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Wednesday, October 4, 2023

Harm reduction: Science, sociology and restrictive regulations

At an online panel discussion on Tobacco Harm Reduction on June 23, 2020, Professor Reuven Zimlichman, Director of the Brunner Institute for Cardiovascular Research in Tel-Aviv University, and Dr Peter Harper, oncologist, and Gizelle Baker, an epidemiologist and PMI’s Director Scientific Engagement, discussed scientifically-proven harm reduction tools with regards to tobacco

IQOS is PMI’s electronic nicotine device. Still, many people around the world, including in Africa, don’t have access to innovative products because of tobacco control restrictions

Nowadays, more than one billion people smoke in the world and the World Health Organisation (WHO) predicts that this number will not decrease until 2025.

In the meantime, progress is being made on alternatives to cigarettes in spite of conflicting positions mainly between the tobacco industry, policy makers, and consumers. This last year, a number of scientific studies have revealed that alternatives to traditional tobacco do less harm than conventional cigarettes. As a result, millions of smokers have already switched to smoking alternatives such as heated tobacco or electronic cigarettes.

Recently, the United Kingdom governmental agency, Public Health England, published a report stating that e-cigarette use is around 95% safer than smoking traditional tobacco. For Prof. Reuven, the situation is complex and should be seen through human condition and behaviour: “Unhealthy behaviors are inevitable. People make poor lifestyle choices despite suffering negative health effects. Heart disease patients continue to lead sedentary lives and eat unhealthy diet, diabetic patients continue to overeat and eat unhealthy food, and chronic obstructive pulmonary disease patients continue to smoke.”

For him, it is important to adapt to these contradictory habits: “There has been a significant decrease in cardiovascular mortality in developed countries in the 1990s and early 2000s. We have seen a lot of campaigns educating populations to have healthy lifestyle, to exercise, to eat well, to stop drinking and quit smoking. Harm reduction targets to minimise the harms that are a consequence of inadequate behaviors. It is very successfully applied in many areas: diet, tanning, physical activity, sugar consumption. With regard to tobacco, studies have shown that switching from tobacco cigarettes to electronic cigarettes allows the artery to dilate significantly more and thus supply significantly more amount of blood to the organs”.

Gizelle Baker from PMI introduced the time factor notion when it comes to smoking-related diseases:

“Smoking-related diseases take decades to develop and within decades, lots of things happen to people. The first thing we know, and we know it from decades of epidemiology on smoking, is that when people smoke, the longer they smoke, the more they smoke, and the more they risk developing smoking- related diseases. We also know that quitting is the best option, but it takes time for this to happen. It takes years to be smoke-free”.

PMI has led hundreds of scientific studies. For the tobacco company, scientific-based research are fundamental:

“We set up our scientific programme to assess how harm reduction works and whether a new product has the potential to reduce the risks of harm, we develop many studies. We had a group who continued smoking, we had a control group who quit and then we had a third group who switched to new products.  We notice that the later group was closer to cessation than the first one who continued to smoke. Those clinical studies conducted around the world, including the United States and Japan showed a reduced formation of harmful and potentially harmful constituents, reduced toxicity and risks, and also reduced exposure in adult smokers.”

Gizelle Baker added that a number of independent studies corroborate PMI’s scientific studies: “There have been over 25 independent studies led by researchers on IQOS that generally confirms that IQOS produces significantly lower levels of harmful chemicals compared to cigarettes. 14.6 million smokers who used to smoke cigarettes are now using IQOS.”

The IQOS is PMI’s electronic nicotine device

How about tobacco harm reduction in Africa?

Still, many people around the world, including in Africa, don’t have access to innovative products because of tobacco control restrictions. The panel of experts is unanimous on this subject: people should have access to information and smokers should be encouraged, when they don’t quit, to, at least, switch to options that they consider better for them.

Gizelle Baker pointed out that “harm reduction is relevant regardless of where you live”.

Pr Zimlichman strengthened this point: “The more important thing is the approach of the governments. They should make decisions that are compatible with medical approach. This will help explain to populations how they can lower their chances of disease by switching if they cannot stop smoking.”

During the Global Nicotine Forum, the question regarding access to information was discussed as well. Marewa Glover, Director of the Centre of Research Excellence in New Zealand, specialised in indigenous sovereignty and smoking, stated:

“Even in some sub-Saharan African countries, there are some strong advocates for tobacco harm reduction. They need to be supported. It is very important for the wider international tobacco harm reduction sector to extend that support and to make sure that newer theories on how to help reduce harms associated with tobacco use are shared through African media outlets, and via health and education platforms for learning.”

On his part, Dr Peter Harper targeted the lack of engagement with doctors by the industry: “You cannot consign a billion smokers to no protection. But the problem is, if you engage with the industry, whether you are a university academic or an independent one, you are really looked down on, which is ridiculous. We have to engage on harm reduction just as we do on everyday life needs.”

In conclusion, a science-based, pragmatic approach to harm reduction has been highly recommended for tobacco harm reduction to be more efficient:

“We know that smokers smoke despite knowing the health risks. What we believe is less harmful is actually more restricted. Cigarettes are legally sold in Australia for example and e-cigarettes are banned or at least sold on prescription. We should be able to differentiate between smoke and smoke-free products. The regulations should be proportionate, fair and equitable. We must protect youth and focus marketing to adult smokers. It is important to also control ingredients and flavors based on science and evidence.”

By Seynabou Sall

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