For any of you who might have missed the important announcement last week about the outcome of a two-year dialogue process, mostly involving US tobacco control and tobacco policy experts, a link to it is provided here http://www.americanlegacy.org/2991.aspx. Noting that the primary goal of tobacco control is to reduce the mortality and morbidity associated with tobacco use, the blueprint that emerged acknowledges that the primary reduction in tobacco-related mortality will come from quitting. Hence many of the policy recommendations (e.g. regulation of all aspects of promotion, advertising and labelling and higher taxes) are consistent with such a conclusion. However, at the same time the blueprint acknowledges that harm reduction principles can also achieve public health gains. As such, policies are also called for which encourage current tobacco users, that are either unable or unwilling to quit, to reduce their health risks by switching from the most to the least harmful nicotine-containing products according to a continuum of risk. On this continuum, cigarettes are seen as being the most harmful tobacco product, with medicinal nicotine products being less harmful than oral tobacco products. To facilitate product switching will require that consumers receive accurate and evidence-based information on the toxicity and relative risk for disease of different nicotine-containing products. This is not before time – it’s crucial that consumers get this kind of information if they wish to self-regulate the risk of their continued tobacco and/or nicotine use other than choose the best option of quitting entirely.
In itself, the incorporation of harm reduction principles in this way as an adjunct to traditional tobacco control policies is not a new approach, see for example : Tobacco harm reduction: an alternative cessation strategy for inveterate smokers By Brad Rodu and William T Godshall Harm Reduction Journal 2006, 3:37 http://www.harmreductionjournal.com/content/3/1/37). But this approach is now given additional weight by the collective standing in the field of the participants in the dialogue process from which the blueprint was derived and it’s another step in the right direction for an arguably much more pragmatic regulatory policy given the stalling quit rates in many countries. Is it therefore too much to hope that those policymakers involved in impending discussions, both on FDA regulation of tobacco, and the crafting and implementation of pertinent aspects of the WHO Framework Convention on Tobacco Control will take note? What do you think?