Wednesday, June 23, 2010

Canadians Who Care About Tobacco Harm Reduction

Toronto’s Non-Smokers’ Rights Association has just become the first Canadian organization to endorse tobacco harm reduction. Together with the Smoking and Health Action Foundation, the NSRA published “Harm Reduction in Tobacco Control: What is it? Why should you care?”

The report (available here) is an accurate and balanced discussion of the issue. It describes smokeless tobacco products (including Swedish snus) and e-cigarettes, and it makes the following recommendations:

1. “Establish a regulatory framework for nicotine products.”

In theory, this is a reasonable approach; a regulatory agency could evaluate all tobacco and nicotine products with consistent criteria. The report suggests that “…availability, price/taxation, and permitted forms of promotion should all be related to the level of risk inherent in their use.” It is unfortunate that American legislation giving the FDA authority over tobacco contained no provisions for regulating tobacco products according to risk.

2. “Shift current tobacco users to the least harmful nicotine product – [pharmaceutical] nicotine replacement therapy.”

The report recommends that smokers be given accurate information about nicotine, specifying that it “is not the harmful substance in cigarettes.” It also points out that pharmaceutical nicotine should be made more affordable and accessible.

3. “Shift smokers who are unable to quit or unwilling to make a quit attempt to a less harmful product – snus.”

The report strongly counsels against misinforming smokers: “The public has the right under Canadian tort law to accurate information about the relative risks of using tobacco products and to make choices based on the facts. The current warning on smokeless tobacco products, ‘This product is not a safe alternative to smoking,’ is woefully inadequate as it provides no information regarding relative risks.

“Governments and health organizations must improve messaging, both on the product and in other media, about the relative risks of cigarettes, smokeless tobacco products, and non-tobacco nicotine products to ensure that the public is better informed and does not rely on tobacco companies for risk information.”

Although NSRA doesn’t trust tobacco manufacturers, it’s ironic that governments and health organizations are now the dominant sources of inaccurate risk information.

4. “Monitor the impact of alternative nicotine products.”

The report calls on “Health Canada and or other government authorities” to “conduct post-market surveillance of the promotion…” and “health impact of alternative nicotine products” like e-cigarettes, as well as safer smokeless alternatives. That’s a reasonable requirement. In comparison, the U.S. FDA legislation requires manufacturers of safer tobacco products to prove that they will have no population effect BEFORE they are marketed (described here).

The NSRA joins three other respected professional organizations in endorsing tobacco harm reduction. In 2006, the strategy was endorsed by the American Council on Science and Health, whose mission is to promote sound science in regulation and in public policy and to assist consumers in distinguishing real health threats from purely hypothetical ones. Throughout its history, ACSH has published many articles about the health risks of smoking, and it has held the tobacco industry accountable for its role in the devastating toll from tobacco. In the late 1970s, ACSH founder Elizabeth Whelan published a landmark anti-smoking book, A Smoking Gun: How the Tobacco Industry Gets Away with Murder. More information is available here.

In 2007, Britain’s Royal College of Physicians, one of the oldest and most prestigious medical societies, strongly endorsed tobacco harm reduction. The Royal College concluded “…that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved… 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.” The Royal College report is available here.

In 2008, the American Association of Public Health Physicians became the first U.S. medical organization to formally adopt a policy of “…encouraging and enabling smokers to reduce their risk of tobacco-related illness and death by switching to less hazardous smokeless tobacco products.” Their report is available here.

It is gratifying to see the sound medical principles of tobacco harm reduction being adopted by the broader public health community.

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