Tobacco Harm Reduction

There are a bunch of policy options designed to reduce the harm to health caused by tobacco.

Right now, those option focus on reducing exposure to second-hand tobacco smoke pollution, reducing initiation of smoking among young people, and encouraging existing smokers to quit. In many developed countries these policies have had some success, with significant reductions in the proportion of the population who smoke. In some other countries there has been little progress or smoking has actually increased. At the end of the 20th century almost half of all men on the planet were smokers. Perhaps the main hope for improving this situation is via implementation of the World Health organization’s Framework Convention on Tobacco Control (FCTC). Details on the FCTC can be found at;
http://www.who.int/tobacco/framework/en/

There have also been moves to reduce the harm to health via increased regulation of the tobacco industry and the products it sells. For example, in the European Union, there are fairly tight regulations governing the advertising of tobacco, the emissions from cigarettes, the warnings on packs and also an almost complete ban on oral snuff tobacco.

In the United States, there is currently a piece of legislation that has cleared a number of initial hurdles, (but with a few more to be crossed) that would, for the first time, give the US Food and Drug Administration (FDA) the right to regulate tobacco products. Though most people agree that it is only right that the tobacco industry should be more tightly regulated, there are differences of opinion as to the way to do it that would be most likely to lead to reduced harm to health.

One model (on which the current FDA legislation appears to be based), involves reducing the potential nicotine delivery from tobacco products gradually down to the level at which they would no longer be addictive. The existing smokers would hopefully gradually switch over to nicotine replacement products or give up nicotine altogether.

Another model involves gradually reducing the permissible toxins levels that can be emitted by tobacco products, while keeping the nicotine delivery at a level that users can still be addicted. In the end this policy might end up at a similar place to the previous one, with users using clean nicotine products, without any tobacco.

Both of these models have merits. However, there may be problems with the time delay before reaching the point where there is significantly less harm being caused. There may also be challenges for enforcement, as it may be difficult for enforcement authorities to tell if a cigarette is reduced toxin/nicotine or a regular cigarette that has been smuggled in from another country. Another potential problem with both these strategies is that they pretty much put the tobacco industry out of business. Now it’s a fair bet that the tobacco industry would not want to go out of business, and would use its considerable resources and influence to prevent these policies from being implemented to their fullest extent.

This is where a similar but slightly different policy, may have some merit. With this model, the tobacco industry is given notice by regulators that smoked products can no longer be sold in this country 10 years from now. They are told that they should plan for this, by switching their consumers to products that do not involve combustion, i.e. any form of smokeless tobacco.

Now the companies won’t love this idea either. But it at least gives them a way to stay in business and also gets them out of the lung cancer and emphysema business, which has always been a slight PR negative for the tobacco industry. I believe that this policy stands the best chance of being sustainable and acceptable to all stakeholders.

If you would like to view a full slide show and talk I presented to a meeting of tobacco industry representatives that laid out this approach, it can be viewed on the supercourse (a free health teaching website) at: http://www.pitt.edu/~super1/lecture/lec31261/index.htm

Labels: cigarette smoking, FCTC, FDA, harm reduction, jonathan foulds, nicotine addiction, tobacco

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