Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction; IOM 2001
The U.S. Institute of Medicine (IOM) was established in 1970 by the National Academy of Sciences to secure the services of eminent
members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute
acts under the responsibility given to the National Academy of Sciences by its Congressional charter to be an adviser to the
federal government and, upon its own initiative, to identify issues of medical care, research and education.
The report is written from an anti smoking perspective and heavily promotes the use of pharmaceutical products as methods of
reducing risk even to the extent of "long term nicotine replacement therapy" which is likened to the usage of methadone by
heroin addicts.
Reduced risk cigarettes are discussed in some detail. They are here considered in a context of being “potential reduced
exposure products” (PREP.) The PREP definition encompasses tobacco products, cigarette-like products, and pharmaceutical
products.
Background
Between 1968 and 1979 the US National Cancer Institute experimented with less hazardous cigarettes, concluding that cigarettes
that are intrinsically less hazardous to human health are feasible. In 1979 that research was blocked in favour of moves
towards the abolition of tobacco: a non-smoking world.
Analysis of the IOM report
The introduction to the IOM report starts with a quotation by Ernst Wynder at the conference on safer cigarettes in 1979:
"It is important to appreciate that a virtually harmless cigarette smoked by only 1% of the population will have a lesser
impact on the reduction of tobacco related diseases than a somewhat more harmful cigarette smoked by 80% of the total
smoking population. Research on the less harmful cigarette should therefore be directed toward developing a cigarette
containing the lowest possible amount of harmful elements for all tobacco related diseases, but one that has sufficient
acceptability for the largest segment of smokers."
The use of this quotation in the introduction of the report shows that the Institute of Medicine appreciates that for less
hazardous cigarettes to be successful they must be acceptable to consumers. It is criminal that this statement was made in
1979 and is only now being suggested as the way forward after three decades of failure by the abolitionists within
tobacco control who had claimed they would achieve a "smoke-free America" by the year 2000.
It is also worth pointing out that the authors themselves take great care throughout their report not to use terms such as
"virtually harmless cigarettes" as used in the above quotation. They instead use terms like "modified risk tobacco" or
"reduced risk tobacco."
Definition of harm reduction.
For the purposes of this report, a product is harm reducing if it lowers total tobacco related mortality and morbidity even
though use of that product may involve continued exposure to tobacco related toxicants. Many different policy strategies may
contribute to harm reduction. However, this report focuses on tobacco products that may be less harmful or on pharmaceutical
preparations that may be used alone or concomitantly with decreased usage of conventional tobacco. The committee does not use
the term "safer cigarette", in particular, in order to avoid leaving the impression that any product currently known is "safe".
Every known tobacco containing product exposes the user to toxic agents; every pharmaceutical product can have adverse effects.
The IOM defines less harmful products as those that are likely to result in lower morbidity and mortality. The term 'safer' is
deliberately avoided for fear of promoting smoking because they state that every known tobacco product exposes the user to
toxins.
Side effects of pharmaceutical products are also noted here. That does not stop doctors from suggesting, for instance, that
Tylenol is safer for children than is aspirin. The fear, here displayed, of that which is ‘safer’ is an aspect of
prohibitionist mentality.
Every known alcoholic beverage, and cup of coffee, exposes the user to toxic agents. Every known car can crash. Safer
cigarettes would be safer cigarettes. The refusal to say so is, if perhaps partly pathological, also and certainly
sociopolitical in origin. The whole idea behind less hazardous cigarettes should be that they progressively evolve into a
product that is safer beyond question; in avoiding the term 'safer' the IOM ensures the continuance of the highly funded
tobacco control movement because nothing can ever be 100% risk free. Even things that are good for health carry elements of
risk as well. As long as cigarettes can be classed as "not safe" an argument for control can be maintained.
