products are being developed and offered as harm-reducing alternatives to conventional tobacco products. The task before this committee is to address the science base for implementing a harm reduction approach, and for assessing the impact of such an approach on public health. The committee’s task is not to recommend whether or not tobacco harm reduction should be pursued. Furthermore, the committee’s effort to carry out its charge should be understood as only one component of a comprehensive tobacco control policy.

This report shows that the prospect of harm reduction presents both promise and uncertainty. For tobacco and pharmaceutical companies to be investing in products that reduce exposure to tobacco toxicants could be a salutary development. Nonetheless, despite advances in understanding tobacco toxicology and the pathophysiology and epidemiology of tobacco-related diseases, little is known about the health effects of using products that reduce exposure to one or more tobacco toxicants or about the public health consequences of promoting tobacco-related products or pharmaceutical products as potential reduced-exposure products (PREPs). It will take many years of research to develop definitive data. It is also clear, however, that action must be taken now, even as better data are being developed, to respond to the already emerging market for PREPs and to ensure that the necessary data are developed, that consumers are accurately informed, and that the public health is fostered.

Until adequate data are available, individual and regulatory choices will by necessity have to be made on the basis of predictions of risk and harm reduction based on inference from indirect evidence. Action should therefore be taken not only to monitor the market, but also to shape it as scientific knowledge unfolds. Despite continuing ambivalence among some health officials about the wisdom of embracing harm reduction as a public health policy, numerous consumers will be taking steps in this direction, with or without scientific guidance. The aggregate effect of these decisions might make an important contribution to public health— or might further exacerbate the problems posed by tobacco products. Policy makers must use the best that science has to offer to ensure that the harm reduction strategies pursued by tobacco and pharmaceutical manufacturers and by individual consumers will truly reduce harm, and to the greatest extent possible.

The committee was drawn by its charge into considering how best to implement the scientific and policy recommendations in this report and, in so doing, was necessarily required to address some features of a regulatory framework for PREPs. The regulation of tobacco products is most certainly controversial and many approaches have been proposed. Tobacco regulation conceivably includes taxation, access by minors, point of sales, etc. For the purposes of this report the regulatory framework

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