A less harmful way?

I write my column A less harmful way? in TCS Daily on 15 November 2002.

Increasing the range of choices individuals can make is the right thing to do

The 3rd International Conference on Smokeless Tobacco was recently held in Stockholm, Sweden. Scientists from all over the world arrived to discuss tobacco prevention and public health effects.

One of the most interesting new strategies discussed was harm reduction, which means decreasing public health damages by shifting consumption from more dangerous sorts of tobacco to less harmful ones. Since the conference was held in Sweden, the traditional Swedish smokeless tobacco called snus - similar to chewing tobacco in the U.S. - was the main focus.

The reason to discuss smokeless tobacco is that there seem to be fewer health problems associated with it than with cigarettes (for instance, the absence of lung diseases), a lower potential for physical addiction, better potential for users to quit, and it is cheaper than either cigarettes or other smoking substitutes.

According to Lars M. Ramström, Ph.D at The Institute for Tobacco Studies of Stockholm, the use of snus as a substitute for smoking in Sweden is one of the factors contributing to the country’s low smoking rates both by reducing the number of people who start smoking and by serving as a commonly used and effective smoking cessation aid.

Critics worry the tobacco industry would use a harm reduction strategy to down-play the health risks posed by any kind of tobacco consumption. But urging smokers to switch to smokeless tobacco is not proposed as the only way to decrease smoking, but as an option to be offered to increase people’s choices. Smokeless tobacco is a cheaper alternative than nicotine patches, chewing gum, etc. Smokeless tobacco would not be promoted as a harmless product, as indeed it is not, but as a product for harm reduction.

Critics of harm reduction also may underestimate the potential for risk reduction. The status quo for smokeless tobacco in Europe today includes a complete ban in most of the European Union except Sweden, which was granted an exemption for snus. Evidence that this policy of intolerance is working is extremely poor, as pointed out by Mr. Clive Bates of the Action on Smoking and Health (ASH) of London, UK.

The existence of smokeless tobacco at least admonishes us to consider its possibilities with an open mind. To not openly discuss the pros and cons of smokeless tobacco, or prohibiting smokeless tobacco manufacturers from informing smokers about its existence as an alternative to smoking, is a great mistake, since it deprives smokers of a potentially life-saving possibility.

Despite the efforts of tobacco control advocates, the number of smokers in the world will increase in the immediate future if only because rising incomes in underdeveloped countries will mean more people can afford to buy tobacco products. Turning some of these smokers toward smokeless tobacco is not the last step in harm reduction, but it would be a large and beneficial step nonetheless.

Increasing the range of choices individuals can make is the right thing to do, at least until something even less harmful and less costly is developed.