Saul Shiffman

I find myself wondering whether the conference has met our goals, and I find that it has - not because we have conclusions or a clear policy from it, however. Someone asked me what I thought was going to happen in the next year as a result of this conference, and my quick answer was, “Nothing”. In fact, I think we have accomplished our goals because we have raised the right questions. You have all seen the bumper sticker that says “Question authority”. The scientific version says “Question assumptions”, and I think we have done that for the last day and a half.

On the issue of the benefits of some kind of harm reduction strategy - and we did consider a diversity of these - my perceptions are pretty clear. The advantages of particular strategies remain to be established, but the benefits are definite, and the end goal of improving health with concomitant reductions in morbidity and mortality, is clear and underlines our commitment to the area.

The side effects of a harm reduction policy are more controversial. It is important in policy considerations to plan for the possibility that policies will have unintended consequences that often dwarf the intended consequences. It is one of those cases where the operation can be a success, but the patient expires. The concern I heard is that a policy promoting harm reduction would dissuade cessation and would provide a mixed message, particularly to youth in whom we are concerned with smoking prevention. No one raised this issue, but it strikes me that there is a potential for a mixed message with regard to the issue of secondhand smoke. If we are saying that a smoker can smoke in a way that is relatively less risky, are we not implying that the risk …