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Expert blames smoke, not nicotine, for causing deaths

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A public health expert blames smoke, not nicotine, for causing thousands of deaths caused by cigarette smoking each day.

“There have been many decades of research on the health effects of cigarette smoking, and we have known since at least the 1970s that the primary cause of the cancers, heart and lung disease is the repeated inhalation of smoke,” said Prof. David T. Sweanor, chair of the advisory board of the Centre for Health Law, Policy & Ethics at the University of Ottawa.

Sweanor is a Canadian legal expert who believes that tobacco harm reduction is one of the greatest public health breakthroughs in history. He has been at the forefront of global efforts to reduce cigarette smoking for nearly four decades.

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“Our bodies are simply not designed to inhale smoke. We see similar disease patterns in those who cook food over open fires with poor ventilation and in firefighters exposed long-term to smoke inhalation,” said Sweanor.  He said it is the tar from combustion, and not nicotine, that contains carcinogens and toxicants.

Sweanor made the clarification to highlight the benefits of smoke-free nicotine products such as electronic cigarettes, heat-not-burn tobacco products and oral products like Sweden's snus as less harmful alternatives to combustible cigarettes which cause 20,000 deaths a day globally.  He said making these innovative nicotine products available to countries such as the Philippines will help millions of smokers reduce their exposure to smoke and illnesses.

He said contrary to popular belief, nicotine is not the substance causing these illnesses.  “The nicotine itself is not the problem. The global health catastrophe we face is due to the way it’s delivered. In short, for anyone wishing to tackle the global toll of 20,000 lives a day lost due to cigarette smoking, we need to remember just four words: ‘it’s the smoke, stupid’,” said Sweanor.

Sweanor said nicotine can be compared to caffeine because it is a psychoactive substance that is addictive and gives assorted benefits to many users. “By themselves, neither have significant health risks when used at normal dosage levels. But if obtained through a toxic delivery system such as smoking, great injury can be caused,” he said.

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He said recent technology developments have made it possible to consume nicotine without combustion, offering smokers less harmful alternatives to smoking.   Unlike combustible tobacco, he said e-cigarettes, heat-not-burn tobacco products and snus deliver nicotine without burning tobacco.

Various scientific studies have confirmed that these smoke-free nicotine products are significantly less harmful than traditional cigarettes.  Public Health England and the Royal College of Physicians state that e-cigarettes are likely to be at least 95-percent less harmful to humans than combustible tobacco.

Experts said these smoke-free alternatives also offer the same pleasure as cigarettes with less risk of the dangerous toxins and carcinogens found in tobacco smoke.  A February 2019 clinical trial by UK's National Institute for Health Research (NIHR) found that e-cigarette was twice as effective as nicotine replacement treatments such as patches and gum at helping smokers quit.

Sweanor said these findings make smoke-free nicotine products the best way out of smoking today.  “We now can get rid of cigarette smoking much as many countries have got rid of various infectious diseases and transitioned consumers away from a broad range of other overly hazardous products.  We can use science, technology and reason to draft regulations that can end cigarette smoking, and thus address the 20,000 daily deaths globally that are caused by that smoking.  We can make public health history no less significant than the eradication of smallpox,” he said.

Sweanor cited the case of Japan where a third of its cigarette market disappeared in just over three years after heat-not-burn tobacco products became available in the country.

“Product substitution works and appears to work better than any other strategy we have used to date in reducing cigarette smoking. We have also seen this impact in Sweden, Norway, Iceland and other countries as well, and with a variety of low-risk non-combustible alternatives to cigarettes,” he said.

Sweanor said it is important that countries give smokers a range of viable options to get off lethal cigarettes and use policy measures like differentiated pricing and marketing rules to speed the move away from deadly smoke inhalation.

Unfortunately, he said, governments are lagging too far behind science and technology. “They often fail to understand the absolutely enormous differences in risk between different nicotine products and inadvertently protect the cigarette business by seeing low-risk alternatives as a threat rather than an opportunity,” he said.

Sweanor said instead of insisting on “quit or die” strategies, governments should ensure that people who smoke cigarettes have truly viable options.

“The combined offering in terms of consumer needs and wants, and the information, availability and pricing of the low-risk alternatives should ensure that the safer choice is an easy choice,” he said.

“Viable alternatives to cigarettes can reduce cigarette consumption dramatically,” said Sweanor.  “We can seize the opportunity technology now makes available to end the cigarette epidemic.”


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