Report on Tobacco Harm Reduction by Royal College of Physicians

The Royal College of Physicians of London (established in 1518) has a long history of producing influential, cutting edge reports on topics of critical importance to public health. For example, the RCP’s 1962 report “Smoking and Health” was the first major report to conclude that smoking causes lung cancer. The RCP has 12,500 fellows in over 90 countries and their reports have a similar status to the Surgeon General’s reports in the United States.

On Friday (October 5th) the Royal College of Physicians (London) released their latest report on tobacco and health, entitled, “Harm Reduction in Nicotine Addiction: Helping People Who Can’t Quit”. In the preface to the report, Professor John Britton, Chair of the RCP’s Tobacco Advisory Group, stated,

Harm reduction is a fundamental component of many aspects of medicine and, indeed, everyday life, yet for some reason effective harm reduction principles have not been applied to tobacco smoking. This report makes the case for radical reform of the way nicotine products are regulated and used in society. The ideas we present are controversial, and challenge many current and entrenched views in medicine and public health. They also have the potential to save millions of lives. They deserve serious consideration.”

The 242-page report was written by a group of leading experts on tobacco from the UK, New Zealand, Canada and the United States. It reviews the history of tobacco use, the neurobiology of nicotine addiction, the health risks of various nicotine products and current regulation of nicotine delivery products, before making recommendations on future nicotine product regulation. Among the key conclusions and recommendations are the following:

- Most of the deaths and disease caused by smoking in the near and medium term future will occur in people who are smoking now.
- Current preventive approaches will be ineffective for the millions of smokers who, despite best efforts to persuade and help them to quit, will carry on smoking.
- Harm reduction in smoking can be achieved by providing smokers with safer sources of nicotine that are acceptable and effective nicotine substitutes.
- There is a moral and ethical duty to provide these products to addicted smokers.
- Current systems of regulation of nicotine products inhibit the development of innovative medicinal nicotine substitutes for cigarettes and perpetuate the use of the most dangerous nicotine products (cigarettes). This is unjust, irrational and immoral.
- The unprecedented and unjustifiable market freedoms enjoyed by manufacturers of cigarettes and other smoked tobacco products must end.
- Low nitrosamine smokeless tobacco products may have a positive role to play in a coordinated and regulated harm reduction strategy which maximizes public health benefit and protects against market exploitation.

The report provides numerous examples of the kinds of irrational regulation currently in place around the world and the effects it has on cigarette smoking for health. In the European Union, for example, Swedish snuff (snus) which has health risks around 90% lower than cigarettes, is banned in every country except Sweden, while cigarettes are available everywhere. Why restrict the public’s choice of tobacco products to only the most harmful ones? In the United States (and many other countries), medicinal nicotine products (e.g. nicotine gum) are sold in packs covered in lengthy warnings and contraindications, while cigarette packs have a very small, brief health warning on the side of the pack. The net result is that many smokers mistakenly believe that the medicinal nicotine products are about as harmful as smoking and so are less inclined to use them.

The new Royal College of Physicians report contains a wealth of information about tobacco, nicotine and health, as well as radical new proposals to reduce the number of smoking-caused deaths. The pdf of the report is available online at no cost at:
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About the Author

MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.