People who cannot or are unwilling to give up smoking combustible tobacco should be encouraged to use safer alternative tobacco harm reduction products, heard the 4th Scientific Summit on Tobacco Harm Reduction: Novel products, research and policy, writes Chris Bateman for MedicalBrief. But it would be immoral to promote them to anyone else, especially young people.
This was the consensus among an elite multi-disciplinary group of medical professionals and harm reduction proponents in the closing session of the Summit. Attended by thousands of doctors and researchers, regulators and tobacco industry funded stakeholders across the world, the conference was held virtually on 29 and 30 September 2021.
Delegates heard that globally, eight million people die prematurely every year from smoking-related diseases, despite all efforts to control the smoking habit and its long-known harmful health effects. Yet more than one billion people now smoke – and the total number of smokers is growing.
In the European Union alone, tobacco smoking is the leading preventable cause of cancer mortality, with 27% of all cancer deaths linked to smoking. The conference heard that if smoking was eliminated, as much as 90% of all lung cancers could be avoided.
Organised by the International Association on Smoking Control and Harm Reduction, (SCOHRE), the conference’s final session was based on smoking cessation being “the best way – if and when it works”.
The previous two days of intensive debate, discussion, research paper presentations and input from regulators, activists and lobbyists centred on limiting the negative effects of smoking though the use of alternative products that are less harmful than cigarettes.
The ethics of lesser harm…
Professor Anastasia Barbouni is an expert in public health, hygiene and disease prevention in the Department of Public and Community Health at the University of West Attica in Athens. He asked a panel of SCOHRE members whether it was “ethical and moral” to find something safer then combusting tobacco – “yet not absolutely safe”.
First to respond was cardiologist Professor Ignatios Ikonomidis, Director of Echocardiography and the Laboratory of Preventive Cardiology at National and Kapodistrian University of Athens.
His take: It’s immoral if I leave a patient with heart disease or cancer to carry on smoking combustive cigarettes. It they’re not willing to stop or have tried and failed, I have to provide them with an alternative.
“The chances of them having a second heart attack or a new cancer or any aggravation of their current disease is thus reduced. It would be immoral for any doctor to close their eyes and say keep on smoking,” he asserted.
Ikonomidis said healthcare professionals should use all options to reduce harm and explain the pros and cons of each product. “People by themselves opt to switch from tobacco smoking to novel products. It’s a step in the right direction and we’re not going to place obstacles in their way,” he added.
Barbouni stressed that it was up to smokers to switch and replace cigarettes with non-combustible products – it was not a good idea for non-smokers to start using alternative products, as this would negate the purpose of harm reduction.
To smoke or not to smoke – and how
Tunisia’s Professor Fares Mili, a pulmonologist and addictologist from the Mayo Clinic in the United States, appealed to scientific associations to “gather the wherewithal to deal with policy-makers (and their own peers) in order to empower smokers with another choice.”
He said it was fundamentally a human-rights issue.
Mili, who is also chair of the Tunisian Society of Tobaccology and Addictive Behaviors, said it was imperative that healthcare professionals replace the toxicity of the products their patients used with less toxic ones, allowing them free choice.
South African psychiatrist Professor Solomon Rataemane, chair of the SA Ministerial Advisory Committee on Mental Health, urged healthcare professionals to attend to underlying mental health issues among smokers. He said far too many smokers suffered high levels of anxiety and depression.
“You need some kind of smoking cessation clinic for understanding and explaining how vaping products work. Some smokers don’t necessarily want to stop completely, and others will want to stay with vaping – there are many combinations, but the choice must be given to people.”
‘Alliance stigma’
Ikonomidis said scientific associations and governments should band together as they did when the COVID-19 pandemic took hold last year, in order to jointly reduce the stigma created when scientists work with multi-national tobacco companies to reduce health related risks.
“We need to find open ears among regulators and policy-makers – that’s the next step. But first we must persuade our scientists that this can be done.”
Mili reminded delegates of the World Health Organisation’s strong resistance to harm reduction products and its’ single-minded approach of simply getting people to quit.
“We must convince them to collaborate with scientific associations who must bring consensual evidence to help them change their decisions,” he said.
Ikonomidis said crucial to convincing the WHO would be discussion around youth being targeted with alternative harm reduction products by multi-national companies.
“We have to keep strict regulations regarding use of these products by those under 18 – and make it clear that we’re speaking about smokers who want to quit and use less harmful versions of tobacco, not new initiates to these alternative products,” he stressed.
4th Scientific Summit on Tobacco Harm Reduction: Novel products, research and policy
Global tobacco control ‘hugely outdated’ – Dr Kgosi Letlape
See also from the MedicalBrief archives
Tobacco smoking control – Much research, little action
WHO versus Public Health England over e-cigarettes
Tobacco harm reduction – The lesser of two evils
Profound problem of misinformation for public health and tobacco harm reduction
US regulator: Hard to balance benefits and harms of cigarette alternatives