Experts reconsider Tobacco Harm Reduction meaning as studies show evidence-based programmes are effective in saving souls

A recent study by Tobacco Research Network has established that evidence-based Tobacco Harm Reduction (THR) programmes are effective in reducing illness and saving lives and that, when properly managed, they greatly improve public health.

The network director Clifford E. Douglas made these assertions during the E-Cigarette Summit, which was held from December 7-8, 2021.

Clifford E. Douglas

Douglas made a presentation titled “Shifting the paradigm: Tobacco control and THR are scientifically complementary approaches to reducing illness and saving lives” in which he called for a THR process that is devoid of subjectivity, politicized enquiry and review.

THR is a public health strategy to lower the health risks to individuals and wider society associated with using tobacco products. It is an example of the concept of harm reduction, a strategy for dealing with the use of harmful drugs.

However, a Senior Lecturer in Tobacco Harm Reduction at King’s College London, Dr. Debbie Robson, observed that definitions of THR have evolved since the late 70s and more recently include targeting people who cannot or do not want to quit nicotine.

Robson said those who cannot or do not want to quit nicotine are often people with mental health and substance abuse problems, but also those in routine and manual occupations as well as those living in social housing and in certain geographical locations.

“There are several challenges and opportunities relating to THR and this presentation will highlight a few of these, such as the need to reconsider how we measure THR and how we incorporate and prioritise what outcomes matter most to people who smoke or vape,” she said.

Robson therefore recommended that the discourse around THR needs to evolve and expand rather than be constricted or silenced.

Hence, in his presentation, Douglas emphasized that THR needs to be about science and the realities of human behaviour, not an industry plot.

“Policy should be based on credible science, not biased by preconceptions and misconceptions. Policy-based science must be developed to better educate the public, public health/medical communities, the media and decision makers. Smokers shouldn’t have to die because they don’t know there are less harmful sources of nicotine.

“Significant misperceptions persist among the public and health care professionals regarding the role of nicotine. It is depicted as Public Health Enemy #1 and this deters smokers from NRT. If we continue to live in a world where nicotine is believed to cause the deadliest tobacco-related illnesses we’ll have a very difficult time succeeding,” he said.

Recently, 100+ independent global experts on nicotine science and policy recently sent an open letter to all nations involved in the WHO FCTC.

Douglas said this encouraged promotion of THR and criticised the WHO for misleading the public on the relatively lower risks of different tobacco products and for aggressively rejecting a strategy that could prevent millions of deaths.

“Yet, a response from one delegate was to imply that the experts were a front for the tobacco industry – a sad and counterproductive misrepresentation. The debate is often wrongly depicted as Public Health vs Tobacco industry. The Public Health side attributes Harm Reduction advocacy and any science that lends credence to THR to the influence of industry. This leads to a simplistic ‘us and them’ debate where THR advocates are considered to be tools for the tobacco industry,” he observed.

Chairman of the Australian Tobacco Harm Reduction Association and Author, Dr Colin Mendelsohn disclosed that smokers who switch to vaping have improved health, reduced toxin exposure, save money, and both smell and feel better.

However, Mendelsohn lamented that most doctors are unsupportive of vaping because they “are poorly informed, have concerns about effectiveness, safety and addictiveness and few recommend it to patients.”

“There is little training available and they tend to get their information from the media and patient feedback rather than scientific research. Nicotine use represents minimal risk of serious harm to physical health yet 4 in 5 US doctors wrongly believe it contributes to cardiovascular disease, COPD and cancer.

“Doctors have a duty of care to keep their knowledge up to date and not allow their moral views to deny patients access to medical care. However, they are mostly failing in this. Fortunately, Australian GPs who have started prescribing vaping are getting great feedback from patients,” he said.

Another speaker, Director of the Faculty of Medicine and Health Citizen’s Academy, Professor Caitlin Notley, expressed concern that World Health Organization (WHO) deliberately put across a simple, non-nuanced message, which could prevent people from switching away from cigarettes to less harmful forms of nicotine.

Notley argued that there is no evidence that vaping is harmful to mental health outcomes.
Asked what tobacco control groups should do or say to better influence the public, Caitlin recommend that the message around vaping and mental health should be the same as the general message: vaping is a less harmful way for people to continue to use nicotine.

In her closing keynote, University of Edinburgh’s Linda Bauld, OBE, observed that just as with Covid 19, at the start of the vaping era there were many unknowns.

Bauld said because of this, many countries did not know how to regulate or respond to vaping.

“For example, we didn’t know the relative risks or whether they would help people to stop smoking. With both Covid and vaping, building evidence has been crucial. Investment has transformed what we know about vaping, and has informed policy decisions.

“However, this has been underfunded and concentrated in high-income countries. Another common factor is which stakeholders matter in each debate: The role of the WHO has also been different. They have played a leading role in the pandemic, but in vaping their position has been very controversial,” she said.

Bauld commended the media for the big role it has played in both vaping and Covid-19.
She said although the coverage hasn’t always been accurate or helpful, as it is the bad news that makes the headlines, the media has proven to be a powerful tool for good.

“Some, but not all, media outlets have worked hard to address misinformation,” she said, citing Science Media Centre, which has done more than any other organisation to help achieve more balanced, evidence based coverage on both Covid-19 and vaping.

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