Note too that tobacco is said to expose users to toxins while pharmaceuticals merely have adverse effects. Adverse effects
from chemical agents are toxic effects. The committee says specifically that it will not use the term “safer cigarette” but
does not take the same pains to rule out the idea of “safer drugs.” Also notable in the report generally is that the “adverse
effects” of pharmaceuticals are not expressly linked with notions of risk or lack of ‘safety.’ Again the selectiveness in
perspective and terminology represents bias oriented toward the continuance of technocratic tobacco control, a huge industry,
to which the authors incidentally owe their living.
In considering the health effects of modified tobacco products it is important to remember that the health consequences of the
use of any such product are determined not by the toxic agents removed from the product but by the actual exposure to the toxins
that remain. Harm reduction is the net difference in harm between the products as actually used.
There is strong evidence that in the range of exposures involved in smoking, there is a quantitative relationship between the
magnitude of exposure and the incidence of tobacco related illnesses.
This is a clear example of the fact that they don't know why cigarettes are harmful. They just rely on statistical correlation
to infer that they are. If actual science told them what was harmful in a cigarette they would obviously seek to remove it. In
practical terms, a manufacturer can remove all of the formaldehyde, benzene and arsenic, etc., but tobacco control will still
be able to claim that the product is not "safer" and has only an unprovable reduced risk.
As usual tobacco control wants to have its cake and eat it too. Delighted to scare the public with adverts naming "deadly"
substances in tobacco smoke, tobacco control is unwilling to admit that the product would be safer if the substances were
removed. So which is it? Are the specified “deadly” substances” truly “deadly” or aren't they? If they are then why isn't the
product "safer" once they are removed? If they aren't then why is tobacco control misrepresenting the facts to the public? Is
the tobacco control crusade for physical health or is it really about "moral" health?
The latent period between beginning exposure to tobacco and the development of the most major adverse consequences is so long
that empirical, direct evidence (assessment of immediate and long term toxicity of individual tobacco products in humans) that
one tobacco product is less harmful than another will rarely be available in time to be a basis for informing users.
With a single paragraph the existence of tobacco control is ensured indefinitely. Tobacco control has already claimed that
there is a 50 year lag between taking up smoking and the onset of disease (Peto, 2000, “The future worldwide health effects of
current smoking patterns”). They will control less hazardous cigarettes and as long as there is still lung cancer or heart
disease in 50 years time they will still be able to claim that cigarettes are not "safe".
No one knows the dose response relations, the specific toxins, the pathogenic mechanisms or the interrelationship between the
many components of tobacco smoke with enough precision to make scientifically reliable judgments about the risk or actual
harm reduction associated with use of any tobacco product. Since we do not know which of many toxins may be the cause of
specific harmful effects, we can only infer but we cannot know the health effects of the elimination of any one or several
tobacco components.
Directly from the horse's mouth. They have no scientific evidence that cigarettes are harmful! Forces International has
been telling its readers this for years, and here, the highest medical authority in the United States admits that it's true.
They don't know the pathogenic mechanisms to any scientifically reliable level and they can't identify ANY toxins that are
responsible for harming health.
Tobacco control always has and still does use the formula: 'B' follows 'A' so 'A' must cause 'B', even though they have no clue
why.
In their own words they can only "infer" the health effects of removing tobacco components; by default then they can also only
"infer" the health effects of them being there in the first place. Strange then that the warnings on cigarette packets do not
say - "Warning: statistics can be used by the credulous to infer that smoking may harm you".
Here the most un-scientific part of the epidemiological approach and the ensuing politics becomes particularly evident. Science
relies on repeatability and experimentation, leading to proof. Instead of declaring the inability to prove, a claimed consensus
of opinion within the tobacco control movement (and often suppression of dissent) replaces scientific demonstration, thus
turning science into a gun-point "democracy." That is probably the reason it was "scientifically demonstrated"
that the Sun and other celestial bodies rotated around the Earth: because a claimed scientific consensus said it was so. That was
before the invention of the Scientific Method.
