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As a
low-toxicity smokeless manufacturer, BAT wanted regulations to keep out
high-toxicity products. On the other hand, BAT needed breathing space
from public health groups’ criticisms for smokeless products to
become established (as an alternative to cigarettes).
Laugesen noted that the price of NRT was
about the same as cigarettes in New Zealand, whereas in the US it
was some three times more expensive than cigarettes. In a comparison of
consumption reductions in men in New Zealand and Sweden, Laugesen noted that between 1990 and 2000 Sweden had reduced cigarette consumption to a greater extent than New Zealand, without raising the costliness of cigarettes as in New Zealand. He thought the greater reduction in male cigarette consumption
in Sweden was due to the rising male consumption of snus in Sweden. Laugesen commented that a risk-based tobacco excise could be
implemented such that excise taxes were levied proportional to the risk
of each tobacco product. Finally, he commented that the use of
smokeless forms of nicotine would have the following effects on
mortality rates: help to end
indoor second-hand smoke exposure which would impact on mortality
within around three years; aid smokers to quit smoking and reduce
relapse which would impact on mortality rates within a period of around
15 years; and be an alternative to smoking for teenagers which would
have an impact on mortality over a longer period from about 20 to 50
years.
Laugesen then went on to outline the
risks from adopting such an approach. In particular, he was concerned
that it could blur the quit message.
The current simple quit message is clear
and unequivocal, whereas refining this to say ‘quit smoking but you don’t
have to quit nicotine or tobacco’ means educating smokers
that nicotine is not necessarily bad after all. To counter this, more
emphasis has to be placed on the dangers of smoking.
Lack of policies and research to support
reducing combustible sales to zero, could mean that this end-goal is
seen as unobtainable.
In
addition, if there was no firm goal to end smoking, reduced toxicity
cigarettes could be seen as cementing the continuance of smoking, instead
of a precautionary protective measure for smokers until such time as
cigarettes are no longer sold.
Laugesen believed that the health
community, in its zeal to oppose the tobacco industry, often: failed to
differentiate between the cigarette manufacturers and the smokeless
companies and the risks of their respective products;
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encouraged members not to communicate
with any part of the industry; and failed to major in cigarette
research and science, leaving the field of regulation to the expertise
of the cigarette makers.
In particular he felt it important that
funding be found for the research to replace cigarettes as a nicotine
source. He believed that the simplest way was a tax levy per cigarette
or funding could be donated by industry with ‘no strings
attached’ on how it was used.
Laugesen summarised by saying that
comprehensive tobacco control programmes, even with the help of
subsidised NRT are slow in reducing smoking prevalence. Nicotine
products and snus are far safer than any modified cigarette. The ERS
need to inform people in Europe that this is indeed the case. Cigarettes are the most dangerous
of all tobacco products and public health groups need to adopt the
overarching goal of phasing out cigarettes. Research is needed to
clarify whether fast-acting nicotine will match the effects of snus, be
safer than snus and superior to current NRT products. He believed that
multi-centre research on alternatives to smoking was required.
Discussion Some believed that the
proposal to ban cigarettes would not work. Laugesen answered that the
end goal of banning cigarettes need not be immediate, and also need not
happen in our lifetime, but that a start needed to be made. Some
countries already contemplate the feasibility of a zero prevalence of
smoking, such as Australia. Having such a goal will help clarify thinking in this area,
and make tackling the issue of smokeless tobacco products more urgent.
Consensus statement. Following the
discussion, Godfrey amended the meeting consensus statement to reflect
the comments made, as follows:
·
Harm reduction is desirable as part of a comprehensive tobacco
control programme
·
Nicotine is not the problem
·
Combustible products are the problem
·
The status quo should not continue
·
Snus is a lot less harmful than cigarettes
·
Snus also has potential as a smoking cessation aid
·
Lifting the EU ban on snus within a proper regulatory framework
needs to be considered
·
The ‘playing field’ for clean nicotine should be
levelled by deregulation, taxation and pricing measures
·
Toxic ingredients should be removed from conventional cigarettes.
Rapporteur Dr Ann McNeill, UK
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