Is smoke-free tobacco a safe substitute for ordinary tobacco?

Smokers simply do not like products that merely deliver nicotine, and therefore ‘we should not assume that smokers would be willing and able to substitute a nicotine maintenance product for their cigarette smoking’ (p. S54).

Big Tobacco cannot be trusted to develop and market a safer tobacco alternative The final argument is that the tobacco companies, based on their history of lies and deception, simply cannot be trusted to developand market a safer tobacco alternative.28 Fairchild and Colgrove28make a related point, that ‘prioritizing the reduction of harm,however great or minimal, may necessitate some level of cooperationwith the tobacco industry and will certainly prove lucrative for it’(our emphasis added, p. 201) Thus, tobacco harm reduction willnecessarily benefit the tobacco industry regardless of what else might be achieved. Analysis of Arguments in Light of the Emergence ofElectronic Cigarettes

With the emergence of electronic cigarettes, the harm reduction debate in tobacco control has changed. We now address the five major arguments against harm reduction in light of the emergence of electronic cigarettes.

Promotion of safer alternatives will inhibit smoking cessation/ prevention efforts In contrast to reduced risk cigarettes or smokeless tobacco products,electronic cigarettes are not tobacco products. Thus, switching toelectronic cigarettes is not an alternative to smoking cessation,but rather a form of smoking cessation akin to long-term use ofNRT. Moreover, because ‘low absolute abstinence rates suggestthat nicotine alone may not be sufficient to suppress y abstinencesymptoms effectively’ (p.551),22 higher abstinence rates are likelyto obtain from a product that better addresses these symptoms.

Crucially, electronic cigarettes could entice smokers who were not otherwise inclined, to attempt to quit. Although the use of electronic cigarettes by nonsmokers is a theoretical concern, there is no existing evidence that youths or nonsmokers are using the product.

Regulations can address the sale and marketing of these products to minors. Skepticism about the role of combusted products in harm reduction Electronic cigarettes, such as NRT, are not tobacco products and no combustion takes place.

Alternatives promoted as safer may actually be equally or more dangerous Thus far, none of the more than 10 000 chemicals present intobacco smoke,4 including over 40 known carcinogens, has beenshown to be present in the cartridges or vapor of electroniccigarettes in anything greater than trace quantities. No one hasreported adverse effects, although this product has been on themarket for more than 3 years. Still, the FDA struck a more ominoustone in its July 2009 press release, warning of the presence ofcarcinogens at ‘detectable’ levels.29 Yet it failed to mention thatthe levels of these carcinogens was similar to that in NRT products

Whereas electronic cigarettes cannot be considered safe, as there is no threshold for carcinogenesis, they are undoubtedly safer than tobacco cigarettes.