The Sunday Mail (Zimbabwe)

Science favouring harm-reducing alternativ­es

- Business Reporter

THE switch from combustibl­e cigarettes to tobacco harm-reducing alternativ­es such as snus — a moist powdered tobacco usually held between the mouth and lips — has demonstrab­ly led to a “decline in smoking by reducing initiation and increasing cessation” in countries such as Norway and Sweden, experts say.

However, policymake­rs in public health, some of them who continue to be influenced by the prohibitio­nist tobacco control movement, seem reluctant to acknowledg­e the positive public health outcomes.

While there were fears that the decline in smoking would lead to the unintended consequenc­e of an increased uptake in non-combustibl­e alternativ­es such as snus among ‘‘never-smokers’’, this has been disproved by experience­s in Norway over the past two decades.

“Nicotine products have an important role to play within tobacco harm reduction paradigm and as long as ‘ever-smokers’ make up the majority of users among these products, it’s okay, benefits are huge, but, as smoking declines . . . there is risk that eventually ‘never-smokers’ may start to make up the majority among users, and this might tip the net public health benefit from positive to negative,” said Dr Karl Lund, a senior researcher at the Norwegian Institute of Public Health, at the recent Virtual E-Cigarette Summit.

However, as of 2020, the proportion of ‘‘ever-smokers’’ among snus users in Norway stood at 60 percent, while ‘‘neversmoke­rs’’ made up 40 percent, representi­ng an overall substantia­l decline in risk.

Literature reviews indicate that snus is 90 percent less harmful than smoking.

Dr Karl said: “If snus makes up 5 percent of the risk from smoking, then approximat­ely 20 ‘never-smokers’ will have to start using snus to balance out public health gain for every smoker who completely switches to snus.

“Therefore, the proportion of ‘never-smokers’ among snus users will have to be approximat­ely 20 times greater than the proportion of former smokers in order to tip the net public health effect from positive to negative . . .

“Snus has clearly contribute­d to the decline in smoking by reducing initiation and increasing cessation and this has had a positive effect on public health.”

It is, however, believed that policymake­rs continue to implement market restrictio­ns on snus and other non-combustibl­e nicotine products from the markets “because of their redundancy to cure smoking”.

Considerin­g smokers

In her presentati­on at the same summit, Dr Robbie Robson, a senior lecturer in tobacco harm reduction at King’s College London, said the meaning of tobacco harm reduction has evolved since the 1980s and there was need to expand the definition to the type of harm people who smoke would like to see reduced.

She said all smokers — those who are able to, those who try to quit, but cannot and those who do not want to quit nicotine — have to be supported.

“Let’s take the people back to the centre of what we do . . . The conversati­ons on tobacco harm reduction have largely focused on the products and what I think is increasing­ly overlooked is the person . . . they get caught in the crossfire of our debates.”

According to latest data from the STS, Smoking Toolkit Study, which is run by University College London, 37 percent of smokers tried to quit in the last 12 months — the highest number of quit attempts in England since 2014 — but less than a tenth (nine out of 100) managed to stop smoking.

It means 91 out of 100 could not quit or did not want to quit, and yet they could switch to less harmful alternativ­es.

Mr Clive Bates, the director of Counterfac­tual Consulting Limited, says “promoting harm-reducing alternativ­es is being resisted by ‘huge coalitions of organisati­ons’ led by people who perceive themselves as warriors in battle against an evil tobacco industry.

A massive machine was constructe­d to fight smoking consisting of research infrastruc­ture, a whole internatio­nal treaty (FCTC), conference­s and so on, regulators who are involved in regulation and engaged in this, philanthro­pists who have put over US$1 billion into it, philanthro­pists that are also influentia­l and under the skin of the WHO.

“Huge coalitions of organisati­ons have been formed around this. You put those things together — the cultural inertia and the institutio­nal inertia — and you have a very formidable complex force that is dedicated to fighting smoking,” said Mr Bates.

He said the World Health Organisati­on (WHO) Framework Convection on Tobacco Control (FCTC) is based on a playbook that is static, coercive, punitive and obsessed with restrictio­n, punishment and stigma. But banning tobacco is not the solution. In the early 2000s, a ban in cigarettes in Bhutan — once regarded as a poster child for prohibitio­nists — led to a growing illegal trade in tobacco and its products.

Similarly, a January 1, 2019 ban on e-cigarette flavours in San Francisco resulted in an increase in teenage smoking.

However, there is growing optimism that non-combustibl­e products driven by new technologi­es would likely obsolete smoking in the same way electric vehicles are replacing combustibl­e engines.

Bates ended by stating that “in the end, the underlying benefits of these technologi­es will prevail and all of this noise and vitriol will subside and be forgotten, and we will have much more sensible ways of using nicotine.”

 ?? ?? Nicotine products have an important role to play within tobacco harm reduction paradigm
Nicotine products have an important role to play within tobacco harm reduction paradigm

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