Clearing the smoke or muddying the water?
- Action on Smoking and Health
After two years, 500 pages and thousands of person hours, the authors of the Institute of Medicine report on the science base for tobacco harm reduction must have been horrified by the headlines following the news conference (see box) launching their report.1 (See executive summary on p 189.)
The Food and Drug Administration asked the Institute of Medicine four questions. The first three seek guidance on what happens when an individual uses a product or strategy for reducing harm—is there potential for a genuine health gain and how should this be evaluated? The fourth question addresses what happens to the population as a whole when harm reduction strategies are presented to smokers.
These questions are not simple, and largely untestable in advance of the widespread use of the products. The question about how the population as a whole will respond can never be answered in advance because it will depend on so many future unknowns—most notably the regulatory framework into which the products are actually launched and what marketing claims are actually permitted.
In this swamp of uncertainty and difficulty there also lurks the tobacco industry, especially Philip Morris, which sees its interests in “appropriate regulation” of reduced risk tobacco products.
It was hoped that the eagerly awaited report might address these questions and assist regulators and public health professionals to navigate through this treacherous terrain.
Some of the headlines following the Institute of Medicine report launch
- “Safer” cigarettes may be as harmful as regular varieties—Washington Post
- “Safer” cigarettes no such thing, panel finds—Reuters
- Panel questions tobacco therapies—Associated Press
- Less tobacco may not mean less risk—CNN.com
- No such thing as “safer” cigarettes—MSNBC
- Is “cold turkey” the only safe way to quit smoking?—CBS HealthWatch-Medscape
The report adopts three main themes: firstly, the authors lay out the evidence needed …