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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction
applicability of this finding to specific tobacco interventions remains to be established.
The committee concludes with two other observations:
Harm reduction presents major problems of measurement. Harm is much more difficult to measure than is prevalence or even quantity consumed, the conventional targets of control. As Single (1997) notes with respect to illegal drugs: “[A]s a practical matter, it is very difficult to determine whether specific policies involve a net reduction in drug-related harm.” It requires estimation not only of numerous disparate outcomes but also assessment of how much of their change can be attributed to the intervention. For example, vehicle fatalities are determined by many factors; it is a complex research task to identify the contribution of seat belt laws or more stringent Blood Alcohol Content laws. Harm reduction in the tobacco control field will require the development of complex surveillance programs and very difficult issues of attribution.
Public health advocates opine that tobacco is a “special case,” because tobacco is the only consumer product that when used exactly as intended is lethal. Further, they posit that it is unconscionable to market an addictive product to youth who are not competent to make informed judgments about long-term risks in the face of perceived short-term benefits. Finally, an undeniable history of suppression of information about the health risks of tobacco and tobacco product design changes leads many to seriously question any assessment of harm reduction potential by the manufacturers of the products. Just as harm reduction with respect to illicit drugs has been hurt by its association with the legalization movement, so too has the tobacco companies’ use of false messages about the benefits of light and filter-tipped cigarettes created suspicion in the field of tobacco control. Therefore, the burden of proof for a benefit of novel, potential exposure or harm reduction tobacco products entails special considerations beyond that required of many other scientific questions.