists. The glaring omission at the time—and bear in mind there were no smokeless nicotine alternatives then—was that harm reduction was only placed into Article 1D in parallel to what was happening in HIV/AIDS, where harm reduction was understood as a powerful public health tool. Fast forward to today: the Framework Convention has the provision for harm reduction, but it is not recognised or studied as it should be. The “anti-vaxxer” analogy is apt; we have had 10 to 15 years of national-level data, in addition to Sweden’s experience, yet it has not been studied. That, to me, is a criminal offence. You can have an opinion, as long as it is evidence-based. In that regard, the WHO is neglecting its duty. They could rectify this self-induced error by seriously elaborating on what harm reduction could mean, but to do so, they would have to overcome the ideological and financial barriers they face.
Peter Beckett: Let’s discuss those financial barriers, specifically the Michael Bloomberg-shaped barrier. It seems like a subversion of democracy when the peculiar tastes of one very rich man dictate the global narrative on harm reduction. People who should know better seem to have looked at the size of the cheque on offer and gone with it. Yet, you defend the people who work at the WHO. How do you reconcile those two things?
Delon Human: In studying the motives of Mr Bloomberg and the “WHO-Bloomberg-Gates complex,” billionaires tend to work in tribes. When Bloomberg started investing in global health, there was initial joy because countries weren’t willing to invest enough themselves. Some of those investments had a remarkable return. He and the Bill & Melinda Gates Foundation divided the world into non-communicable and communicable diseases. Both philanthropic structures have made a net positive contribution to global health. However, in terms of tobacco control, there has been an enormous deficit. If Mr Bloomberg had simply applied the same harm reduction recipes he used in the US to global tobacco control, hundreds of millions of lives would be saved. Derek Yach and I determined that if nations embraced tobacco harm reduction and earlier diagnosis of conditions like lung cancer, we could save at least 100 million lives by 2060. For Indonesia, with a 60% smoking prevalence, 5 million lives could be saved. The question is why Mr Bloomberg’s intellectual advisers haven’t given him that data. It’s not an “either-or” situation; they could continue classic tobacco control while adopting harm reduction. Unfortunately, the individuals within that system are well-paid. I call it financial capture. If you work for an NGO, you don’t have to do science; your job is to name and shame those who embrace harm reduction, or speak at conferences and get paid for it. Then you get complacent. My plea to those who put my name on a site for speaking in favour of harm reduction is: look at the data. If you disagree, replicate or do other science to refute those numbers.
Peter Beckett: They aren’t going to listen because they view us as having horns. Every industry conference I go to, someone says we need to break out of our silos and talk, and my eyes roll back in my head. Can we stop pretending that’s an option? If we accept that, what is left other than aggressive personal campaigning?
Delon Human: I share your frustration, but I would push back slightly. I see it as playing the long game. Fifteen years ago, when smokeless nicotine alternatives were introduced, it wasn’t a hypothetical discussion; it was a practical choice. We now have more than 130 million consumers of smokeless nicotine alternatives, and companies have invested billions in innovation. We have the fire escapes, but the narrative is lacking. Confrontation rarely works at the international healthcare level.
Peter Beckett: But it works for the other side.
Delon Human: It works for them for the moment, but “drone warfare”—a more intelligent, aggressive approach via the side doors—would be more effective long-term. Take wound care: if a patient with diabetes has chronic foot ulcers and they smoke, it is a death sentence for the wound—it decreases recovery and leads to amputations. If we can prove the case in a subset like wound care and build a faculty of health professionals who take this seriously, we will have more success.
Peter Beckett: Why is this not happening in mental health? That seems the obvious starting point.
Delon Human: That is a brilliant point. If you look at mental health institutions, smoking prevalence is often 70 to 80%. People smoke as a coping mechanism, which should be considered in the overall treatment plan.
Peter Beckett: I suggest that for 70 or 80% of patients committed to inpatient psychological care, there must be a rationale to use nicotine.
Delon Human: I agree. If that person isn’t smoking, they often do much worse; you get more conflict within the institution. It is a pragmatic decision from both sides—the carer and the patient. Mental health is a primary subset of public health we need to address. There is a false division between individual health and public health. For a person with schizophrenia, nicotine is an important way to cope. It is a rational, evidence-based choice.
