On June 26th the American Council on Science and Health assembled a distinguished panel of scientists in New York City to present a one day educational symposium for the media on the concept of harm reduction. Harm reduction aims to decrease the negative health consequences of risky behaviors by modifying exposures or using less hazardous alternatives. While harm reduction has been applied across a wide spectrum of risky behaviors, including sexual practices and intravenous drug use, the ACSH symposium focused on the strategy applied to two specific examples: cigarette smoking and alcohol abuse.

The day opened with remarks by ACSH president Dr. Elizabeth Whelan and an introduction by Dr. Kimberly Thompson, ACSH adviser and associate professor of risk analysis and decision science at the Harvard School of Public Health. Dr. Thompson described the broader topic of risk evaluation and management, and discussed the influence that sensational media reports have on people's perspectives of their greatest health risks.

The morning session presented the pros and cons of applying harm reduction strategies to smoking—and, in particular, focused on the arguments of whether or not to promote and endorse smokeless tobacco products as a less risky alternative. Dr. Gregory Connolly, Director of the Massachusetts Tobacco Control Program, opened the session. Dr. Connolly expressed concern that the product would serve as a gateway drug to cigarettes. Reviewing the history of tobacco advertisement in America, he argued that allowing the smokeless tobacco industry to market its product as a safer alternative to smoking, without strict regulation, may lead to an increase in addiction by young users who would then potentially switch to cigarettes. He implored that strict regulation is needed to ensure that smokeless tobacco products do not enter the market and make claims that could mislead consumers. Dr. Philip Cole, professor emeritus of the department of epidemiology at the University of Alabama at Birmingham, proposed the use of alternative nicotine delivery systems. He noted that while some 50% of smokers die prematurely from their habit, only about one half of one percent of smokeless tobacco users are killed by their habit. To reduce the devastating toll of cigarette-related death and illnesses, he advocated for the use of alternatives such as the patch, nicotine gum, nicotine inhalers, and smokeless tobacco, by smokers who would otherwise be unable to quit.

The afternoon session explored harm reduction strategies applied to alcohol abuse and opened with Dr. Sally Satel, W.H. Brady Fellow at the American Enterprise Institute and staff psychiatrist at the Oasis Clinic in Washington, D.C. Dr. Satel argued that for many people who are problem drinkers but not full-blown alcoholics, abstinence may be an unrealistically high hurdle, adding that a more attainable goal would be to moderate their drinking or take part in controlled drinking. Dr. Peter Provet, President of the Odyssey House treatment center, followed Dr. Satel and urged abstinence as the best method of dealing with problem drinkers. Dr. Provet stated that proposing moderate alcohol consumption as a treatment option for people with abuse problems was not only bad policy, but also a threat to the entire alcohol-abuse tradition, which is based on the consistent, frequently reinforced message of abstinence.

Luncheon speaker Dr. George Lundberg, editor of Medscape General Medicine website, editor-in-chief emeritus of Medscape and former editor of the Journal of the American Medical Association, summarized the discussions. Dr. Lundberg described cigarettes and alcohol as two of the greatest sources of harm in our society—noting that the debate over the best treatment options will continue, and that harm reduction strategies are worthy of a place in the public health world. Dr. Lundberg advocated the use of harm reduction methods for those who are long-term abusers and added that we have to accept the fact that people will most likely always be victims of their addiction.

The symposium was well attended by members of the media and drew impressive media coverage. Related news stories include a June 20th New York Sun article "Start Chewing May Be Tobacco Option: Harm Reduction To Be Topic at Health Symposium"; a July 2nd Wall Street Journal article "Kicking the Habit (Sort Of): New Theory Lets Smokers Smoke, Alcoholics Drink"; a June 28th posting on ScienceDaily.com titled "Dry Snuff's Oral-Cavity Cancer Risk Higher Than Moist Snuff, Chewing Tobacco"; and a July 10th Reuters Television Special Report, "Will Less Be More When It Comes to Addiction?" Additionally, on July 3rd ACSH medical director Dr. Gilbert Ross appeared in a segment on the Fox News Channel show, "The Big Story with John Gibson," discussing harm reduction as a public health strategy.