Public Health Physicians’ Group Endorses Harm Reduction as Alternative to Smoking

Published March 1, 2009

The American Association of Public Health Physicians has officially endorsed tobacco harm reduction, in which smokers substitute other forms of tobacco and nicotine for cigarettes, cigars, and pipes instead of quitting outright, as a last resort for chronic tobacco users.

“It’s better than smoking, but it’s still not perfect,” said Kevin Sherin, M.D., president of AAPHP, headquartered in Rolling Meadows, Illinois.

Complaints from Advocacy Groups

The endorsement, made public at the end of 2008, is noteworthy because it is the first time a U.S. medical organization has endorsed tobacco harm reduction as a viable strategy for reducing deaths due to tobacco use.

The decision met resistance from advocacy groups who believe tobacco harm reduction should be used only as a tool to help smokers quit altogether, not as an approach for long-term mitigation of potential health concerns. Proponents of the endorsement, however, say the use of tobacco alternative products could keep more people alive.

“If we find something that can reduce harm by 99 or 98 percent, that seems like a reasonable approach, especially when there are hundreds and thousands of people in the United States who die from tobacco every year,” said Sherin.

“So if you can make an incremental inroad into reducing the harm related to it, even though you’re taking a controversial stand, it seems like a reasonable approach,” Sherin said.

Perhaps Best Last Resort

Sherin said as a family practitioner he can see the importance of this option for individual patients, especially considering how many people seem unable to quit smoking despite their best efforts.

Sherin said between 50 and 60 percent of the people who try to quit using tobacco products fail, even if they’ve used aids such as nicotine patches and sought support from family, friends, and others who have quit smoking. When tobacco users have repeatedly tried and failed to quit, tobacco harm reduction products might be their best last resort, he said.

Products used for tobacco harm reduction can contribute to high blood pressure, coronary heart disease, and oral cancer, but they dramatically reduce the frequency of those effects when compared with smoking, say proponents.

“It doesn’t mean we’re endorsing a tobacco product, but it does have a role for people who have tried everything else to quit smoking, and it does have a role in trying to reduce the deaths and devastation caused by tobacco,” Sherin said.

Stand Pat, Others Say

Others would prefer to stick with current efforts to concentrate on cessation of all tobacco use.

“Doctors should urge patients to quit smoking, not switch to the lesser of two evils,” said Peter Pitts, president of the Center for Medicine in the Public Interest and a former FDA associate commissioner.

“I think as long as the final goal for patients is complete cessation, tobacco harm reduction products are a valid type of therapy,” Pitts said. However, he added, “Clearly, it should not be used for an extended length of time or as a substitute for quitting.”

Although Pitts has never smoked, he said he helped his wife successfully quit smoking, and while he agrees tobacco harm reduction products can be helpful as an aid to quitting altogether, he cannot fathom doctors would encourage their patients to use indefinitely what he sees as a harmful product.

“I would say it’s giving up the fort too easily,” Pitts said. “I don’t think there’s a patient in the United States who can’t, with the appropriate treatment, be weaned off a tobacco product. It’s a cop-out.

“I’m not aware of anyone who has been unable to quit smoking,” Pitts continued. “If someone is unable to quit smoking, I don’t see the value of quitting one bad habit for another. There is no clinical evidence of someone who is clinically unable to quit using tobacco.”

Jillian Melchior ([email protected]) writes from Michigan.