Download - Tobacco Harm Reduction
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 1
Tobacco Harm Reduction
Buyer/Hagan/Burr v. Kennedy/Waxman
A Public Health Perspective
Live Video Presentation to TMA Meeting, Williamsburg, VA, May 18, 2009
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 2
Joel L. Nitzkin, MD, MPH,DPA,
Chair, Tobacco Control Task Force
American Association of Public Health Physicians
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 3
Tobacco Harm Reduction Background
o Public Health Perspectiveo Deaths due to Tobacco Products
Opposition to Harm Reduction The Two Proposed Bills AAPHP Recommendations JLN Contact Information AAPHP web site; tobacco issues page
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 4
Public Health Perspective Future illness and death from tobacco
products Near-term (next 30 years) – current
smokers Far-term – current and future teens
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 5
Deaths Due to Tobacco Products Cigarette smokers
o 400,000 per yearo Major causes
Lung Cancer Other Lung Disease Other Cancer Heart Disease
Environmental Tobacco Smokeo 38,000 per year (lung cancer and heart disease)
All Othero Less than 10,000 per year (other cancer)
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 6
Deaths due to Tobacco Products
The problem is cigaretteso (not other tobacco products)
The problem is products of combustiono (not specific chemicals in tobacco)o (smoking also kills non-smokers)
Safe cigarette probably not possible
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 7
Options for Reducing Deaths from Cigarettes
Cessation Harm Reduction
o (smokers switching to less hazardous products to maintain their nicotine addiction)
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 8
Smoking Cessation Spontaneous quit rates
o About 3% per yearo Almost all “cold turkey”
With counseling and NRT’so Increases rate to about 5% (when measured
1 year post-intervention)
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 9
Harm Reduction Switching from cigarettes to snus or alternative
nicotine delivery products (sticks, strips, e-cigarettes, etc)
Eventual reduction in risk – 99% or better Lives saved over first 20 years – about 50%
o Increased risk of death in smokers continues 5-15 years after quitting
o Of 8 million smokers who will die of a tobacco-related illness over next 20 years – 4 million could be saved by harm reduction (AAPHP projection)
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 10
The Case Against Harm Reduction Most people do not believe risk reduction 99%
or better Should we encourage use of products that will
kill 400 to 4,000 people per year? Will marketing reduced risk products addict
more teens to nicotine? Will that addiction lead more teens to
cigarettes? No research to “prove” the efficacy of harm
reduction in the United States Concept of “Tobacco Free Society”
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 11
Kennedy/Waxman(as seen by AAPHP)
Focused entirely on teens; totally ignores current smokers
Gives image, but not substance of effective federal regulation
De-facto ban on new reduced risk products (new = after 2/15/07)
Favors Altria/Philip Morris Promotes concept of reduced exposure
cigarette Does nothing of substance to reduce teen
tobacco use Some version of this bill will become law
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 12
Buyer/Hagan/Burr(as seen by AAPHP)
Focused on current tobacco users (largely ignores teen initiation of tobacco use)
Minimal regulation of marketing Criminalizes youth, lets store owners off
with token penalties Even-handed re tobacco industry
stakeholders No chance of becoming law
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 13
AAPHP Recommendsmultiple amendments to Kennedy/Waxman
Favor harm reduction Eliminate concept of reduced exposure
cigarettes Reduce restrictions on regulatory agency Add graphic warnings to cigarettes Authorize federal agency health
education, surveillance and research Agency other than FDA Address illicit and contraband products
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 14
Joel L. Nitzkin, MD, MPH, DPA Chair, AAPHP Tobacco
Control Task Force (504) 899-7893 (800) 598-2561 Cell (504) 606-7043 [email protected] New Orleans, Louisiana
5/18/09 TMA AAPHP Tobacco Control Task Force Slide 15
AAPHP Tobacco Issues Page www.aaphp.org Click on “tobacco
issues” Multiple background
and policy documents