Journal of the New Zealand Medical Association, 08-September-2006, Vol 119 No 1241
Tobacco harm reduction in New Zealand
McCormick and colleagues’ editorial (Where to next with tobacco smokers? NZMJ 21 July 2006; http://www.nzma.org.nz/journal/119-1238/2084) challenges us to use harm reduction to reduce tobacco smoking and its consequences.
Snus (pasteurised tobacco) is the best known such product. No one size fits all, and so the Clinical Trials Research Unit (CTRU)—as conveyed in their letter Working with what we have before getting into bed with the tobacco industry. NZMJ 18 August 2006; http://www.nzma.org.nz/journal/119-1240/2139)—is trialling a range of nicotine replacement therapy (NRT) and enhanced fast acting NRT products. Besides helping people stop smoking, these products may assist those with emphysema or schizophrenia who find it too difficult to quit. The more choices available to smokers, the more will find a product to their liking.
Cigarettes have killed some 200,000 New Zealanders so far. Moral outrage is justified, but should not blind us to future health gains obtainable by astutely using industry know-how for public health ends. The industry does not know how to make safe cigarettes, but it does know how to make much safer smokeless products such as snus.
Snus has decreased Swedish male smoking and cancer rates below New Zealand levels (14% of Swedish men smoke, 20% use snuff; 23% of New Zealand men smoke). Snus’ clinical effectiveness needs testing by a randomised controlled trial. If New Zealand research can prove that nicotine-only products are just as effective, well and good.
Sweden has lowered male smoking rates dramatically while spending 23% as much on tobacco control per capita, while their cigarettes are twice as affordable as in New Zealand. (Swedish expenditure at community level was not counted.) Treasury and the Ministry of Health needs to take a hard look at the effectiveness of the New Zealand regulated market model of tobacco control, not to disinvest, or to dismantle it, but to consider tweaking it, to get more fully-researched harm-reduction products on sale alongside cigarettes, at half the price. Every smoker switching to smokeless means reduced tobacco mortality.
Further data on all known possible harm reduction options for smokers are found at http://www.smokeless.org.nz
Conflict of interest: SmokeLess is not in receipt of any tobacco, smokeless, nicotine or pharmaceutical company funding, nor is the writer.
Chair, SmokeLess New Zealand Inc
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