Ken Warner, School of Public Health, University of Michigan, 109 S. Observatory, Ann Arbor, MI MI 48109-202
Like it or not, an era of tobacco "harm reduction" is coming. Tobacco companies are introducing novel, ostensibly reduced-yield products at the rate of approximately one every three months. Especially in an unregulated tobacco product marketing environment, as exists in many countries, the forces compelling this spate of novel products ensures a steady flow of them. The question thus is not whether or not the public health community should encourage harm reduction, but rather how we will respond to its pursuit by the tobacco industry. In contemplating this future, and the regulatory possibilities that might be introduced, we need to understand that such a movement holds both potential benefits and clear risks. This paper evaluates both. Benefits include the reduction in health risk realized by inveterate tobacco product consumers who switch from conventional cigarette smoking to consumption of alternative products that reduce exposure to hazardous substances and hence reduce risks to health. Risks include consumers' maintaining tobacco product use, when otherwise they would have quit their use altogether, former consumers returning to tobacco product use, and children who would not have initiated tobacco use being induced to do so by the promise, implicit or explicit, of little to no risk in using novel products. Assessing the balance between risk and benefit is a challenge of prodigious proportions.