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


Joel L. Nitzkin, MD, MPH,DPA,

Chair, Tobacco Control Task Force

American Association of Public Health Physicians


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


Public Health Perspective Future illness and death from tobacco

products Near-term (next 30 years) – current

smokers Far-term – current and future teens


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)


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


Options for Reducing Deaths from Cigarettes

Cessation Harm Reduction

o (smokers switching to less hazardous products to maintain their nicotine addiction)


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)


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)


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”


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


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


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


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


AAPHP Tobacco Issues Page www.aaphp.org Click on “tobacco

issues” Multiple background

and policy documents

tobacco harm reduction

Documents