Tobacco Caused Disease – A Pandemic We Can Rationally Tackle

The most recent pandemic has served as a catalyst for us to restructure how we adapt to new problems and devise new measures to mitigate future shocks. Reduced harm caused by substance addiction is one of the most important components of eliminating vices in the world.

The Economic Times convened a group of prominent specialists to investigate and track the consequences of substance usage over time for the fourth edition of the Consumer Freedom Conclave. David Sweanor, J.D., chair of the Advisory Board at the University of Ottawa's Centre for Health Law, Policy, and Ethics, Adjunct Professor Faculty of Law, University of Ottawa, Global Leadership Council, Boston University School of Public Health, provided greater perspectives into the various aspects of harm reduction, challenges faced in the reduction of tobacco abuse, and the importance of evidence-based harm reduction.

1. Tobacco harm reduction - how consumers could secure the greatest public health win of the 21st Century?

Rational public health policies require that when we identify risks, we seek to reduce them. This makes tobacco harm reduction an issue with extraordinary potential. The harm is enormous and the ability to reduce it both straightforward and dramatic.

Currently tobacco use causes an estimated at 8 million a year globally. India alone accounts for roughly a million of these deaths. This harm is almost entirely due to unnecessarily toxic ways of getting nicotine. Inhalation of smoke and other toxic forms of tobacco use still dominate the market.

Yet we know that nicotine can be delivered in ways that are very acceptable to consumers and at minimal risks to health. A global revolution is already underway as technology allows the replacement of deadly products, and government policies are starting to focus on accelerating this transformation.

2. Could you share with us what are some of the leading challenges consumers struggling with addiction face today, in the context of determining whether to quit cold turkey or to find a safer alternative?

Many people have a dependence on nicotine both in an addictive and a self-medication sense. Just as some people find early mornings near-impossible until they get caffeine, other people cope with life with nicotine.

Giving consumer-acceptable alternatives to toxic tobacco products is invariably going to be far less difficult than trying to end any type of use, just as switching from coffee to tea is easier than totally quitting use of caffeine.

3. Do you think the harm reduction approach is evidence-based? Is there adequate application of harm reduction principles in clinical practice in your view?

There is no question that cigarettes are exceptionally lethal. Also, it is clear that nicotine use need not be a significant health risk. Decades of experience with low-risk alternatives in countries such as Sweden proves the point.

We also have many decades of evidence that substitution of lower risk products and services for higher risk ones has been a very effective strategy to protect health and wellbeing.

In the case of cigarettes, Japan has seen sales drop by nearly half in just six years as a technology that merely heats rather than burns tobacco was allowed onto the market. Consumers have been switching, just as they have moved to safer water, food, pharmaceuticals and a myriad of other products.

In clinical practice we regularly see evidence-based interventions to reduce harm; everything from dealing with blood pressure to cancer screening to advice on exercise and diet. But when we use policy measures, we can expand these interventions to a societal level.

4. Which countries have set the benchmark, when it comes to creating sustainable and scalable harm reduction frameworks in your view?

Virtually all countries have a history of effectively using harm reduction strategies on a wide range of issues, and the result is far safer foods, medicines, automobiles, aircraft, workplaces, toys, etc.

On nicotine, Sweden has shown that its use need not be a significant health risk. The UK shows us that harm reduction can be incorporated into comprehensive tobacco control policies. Japan shows us that cigarettes can be replaced very rapidly by lower risk products.

Other countries are making similar moves. But none has the potential of India to fundamentally change the global trajectory of tobacco caused death and disease.

5. India's goal is to reduce tobacco usage by 30% by 2030. What role can harm reduction play in addressing India’s tobacco goals?

To achieve health goals, it is the death and disease from that tobacco use that needs to be reduced. With current alternative nicotine delivery technologies, a 30% reduction in the total population risks can be achieved extraordinarily rapidly. Likely by 2025.

By 2030, even with already-known products and risk-proportionate regulatory, taxation and educational efforts, tobacco caused disease could be well on its way to being a subject for history books rather than medical studies.

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