Legislature Is Right to Consider Science-Based Tobacco Policy

Published September 17, 2012

Most smokers want to quit, but few realize that quitting doesn’t require abstinence. Tobacco harm reduction, a smoking cessation strategy with “the potential to save millions of lives,” will be the subject of a hearing September 19 by the Indiana Health Finance Commission.

Tobacco harm reduction is based on a simple premise: Smokers who are unwilling or unable to quit can achieve nearly all the health benefits of abstinence by switching to smoke-free cigarette substitutes, including newer products such as snus, dissolvables, and electronic cigarettes.

These tobacco products eliminate the smoke, thus eliminating virtually all the risk.

Smoke-free products are practical cigarette alternatives because they deliver satisfying doses of nicotine, which, while addictive (like caffeine), causes no smoking-related diseases.

Decades of medical research prove that smokeless tobacco use is at least 98 percent safer than smoking. Although no tobacco product is absolutely safe, claims about smokeless tobacco risks are often exaggerated by tobacco prohibitionists who cherry-pick scientific studies for obscure epidemiologic findings. They ignore the overwhelming scientific evidence documenting that there’s little or no risk from smokeless tobacco use.

In fact, all health risks from smokeless tobacco, including the risk for oral cancer, are so low as to be barely measurable. Statistically, a consumer of smokeless tobacco has about the same risk of dying from its use as an automobile user has of dying in a car accident.

Prohibitionists, who traditionally dominate U.S. tobacco policy discussion, are hostile to any solution not aimed at full tobacco abstinence. A common strategy they use is to refocus the tobacco debate as a discussion of children’s safety. Eliminating children’s access to tobacco is important, and Indiana is accomplishing that goal: This year, based on some 4,100 Indiana retail inspections, the FDA reported a compliance rate of 98.9 percent.

The eight million Americans–including 198,000 Hoosiers–who will die from smoking over the next two decades are not children; they are adults age 35 years and older. Prohibitionists offer these inveterate smokers only “behavior therapy” and the temporary use of expensive nicotine replacement products that provide too little nicotine to enable smokers to quit permanently. Medical journals confirm that nicotine gum and patches fail 93 percent of the time as quit-smoking aids.

These adult smokers need information and incentives to switch from cigarettes to smoke-free alternatives that work.

Prohibitionists complain that arguing for a switch from cigarettes to smoke-free tobacco is an industry ploy. Nothing could be further from the truth. Tobacco harm reduction is backed by legions of peer-reviewed research articles published in the world’s leading scientific journals. It is endorsed by the British Royal College of Physicians, the American Association of Public Health Physicians, and others. The Royal College concluded “that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved.”

Tobacco harm reduction is saving lives in Sweden, where men smoked less and used more smokeless tobacco–Swedish snus–over the past century than in any other Western country. The result: Swedish men have the lowest rates of lung cancer–indeed, of all tobacco-related deaths–in the developed world.

The Swedish snus experience is not limited to men. Increasing numbers of Swedish women are using recently introduced spit-free, socially acceptable snus products.

Last year, Gov. Mitch Daniels signed into law HB 1004, making Indiana the second state to officially promote tobacco harm reduction. The Indiana General Assembly found “that the tax rate on smokeless tobacco should reflect the relative risk between such products and cigarettes.” The legislation set the stage for the state to develop a rational tobacco tax policy, providing an economic incentive for smokers to switch from high-risk, high-tax cigarettes to low-risk, low-tax smokeless tobacco products.

The General Assembly deserves praise for considering this important public health issue.

Brad Rodu is a senior fellow of The Heartland Institute and holds the Endowed Chair in Tobacco Harm Reduction Research at the University of Louisville’s James Graham Brown Cancer Center.