Baccy to the futureHow to regulate lower-risk smoking products
It is hard to trust Big Tobacco. But anything that reduces harm should be welcomed
SMOKING is a scourge. It is the leading preventable cause of cancer and kills over 7m people annually, mostly in low- and middle-income countries. In America, where it is linked to one death in five, it is estimated to cost more than $300bn a year in medical bills and lost productivity.
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Big Tobacco is doing nothing illegal by producing and marketing cigarettes. But the industry has an inglorious history of lying about the effects of cigarettes on human health. Although rates of smoking in much of the rich world are declining, tobacco firms fight measures, such as restrictions on advertising, that are designed to clamp down on cigarette use in emerging markets. No wonder people are cynical when they hear tobacco bosses evangelise about the benefits of new, lower-risk products such as e-cigarettes and heated tobacco products (see article). Even so, regulators weighing up how to treat safer alternatives to cigarettes are often too harsh.
The goal of policymakers ought to be harm-reduction. Too often, however, the focus is not on “reduction”, just on “harm”. E-cigarettes let users inhale nicotine without the toxicity that comes from burning tobacco. It seems clear that e-cigarettes are much less harmful than the ordinary sort; 95% less so, according to Public Health England, a government agency. There is scant evidence that they are a gateway drug that encourages non-smokers to start puffing and eventually to move on to more dangerous products. Britain’s Royal College of Physicians thinks they could help prevent deaths.
Plenty of regulators take a different tack. Brazil, Singapore and Thailand, among others, have banned e-cigarettes outright. In October New York became the 11th American state to ban e-cigarettes from workplaces, bars and restaurants. France has also imposed such a ban, “to protect the public”. The World Health Organisation’s anti-tobacco group in 2016 suggested that countries prohibit or restrict the use of e-cigarettes.
Heat, not light
These decisions are based on gaps in the evidence proving that the products are safe over long periods. Such concerns are not to be dismissed: more independent research into their effects is needed. But a full auditing of their impact on health requires studies that will take many years. The damage from conventional cigarettes is happening now. It is perverse to ban a less harmful product like an e-cigarette from a market that allows the more dangerous version to be sold on every street. It is scarcely more sensible to treat every product as equally unhealthy when one is known to be lethal, and others are likely to be less harmful.
The same broad logic ought to apply to heat-not-burn (HNB) products, Big Tobacco’s latest wheeze. Conventional products involve the combustion of tobacco at very high temperatures, which produces many of the toxic substances in cigarette smoke. But because HNB products warm the tobacco rather than burn it, they are likely to harm smokers less than cigarettes do. An advisory body to the British government concluded this month that two HNB products already on the market in Britain, although unhealthy, contained between 50% and 90% fewer harmful or potentially harmful substances than cigarettes. They may also be better at converting hard-core smokers than e-cigarettes, since they look, feel and taste more like the real thing. HNB products should be treated more cautiously than e-cigarettes because they are less well understood and because they do contain tobacco, with its cargo of carcinogens. But they should be allowed on the market, and they should also be taxed less heavily than normal cigarettes.
It would be ideal if people did not smoke at all. But plenty choose to do so, despite the effect on their health. The right approach is to nudge them towards products that cause the least damage. America’s Food and Drug Administration is aiming for a sensible combination of stick and carrot. It is trying to make conventional cigarettes less addictive by forcing tobacco companies to cut nicotine levels. At the same time it is providing firms with a path to market for lower-risk smokes, the effects of which it will continue to review. It may give approval to Philip Morris to start selling IQOS, its HNB product, in early 2018. That will gall Big Tobacco’s many critics. But it is foolish and puritanical to withhold alternatives that could help save lives which would otherwise be lost.This article appeared in the Leaders section of the print edition under the headline "Baccy to the future"