Experts in Government, Public Health, Public Policy and Science Outline Blueprint for Reducing Death and Disease from Tobacco in the United States

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?

21 comments ↓

#1 supercallousSi on 03.02.09 at 5:19 PM

An almost identical approach was used by the Nazi’s in reducing the number of Jews in the Fatherland.Do rational ,freedom loving people wish to condone a similar episode in History ? I’m open to offers as to who is the most corrupt :- WHO,TC or the US Gov’t.

#2 TAZ on 03.02.09 at 6:17 PM

Date: 3/2/2009

Support Youth Prevention and Tobacco Harm Reduction Act

Current Cosponsors: Buyer, Deal, McIntyre, McGovern

Dear Colleague:

The Centers for Disease Control and Prevention (CDC) reports that cigarette smoking accounts for an estimated 438,000 deaths (nearly
1 of every 5 deaths) each year in the United States. Smoking causes about 90% of lung cancer deaths in men and almost 80% of lung cancer deaths in women.

In the coming days, we look forward to introducing legislation that will promote the prevention of youth smoking, promote public education about the harmful effects of tobacco use, and support harm reduction strategies which enable smokers to understand the relative health risk of tobacco products and encourage them to make informed health decisions.

In October 2008, the American Association of Public Health Physicians (AAPHP) issued a “Resolution on Tobacco Harm Reduction.”
Highlights of this resolution include:

* “There is substantial scientific evidence that selected smokeless tobacco products can satisfy the nicotine addiction of inveterate smokers while eliminating most, if not all, risk of pulmonary and cardiovascular complications of smoking and while reducing the risk of cancer by more than 95%”

* “Current abstain, quit, or die tobacco control policies in the United States may have reached their maximum possible public health benefit because of the large number of cigarette smokers either unwilling or unable to discontinue their addiction to nicotine”

* “There is evidence that harm reduction works and can be accomplished in a way that will not increase initiation or impede smoking cessation”

* “Current federal policy requires tobacco product labeling that leaves the incorrect impression that all tobacco product present equal risk”

* “Be it Therefore Resolved that the AAPHP go on record as favoring Harm Reduction as a component of public health efforts to reduce tobacco-related illness and death.”

Please join us in cosponsoring bipartisan legislation to promote tobacco harm reduction policies as part of a comprehensive approach to tobacco legislation. Please contact Allison Hite (Rep.
Buyer) at 5-5037, Kim McClellan (Rep. McIntyre) at 5-2731 or Blake Fulenwider (Rep. Deal) at 5-5211 with any questions or to sign on as a co-sponsor.

Regards,

Steve Buyer Member of Congress
Mike McIntyre Member of Congress
Nathan Deal Ranking Member, Subcommittee on Health, Committee on Energy and Commerce

#3 TAZ on 03.02.09 at 6:28 PM

Further encouragement to get the word out as soon as possible before Waxman’s bill is just passed without any input and logic!

March 2, 2009

Dear Representative

Smokefree Pennsylvania urges you to oppose Rep. Waxman’s FDA tobacco
legislation, and to support Rep. Steve Buyer’s common sense tobacco harm
reduction alternative.

We oppose Rep. Waxman’s legislation, a deal negotiated by Philip Morris and
the Campaign for Tobacco Free Kids in 2004, because it protects the most
hazardous tobacco product (cigarettes) from market competition by the least
hazardous smokefree (i.e. smokeless) tobacco products, as it:

– fails to inform cigarette smokers that smokefree tobacco products are far
lower risk alternatives,
– deceives the public to believe that smokefree tobacco products are just
as hazardous as cigarettes,
– prohibits companies from informing smokers that smokefree products are
less hazardous,
– discourages and may halt development/marketing of new lower risk
smokefree tobacco products,

Sound product regulations truthfully inform consumers (and the public)
about risks of different products. Although cigarettes are about 100 times
deadlier than smokefree tobacco products, nearly 90% of smokers incorrectly
believe that smokefree tobacco products are just as hazardous as
cigarettes, and Rep. Waxman’s legislation would perpetuate this health
myth/fraud.

