Tobacco Harm Reduction Catches On

Yesterday I mentioned the controversy over legislation that would give the FDA authority to regulate tobacco products, authority the FDA itself (or at least its current head) does not want. One reason for the agency's leeriness is the possibility that FDA regulation could actually increase the harm associated with tobacco use. One way that could happen, as I've noted before, is through censorship of truthful comparative risk claims—in particular, efforts to promote smokeless tobacco as a harm-reducing alternative to cigarettes. Last week there were a couple of positive developments in this area.

Britain's Royal College of Physicians endorsed the concept of tobacco harm reduction, saying snus (Swedish-style oral snuff) and other nicotine-delivering products should be available to smokers who want to cut their risks but are not prepared to give up their drug habit. In a commentary published by The Lancet (which has long supported "less harmful nicotine delivery systems"), two doctors who worked on the RCP report, John Britton and Richard Edwards, note that the health risks associated with snus are roughly 90 percent lower than the health risks associated with cigarettes. They question the E.U.'s ban on smokeless tobacco (which does not apply in Sweden) and the policy of treating nicotine replacement products as quitting aids instead of long-term replacements for cigarettes:

We believe that the absence of effective harm reduction options for smokers is perverse, unjust, and acts against the rights and best interests of smokers and the public health. Addicted smokers have a right to choose from a range of safer nicotine products, as well as accurate and unbiased information to guide that choice.

Britton told The Independent:

Smokers smoke because they are addicted to nicotine, but it isn't nicotine in cigarette smoke that kills….We need to liberalise the medicinal market and introduce a decent cigarette substitute. We may end up with millions of people addicted to nicotine inhalers, but so what? Millions are addicted to caffeine.

Although there is more to the cigarette habit than nicotine (one reason the success rates for "nicotine replacement therapies" are so low), smokers certainly should be free to switch to other, less dangerous sources of nicotine if that's what they want. The distinction that Britton draws between addiction and the harm associated with it is a vitally important one that discussions of drug policy tend to overlook. There is no rational reason we need to pretend that nicotine gum, patches, and inhalers are medicines that treat the disease of nicotine addiction, as opposed to safer ways of getting the same drug. 

Another encouraging sign regarding snus: Last week The New York Times ran a story about snus products in the U.S. that clearly reported the truth: Although not 100 percent risk-free, snus is indisputably less dangerous than cigarettes. The Times quoted Thomas Glynn, director of cancer science and trends at the American Cancer Society, who questioned the evidence that "smokers are able to switch to smokeless tobacco and remain switched." But even Glynn conceded that "if every smoker in the United States were to switch to smokeless tobacco, 'in the next decade we would see fewer cancers and less heart disease.'" That acknowledgment is significant, since American anti-smoking groups (like American public health agencies) generally have been hostile toward harm reduction via smokeless tobacco, muddying or denying the product's clear health advantages. By contrast, Britain's Action on Smoking and Health has supported tobacco harm reduction for years.

Why was last week's story more scientifically accurate that the usual Times take on smokeless tobacco? Probably because it ran in the business section instead of the health section.

[Thanks to Brad Rodu and Bill Piper for the tip about the RCP report.]