Targeting smoke rather than nicotine: a big change may be at hand for harm reduction

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No Cigs for You!The vast 21st century conspiracy I ve somewhat ironically labeled The Tobacco Control Industry includes the CDC, the FDA, and just about all the major public health nonprofits as well as many academic centers. These groups have been reluctant, to say the least, to acknowledge the likely benefits and low risk of harm to smokers trying to quit using non-combustible tobacco and nicotine products, including Swedish-style snus and e-cigarettes (among other innovative products). These authorities have denied and distorted facts and that demonstrate the low risk of chemicals in e-cig vapor. Even worse, they have demanded that desperate smokers stick with the FDA-approved methods: they are evidence-based, when in fact they have been proven to not work. The result of this monolithic distortion and stonewalling is that smokers keep smoking, and dying.

So imagine our surprise to see a Perspective piece in the current New England Journal of Medicine entitled Smoke, the Chief Killer Strategies for Targeting Combustible Tobacco Use. (emphasis ours). Just the title alone sent a thrill through my spine, opined ACSH s Dr. Gilbert Ross, a long-term observer of and commentator upon the tobacco harm reduction scene.

He continues, Then I noticed the authors: Drs. Mike Fiore and Steven Schroeder (and Timothy Baker, PhD), both of whom are well-known in the tobacco control community as antagonists to the implementation of a harm-reduction strategy: allowing or encouraging smokers to get their craved nicotine from sources other than cigarettes, the most toxic form.

Apparently, they are not any more. Here are some key excerpts:

But research now quite clearly highlights the specific harms of combustible tobacco use (cigarette, pipe, and cigar smoking): given that up to 98% of tobacco-related deaths are attributable to combustible products, the net harms of these products, including harms from secondhand smoke, dwarf those of other forms of tobacco use ¦

Evidence shows that all the noncombustible delivery vehicles are substantially less dangerous than combustible tobacco products.... Noncombustible forms include multiple nicotine-replacement therapies (NRTs) as well as smokeless tobacco (e.g., snus) and the electronic cigarette (e-cigarette). Over the past few years, smokers have begun using e-cigarettes at a markedly increasing rate. More than 20% of smokers report having tried them, and some early evidence suggests that e-cigarette use may help smokers reduce or quit combustible tobacco use.

And perhaps most importantly:

Furthermore, we need to communicate intelligently about harm reduction: not all nicotine-containing products are equal, and the public health focus should be on eliminating combustible tobacco products, even if some people who give up combustibles will continue using FDA-approved medications, e-cigarettes, or smokeless tobacco products indefinitely.

Of course, their comments are interspersed with too many caveats and hypothetical risks, as compared to what the evidence shows at this point, added Dr. Ross. But in my mind, this new direction is a landmark in the discussion of e-cigarettes and tobacco harm reduction. As more data accumulate, I feel confident that the entire Tobacco Control Industry will 'change their evil ways,' and at last begin to open their eyes and acknowledge these simple facts: the current approach to helping smokers quit is not and has not been working; and the new approach of encouraging non-combustible sources of nicotine will likely be much more effective at very little cost in terms of adverse health effects.