A Public Health Perspective on Tobacco Harm Reduction

by Joel L. Nitzkin, MD

to AMA Reference Committee D and House of Delegates

On behalf of the American Association of Public Health Physicians

June 7, 2018

Introduction and Summary

This White Paper has been generated in response to the AMA CSAPH Report 5-A-18, titled “Tobacco Harm Reduction: A Comprehensive Nicotine Policy to Reduce Death and Disease Caused by Smoking (Resolution 403-A-17).”

Based on the analysis presented herein, the American Association of Public Health Physicians (AAPHP) recommends that CSAPH 5-A-18 report be referred back to CSAPH for further development. As seen by AAPHP, the current report is incomplete and contains multiple misleading and technically incorrect assertions.

As seen by AAPHP, the Council, in its review of this literature, did not consider federally sponsored survey data from the US, Great Britain, and other countries that show substantial reductions in both teen and adult smoking in response to the introduction of e-cigarettes, related vapor products and other relatively low-risk alternatives to cigarettes. They seemed to uncritically accept deeply flawed studies dealing with teen recruitment, smoking cessation and toxicity of these relatively low risk products. The Council disregarded the long-term limitations of current pharmaceutical protocols and did not consider the inherent bias against tobacco harm reduction implied by the goal of “a tobacco-free society.”

Our AAPHP 14-page White Paper provides specific information about the additional work that will facilitate Council re-analysis of the issue of tobacco harm reduction.  By aligning policy with science, we hope our AMA will play a more substantial role in guiding national policy toward a future virtually free of tobacco-related addiction, illness and death.

An AAPHP Perspective on Tobacco Harm Reduction 2018-06-07.pdf