The World Health Organization predicts that if current trends continue, the likely toll of tobacco will amount to one-billion lives cut short worldwide. By tobacco, however, anyone with knowledge of the spectrum of tobacco-related disease knows it s the inhalation of cigarette smoke hundreds of thousands of times over decades that would be responsible if that catastrophic prediction comes to pass the relative harm of non-combustible tobacco and nicotine-delivery products is in the order of one percent that of smoking. Yet the new policy guidelines barely tinker with lethal, addictive cigarettes while effectively banning products that have been shown to help smokers quit.
Earlier this month, the European Union Health Commission released the draft of its latest Tobacco Products Directive, expressing the overall approach to regulation of tobacco and nicotine products planned for the 500 million residents of the 27 countries of the EU. While some parts of it may have a beneficial impact on smoking rates, albeit minor, the net effect will be, paradoxically but inevitably, damaging to Europeans health. The Directive proposes to continue (indeed strengthen) the prior ban on Swedish smokeless tobacco, known as snus. Worse, restrictions and regulations dealing with the relatively new devices known as e-cigarettes will effectively ban them.
In the EU, where fully one-third of the adult population still smokes, there are almost 700,000 smoking-related deaths each year. The region is number one worldwide in the devastating effects of smoking with this exception: In Sweden, the only EU country where snus is not banned, only 16 percent of men smoke. This fact has been validated since those statistics began to be accumulated after World War II. The Swedish male population consumes more nicotine in the form of snus than from cigarettes and they have the lowest rate of smoking-related disease and death in Europe to show for it.
Yet when Sweden was admitted into the EU in 1992, the continental ban on snus was in effect, and the country had to get an exemption to continue to manufacture and sell snus as long as it was marketed only in Sweden. Enlightened public health experts in the region, and elsewhere, had hoped that the new TPD would ease these restrictions, given the clear evidence of its efficacy in reducing the harm of tobacco, while the approved products for helping smokers quit fail over 90 percent of the time.
Electronic cigarettes, first sold outside China only over the past seven years or so, have few solid studies attesting to their benefits for helping smokers quit. But millions of smokers have offered case studies in networks and chat rooms of vapers, their own term for e-cigarette use, offering testimony to their efficacy in helping them quit and pleading for authorities to allow them continued access. The product, in various forms, essentially supplies the drug smokers crave nicotine without the toxic, deadly smoke. The vaporized nicotine is inhaled with flavorings and substances such as propylene glycol, all completely harmless based on years of safe use.
So why would any official directive aimed at improving health advocate banning, in effect, effective and relatively harmless nicotine-delivery methods that help smokers quit, while allowing the most harmful consumer product cigarettes to keep on killing? No valid explanation comes to mind. Some say that all tobacco is dangerous, so why allow snus? Others allege that the cigarette look-alike, e-cigarettes, impede the policy of de-normalization of smoking, since users of e-cigarettes may appear to be smoking. And others say they believe that smokeless tobacco or e-cigarettes may entice youngsters into a nicotine-dependent lifestyle, and eventually into smoking although there is no evidence supporting that gateway effect and plenty against it.
Continuing the ban on smokeless tobacco in the EU is antithetical to public health for many reasons. Adding what amounts to a ban on e-cigarettes will tie the hands of millions of EU smokers desperate to quit, and force a like amount of successful quitters back on to lethal addictive cigarettes. The bottom line is that the current TPD draft, if approved by the nations of the EU, will allow the continued sale of pharmaceutical products sold as aids to smoking cessation, which have been shown over and over again to be largely ineffective. Cigarettes will remain available on every street corner, and lack of effective cessation aids will help the cigarette industry maintain its hugely profitable European markets. Big Pharma and Big Tobacco will be the winners, while condemning millions of smokers to cruel death or disability.
Relaxing, not tightening, strictures against harm reduction products should be implemented in the EU, and as soon as possible, as thousands die needlessly each day from inhaling smoke.
By ACSH's Dr. Gilbert Ross. Published in Forbes.com on Jan. 10, 2013.
