Saving Smokers

[Thomas3.20.2010]

A slow-motion tsunami of disease and death, at last on the wane in North America and Europe, is blazing its seemingly irresistible path across Asia, Africa and Latin America. It's slated to claim one billion – billion! – lives over the course of this century, more than all the world wars combined. The vector of this cruel epidemic is not weaponized contagion, nuclear terrorism, nor drought and famine. 

The killer is the cigarette. This frightful toll is actually not inevitable; in fact, we — those of us in the medical and public health sciences — have the means to largely ameliorate this desperate situation. But seemingly mindless of the tragic consequences, those running our governmental and private nonprofit health agencies — in near-unanimous lockstep — refuse to acknowledge an approach with vast lifesaving potential. Worse, they conspire to distort the science and suppress communicating the truth to those whose need to hear it is most dire: addicted smokers.

The lifesaving concept is harm reduction; simply put, it allows nicotine-addicted smokers to satisfy their craving by supplying them with their drug of choice without the lethal tobacco smoke: the real killer. In fact, tobacco harm reduction is the same concept that led to the development of nicotine patches, gums, and inhalers. While it’s the nicotine that keeps smokers coming back for more, it's the smoke – inhaled hundreds of times a day — that causes the myriad deadly smoking-related diseases.

Yet, while smokers for decades have been handed the tired mantra, “Stick to the old reliable FDA-approved cessation aids,” the sad fact is that these products have been proven ineffective in study after study. The best of them increase quitting “success” rates from 5% "cold turkey" to maybe 10%. This type of success is killing millions of smokers. These products simply do not deliver the nicotine "hit" that smokers require, nor the taste and rituals of smoking tobacco

A better approach exists: a tobacco product called "snus," smokeless tobacco in small teabag-like sachets, has been shown among men in Sweden to help reduce smoking rates and smoking-related disease to the lowest level in Europe. Snus-type smokeless products — contrary to popular belief — do not cause any of the cigarette-related diseases, and of course there is zero second-hand smoke.

Over the past few years, numerous other reduced-risk tobacco products and "clean-nicotine" devices have been developed, mainly (but not exclusively) by the tobacco industry. These include dissolvable oral orbs and sticks, and electronic cigarettes ("e-cigarettes") that look like cigarettes but deliver nicotine vapor which is inhaled like cigarette smoke. 

Given the devastating fact of the increasing uptake of smoking – and its attendant health impacts — in less developed regions, you’d think public health leaders worldwide would be eager to consider any promising technology for helping smokers get off and stay off deadly, addictive cigarettes. Au contraire — these same “leaders” take every opportunity to ban or restrict the alternatives, going so far (in the US) to try to prevent the importation and sale of e-cigarettes. This wrong-headed regulation was only blocked thanks to a Federal judge, to the immense gratitude of millions of ex-smokers who relied on this innovative product to quit.

Officials and NGOs, suspicious of tobacco companies’ motives, have falsely accused them of targeting youngsters with "candy-flavored" dissolvable products – sometimes even before the product hit the market. This precaution derives, of course, from the reprehensible, corrupt behavior of "Big Tobacco" in the 20th century. In fact, the international tobacco control treaty (“The Framework them Convention”) specifically urges governments to reflexively ban innovative reduced harm products, and find reasons why later, rather than undertake research into these nearly harmless and beneficial products. Those responsible for our own law giving tobacco oversight to the FDA, enacted in 2009, grandly claim to have markedly reduced teen smoking by such endeavors as banning candy-flavored cigarettes (smoked by no one) and by forcing tobacco companies to reveal their ingredients — useless information. Meanwhile, the same law established near-impossible hurdles for reduced-harm products to enter the market, effectively condemning addicted smokers to "quit, or die."

While the irresponsible activities of the cigarette companies in days gone by will never be forgotten, the goal now should be saving millions (or more) lives — and a billion others. The time to get with the 21st century has arrived. Yet, the CDC, FDA, American Cancer Society, and others refuse to acknowledge the current facts: reduced risk/reduced harm nicotine delivery methods can help smokers quit while the "old reliable" FDA-approved products do not. 

A British expert speaking for the Royal Society of Medicine put it thusly:“The absence of effective harm reduction options for smokers is perverse, unjust, and acts against the rights and best interest of smokers, and of public health. Addicted smokers have a right to choose from a range of safer nicotine products, as well as accurate and unbiased information that guides that choice.”

Over 450,000 are lost each year in our country alone to smoking, and multiples of that number are left too ill to work or enjoy life. Most smokers wish to quit, yet few succeed, while our leaders issue platitudes and refuse to tell the truth. It is long past time that this should have changed – but better late than never. Smokers, and the families they leave behind, are the real victims of this public health travesty.

Dr. Gilbert Ross is the Executive Director and Medical Director of the American Council on Science and Health (ACSH), a consumer education-public health organization. He received his undergraduate degree in Chemistry from Cornell University’s School of Arts and Sciences in 1968, and received his M.D. from the N.Y.U. School of Medicine in 1972.