The potentially life-saving switch by smokers to non-combustible nicotine products is being severely undermined by skewed perceptions about their safety – especially in America where only one in eight people realise that alternative nicotine delivery products are less dangerous than cigarettes.
This was said at the 3rd Global Scientific Summit on Tobacco Harm Reduction: Novel products, research & policyby Clive Bates – engineer, environmental technologist, public health campaigner and former top advisor to ex British Prime Minister Tony Blair – writes Chris Bateman for MedicalBrief. The virtual summit, organised from Athens, was held from 24-25 September 2020.*
Bates, founder of the consulting and advocacy outfit Counterfactual, said new categories of nicotine delivery had one important thing in common; there was no combustion, and they exposed users to vastly lower levels of toxins.
“It’s one to three orders of magnitude less – and much less hazardous to your health. Getting this across to people is notoriously difficult.
“American survey data are quite depressing. For example, when it comes to vaping and e-cigarettes, one in two Americans think of them [being] as harmful or more harmful than smoking cigarettes – it’s incredible,” he said. Further, half of all Americans thought nicotine was a hazardous agent that most caused cancer in smoking, whereas tar is the villain.
The US Tobacco Act allowed three types of advertising claims: ones that promoted a lower level of a harmful substance, presented reduced exposure to it, or conveyed that there were no toxicants.
It was a good framework – but with one major flaw. This was because risk communication was generally meant and designed to inform consumers and help them make a decent product choice.
However, the US Tobacco Act was designed to ration and control what companies said about their products. This meant that if a tobacco manufacturer and product designer could not make any of these claims, no information was provided.
“Unless it’s cost-effective, no claims are made to the public,” Bates said. This made it “incredibly hard” to take cases to the US Food and Drug Administration, FDA. It was also hugely costly for a company to make a reduced exposure claim.
Risk perception gone awry
Another problem was ‘materiality’ warnings put on smokeless tobacco products, like ‘This can cause gum disease and/or mouth cancer’. “The implication is that these risks must be quite high. It’s hard to prove absence of risk in the cancers mentioned. The implied high risks are simply not supported by the science,” Bates complained.
He satirically compared this to accidentally cutting off an arm using a lawn mower or choking to death on a bacon slice. “They don’t see fit to place a warning like this on those products. Surely you must suggest the magnitude or materiality of the risk,” he asserted.
When it came to the proven lower health risk of snus, for instance, saying ‘this product is not a safe alternative to cigarettes’ was misleading because while the intention might just be to say snus was not safe, it implied that snus was as harmful as cigarettes. “What consumers hear is, ‘there’s no safety dividend here’, whereas a more accurate alternative would be to say: ‘This tobacco product presents a substantially lower risk to health than cigarettes’.”
Another prime example of a misleading disclaimer was: ‘This product contains nicotine which is a highly addictive substance – it is not recommend for use by non-smokers.’ “Remember, half of people think nicotine causes cancer,” Bates added.
The net result was that people thought there was no point in switching to a far less-harmful nicotine-based product.
Health warnings protect cigarette trade
The claims or disclaimers unintentionally functioned as protection for the cigarette trade, and were “perverse and counter-productive”, Bates argued. “They’ve taken risk perception in the wrong direction for all the wrong reasons. It’s scandalous – even now the Centre for Disease Control refuses to be clear on this.”
Reviewing the situation in other countries, Bates said the European Union approach was “all wrong – you can’t even make differentiated claims”.
In the United Kingdom, Public Health England – controversially – allowed television advertising saying that e-cigarettes were a good way to stop smoking, while the Canadian government approved a slew of pragmatic and accurate risk related statements which, sadly, had yet to be implemented.
The right approach was to be candid and follow the Swedish example where snus producers were able to claim that using snus was 95% safer than smoking cigarettes.
Bates was asked whether following a harm reduction policy and encouraging new smokers to go straight to new alternative nicotine products would encourage a smoking culture. He said no: the biggest concern authorities had about harm reduction was how it might ‘re-normalise’ smoking – yet this had not happened. “If anything, it’s done more to de-normalise consumer alternatives to smoking.
“Normalising stopping smoking by switching to alternatives is the way to go. If people see friends using these alternative products, we get a role-modelling effect and have diffusion of the technology into the population. It normalises a really good behaviour and I should be free to advertise it. The greater the use, the more the harm reduction,” he responded.
* Based in Greece, the 3rd Scientific Summit on Tobacco Harm Reduction was organised by the University of Thessalyand the University of Patras with the University of West Attica and the National and Kapodistrian University of Athens.
[link url="https://www.nosmokesummit.org"]3rd Global Scientific Summit on Tobacco Harm Reduction: Novel products, research & policy[/link]