No Smoke, Less Harm: A Path to Saving Lives

Despite decades of public health campaigns highlighting the dangers of smoking, misconceptions and misinformation about nicotine persist. Contrary to popular belief, nicotine itself does not cause cancer and plays a minimal role, if any, in tobacco-related diseases. It's time to dispel these myths and acknowledge the potential of tobacco harm reduction (THR) strategies in saving millions of lives.

It is essential to recognise that there will always be individuals who choose to consume nicotine, much like those who consume caffeine. It is known that humans have used nicotine for more than 12,000 years; it is foolhardy for modern policymakers to believe that they can be the ones to eradicate it.

Smokefree Sweden’s new report, No Smoke, Less Harm, illustrates that rather than demonising nicotine, the focus should shift towards reducing the harm associated with its consumption. Sweden serves as a prime example of how THR can mitigate tobacco-related diseases despite similar levels of nicotine consumption compared to other European countries. By embracing smoke-free nicotine products, Sweden has significantly lower rates of tobacco-related illnesses and premature deaths.

Compared to the rest of the European Union (EU), Sweden boasts 44 percent fewer tobacco-related deaths, a 41 percent lower cancer rate, and 38 percent fewer deaths attributable to any cancer. If Sweden’s approach to reducing the use of combustible products rather than a puritan war against consumption of nicotine is replicated across the EU, many millions of lives could be saved in just a few years.

Consumers are increasingly understanding this concept, while governments have mostly not. Those who have successfully moved away from smoking using snus, vaping products, and other safer alternatives are constantly frustrated and confused as to why the huge benefits that they have experienced are not being recognised by legislators.

The concept of harm reduction is not new. It's about enabling consumers to use potentially harmful substances in less risky ways, thereby preventing the devastating health consequences.

This principle, encapsulated in the motto "No Smoke, Less Harm," should inform the global approach to tobacco control policy. It's time for institutions like the World Health Organization (WHO) – which has long endorsed harm reduction for drug use - to formally integrate THR as the fourth pillar of tobacco control, alongside taxation, regulation, and education.

Harm reduction products offer a perfect alignment of business, economic, and public health goals without the state having to do anything but allow them to be sold to adults who would otherwise smoke.

To achieve meaningful progress in tobacco harm reduction, several actions must be taken. First and foremost, EU and WHO member states must adopt a risk-proportionate regulatory framework that distinguishes between smoked and smoke-free nicotine products. This approach recognises the varying levels of risk associated with different nicotine delivery methods and allows consumers access to safer alternatives.

Furthermore, combating nicotine misinformation is paramount. Misconceptions about the risks of nicotine can deter smokers from transitioning to safer alternatives. It's crucial to actively eliminate false narratives and provide accurate information about the relative risks of different nicotine products.

Research plays a pivotal role in building the evidence base for tobacco harm reduction. All stakeholders, including governments, research institutions, and industry, should invest in rigorous scientific studies to evaluate the safety and efficacy of THR strategies. By gathering robust evidence, public health policies can be better informed and consumers will be empowered to make smart and life-saving choices about their health.

At the heart of THR lies an ethical imperative: the recognition of consumers' fundamental human right to health. Individuals have the right to access accurate information and safer alternatives to smoking. By respecting this right, policymakers can support THR initiatives that prioritise public health and individual autonomy.

Lastly, monitoring and evaluation are essential components of effective tobacco harm reduction strategies. WHO and member states must step up efforts to track the impact of THR interventions, including changes in smoking prevalence, tobacco-related diseases, and public perceptions of nicotine use.

We have overwhelming data now to show that harm reduction works. The Swedish experience has shown conclusively that abstinence only policies are vastly inferior to those which meet the consumer where they are instead of where governments wish them to be. There is no longer any meaningful justification for pursuing futile policies to restrict nicotine use instead of accepting that, like coffee, there will always be those who consume it.

The real public health enemy is smoking combustible tobacco, not nicotine.

Embracing THR is not only a pragmatic approach to reducing the burden of tobacco-related diseases but also a moral imperative. By fundamentally differentiating between smoked and smoke-free products and adopting risk-proportionate regulatory frameworks, millions of lives can be saved. It just takes enlightened policymakers to recognise that, not bury their heads in the sand like the WHO.

It's time to prioritise THR awareness and adoption, dismantle nicotine misconceptions, and uphold consumers' right to health. A future can be built where tobacco-related diseases are relegated to the past, and every individual has the opportunity to lead a healthier, smoke-free life, if only influential organisations adhere to a simple, progressive mantra.

No smoke. Less harm.

Martin Cullip is an International Fellow at The Taxpayers Protection Alliance's Consumer Center and is based in South London, UK.

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