It is reasonable to expect that some of the new products will reduce exposure to tobacco toxins and possibly reduce harm to
some users and to others who are exposed to them. It is, therefore, urgent and important that the assessment of exposure to
tobacco toxins resulting from the use of modified tobacco products or drugs be based on the best available evidence, made by
the most qualified judges, and communicated to policy makers and the public completely and honestly.
If it is "reasonable to expect" that reducing exposure to toxins might reduce harm why isn't it also reasonable to expect that
the complete removal of those toxins would make the product "safe"? Again we see an example of having their cake and eating it;
in order for there to be a continued tobacco control movement they need something to control. They can't identify a single
toxin responsible for harming the user so they can't say that the removal of one or more will achieve anything, but they can
argue for a policy of harm reduction by reduction of exposure to those same toxins.
Roughly translated, that means that, if a manufacturer were able to remove all of the toxins tobacco control could still claim
that cigarettes are not safe. That is because what it is in cigarettes that harms people is not known. However, if a
manufacturer merely reduces the level of exposure to toxins, then they will say the product can be reasonably expected to be
less harmful. Reduction of toxins is rewarded; removal of them is not.
It appears then that tobacco control has a vested interest in retaining a status quo; risk reduction can be maintained
indefinitely once they lay the ground rule that even total removal of all toxins still won't make cigarettes "safe"
or even “safer,” as they will put it. Again, what they’re up to, is keeping themselves in business. The IOM has set a standard
for tobacco control in which cigarettes can continually become less harmful but can never become safe enough that they no
longer need controlling.
Note also in the previous quote the supposition that new products could “reduce harm to some users and to others who are
exposed to them.” Risk from passive smoking is, always has and always will be, a ridiculous supposition in itself. Still it’s
interesting to see admission of the possibility of reducing the non-existent risk.
All of this spins from the elimination of the concept of threshold, under which a product used to be considered safe. The
pursuit of absolute zero risk (in this case, absolute zero toxins) puts activists and public health authorities in the position
of being always able to claim that there is a danger, thus ensuring endless funding at the expense of the public purse,
regardless of the fact that absolute safety from absolute absence of risk is unachievable in anything.
The continuing introduction of new tobacco products with implicit or explicit claims of risk or harm reduction makes it
important and urgent that the capacity for the best possible scientific assessment of these claims be put in place.
Unfortunately there is no reassurance anywhere in the report that the "best possible scientific assessment" will be any
better than it is currently.
Regulatory Principles.
4. Manufacturers should be permitted to market tobacco related products with exposure reduction or risk reduction claims only
after prior agency approval based on scientific evidence (a) that the product substantially reduces exposure to one or more
tobacco toxicants and (b) if a risk reduction claim is made, that the product can be reasonably expected to reduce the risk of
one or more specific diseases or other adverse health effects, as compared with whatever benchmark product the agency requires
to be stated in the labeling. The "substantial reduction" in exposure should be sufficiently large that measurable reduction in
morbidity and/or mortality would be anticipated, as judged by independent scientific experts.
5. The labeling, advertising and promotion of all tobacco related products with exposure reduction or risk reduction claims must
be carefully regulated under a "not false or misleading" standard with the burden of proof on the manufacturer, not the government.
The agency should have the authority to conduct its own surveys of consumer perceptions relating to these claims.
6. The regulatory agency should be empowered to require manufacturers of all products marketed with claims of reduced risk of
tobacco related disease to conduct post marketing surveillance and epidemiological studies as necessary to determine the short
term behavioural and long term health consequences of using their products and to permit continuing review of the accuracy of
their claims.
7. In the absence of any claim of reduced exposure or reduced risk, manufacturers of tobacco products should be permitted to
market new products or modify existing products without prior approval of the regulatory agency after informing the agency of
the composition of the product and certifying that the product could not reasonably be expected to increase the risk of tobacco
related illnesses compared to similar conventional tobacco products, as judged on the basis of the most current toxicological
and epidemiological information.
