Can scientifically substantiated smoke-free products positively contribute to public health?

Watch Dr. Franzon's presentation:

 

Below is the transcript of the video:

Hi, I’m Mikael Franzon, a Psychologist by training with a PhD in Neuroscience. I have worked as a scientific advisor for PMI (Philip Morris International) for 5 years. Before PMI I worked in the pharma industry for over 25 years, for companies like Pharmacia, Johnson and Johnson, and Pfizer - developing medicinal nicotine products as well as working with Varenicline for tobacco harm reduction.

Today, I’m going to talk to you about whether smoke-free products can positively contribute to public health. What are the underlying thoughts? What are the necessary requirements?

We all know that smoking is harmful. It is addictive, and the health risks of smoking are well established. But what is the root cause behind this? Looking in the smoking literature we see mentioning of tar and nicotine. Let’s take a closer look how they relate to risk.

So, what is tar? It is simply the total weight of solid and liquid residue in cigarette smoke after the weight of nicotine and water has been subtracted. Scientists call it Nicotine Free Dry Particulate Matter (NFDPM). Tar does not consider what is in the residue or inform on how many harmful chemicals are actually part of it.

Nicotine is addictive and it is not risk free. However, leading authorities, including the U.S. Food and Drug Administration (FDA) and the U.K. Royal College of Physicians agree that nicotine, while addictive, is not the primary cause of smoking-related diseases.

When you burn tobacco, physical and chemical reactions occur. Over 6’000 chemicals are emitted, and around 100 of them are linked to smoking-related diseases. These around 100 harmful and potentially harmful constituents are inhaled in the smoke. The more a smoker smokes, the higher his or her exposure to these chemicals. This exposure causes the disruption of biological mechanisms, leading to changes at the cellular and tissue level.

Finally, an accumulation of these changes over time leads to the development of smoking-related diseases. Finally, the more people develop smoking-related diseases, the bigger the impact on public health.

Since cigarettes are legally produced, sold, and consumed, the way to improve public health is that we need to reduce the number people who consume cigarettes. Which is why most current tobacco control strategies are focused on:

• Minimizing initiation: If you don’t smoke, don’t start.
• Encouraging cessation: If you smoke, quit.

If, over time, more smokers successfully quit smoking than start or relapse using cigarettes, the number of smokers declines. Despite the fact that over last three decades, we have seen declines in the smoking prevalence, the global population is growing. The combined effect is that there will be 1 billion smokers in 2025 – which is basically unchanged compared to the year 2010.

By definition, the best thing a smoker can do to reduce this risk of developing smoking-related disease, is to quit tobacco and nicotine altogether. But we all know that many won’t. Would encouraging those smokers to switch to less harmful alternatives improve individual and public health?

In other words, we could supplement existing tobacco control strategies for smokers who would otherwise continue to smoke by promoting switching to less harmful alternatives. If you don’t quit, change.

For these alternatives to be able to reduce population harm, they must be scientifically substantiated to:

•  Avoid combustion, and emit significantly fewer and lower levels of toxicants than products that burn tobacco, and
•  Reduce the exposure to toxicants in smokers who switch completely to these products compared to those who continue to smoke cigarettes

And this reduction in exposure should lead to a reduction in harmful health effects compared with continued smoking.

Additionally, it will be important that smokers who would otherwise continue to smoke completely switch to these alternatives in big numbers. And that the unintended consequences are minimized. That is, low initiation with alternative and low relapse of former smokers.

There is a simple equation to illustrate what I have been describing:

Public Health Benefits = Product Risk Reduction X Smokers Switching.

If we do nothing the status quo will continue. One billion people will continue to smoke cigarettes, and therefore the actual number of people at risk of developing smoking-related disease will also stay the same. But if we want to maximize the public health benefit, we need to address two fundamental challenges.

The first, product risk reduction, is a technological challenge. We need to develop products which reduces the exposure to harmful and potentially harmful constituents, thereby offering the potential of reduced risk and harm.

The second, smokers switching, now is a behavioral challenge. This is linked to the acceptance of the product. Simply put: the more smokers who switch, the bigger the public health benefit. But it is not quite this simple. It is also important to encourage smokers to switch completely and to stick with it. And equally as important: we need to minimize use by unintended users such as never-smokers, former-smokers, and youth.

We could develop the perfect technology but if no one wants to use it the public health benefit will be zero. I am convinced that smoke-free products can positively contribute to population harm reduction, which is the reason that I decided to join PMI.

Now I am going to let my colleagues present to you some of the data and findings that demonstrate this. First, Andrea will present on product risk reduction and then Steve will present what we know about smokers switching.

Thank you for joining us today.