Quitting smoking is always the best choice, but that's not the only way to reduce the harm of smoking. For some time now, the scientific community has agreed on the validity of alternative products, from electronic cigarettes to "hybrid" products, such as - to mention the best-known one, produced and tested in Italy - the Iqos marketed by Philip Morris, which does indeed contain tobacco but inside a device that doesn't burn it but only heats it.
These issues, i.e. a new approach to smoking within a broader discourse of public health protection, were recently discussed in two important events for the world of tobacco: the Scientific Summit on Tobacco Harm Reduction and the Global Tobacco & Nicotine Forum (Gtnf). The first was attended by 55 experts from 26 countries, who formed a new alliance to innovate strategies capable of helping people quit smoking but also "to inform policy makers, regulators and the population on the benefits of a new approach ”, aimed at improving policies for harm reduction also through the use of reduced-risk devices.
An interesting case history also emerged during these meetings: for the first time a European country, Greece, has implemented an innovative approach, which inevitably has garnered acclaim from cigarette manufacturers. While aware of the damage caused by smoking, companies are nonetheless interested in an approach that can safeguard production chains that have enormous employment and economic importance. This is why Greece has embraced this paradigm shift, with a law actually approved as early as 2019.
The new Greek legislation on smoking “is built on 4 pillars: prevention; the protection of the population from secondhand smoke; assist those who want to quit in specialized centers and lastly the evaluation of new devices with the principle of harm reduction”, explained the expert Ioannis Faropoulos in the reading dedicated to the new legislation. But the law promoted by the Ministry of Health itself also aims at a new method of communication on risk reduction.
Athens in fact allows communication to adult smokers of scientifically substantiated claims; and deals with different types of products without combustion, already on the market and which may arrive in the future. Covering all types of risk: reduced or reduced damage, reduced exposure and toxicity. It also establishes scientific standards that justify the various types of risk and includes provisions on post-market surveillance.
The need for a new approach, less drastic and accompanied by adequate communication on the various levels of riskwas feared by the scientific world itself. To quote one of the interventions, that of David Khayat, former president of the National Cancer Institute and head of medical oncology at the Clinique Bizet in Paris, "the peremptory 'stop smoking or you will die' with which some doctors still try to convince patients about risks related to cigarettes does not work and must be changed.
"As a doctor - added the oncologist on the occasion of the Scientific Summit on Tobacco Harm Reduction - I cannot accept 'stop or die' as the only choice offered to a smoking patient. I remember that 64% of those diagnosed with cancer continue to smoke. Some countries have abandoned quit or die strategies and introduced reduced-risk devices into tobacco control policies, with results. In 1990 the first globally recognized risk factor for cancer was smoking, in 2017 it is still smoking.
Traditional cigarettes, Khayat recalled, contain over 6 chemicals and ultrafine particles, 93 of these are on the Food and Drug Administration (FDA) list as potentially harmful, most, about 80, are carcinogenic or potentially carcinogenic. "But these risks increased in the combustion process compared to heating." That's why not all tobacco products are created equal.
Finally, there was no shortage of concrete proposals. And obviously, in the light of this new paradigm, welcomed for the first time by the Parliament of a European country, there have been requests for reduced taxation on products that present less risk. “Accessibility to low-risk devices could be increased by focusing on taxation proportionate to the effects produced. Thus the most dangerous products, such as cigarettes, they should have a higher tax rate compared to reduced-risk devices,” said David T. Sweanor, Center for Health Law, Policy & Ethics, University of Ottawa.
“The greater the difference between the two 'choices', the more likely we are that people will switch to lower-risk alternative products. Today there are new technologies that they can help us get rid of traditional cigarettes – observed Sweanor again -. We have this extraordinary opportunity and also the ability to transform the cigarette business into something completely different in a short time.” What's more, it can help smokers themselves, over time, to quit.
The scientific world is convinced of this too, or at least a part of it. Giuseppe Biondi Zoccai, professor of Cardiology in the Department of Medical-Surgical Sciences and Biotechnologies of the Sapienza University of Rome, argued, for example, that "electronic cigarettes are modified risk products which can improve quit rates and help in the process of detachment from traditional cigarettes”.
However, not even alternative products are risk-free and in the other event held recently, the Global Tobacco & Nicotine Forum, this was also discussed, namely to encourage the use of alternative products to combustion cigarettes for the nicotine intake, such as heated tobacco, e-cigarettes, and snus (tobacco for oral use), but by setting more rigid limits for marketing to control the quality of the products and contain the spread among young people.
“Today one in five deaths in the United States is linked to smoking. But we need more information and transparency: Alternative products are not comparable in risk to smoked tobacco and in general there is a lot of confusion about the nicotine contents of different products,” said Clifford E. Douglas, director of the Tobacco Research Network and associate professor at the University of Michigan . What's more, it is in the USA that a real squeeze is underway against alternative products, in contrast with what is happening in Europe and in particular in Greece.
In conclusion, the world (businesses and consumers) has long since become aware of the risks of smoking (and passive smoking). But the new challenge is to correctly inform governments and populations, in order to limit the negative effects of smoking on health by providing smokers with alternative products to traditional cigarettes, and at the same time without disappointing consumer expectations.