Less hazardous tobacco products will be subject to ongoing tests of statistical correlation. Once again this ensures the status
quo; as long as smokers die, tobacco control will be able to continue to "infer" (statistically) that smoking caused it,
without any obligation to produce scientific proof. The claimed "consensus of opinion" amongst tobacco control advocates must
live on! With an adoption of such "regulatory principles," their funding is ensured for as long as less hazardous tobacco
products are permitted to be marketed.
Under the advice of this report; tobacco cannot be banned, cigarettes can be manufactured to reduce risk but can never be
labeled as safe and tobacco control will be paid to monitor it all for ever and a day. Thousands of people in tobacco control
can keep their six figure salaries, the tobacco industry can once again market cigarettes and the statistical research units
can keep receiving the big payments to ask the relatives of deceased people how much smoke that person inhaled during their life.
Furthermore, point 5 reverses the burden of proof to the manufacturer whilst allowing the FDA not only to maintain control of
the cigarettes, but to reverse at any time its claims that the product represents a "modified risk", thus itself
circumventing the "false and misleading" clause that it imposes upon the manufacturers.
Point 6 demonstrates that it’s impossible to scientifically quantify the benefit of modified
risk beforehand. While continuing to rely on long-term epidemiological studies that, by definition, cannot establish scientific
causality but only the claimed consensus of opinion within tobacco control on the attributions of causality, the success or
failure of claims will be at the mercy of the beliefs of those who seek to control tobacco; if the winds
become favourable to the proposed product, the merit will belong to the regulating authorities; if the winds become unfavourable,
the blame will be with the manufacturer. It is a no lose situation for tobacco control.
Retaining nicotine at pleasurable or addictive levels while reducing the more toxic components of tobacco is another general
strategy for harm reduction.
Experience with NEXT, a cigarette with extremely low nicotine levels that did not succeed in the marketplace, suggests that
nicotine is one of the factors crucial to the success of a tobacco product.
The IOM recognises that the "success of a tobacco product" is necessary in order to maintain control over it. Efforts by
abolitionists within the anti-smoking movement to achieve prohibition by default (by making the product unacceptable to
consumers) would only drive the manufacture and sale of cigarettes underground and there can be no regulatory control
over a black market. Clearly, tobacco control does not want to be left in control of a legitimate market that has no
consumers because the product has been made unpalatable.
The only way to retain control is to ensure that legitimate tobacco products continue to be available and that they remain
acceptable to consumers.
For many diseases attributable to tobacco use, reducing risk of disease by reducing exposure to tobacco toxicants is feasible.
Again the IOM asserts that risk reduction is feasible but fails to acknowledge that there must inevitably be a point of
reduction of risk at which control over the product is no longer required. Indeed, if manufacturers throughout the
next century remove all possible harmful substances and add beneficial ones it is also "feasible" that smoking would become
beneficial for health.
The Health Policy Center has already stated that tobacco products that are no more harmful than other everyday products are
feasible within 20 years. How much more "risk reduction" will be possible in the 20 years following that? Or 20 years still
further on? At what point will the benefits of smoking (current or future) outweigh any perceived risks?
The committee believes that harm reduction is a feasible and justifiable public health policy but only if it is implemented
carefully to achieve the following objectives:
Manufacturers have the necessary incentive to develop and market products that reduce exposure to tobacco toxicants and that
have a reasonable prospect of reducing the risk of tobacco related disease.
Consumers are fully and accurately informed of all of the known, likely, and potential consequences of using these products.
Promotion, advertising, and labelling of these products are firmly regulated to prevent false or misleading claims, explicit
or implicit.
Health and behavioural effects of using PREPs are monitored on a continuing basis
Basic, clinical, and epidemiological research is conducted to establish their potential for harm reduction for individuals
and populations
Harm reduction is implemented as a component of a comprehensive national tobacco control program that emphasizes abstinence
oriented prevention and treatment.
