Is civil dialogue and engagement between diverse stakeholders with respect to tobacco harm reduction feasible? A review of the past, present and future
With a billion smokers in the world and an annual toll of 7 million premature deaths, more can be done to significantly reduce or even eliminate the use of combustible products. Part of that effort involves the development of science- based consumer acceptable lower risk alternative products. The public health community, policy makers, and regulators are very much divided as to whether harm reduction is a viable strategy. Part of these differing views have deep roots in the distrust of the tobacco industry that for decades denied that its products caused serious harms and then developed unregulated products which made implied claims of safety (i.e. low tar and nicotine). This personal essay will explore the past, present and the future as means of determining whether there may be a path forward in making 'harm reduction' a part of the solution rather than being seen as part of the problem. The first area reviewed will be starting in the 1950's until about 2000, focusing on tobacco industry tactics and strategies to misuse science and to deny that their products caused cancer, heart disease and other harms. The second period will cover the time from the Master Settlement Agreement (1998), through the passage of the Tobacco Control Act in 2009 and up until the present day. The third area will be on whether it is possible in a regulated environment for diverse stakeholders to engage in a civil dialogue that focuses on making harm reduction a legitimate way of significantly reducing disease and death from cigarettes.