Harm reduction over morals to reduce smoking deaths.

  • Laura Eggertson
  • Published 2016 in
    CMAJ : Canadian Medical Association journal…

Abstract

Canadian tobacco-control policies could save tens of thousands of lives this century if regulators applied ethical public health principles such as harm reduction instead of taking a moralistic approach to tobacco consumption, says a leading opponent of Big Tobacco. “We have a very long history of beating the cigarette companies,” says David Sweanor, an adjunct professor of law at the University of Ottawa. “In my experience, it’s not hard to beat cigarette companies. It’s hard to get our colleagues to accept what you should do in terms of a pragmatic strategy rather than an absolutist one.” Sweanor, who spoke recently at the National Health Law Conference in Ottawa, argues that tobacco-control efforts have demonized not only the tobacco companies but also smokers, distorting the policy debate as a result. Although research has long linked cancer to inhaling smoke from cigarettes, rather than nicotine itself, that evidence has not effectively influenced regulatory approaches, he contends. As a result, in the more than 30 years that Sweanor has been involved in global tobacco litigation against tobacco companies, including as legal counsel for the Non-Smokers Rights Association, smoking has remained the leading cause of preventable death in Canada. Despite major reductions in smoking rates, smoking will cause a million deaths among Canadians by the end of the century, he says, based on current trends and consumption. “I’m not pleased with what we’ve accomplished,” says Sweanor, whom the Pan American Health Organization has named one of its Public Health Heroes. “Certainly, playing with affordability has been far and away the most important thing we’ve done. But I think any action we look at has to be seen against what was achievable.” Sweanor’s arguments highlight the tension in the tobacco-control community and among public health officials over the issue of e-cigarettes, vaping and other nicotine-replacement products. Some smoking cessation proponents believe insufficient evidence exists that e-cigarettes will help people quit smoking, despite the fact that e-cigarettes either vastly reduce or in some cases eliminate the nitrosamines that cause cancer. Those who argue for bans on e-cigarettes are afraid they will become “gateway” devices to tobacco, particularly for young users. Others, including Sweanor, point to examples from countries such as Sweden as the reason Canada should take the same harm-reduction approach to reduce smoking that public health officials apply to injection drug use (safe injection sites) and sexual health, (promoting and distributing condoms). In Sweden, the use of snus, a smokeless tobacco product that people (primarily men) rub on their gums, is driving down the use of cigarettes. There are far fewer tobacco-related deaths among men in Sweden than in other European countries, Sweanor pointed out in a recent article he coauthored in the New England Journal of Medicine. “We’re just telling people ‘Thou Shalt Not’ and it doesn’t make any public health sense. We could virtually eliminate the risk by getting rid of the smoke,” he says. By ignoring the public health dictate of reducing the risk for people who conHarm reduction over morals to reduce smoking deaths

DOI: 10.1503/cmaj.109-5203

Cite this paper

@article{Eggertson2016HarmRO, title={Harm reduction over morals to reduce smoking deaths.}, author={Laura Eggertson}, journal={CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne}, year={2016}, volume={188 1}, pages={E16} }