Giving "manufacturers the necessary incentive to develop and market" safer products should have been the way forward in 1979.
Blocking that in favour of forcing smokers to quit was ideologically motivated and if the millions of tobacco related deaths
are to be believed it was the most unethical and criminal public health policy imaginable.
Consumers will never be "fully and accurately informed" by the tobacco control movement. Providing full and accurate
information would bring the movement’s downfall. How much funding would be given to a tobacco control advocate that warned
smokers - "Smoking MIGHT harm you but we don't know why"? How long would tobacco control exist if it admitted there was a point
at which smoking could become safe in practical terms?
Consumers will be no more "accurately informed" in the future by tobacco control than they have been in the past because
accurate information would definitively negate the need of and funding for tobacco control. As the IOM would have it, the
"total truth" about the product is a sole province of tobacco control – complete with executive powers ensuring that
consumers remain "informed" ONLY by anti smokers: "It is so because we tell you so". As customary of
tobacco control, no official debate with any opposition or public accountability on the demonstration of its assertions is
contemplated, or even conceivable.
The regulation of "promotion, advertising and labelling" is designed so that smoking can always be conveyed as socially
unacceptable and not safe. We will not see adverts for a brand that state "Our cigarettes are no more harmful than cola",
not because that won't be possible in the near future but because tobacco control is worried that it would promote smoking and
undermine their existence. What we will see instead is a system of advertising that will highlight reduced elements of risk
while making dozens of disclaimers by way of other possible things the brand MIGHT still cause. All of this will be
“authoritatively” backed up by anti smoking statistical correlation of course. Once again, manufacturers will be responsible
for "attributed" disease while public health authorities will not be under any obligation to demonstrate the
scientific causality of their assertions beyond epidemiological interpretations and biased, opinion driven attributions.
"Health and behavioural effects" will be monitored. Obviously there will be a need to show some health benefits in
order to justify the continued promotion of less hazardous products but without the product ever becoming "safe" to
justify their own continued existence.
The "behavioural effects" are the consumers response to the new products; rises in smoker prevalence would be bad for this
program because they will always declare the product as unsafe. They therefore advocate a system which still victimises smokers
and keeps smoking socially unacceptable while claiming public health successes for those unwilling to be forced into quitting.
It would suit both sides in the control of tobacco if smoking rates were retained at current levels (the status quo.) This
'level' of smokers would be referred to as "addicts unable to quit" that could be helped only by using less hazardous products.
(This fits well with the IOM analogy of the Methadone program).
We know full well what "basic clinical and epidemiological research" may be perverted into, as one can refer to the
past to look into the future. They will subject animals to the equivalent of several thousand cigarettes a day and ask people
to recall how much smoke from a "less hazardous" brand they have inhaled over given periods of their lives whilst
completely ignoring anything else that they might have inhaled, eaten or drank. Basically the same junk science will be used to
maintain smoking as an unsafe, socially unacceptable habit that requires controlling.
The committee's objectives are summed up with "Harm reduction is implemented as a component of a comprehensive national
tobacco control program that emphasizes abstinence oriented prevention and treatment". No matter how much "risk
reduction" is achieved this will ensure that they can still "control" the tobacco market. In short, nothing will
change as long as the smokers themselves continue to passively accept their status of "sick citizens in need of a cure"
and not constitute themselves into groups of power that demands the end of persecution, denormalisation and cultural engineering
in exchange for the use of safer products.
The committee recommends that smokers be informed at every opportunity that all tobacco products, including modified tobacco
PREPs and cigarette like PREPs, are toxic and poisonous. (emphasis in original IOM report.)
A further affirmation of the need for ongoing control. They use the rather frantic, redundant and overbearing term "toxic and
poisonous" at the end of a statement highlighted in bold. Toxic of course means poisonous so why the need to repeat it twice
in bold?
