Demystifying Nicotine: Unethical to Deprive People of Less Harmful Alternatives says health activist

Health Activist and Harm-Reduction Advocate, Dr. Kgosi Letlape
Health Activist and Harm-Reduction Advocate, Dr. Kgosi Letlape

Smoking cigarettes is the most harmful form of consuming nicotine and it is the duty of government, industry and society to ensure that smokers have access to less harmful nicotine products.

This was the expressed view of Health Activist and Harm-Reduction Advocate, Dr. Kgosi Letlape in a recent briefing to industry, media and tobacco harm-reduction advocates entitled ‘Demystifying Nicotine’.

“It is unethical for us to deprive people of alternatives that are less harmful to their health and tobacco is no exception,” Dr. Letlape said.

He asserted that South Africa’s approach to regulating less harmful nicotine products should include a review of the scientific evidence and best practices from other countries that are making rapid progress in reducing smoking rates and improving the health profile of their societies by incorporating harm reduction into their tobacco control strategies.

He compared tobacco harm reduction to South Africa’s response to the HIV/AIDS epidemic, “During the early 2000’s we knew that could not eradicate people’s need for sex, so the issue of ‘abstain or die’ was not an option, if you chose that, it was a dying option.”

He continued: “We educated people on responsible sexual behaviour and promoted treatment to reduce harm. If we did not, we would have had millions of preventable deaths in our society,” he explained. “It is the same with tobacco harm reduction – quit smoking, but if you can’t, then change to a less harmful alternative.”

Dr. Letlape clarified that nicotine while addictive and not risk-free, is not the main cause of smoking-associated diseases. He went on to quote South African born Prof. Michael Russel who wrote in 1976: ‘People smoke for nicotine but they die from the tar’. 

A study by the Foundation for a Smoke Free World shows that 69% of South African respondents believe that nicotine is the primary cause of cancer, and a study from Rutgers University found that approximately 80.5% of physicians also believe that nicotine causes cancer.

“The harmful chemicals which are produced when tobacco is burned is the main cause of smoking related diseases, and in terms of harm reduction, when we don’t burn tobacco, we significantly reduce the levels of harmful chemicals that are released and that the body is exposed to,” Dr. Letlape added. “Therefore, these products are less harmful than smoking and people need to know this, so they can choose better alternatives if they don’t quit smoking. Less harmful does not mean harmless.”

He went on to explain that nicotine replacement therapies like patches, gum and lozenges have been offered as an alternative for some time, but the success rates are low and there is relapse.

“Smokers have preferences and they need to choose the most effective alternative to stop smoking cigarettes,” he added. “The oldest alternative is smokeless tobacco in the form of snuff in South Africa and snus in Sweden, and more recently, novel products like e-cigarettes and heated tobacco are proving more effective at helping people move away from cigarettes.”

He cited several examples where less harmful nicotine products are being regulated differently from cigarettes to provide smokers with better alternatives:

  • “Sweden has displaced cigarette smoking with the use of smokeless tobacco (snus); there are 40 years of epidemiological evidence showing that the Swedes have the least problems with diseases attributable to the use of tobacco.
  • Smoking cessation clinics in the UK support smokers who can’t quit to adopt less harmful nicotine products like e-cigarettes – it’s part of the government’s strategy.
  • In Japan, where the government is also a producer of combustible tobacco products, they have allowed the introduction of heated tobacco products which have accelerated the decline in smoking rates according to a study for the American Cancer Society.
  • The U.S Food and Drug Administration has authorized the marketing of a heated tobacco product as a Modified Risk Tobacco Product (MRTP) with reduced exposure information in the US finding that it was “appropriate to promote the public health”. It has also authorized the marketing of certain snus brands with information that it puts you at lower risk from several smoking-related diseases.”

Dr. Letlape highlighted that while combustible cigarettes are the most harmful way of consuming nicotine, they are also the most accessible and affordable in South Africa.

“Nicotine products have different risk profiles and should be regulated accordingly, we do not regulate or tax nicotine patches, gum and lozenges in the same way as cigarettes, so why should we regulate and tax e-cigarettes and heated tobacco in the same way as cigarettes? This will only make it difficult for people to have information about them and to afford them,” he said. “Our tax policy must make harm reduction affordable – lower tax rates will incentivize people to change to better products than cigarettes, higher taxes will not. Harm reduction must be affordable.”

In closing Dr. Letlape stated that:

“There are four groups of addicts in relation to the tobacco industry: the government are addicted to the taxes, the industry is addicted to profit, the smokers are addicted to nicotine and the healthcare professionals or experts are addicted to being anti-smoking.

The government needs to incentivize smokers to change to less harmful products through regulations that will enable smokers to get all the information on less harmful products and by taxing them at a lower rate than combustible cigarettes, as in Japan, Sweden, the U.K. and the U.S. If we switch people to less harmful products, we will reduce the burden of disease on the health system in the long run resulting in greater savings in healthcare costs when we have healthier citizens.

To the industry, there is absolutely no reason why they are not switching to less harmful products, but regulators need to create incentives for smokers to move to less harmful products.

Smokers should quit smoking and nicotine completely, but for those who don’t they should change to less harmful products. Smokers are human and they have human rights. If they make bad choices, we have a duty ensure that the choices they are making are less harmful to their health.

There are healthcare professionals and experts in tobacco who attack less harmful products and spread falsehoods, saying that these products are equally harmful or even more harmful than combustible cigarettes.  It is our duty to ensure that there is truthful communication about less harmful nicotine products.”

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