Gilbert Ross finds that public health regulators, through willfull resistance of tobacco harm reduction strategies, are killing smokers.
Cigarettes are by far the gravest threat to America’s public health — a killer far worse than obesity, contagious diseases, and cancers of the colon, prostate and breast combined. Forty-six million Americans still smoke, despite all the warnings and taxes. That’s about one-fifth of us — way down from its peak in the 1960s, but stubbornly resisting further declines. About 450,000 Americans die needlessly each year from inhaling the toxins and carcinogens in smoke.
Now consider that science actually has the means to dramatically reduce this public health catastrophe: tobacco harm reduction. As applied in other areas of public health, the benefits of harm reduction are well known: the idea is to reduce the health consequences of a substance or behavior without demanding complete abstinence from it. Distributing condoms to people who are known to engage in risky sexual activity is one example; providing IV drug addicts with sterile needles is another. By contrast, the “abstinence only” approach demands that the addict completely renounce their substance of abuse. It’s an all-or-nothing attitude that, unfortunately, fails to help a lot of the people who need it most.
Although about two-thirds of smokers would like to quit, and one-third actually try to quit each year, fewer than five percent succeed. For those 450,000 American smokers who die each year, clearly, an abstinence only approach has not worked. Nicotine addiction is extremely strong. Yet, in a perversion of science-based public health policy, the truth about effective methods to help more smokers quit has been ignored, indeed suppressed, by our public health authorities who continually deny the mountain of epidemiological evidence pointing to the benefits of tobacco harm reduction.
Tobacco harm reduction advocates the use of reduced-risk nicotine products, which allows addicted smokers to curtail their smoking without forcing them to eliminate nicotine altogether — an extraordinarily difficult task. Nicotine is the major reason inveterate smokers fail to quit: the craving for nicotine is as strong as that for heroin and cocaine. Yet the spectrum of smoking-related disease is not caused by nicotine, but by the products of tobacco combustion inhaled many times a day for decades. Nicotine is addictive, but it is not itself harmful.
That explains why tobacco harm reduction saves lives. Its goal is to reduce the devastating health risks of tobacco. The success of this policy in Sweden over the past four decades is widely accepted — but not among America’s tunnel-visioned health regulators. Thanks to snus, moist smokeless tobacco in small pouches, Swedish men have the lowest smoking rate and the lowest rate of smoking-related disease and death in Europe.
Yet our public-health officialdom ignores or denies these data, adhering to the mantra “There is no safe alternative to smoking.” They ignore or deny the results demonstrating that snus-type smokeless tobacco is about 99% less harmful than cigarettes. On the other hand, studies of the traditional cessation methods show that these products — patches, gum, inhalers, medications — simply do not work. But that inconvenient fact has not deterred our officialdom from insisting that smokers stick to these useless products. Their abstinence-only attitude refuses to acknowledge the documented benefits of smokeless tobacco as a cessation aid, not to mention the apparent benefits of newer products, such as dissolvable tobacco and “clean nicotine” delivery systems that include electronic cigarettes.
Worst of all, there is little hope in sight to remediate this tragic situation. The FDA’s position is that the benefits of reduced risk products for harm reduction must be “proven” before they can be recommended to smokers in America. But here’s the Catch-22: Only the tobacco industry has the requisite expertise and finances to perform the long-term, large-scale, super-expensive studies needed to prove the benefit of these products to the FDA’s satisfaction. The tobacco industry is explicitly barred, however, from supplying the needed data.
Given the intolerable loss of life and health attributable to smoking, why are the skeptics at the FDA, the American Cancer Society and the CDC stonewalling America’s smokers about harm reduction? I believe it’s because those experts recall too well the tobacco industry’s reprehensible behavior during the last century, and simply do not trust anything that the industry proposes.
But who pays for this failure to enter the 21st century and accept reality? Not the experts. Not the tobacco companies. No, the victims are the 45 million addicted smokers, and the families of those who couldn’t quit before cancer or heart disease struck. The time is long past when that approach should have evolved, to help smokers get the help they need to quit the death-dealing cigarette.
Dr. Gilbert Ross is the executive and medical director at the American Council on Science and Health.