Just by the way, from the Oxford English dictionary;
Toxic: adjective 1 poisonous. 2 relating to or caused by poison. noun (toxics) poisonous substances.
Once again we have the situation where we are being warned about the "poisonous poisons" in tobacco products but this time in
the very same document that claims removal of those poisons won't make the product safer because they don't really know whether
they are causing disease in the first place. The paragraph is, in its entirety, a health scare tactic to be used purely for the
maintenance of control.
The evaluation of conventional tobacco products and tobacco related PREPs is complicated by a lack of adequate in vivo models
of tobacco related morbidities in man.
The IOM again admits that they have no real scientific evidence of tobacco related disease in man. They have "a
lack of in vivo (in living organisms) models", which means that they cannot scientifically demonstrate tobacco related
causality in man. Obviously if they can't prove that existing products are harmful to man it will be "complicated"
to demonstrate risk reductions for less hazardous products.
This situation is incredibly convenient for the maintenance of a status quo; reductions from an already unknown level of
morbidity/mortality will automatically be an unknown reduction.
The effects of PREPs on cancer risk from environmental tobacco smoke (ETS) are uncertain because of the difficulties in
measuring reduction in exposure.
If they can't measure exposure how do they judge ETS to be harmful in the first place? If they can measure exposure why can't
they measure reductions in it? Once again they want their cake and they want to eat it too. Fewer than 8% of all ETS studies into
lung cancer and smoking show ETS to be harmful (see link),
and even with those few the risk is so tiny that it could be easily explained away by chance, bias or lack of accounting for
other factors.
The real reason for this paragraph in the IOM report is to maintain an illusion of perceived harm from ETS, so that possible
widespread use of reduced risk cigarettes does not lead to demands for lifting of smoking bans. In reality of course
they cannot possibly be "certain" of ETS harm and at the same time be "uncertain" of risk reduction, but in
claiming that this is the case they keep the arguments for control over ETS. The IOM clearly recognises that control over ETS
is vital to maintain smoking as a socially unacceptable habit
Until adequate data are available, individual and regulatory choices will by necessity have to be made on the basis of
predictions of risk and harm reduction based on inference from indirect evidence. Action should therefore be taken not only
to monitor the market, but also to shape it as scientific knowledge unfolds.
This is a potentially disastrous call by the IOM: the market can only ever be "shaped" by consumer demand. "Predictions of
risk and harm reduction based on inference" to shape the market will be the downfall of a desirable goal to achieve an
unquestionably safe product; the elements of greed and ideology within tobacco control will always ensure that such
"inference" remains negative and that will be reflected in the "shaping" of the market.
The market should be shaped by consumers and acceptable, safer products of choice, not by professional anti smokers who don't
have the first clue as to why people smoke in the first place and who are paid handsomely to promote the denormalisation of
smokers.
Furthermore, a strong element of Marxist pseudo-economics is visible in this statement, encapsulated in an all-fascist approach
of corporate cooperation with the state. That envisions the state – not the consumers and the free market – as determining the
need of the people for a product. That faith – which has nothing to do with health and all with ideology – has been at the
foundation of the economic downfall of the Soviet Union and the ideological foundation of Fascist Italy and Nazi Germany. It
represent a precedent for an adoption of policies to regulate products that are "potentially" dangerous in the
unquestionable opinion of self-referencing "public health" institutions, which in turn are not accountable for any
scientific demonstrability according to the Scientific Method. In short, the entire industrial production of a nation has just
to hope that "public health" does not select whatever product as a target, as the precedent is already set for total
regulation by the state.
Despite continuing ambivalence among some health officials about the wisdom of embracing harm reduction as a public health
policy, numerous consumers will be taking steps in this direction with or without scientific guidance.
