Harm reduction in focus at Global Forum on Nicotine 2018

The Global Forum on Nicotine (GFN) is an annual conference that brings together researchers, manufacturers, and users of nicotine, a wide spectrum of participants rarely found in other similar conferences. 

The starting point is the now scientifically well-established fact that nicotine itself is not particularly harmful to health. It is cigarette smoke containing tar that is responsible for the negative consequences.

Harm reduction

At root, it’s about harm reduction.  

By striving to reduce harm and at the same time respect the fact that very many adults clearly want to use nicotine in some form, you immediately set up a contrast with the official policies of many countries.

Anyone who wants to reduce the level of smoking can find plenty of evidence that giving consumers freedom of choice is the best way forward. Those who hate the tobacco industry in itself, on the other hand, will never succeed in reducing smoking to the same extent. 

They are missing the major transformation currently underway in the industry, away from smoking tobacco towards other products.

Lack of understanding

Of these new products, it is snus which has the longest and best-established record on reducing smoking. Since 1992, Sweden has been the only country in the EU where snus has not been banned, and today the proportion of smokers is also lower in Sweden.

But with the introduction of e-cigarettes, other countries have also begun to reduce the proportion of smokers. 

What is fascinating is that in countries like Australia, where taxes have been raised and the state decides what the packaging should look like, but where snus and e-cigarettes are banned, there has been less success in reducing smoking than in countries where consumers have been offered alternatives.

For a long time, it has been known that smoking is harmful. And for almost as long, there has been the realization that “smokers smoke because they want nicotine, but they die of tar,” as Professor Michael Russell put it in back in the early 1970s. 

Unfortunately, many regulators over the years have tried to reduce the level of nicotine in cigarettes in the belief that the products would then become less addictive. As a result, smokers smoked more cigarettes – a typical example of how a lack of understanding and overconfidence can lead to detrimental effects.

More research needed

The work of Professor Lars Ramström, who was honored with the Michael Russell Award at GFN18, stands in sharp contrast to this type of deluded thinking.  

Ramström, who has done a lot of research on smoking, diseases and nicotine, began his career as a traditional tobacco opponent, but changed his mind when he realized that it was not nicotine itself which was harmful to health, but smoking, that the harm comes from the way in which the smoker ingests nicotine. 

He has since shown that Swedish men are the healthiest in the EU, because of the availability of snus, and produced the statistics that were the basis for the Snus Commission’s report, “Snus saves lives”.

The scientific humility that characterizes the GFN approach could be useful in other contexts. We know enough to do the right thing, but we do not know everything, and more research is needed. 

This is in stark contrast to the people and organizations who are opposed to all forms of tobacco, and who therefore in practice strengthen the position of cigarettes on the market. 

Doctors and researchers from Australia were concerned when the figures from different countries were shown and it became  clear that their “bold” policy had failed.

Patrik Strömer, Secretary General of the Association of Swedish Snus Manufacturers.