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Tobacco Harm Reduction vs. the politics of pleasure

Special Issue of Drugs and Alcohol Today investigates views on Tobacco Harm Reduction

United Kingdom, 17 June 2013 - Opposition to unconventional tobacco products is often based on misperceptions of health harms, ideology and a refusal to engage with the politics of pleasure, according to a collection of papers published in the latest issue of Drugs and Alcohol Today (volume 13, issue 2):

The special edition is timed to coincide with the publication of guidelines on harm reduction approaches to smoking by the National Institute for Clinical Excellence and identifies significant potential for harm reduction approaches in tobacco regulation.

Editor of Drugs and Alcohol Today, Axel Klein explains, “Harm reduction approaches aim at modifying consumption behaviour rather than cessation, and were originally formulated in the illicit drugs field. Advocates promoted a reduction of government sanctions, changes to consumption patterns and the use of evidence in policy making. This provides a contrast with the "tobacco wars," where a growing band of campaigners from the 1920s onwards called for the presence, not the absence, of the state.”

Author Kirsten Bell warns that there has been a sleight of hand with the evidence, with the World Health Organization “making no distinction between cigarettes, e-cigarettes and smokeless tobacco in the production of “tobacco-related disease."'

Opposition to less hazardous forms of nicotine delivery like e-cigarettes or forms of chewing tobacco like the Swedish snus, “is not based on any coherent regulatory pyramid and can only be explained by the hostility of some anti-smoking campaigners towards tobacco harm reduction," according to Neil Wilcox and Patricia I Kovacevic.

There is concern that the public use of e-cigarettes or vaping would reverse the declining trend in tobacco product consumption in European and American consumer markets. It also runs counter to one of the tobacco control lobby's declared intentions to 'de-normalize' smoking. According to Christopher Snowdon many “public health campaigners – like most reformers and ‘moral entrepreneurs’ – prefer prohibition to liberalisation," regardless of the differential harm caused by different products.

Many medical doctors have taken on a default position that no longer distinguishes between the harms caused by different tobacco products. In a survey of practitioners in England and Sweden, Sudhanshu Patwardhan and Marina Murphy show that a sizeable number attribute the carcinogenic effect to nicotine, when it is in fact tobacco smoke that causes disease.

The case of Sweden clearly shows the health benefits of switching from tobacco smoking to other tobacco products. Two papers by Karl Erik Lund and Jenny Cisneros Örnberg show how the sharp drop in smoking prevalence in Sweden and Norway is linked directly to the rise in chewing tobacco, snus, with attendant health benefits.

Snus is unavailable in other countries of the European Union, while e-cigarettes may also soon be subject to restrictions. The disconcerting thing is that the discussion on tobacco has shifted away from concerns over product safety. Brad Rodu and Carl Phillips argue that anti tobacco activists are distorting the evidence about tobacco products. Some may be more concerned with fighting Big Tobacco and settling a score than in promoting public health.

Drugs and Alcohol Today is one of 31 titles in the Health and Social Care collection published by Emerald Group Publishing:

For more information about the journal or the whole collection, contact Jo Sharrocks, publisher,

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