An interesting choice of terminology; why would "some health officials" require "wisdom" to embrace harm
reduction? A more accurate statement would be that: some health officials are criminally negligent to claim that millions of
people will die but then oppose any methods of reducing risk in the unachievable pursuit of a Utopian, non smoking world.
The IOM is pointing out to these purists that consumers are demanding safer products and this is a threat to the entire tobacco
control movement. As we have read throughout this document, it should never be admitted that cigarettes can be safe or safer
because control would then be lost. It is far better to work with the enemy and maintain control of "risk reduction
products" than to allow a natural evolution towards safe cigarettes that would result in the eventual demise of the anti
smoking circus.
New brands and modifications of conventional tobacco products without health claims would be permitted to enter the market
without prior regulatory approval if they are certified to present "no greater risk" than products already on the
market.
The IOM terms this as a "No increased risk threshold for all tobacco products". As long as current products do not
become more harmful they should not be subject to regulatory approval that would effectively ban their production. This would
ensure that existing brands will still be available and that new reduced risk products would have to compete with market
forces. In turn this ensures that the abolitionists within tobacco control could not force "back door" prohibition by making
unacceptable products the only choice for consumers.
Again the status quo is maintained.
It is essential that such labelling in the end be perceived as denoting degrees of risk, not as signifying or implying safety.
The report talks about a degree of risk "table". This would presumably range between extremely risky and very risky in order to
avoid the dreaded implications of "safety" and the detrimental effect that would have on the tobacco control movement. In
controlling the labelling it will always be possible to maintain tobacco as never becoming safe or safer, no matter what is done
to it.
Consideration should also be given to a disclosure that the health benefits of the product's exposure reduction have not yet
been established in scientifically recognised tests or ongoing studies.
A disclaimer to maintain control. They allow a manufacturer to claim reduced risk for purposes of marketing but force them to
also state that it has not been scientifically "proven." Stale mate yet again because the IOM admits that harm has not been
scientifically proven and as such harm reduction cannot possibly be proven either; if you reduce an unknown quantity you will
always be left with another unknown quantity.
In the committee's judgment, harm reduction is a feasible and justifiable public health policy.
The "committee's judgment" would be a noble statement if it weren't for three facts: 1. They are 30 years late in
saying it, 2. They are completely biased against the concept of a goal to make tobacco unquestionably safe to any everyday
definition of the term. 3. They are also biased towards the prevention of tobacco smoking from being, once again, a socially
acceptable fact of everyday life, the way it has been for the last 400 years or so. The implication is that "the world is
a better place without smoking". That is a moral judgment that has never belonged to public health institutions or
science but, more appropriately, to religions or philosophy. That is especially true in consideration that, throughout history,
not even one death has ever been scientifically demonstrated to be caused by smoking. Epidemiology, in fact, claims the ability
to count millions of deaths and, at the same time, states that it cannot scientifically demonstrate the causality of one single
death.
Regression of risk using PREPs might eventually bring a smoker to a risk equal to some lower level of lifetime exposure to
conventional products.
The IOM report admits that it is feasible for smoking to be made as "safe" as other everyday products; shouldn't this
then be the goal of public health? Making cigarettes as safe as a whole "lifetime of exposure to conventional
products" certainly should be a desirable policy for anyone responsible for the health of the public.
The potential for reduction in morbidity and mortality that could result from the use of less toxic products by those who do
not stop using tobacco justifies inclusion of harm reduction as a component in a broad program of tobacco control.
Why must it be within a "broad program of tobacco control"? Why not have a goal to make smoking 'safe' to some
predetermined level and thus save taxpayers worldwide trillions on the cost of the tobacco control movement once that
predetermined level is achieved?
Wouldn't it be a desirable public health policy to make cigarettes as safe as cola for example? It was disclosed earlier that
this is feasible within twenty years. Why then is it necessary to have a highly funded "broad program of tobacco control"?
It is important to consider whether a threshold exists for risk of cancer from tobacco products. This is important for new
smokers who might initiate smoking with a PREP. It is possible that the delivered exposures from a PREP would be below that
threshold, or at least this should be the goal of such a product.