By switching to smokefree tobacco/nicotine products, smokers reduce their
health risks by nearly as much as by quitting all tobacco/nicotine, and
millions have already done so. Besides, smokers have a human right to be
informed that smokefree tobacco/nicotine products are less hazardous
alternatives to cigarettes, and public health agencies have an ethical duty
to inform smokers of this potentially life saving fact. I coauthored a
report “Tobacco harm reduction: an alternative cessation strategy for
addicted smokers” at http://www.harmreductionjournal.com/content/3/1/37

Since 1990, Smokefree Pennsylvania has advocated policies to reduce tobacco
smoke pollution indoors, increase cigarette taxes, reduce tobacco marketing
to youth, preserve civil justice remedies for tobacco victims, expand
smoking cessation services, and inform smokers that smokefree
tobacco/nicotine products are far less hazardous alternatives to
cigarettes.

Thank you for your consideration, and feel free to contact me anytime.

Sincerely,

William T. Godshall, MPH
Executive Director

#4 Rick on 03.02.09 at 9:21 PM

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!!!! My FEAR IS THAT THE JUDICIAL BODY IN PLACE TODAY DOES NOT EVEN TAKE THE TIME TO REVIEW A BUDGET OR STIMULUS PACKAGE. What makes you think they will bother to read the items that we would like to have secured in the proposed legislation? The liberal left has no tolerance for anyone that has an opposing view.

#5 Anonymous on 03.03.09 at 11:58 AM

It’s encouraging to see that an alternative to the reintroduction and passing of the previous legislation is being canvassed (see posts above). This may (or may not?) impact on what happens in the House. But given time to attract more support, it could provide an invaluable backdrop to discussions in the Senate and, irrespective of Rick’s fears (which I do understand), I hope this is the case. Of course children need to be protected, but the people most at risk of death and disease at the moment are middle/late-aged smokers who either don’t want to give up or find it hard to give up. They are the ones who potentially stand to profit most from meaningful information about how they might reduce their risks without necessarily having to quit using tobacco altogether. And that’s why framing legislation to embrace the principles of harm reduction might achieve public health goals faster than would otherwise be the case. I really can’t think of a precedent for consumers not to be made aware by their elected goverment that a safer alternative to the product they use at present is available (can anyone else?). Mind you, the situation is even more bizarre in the European Union. Almost everyone agrees that smokeless tobacco products such as Swedish-style snus are vastly safer than cigarettes, yet it is still against the law to market these type of products except in Sweden. How exactly is that consistent with protecting the rights of the consumer?

#6 Adrian on 03.03.09 at 12:00 PM

For anonymous above read me – just forgot to fill that box in before sending!

#7 HarmReductionProducts on 03.03.09 at 9:28 PM

We will need BETTER products. Has anyone seen the RJR stuff? Little films that crack to pieces and those crappy rods? They may as well buy Star after all if their tablet (sorry, ORB) is the best they can do…. What a JOKE!

#8 butthead on 03.03.09 at 9:36 PM

Oh did you not realize that RJR may have to ante up a billion dollars over a infringement of a patent to Star?

#9 Bill Godshall on 03.04.09 at 10:15 AM

The House Energy and Commerce Committee markup is beginning now, and can be viewed at:
http://energycommerce.house.gov/index.php?option=com_content&task=view&id=1314&Itemid=1

#10 Anonymous on 03.04.09 at 12:34 PM

HRP

#11 Anonymous on 03.04.09 at 12:36 PM

HRP — The RJR product is so weak! The Star product is far superior. Not saying much there either.

#12 TAZ on 03.04.09 at 7:24 PM

In a 39-13 vote, the US House Committee on Energy and Commerce chaired by Rep. Henry Waxman (D-California) on March 4th passed H.R.1256 Family Smoking Prevention and Tobacco Control Act, which is sponsored by Mr. Waxman and would authorize the Food and Drug Administration to regulate tobacco products. The committee rejected Rep. Steve Buyer’s (R-Indiana) substitute that proposed an alternative Tobacco Harm Reduction Center within the US Department of Health and Human Services to encourage ways to reduce harm from cigarette smoking, including a shift toward smokeless products. (Bloomberg News 03/04)

