COMMENTARY: Tobacco harm reduction – no news, or good Snus?
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Published: 10-Oct-2012

OKLAHOMA CITY – There was a certain disarming candor to the trio of witnesses who last week encouraged the Oklahoma State Legislature to consider taking steps to introduce “Tobacco Harm Reduction” (THR) strategies into policy, i.e. using government resources to push less harmful forms of tobacco use as a means to improve public health.

As for the candor part: Former U.S. Rep. Steve Buyer of Indiana, a Republican who is now a lobbyist, Dr. Joel Nitzkin of the libertarian R Street Institute in Washington, and Dr. Brad Rodu of the University of Louisville and the Heartland Institute each said in their presentations they have received support from the American tobacco industry. 

And, here’s the disarming part -- A strong case from evidence, as Nitzkin summarized it, that “smokers they can reduce their risk of tobacco-attributable death by 98 percent by switching to a smoke-free product.”

To be clear, possibilities for future changes in state policy include reallocation of some existing money used to discourage smoking, shifting some portion of the spending toward awareness for smokers that smokeless and e-cigarettes are less harmful. A less likely legislative approach could be, as proposed in other states, to tax smokeless at a lower rate precisely because it is less harmful. 
 
Buyer reflected, “If a tobacco company puts out a less risky product, that’s good. Let them.” In an exchange with state Sen. Jim Wilson of, a Democrat, Buyer welcomed a critical eye about his ties to Big Tobacco, but admonished: “Skepticism is good; common sense is even better.”

He pointed to varied areas of human behavior – including alcohol use, drug addition and sexual behavior -- to bolster his argument that a combination of abstinence and harm reduction is the better part of wisdom. 

Dr. Rodu’s presentation, enhanced with a power point, was a referenced distillation of views and information from his recent commentary for the state’s largest newspaper: “The [THR] strategy is based on science: smokers who have been unwilling or unable to quit can achieve nearly all the health benefits of abstinence by switching to smoke-free cigarette substitutes, including snus, dissolvables and electronic cigarettes.”  

Frequently referenced in the comments was “snus” -- a Swedish smokeless tobacco product from a nation with the lowest smoking rate in Europe, the lowest rate of lung cancer and other smoking-related diseases in the Old World, and relatively high rates of indulgence in the “smokeless” product. 

The three men appealed for, at the least, a serious debate about alternatives to existing policies that present smokers with a “quit or die” message. Rodu described his work as both a physician and a researcher who concluded, in the 1990s, “that switching from cigarettes to smokeless tobacco would benefit most tobacco users, reducing the harm from tobacco use.”
 
Following the THR advocates came a drumbeat of opposition to any disruption of the policy status quo.

Lead-off hitter was Keith Reid of the state Health Department’s center for the advancement of wellness. He dismissed the information from Sweden, saying “cultural” and manufacturing differences account for the Scandinavian outcomes. He characterized “quit rates” as high as 37 percent as reason to avoid THR, which he views as “public health malpractice.”

Tracy Strader of the Tobacco Settlement Endowment Trust spoke emotionally, contending that harm reduction strategies are “distractions.” Her voice shaking, she made little effort to mask animosity toward the advocates of THR, referencing tobacco interests as “racketeers.” 

One revelation from the hearing was Sen. Brian Crain’s almost casual disclosure that the Trust has contributed to support public television programming from its hefty resources. He wondered aloud what that had to do with tobacco control.

The Trust was created by a voter-approved constitutional amendment that allocated tobacco settlement funds to tobacco cessation, provision of insurance to low-income workers, and other issues. Twelve years later, the Trust has a $700 million corpus and garnered $26.8 million in settlement earnings in the most recent report. 

Doug Matheny of Action on Smoking & Health (ASH) attended the hearing, but did not testify. In a statement provided to CapitolBeatOK, he pilloried legislators who have accepted political contributions from tobacco interests. He believes “money distributed by tobacco lobbyists should be refused as a matter of principle.”

A former director of tobacco prevention at the state Health Department, Matheny retired 18 months ago after a 28-year career in government. He has been a strong ally to Dr. Robert McCaffree and others who have pressed for decades to crush tobacco use in the Sooner State.

Like Strader, Matheny sees no or little merit in Tobacco Harm Reduction strategies. 

These folks speak in the name of public health and the public interest, granting little or no merit to the arguments of those who take libertarian views on use of tobacco products, or those somewhere in the middle who are drawn toward recent policy alternatives based in the scientific evidence and a recognition that there may be limits to efficacy of government hectoring.

They work in taxpayer-funded positions financed in part by the historic tobacco settlement, which New York attorney Michael Horowitz described as “the largest ‘peaceful’ transfer of private wealth in human history.”

State Sen. Brian Crain, a Tulsa Republican, chaired the Senate Interim hearing on harm reduction, originally requested by fellow Republican state Sen. Rob Johnson of Kingfisher. The hearing included exchanges of good if sometimes edgy humor between the two GOP legislators and a pair of their Democratic colleagues, Sens. Wilson and Connie Johnson of Oklahoma City.

The latter said she appreciated Crain’s willingness to bring new evidence to the table, while expressing frustration that her advocacy of legalized medical marijuana has not received a similar hearing. 

The Republican Johnson says he is not yet sure what the outcome of the Interim Study will be. He reiterated this in a post-hearing interview with CapitolBeatOK, hinting there might at least be an effort to encourage some reallocation of existing anti-tobacco resources to support the THR message. 

If the status quo stays in place, the practical result of last week’s hearing will be nothing at all. At a time when “flat-line” seems an apt way to describe both tobacco use and the effectiveness of cessation programs, the hearing at least had the merit of offering some new ideas.

In the ideal, the object of good medicine is “Do no harm.” In the real world, an achievable objective for policymakers might be characterized as “do less harm.”

The Kingfisher Republican deserves credit for bringing a fresh approach to an issue policymakers have been tackling for a half-century, with decidedly mixed results.

You may contact Patrick B. McGuigan at Patrick@capitolbeatok.com and follow us on Twitter: @capitolbeatok


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