Smoking Harm Reduction: Evidence and Interests
Abstract
Background: Smoking harms the health of all users, reduces their life expectancy, and also endangers people around them. Nicotine dependence contributes to the continuation of smoking and prolongs harmful exposure. The primary interest of people who smoke is therefore to stop smoking and end nicotine dependence as soon as possible.
Opinion: Some alternative tobacco and nicotine products may reduce exposure to certain harmful substances when they completely replace cigarettes, but their long-term effects on morbidity and mortality remain insufficiently established. Assessing the potential of harm reduction is particularly important because the economic interests of companies selling tobacco and nicotine products depend on the continued market presence of their products. Using examples from Sweden and Japan, this article shows how one-sided success stories can be constructed from real data when comparisons omit evidence pointing to alternative explanations.
Conclusions: The role, conditions, and limitations of harm reduction should be assessed by independent health and scientific experts on the basis of the available scientific evidence and with due regard for the interests of people who smoke. In the longer term, public health should also expand opportunities for health- and wellbeing-supporting action, so that people become less reliant on health-damaging behaviors to cope with difficult circumstances.
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