Big tobacco is trying to hide its greed behind ‘harm reduction’

17 March 2024

By Joanna Cohen, The Hill

You wouldn’t trust a thief to sell you a home alarm system, or a fox to guard a hen house. So why should we trust cigarette companies to help reduce tobacco use?

We shouldn’t, of course. But here we are. For the last several years, the tobacco industry has been co-opting the term “harm reduction” from public health, using it to frame electronic devices and e-cigarettes as the be-all, end-all of smoking cessation tools. And the tobacco industry’s dangerous narrative is poised to pick up steam if it goes uncorrected.

Legitimate harm reduction is a crucial public health concept and strategy. In combatting the tobacco epidemic, effective harm reduction efforts are those evidence-based policy interventions that lead to meaningful reductions in death and disease. Such methods include restricting tobacco advertising and promotion, increasing the price of tobacco products, and establishing 100 percent smoke-free public spaces. These all support people who are ready to quit without requiring abstinence.

These harm reduction efforts, combined with hard-hitting educational campaigns, are proven to help people quit smoking as well as prevent those who haven’t smoked before — including kids and teenagers — from even picking up a cigarette to begin with. These measures are so successful that they’ve left tobacco giants scrambling to retain customers.

Ironically, tobacco companies are now positioning themselves as staunch advocates of tobacco harm reduction in the form of unregulated, commercially marketed electronic devices, some of which can deliver more nicotine than a whole pack of cigarettes.

While simultaneously marketing the products as a lifestyle accessory, tobacco giants such as Philip Morris International, British American Tobacco, and Altria Group are touting electronic products like e-cigarettes and heated tobacco products as agenda-free smoking cessation tools. It is critically important, however, to note that, to date, no company in the U.S. has sought out FDA authorization to market these products as approved cessation devices. Indeed, at times they have even battled this prospect

On the surface, this marketing pivot from peddling an addictive product that led to a global epidemic to supposedly pioneering a “smoke-free world” could seem like a promising evolution in the tobacco market. If only those same companies weren’t simultaneously lobbying against every evidence-based tobacco control measure introduced, enabling tobacco to remain the leading preventable cause of death around the world.

Take, for instance, the tobacco industry’s opposition to the Biden administration’s proposed ban on menthol-flavored products. Tobacco companies are co-opting genuine concerns about over-policing in the Black community as a ploy to push back against the proposed ban on menthol cigarettes, which would disrupt the profitability of a product whose popularity is largely based on years of predatory marketing targeted at Black communities.     

In the media, tobacco industry allies baselessly position e-cigarettes and heated tobacco products as the only viable harm reduction method for people who want to stop smoking. They discount existing FDA-approved cessation methods entirely. Meanwhile, it appears beneficial to the tobacco industry’s bottom line to sell both cigarettes and electronic products. 

Decades of research have shown that cigarettes are incredibly addictive and lethal, affecting both the person smoking them and those exposed to secondhand smoke. As e-cigarettes are newer to the market, there is not yet this same breadth and depth of evidence. Nonetheless, the tobacco industry is leveraging a research gap to position e-cigarettes, with no qualifiers, as a healthy alternative to cigarettes.

Meanwhile, we know that nicotine can still be extremely addictive, and research has established that many e-cigarette liquids contain toxins such as formaldehyde, a known carcinogen. Evidence shows that e-cigarette use is associated with an increased risk of lung injury, cardiovascular damage, poisoning, and burn injuries, not to mention questions that remain about people who use e-cigarettes while also continuing to smoke.

Especially problematic is that the tobacco industry also executes broad advertising campaigns that extend far beyond those who are trying to stop smoking. Indeed, they are potentially cultivating a whole new generation of consumers, including children and young people enticed by appealing flavors, who may spend the rest of their lives trying to curb a nicotine addiction.

This playbook isn’t new. For decades, the tobacco industry refused to acknowledge that cigarettes are deadly while also shelling out hundreds of millions of dollars to make their products as attractive as possible. History cannot be allowed to repeat itself. Leadership and regulation of this market should belong to those focused on saving lives, not selling lies.

Despite attempts to hijack yet another marketable phrase, the strategy behind true tobacco harm reduction is not the tobacco industry’s to spearhead. The motivation of these corporations is to sell more products. Do not mistake their distorted idea of “harm reduction” as anything more than that. 

Dr. Joanna Cohen is chair of the Department of Health, Behavior and Society and director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health. She is a paid consultant in litigation against a tobacco company.The views expressed here are not necessarily those of the Johns Hopkins University.

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