Peter Beckett: I tell my own story: I was diagnosed with ADHD at eight, and nicotine worked far better than Adderall ever did. It was essentially self-medication. I don’t want to give up nicotine, and I think it would be an irrational choice for me to do so. Yet, even the tobacco industry is keen to stress that the “optimal state” is zero nicotine use. Why do they do that when so much lived experience contradicts it?
Delon Human: Health bodies confuse addiction with dependence. All humans have a dependence on some activity or substance—we drink 2 billion cups of coffee a day without calling for a “coffee-free world.” Nicotine is an active molecule; we all agree that delivered via a cigarette, it is highly addictive. But in a smokeless delivery system—an oral pouch, a heated tobacco product, or an electronic cigarette—this can be characterised as a dependence-forming activity. If you were my patient, I would have no hesitation saying, “Peter, you have found your way of coping and self-medicating; continue.” We have found a way that works, but why can’t we have robust research to validate this for others?
Peter Beckett: No business will sell investors on a clinical trial for nicotine to treat ADHD because regulators would laugh them out of the room.
Delon Human: I understand the age restrictions, but for people older than 18, the system is failing them by not providing a balanced recommendation.
Peter Beckett: I was 18 in 2004, so there weren’t many options in the UK then.
Delon Human: But now, you could be part of “Swap to Stop” and encouraged by a system that recognises harm reduction. It didn’t come easily. The UK is a good example of a country that moved from vehement opposition to electronic nicotine delivery systems to a period of reflection and robust evaluation. NICE and the Royal College of Physicians were part of that. New Zealand followed a similar pattern, yet they were derided for it and given the “Dirty Ashtray” award.
Peter Beckett: For listeners who don’t know, what is the Dirty Ashtray award?
Delon Human: At the Framework Convention Conference of Parties (COP), the Framework Convention Alliance—a group of about 500 non-profits—uses it to name and shame countries that even dare to speak neutrally or positively about tobacco harm reduction. Last year, New Zealand, which had the most balanced view of all member states, was given this award.
Peter Beckett: I want to finish by talking about “Smokefree Sweden,” a campaign Health Diplomats has led. What was the inspiration for that?
Delon Human: It has a personal and a professional dimension. Personally, I had not advised my father anything other than the “quit or die” approach. It was only when I was at the World Medical Association and saw the statistics on snus—decades of data showing Swedes had 40% less lung cancer and 60% less total cancer deaths—that I realised I was wrong. I couldn’t understand why snus was banned in the EU but not Sweden. With Swedish stakeholders, we decided to brand this phenomenon and tell the story through incisive forays into data sets, showing that not only is there decreased disease in Sweden, but there is much to learn about how consumers use smoke-free alternatives. We developed reports showing how Sweden compares to other countries. The idea was to present bite-sized data so policymakers could see the reality. Smokefree Sweden is now in its fifth year, and we are finally making headway.
Peter Beckett: We had Charlie Vaughan on an hour ago; he articulates that story perfectly.
Delon Human: Exactly. Smokefree Sweden showcases best practice, but we want to go beyond that—tell the story of Japan and New Zealand. That is the only way to break the deadlock where ideology trumps rational scientific debate.
Peter Beckett: Last question: you and I both have pages on the University of Bath’s “Tobacco Tactics.” I’ve worked for Juul, you’ve had relationships with other companies. Part of the problem is the fear of being seen to be too close to the industry. Do you think we’ll ever convince people that it’s not career death to take funding from the tobacco industry, provided they aren’t dictating your work?
Delon Human: I’ve been involved in the alcohol, food, and cannabis industries, always with the approach of finding balanced, evidence-based ways to use products that have a health impact. Whether we appear on a “Tobacco Tactics” page or not won’t matter over time. They make sure anything you do is on your page; I often have to search for my own biography to see where they’ve listed me.
Peter Beckett: I was almost offended that I didn’t have my own page for years.
Delon Human: And you have one now!
Peter Beckett: I take it as a badge of honour. If what I’m saying annoys people who dislike smokers, so be it. I don’t think they like the way I live, and I am an inconvenient blocker to the world they want to create. Is that something you’ve noticed?
Delon Human: The sad part is that all the money they receive for these websites and name-and-shame campaigns should be used to serve people. If they want to shame those acting in bad faith, that is fair game. But attacking people who are asking for evidence-based, risk-proportionate regulation is something I don’t understand. I’d like to bring them on board and use their resources more pragmatically. It’s a win-win.
Peter Beckett: Delon, thank you very much.
Delon Human: Thank you.