If it is given that tobacco causes cancer despite it never having been scientifically demonstrated then of course a threshold
would exist for risk. If a substance/substances within tobacco cause cancer then it follows that their removal would also
remove the risk or that their reduction would reduce that risk according to the dose response relationships admitted within the
IOM report. Of course the same can be said for any other disease linked to smoking; if you eliminate the substances that might
cause diseases you also necessarily eliminate risk. Most importantly, this statement implies the existence of a threshold of
exposure for active smoking, below which cancer does not statistically appear. Although in contradiction with the statements
concerning ETS that we have seen earlier, the implication is that, if there is a safe threshold of exposure for active smoking,
then there must be one for passive smoking, given that a passive smoker is subject to an exposure that is 75,000 times lower
than that of an active smoker. This is in strident contradiction with the 2006 Surgeon General Report, that states the absurd
and ridiculous conclusion that "there is no safe level of exposure to passive smoking".
Summation
This IOM report represented the beginning of a shift in the struggle for power in the world of tobacco. Smoking has been made an
issue since the 1950s, and that issue has become a massively lucrative vehicle for organisations, politicians, researchers and
special interest groups.
Smoking has been, by far, the most popular social habit of choice for over 400 years and the market is still growing worldwide
with well over a billion smokers; According to the World Health Organisation 1 in 3 men in the world smoke and 10 million cigarettes
are sold every minute, 24 hours a day. Tobacco is a major part of every developed country's economy and tens of millions of
people are employed directly or indirectly by the tobacco industry. Smokers represent the largest consumer group ever witnessed
by an enormous margin and they contribute trillions to Governments, Health Authorities and directly to local public bodies.
This latest shift in the struggle for power is not between the tobacco companies and tobacco control, it is between opposing
ideologies in the tobacco control movement itself. It is very much the product of ideology in itself – an ideology that puts
personal health at the pinnacle of human values, well before freedom, democracies and economies. That health/value is measured
in statistical years instead of quality of life stemming from personal gratification, and indeed quality of life is redefined in
statistical life expectancy, to increase which it is moral to use repression, junk science and scare tactics.
The vilification of smokers has been so complete that without a change of direction such as that now being proposed there would be
nowhere left to go but towards prohibition; there are some within the tobacco control movement that would welcome prohibition
but there are also many who realise it would represent the end of the gravy train.
This IOM report sets itself as a public health saviour with an idea to 'make tobacco less harmful for those who cannot quit'.
They make no excuses for having denied this route for three decades; they know nothing about why people smoke so are not
qualified to make the assumptions that the people they have failed to force into quitting should be labelled as "those who
cannot quit"; they cannot show why they think cigarettes are harmful; they cannot show why they can never be labelled as safe and
at the same time they argue that the burden of an unachievable proof for lower risk should be with the manufacturers.
After 30 years, only a fool would believe that public health suddenly decided that less hazardous products were a good idea
after all. This report and subsequently proposed legislation shifts the power towards those who seek the continuance of tobacco
control by avoiding prohibition and ruling out beforehand any possibility of the product achieving an acceptable level of safety.
Once again we see the control of smokers being decided by greed and power rather than over any real concerns for health problems.
Finally, once again we see that smokers are the objects and not the subjects of their life choices, with the all-Nazi underlying
conviction embraced by public health institutions that the life of the citizen ultimately belongs to the state rather than to
the individual.
All in all, a natural, consumer driven evolution of the product is long overdue and is certainly more appealing than the prospect
of prohibition. However, the growth in power and wealth of the tobacco control movement who now openly run programs of social
change and 'denormalisation' and who make unfounded and contradictory claims with total impunity will mean that smokers are
continually vilified for some time to come unless they decide to empower themselves as a transnational and politically
transpartisan social force that public health institutions have to contend with.