#13 Adrian on 03.06.09 at 12:41 PM

Although the committee voted as it did, the mere fact that an alternative to the Waxman bill was discussed is, I think, a major step forward and can only spur further debate in the Senate. I for one hope that the ensuing discussions lead to a more pragmatic approach to the issue of tobacco regulation that focuses on reducing the health impact of tobacco use across the board rather than being targeted primarily to preventing youth access, which although important, does necessarily not help adult consumers. All tobacco products are not created equal, either in terms of health risks or consumer acceptability. But the consumer acceptability of some less risky products might well increase if accurate information was provided as to the risks of these products relative to cigarettes. In almost every other walk of life, consumers are credited with the ability to make informed decisions. I can see no reason why this should not also be the case in terms of consumers being able to choose between different formats of tobacco products based on truthful and accurate information on where they lie on the continuum of risk.

#14 Cig Guy on 03.06.09 at 11:20 PM

Well said Adrian however I’m not sure if the last part of your statement regarding “consumers being able to choose between different formats of tobacco products based on truthful and accurate information on where they lie on the continuum of risk” is something that our legislature is capable of doing. Can they understand this? Can they think outside of the Waxman Marlboro Protection Plan called HR 1108? This will be the true test! How can we get to them and guide them past their blindness? Maybe you an Bill Godshall should post an article that tells folks what to do that works? Or is it futile! I’ve called the 1-800-govt cares line which seem to be really a 1-800-your a fool line if you think we care what you think lines! Pretty frustrating!

#15 Adrian on 03.09.09 at 4:40 PM

In reply to Cig Guy – nice thought! I think that Bill has tried valiantly to bring attention to what is a pragmatic alternative to the outmoded ‘abstinence-only’ mindset of tobacco control othodoxy and he deserves all the support he can get in doing this. In my own way I have tried to do the same with my contacts. But what I think is a fundamental issue here is political correctness. I know from my own experience of talking to politicians on an individual basis that they get the concept of tobacco harm reduction. Indeed, who would not? It’s just common sense and it is applied in many other areas where risk is involved. Unfortunately in the great scheme of things it is a brave politician that makes a stand against the massed ranks of NGOs and public health charities whose well-funded business model depends on being seen to be hard line anti-tobacco, even if this disenfranchises consumers from having either the information or the choice on safer alternatives to cigarettes if (for whatever reason) they don’t quit tobacco use entirely. I for one hope that the mere fact that an alternative proposal has been put forward will stimulate discussion in the run-up to consideration of the bill by the Senate. At the moment the consumer is caught in the crossfire between the massed ranks of the tobacco control community and the tobacco manufacturers. This can’t be right – smokers may be smokers, but first and foremost they are people, and it’s a sad reflection on the times we live in that some (indeed, many) politicians seem to conveniently forget this.

#16 Adrian on 03.11.09 at 11:18 AM

Just learned that another alternative to the Waxman Bill has been introduced (see below). Not mentioned in the press release is the fact that, among other things, this bill proposes to set up a mechanism to evaluate reduced exposure/reduced risk claims and would also require that product categories (e.g. cigarettes, cigars, smokeless) be ranked on the basis of relative risk. Furthermore, this ranking would be promulgated to the general public. This could all get very interesting!

Press Release of Senator Hagan http://hagan.senate.gov/record.cfm?id=309405&

SENATORS BURR, HAGAN OFFER ALTERNATIVE TO FDA REGULATING TOBACCO
Wednesday, March 11, 2009
WASHINGTON, D.C. – Recognizing that the Food and Drug Administration (FDA) is ill equipped and unsuited to regulate tobacco and tobacco products and concerned about the impact federal tobacco regulation could have on a key industry in North Carolina, U.S. Senator Richard Burr (R-NC) joined U.S. Senator Kay R. Hagan (D-NC) in offering a reasonable, bipartisan alternative to the proposed FDA tobacco regulation. Events such as the recent peanut recall demonstrate that the FDA is overburdened and ill-equipped to handle a large, new mandate.

“I am pleased to introduce this important piece of legislation, along with Senator Hagan, which will provide appropriate federal regulation of tobacco products,” Senator Burr said.

