The European Union is facing a significant legislative deficit on the issue of harm reduction from smoking. While the US Food and Drug Administration (FDA) is assessing new products designed to protect the health of smokers, its European counterpart (EMA) is failing to modernise the institutional framework. The issue is very important for public health, with evidence showing that - apart from reducing mortality and morbidity - the economic cost of hospitalisation for smoking-related conditions is huge and is not covered by the taxes imposed by the State.
The above was mentioned, among others, during a round table discussion, entitled A New Look at Public Health, which took place in Athens, in the framework of the Panhellenic Conference on Public Health 2022.
The discussion was moderated by Professor of Cardiology Ignatios Economidis and Professor of Public Health Anastasia Barbouni. Economidis referred to the opportunity presented by harm reduction products from smoking, saying that the smoking habit is dangerous as it causes cardiovascular problems and cancer. Barbouni stressed that there is now a new reality, which Europe must take advantage of.
Speaking at the conference, the Director of the Cardiology Clinic of the Euroclinic Dimitris Richter, agreed that the new smoking harm reduction products are a new reality, which provides an answer to a number of problems of smokers. He said smokers are going to experts and reporting that they want to, but are not yet ready to quit this harmful habit.
He cited the case of the FDA, saying that the regulatory framework is already in place, under which it makes an assessment of new harm reduction product claims. It follows a similar process to that followed in drug licensing, he said. The dossiers submitted by companies are complete, with analyses and data. According to the speaker, the aim is to reduce the smoking habit and move to less harmful products.
Richter said that in a paper to the European Society of Cardiology he proposes that the same should be done in Europe. He pointed out that the snus product has been licensed in Sweden as the only product that reduces the risk of smoking. Positive to new products - he said - is also New Zealand.
Referring to the situation in the European Union, he noted that each country has its own regime regarding harm reduction products. In Greece, the new 2020 law gives smokers the opportunity to be informed, while a seven-member scientific committee of the Ministry of Health can assess whether each product has a valid harm reduction argument.
According to Richter, Japan's experience shows that every new product that enters the market contributes to reducing smoking. In the UK, a harm reduction strategy has been developed for people who cannot quit smoking. Communication to the public is positive in relation to risk reduction. A favourable regime has also been established for vapers.
The speaker highlighted that 36% of smokers attempt to quit, but only 25% succeed a year later. Those who fail can take nicotine, without the other harmful substances contained in traditional cigarettes.
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Speaking at the same event, Swedish professor Karl Fagerström, noted that smoking is an ideal venue for harm reduction discussion. People said they smoke for the nicotine, which is not the most harmful of the thousands of chemicals released during smoking. It does not cause respiratory problems, heart disease or cancer."[/P]
He cited reports from the head of the FDA that harm reduction is needed for smokers, who should switch to less harmful habits. He said that in the 1970s, when snus use began in Sweden, there was a very large reduction in the smoking habit. There was also a significant reduction in the incidence of cancer.
With the increase in snus use, there has been a similar picture in Norway, where new smokers are only 1% to 2%. Similarly, the smoking habit has declined since 2015 in Japan, where hospitalisations for chronic obstructive pulmonary disease (COPD) and cardiovascular disease have decreased. In England and New Zealand, there has been an increase in e-cigarettes and a simultaneous decrease in smoking.
The professor also mentioned the latest new product, nicotine pouches, which contain nicotine and nothing else. This product has been adopted as a medical product in Sweden. It was compared with nicotine gum and no major differences were found.
He said it is another step in harm reduction, which is done at no cost to health systems. The issue is to make these products more available, he commented. He warned that smoking is a drug addiction, which cannot be easily treated. He stressed that intervention is needed, saying that in the US there is a shift from smoking to cannabis.
Economy
Polish Professor of Public Health Andreij Fal talked about new tools to tackle the smoking habit. He noted that improved access to treatments has reduced mortality, increasing life expectancy. He warned, however, that it is not a question of curing people, but of not making them sick from factors such as smoking.
Of great interest was the analysis he presented on the economic impact of smoking-related diseases. He explained that the countries that suffer the most are those with middle and low incomes. He referred to Poland and the political disagreement on the issue of loss of revenue from tobacco taxation.
He explained that 80% of the price of cigarettes in Poland is taxes, but this does not solve the problem, as 20% of the population still smokes. He suggested increasing prices and taxes on the most harmful products, which are cigarettes. He spoke of a combination of anti-smoking measures and cited the case of the USA, where price increases and bans have led to a reduction in consumption and a reduction in deaths from lung cancer. He concluded that, in the end, much more money is lost in the treatment of smoking-related diseases compared to the revenue from taxes on cigarettes.
It has been observed that a 10% increase in taxation does not lead to a corresponding decrease in consumption, as the decrease does not exceed 4% in high GDP countries, and it has been shown that increasing taxes on cigarettes encourages the black market and illegal imports of cigarettes. Increasing taxes on cigarettes and reducing taxes on alternative tobacco products of potentially reduced harm to the health of users could be another incentive for smokers who want to quit, because in addition to less risk to their health, they will also benefit financially.
Source: ιατροnet
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