tobacco and pharmaceutical industries, and—most importantly—the public, who will have to decide whether or not to use these products.

The committee began with fundamental operating precepts, reiterating and reaffirming overwhelming scientific evidence and the conclusions of many scientific and policy advisory bodies:

Precept 1. Tobacco use causes serious harm to human health.

Precept 2. Nicotine is addictive.

Precept 3. The best means to protect individual and public health from tobacco harms are to achieve abstinence, prevent initiation and relapse, and eliminate environmental tobacco smoke exposure.

Precept 4. A comprehensive and authoritative national tobacco control program, with harm reduction as one component, is necessary to minimize adverse effects of tobacco.

PRINCIPAL CONCLUSIONS

The committee does not evaluate specific PREPs in this report, since the currently available tobacco-related PREPs in particular are most likely prototypes of limited life span. Under present regulatory conditions, tobacco-related PREPs can be changed with little assessment and without disclosure of their contents. Therefore, the committee considered the types of PREPs currently or likely to become available in the foreseeable future. After reviewing a large body of scientific documents and data, hearing presentations from many scientific, regulatory and industrial interests, and publicly soliciting comments on the issues at hand, the committee reaches the following principal conclusions regarding the questions posed by the charge:

Conclusion 1. For many diseases attributable to tobacco use, reducing risk of disease by reducing exposure to tobacco toxicants is feasible. This conclusion is based on studies demonstrating that for many diseases, reducing tobacco smoke exposure can result in decreased disease incidence with complete abstinence providing the greatest benefit.

Conclusion 2. PREPs have not yet been evaluated comprehensively enough (including for a sufficient time) to provide a scientific basis for concluding that they are associated with a reduced risk of disease compared to conventional tobacco use. One narrow exception is the use of nicotine gum in one study for maintenance of cessation, described in Chapters 8, 13, and 14. Carefully and appropriately conducted clinical and epidemiological studies could demonstrate an effect on health. However, the



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