“I am opposed to giving the FDA the authority to regulate tobacco. The FDA is overburdened already, and lacks the capacity or the expertise to take on a large, complicated new industry. Rather than merely oppose FDA regulation, Senator Burr and I have offered an alternative proposal that protects the tobacco industry while also imposing stringent new restrictions that will prevent children from smoking. I will not stand idly by while the FDA is put in charge of such a critical industry to North Carolina,” said Hagan. “I am offering this alternative and will work with my colleagues to garner additional support.”

The Federal Tobacco Act of 2009, introduced today, would establish a federal agency – separate from the FDA – dedicated to regulating the manufacture, marketing and use of tobacco products. The FDA’s mission is to ensure the safety of the food, drugs, and medical devices, not products that everyone knows to be unsafe. If tobacco regulation must take place, this proposal is a more viable and reasonable alternative.

Under the proposal, a new agency – the Federal Tobacco Regulatory Agency – would be established to enforce new and existing federal statutes and regulations governing tobacco products. All tobacco manufacturers doing businesses domestically would be required to register with the Federal Tobacco Regulatory Agency, and significant user fees would fund the agency.

Additionally, the proposal would virtually eliminate the advertising and marketing of tobacco products and the use of terms such as “light,” “mild,” “ultra-light,” “medium,” and “low,” as product descriptors. Companies would not be permitted to use their brand to sponsor events or conduct consumer sweepstakes or contests. Cigarettes would not be permitted to be sold in packs of less than 20, and the backs of tobacco packages would be reserved for mandated disclosure requirements, including surgeon general’s warnings and ingredient disclosures.

North Carolina employs 65,000 people in tobacco industry – from large tobacco companies, distributors, to tobacco farmers in eastern North Carolina.

#17 jredheadgirl on 03.14.09 at 3:56 PM

People are always going to smoke cigarettes. I, for one, will never switch to a smokeless nicotine product. The only real solution is to put research funds into developing a safer cigarette, rather than wasting money on trying to prohibit it. Snus is NOT the answer. Smokeless products are NOT the answer. The longer that we ignore this, the longer we wait for real harm reduction for the billion + people in the world who smoke and will continue to smoke. Remember when we tried to get people to quit drinking alcohol?

#18 Adrian on 03.15.09 at 7:49 AM

I agree that for the forseeable future the majority of tobacco consumption (in the western world anyway) is likely to be in the form of cigarettes. That’s why it’s important that research into ‘safer cigarettes’ should continue. However the barriers to demonstrating that a new combustible product is ‘safer’ than regular cigarettes should not be underestimated. In the absence of validated biomarkers of harm it could take years to do the necessary epidemiological studies. In the case of smokeless products we already have the epidemiology to demonstrate that, while not being entirely safe (few things in life are) overall they are much less risky than cigarettes. Does that mean smokers will switch to these products in droves overnight? No – of course they won’t, it’s a completely different experience. But more might switch if they were provided with accurate and consistent information about the difference in risk. Even if just a small percentage of inveterate smokers switched it could have a significant public health impact. So I guess what I am suggesting is that we should look at harm reduction in a holistic way that factors all possibilities into the mix. This includes a framework for product regulation that a) takes on board the continuum of risk; b) supports the right of consumers to know where the products (including NRT products) that they purchase, or are thinking about purchasing, lie on that continuum; and c) provides incentives to manufacturers to do the R&D on potentially ‘safer’ products, including cigarettes. This incentive should encompass a mechanism whereby any such products would be evaluted objectively rather than either emotionally or politically.

#19 Bertram52 on 03.15.09 at 10:16 AM

Adrian, this is a brilliant summary of where policy should go….. We can only hope that is resonates.

#20 Troubadour on 03.15.09 at 11:19 AM

I’d love to see this policy get traction!

#21 Adrian on 03.16.09 at 5:24 PM

Thanks everyone for the comments on this posting! As we seem (not surprisingly) to have ended up in the regulatory policy box, it would therefore seem to make sense to continue the conversation under the more recent post on an alternative to FDA regulation-hence please feel free to do so there: here is the link
http://www.tobaccotoday.info/2009/03/12/an-alternative-to-fda-regulation-of-tobacco/#comments