Opportunity for Prevention by Understanding Reduced Risk Nicotine Products
If people cannot stop smoking and smoke mainly to obtain nicotine there is no reason why cigarettes should not be made which allow them to have their nicotine without having it contaminated by excessive amounts of tar and CO. MICHAEL RUSSELL, BMJ 1975
Michael Russell, a groundbreaking scientist who led tobacco harm reduction research, understood the potential health gains of reducing the amount of tar in cigarettes. Nicotine replacement therapy (NRT), snus, and e-cigs have emerged as nicotine containing products (NCPs) that provide nicotine without the burning tar in tobacco that causes cancer and heart disease. NRT is approved by the FDA for tobacco cessation, and snus use increased in Sweden while smoking and tobacco-related diseases decreased. Most recently, e-cigs have exploded into the global marketplace and are expected to surpass tobacco sales within the next decade.
We know combustible cigarettes are very dangerous, and snus, e-cigs and NRT provide nicotine to those addicted with much less risk. In a review done for the European Union, [smokeless tobacco products] are clearly less hazardous and in relation to respiratory and cardiovascular disease substantially less hazardous, than cigarette smoking. In addition, the best evidence-based opinion at the present time would be: not safe, but much lower in risk.
However, public understanding of the risks of these NCPs does not reflect the evidence. In a national survey, less than 10% of respondents perceived smokeless tobacco as less risky than cigarettes. And almost half of respondents mistakenly believe e-cigs are not safer than cigarettes. Overall, only 3.5% of respondents agreed with the evidence: no types of cigarettes (such as low tar) are safer, smokeless tobacco is safer, and e-cigs are safer.
As Paul Slovic detailed in 1987, perceived riskiness means more to people than expected number of fatalities. This year saw a frenzy of national media attention and fear around Ebola which killed two people in the US, while tobacco kills 480,000 annually.
Distorted messages from medical professionals and health organizations that portray e-cigs as equally harmful as cigarettes confuse the public on actual risks and prevent reducing the death and disease caused by tobacco use.
Harm reduction must be embraced to support health. Leadership is needed in public health and at the federal level to realign risk perception with reality to reduce the harm of tobacco use and save lives. Clear messages are needed that describe the safety and reduced risk that NCPs offer for tobacco users. Regulation should occur proportionate to risk, supporting reduced risk products and penalizing high risk tobacco products. NCP manufacturers, retailers and life insurers all have the opportunity to support reducing risk through their business practices which will boost their bottom line and the health of consumers. Tobacco companies have joined in, with Philip Morris investing over $2 billion to reduced risk product development.
Action is needed to realign public perception with actual risk. E-cigs and other NCPs offer great potential to reduce US deaths and 6 million annual deaths worldwide. As stated by Derek Yach in the Spectator, all of us involved in tobacco control need to keep that prize in mind as we redouble efforts to make up for 50 years of ignoring the simple reality that smoking kills and nicotine does not.
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