Brad Rodu, a professor of medicine at the University of Louisville, is the foremost proponent of tobacco “harm reduction” in the world. Harm reduction refers to the fact that cigarettes are the most uniquely harmful version of tobacco; other forms do not even have 1/1000 of the potential harm. Now that e-cigarettes are available, Rodu and co-authors consider how these are a potent force for harm reduction. A fresh look at tobacco harm reduction: the case for the electronic cigarette.
Smokers of any age can reap substantial health benefits by quitting. In fact, no other single public health effort is likely to achieve a benefit comparable to large-scale smoking cessation. Surveys document that most smokers would like to quit, and many have made repeated efforts to do so. However, conventional smoking cessation approaches require nicotine addicted smokers to abstain from tobacco and nicotine entirely. Many smokers are unable – or at least unwilling – to achieve this goal, and so they continue smoking in the face of impending adverse health consequences. In effect, the status quo in smoking cessation presents smokers with just two unpleasant alternatives: quit or suffer the harmful effects of continuing smoking. But, there is a third choice for smokers: tobacco harm reduction. It involves the use of alternative sources of nicotine, including modern smokeless tobacco products like snus and the electronic cigarette (E-cig), or even pharmaceutical nicotine products, as a replacement for smoking. E-cigs might be the most promising product for tobacco harm reduction to date, because, besides delivering nicotine vapour without the combustion products that are responsible for nearly all of smoking’s damaging effect, they also replace some of the rituals associated with smoking behaviour. Thus it is likely that smokers who switch to E-cigs will achieve large health gains. The focus of this article is on the health effects of using an E-cig, with consideration given to the acceptability, safety and effectiveness of this product as a long-term substitute for smoking.
The message is that public health initiatives will be much more successful in the area of smoking cessation if nicotine alternatives, such as e-cigarettes and snus, are on offer. The harm from tobacco mainly comes from combustion of tobacco leaves, which generate copious amounts of noxious chemicals, and these are largely absent from alternative, non-smoking forms of tobacco, as well as e-cigarettes.