How should smoke-free alternatives be regulated?

As global debates unfold about the future of public health policies around smoking, one contentious topic remains the order of the day: how should smoke-free alternatives be regulated? This question is central to public health, especially as government policies attempt to balance the protection of public health with respect for individual liberty.

Within the 7th Summit on the Reduction of Associated Negative Effects on Smoking, held September 16 and 17, 2024 David Sweanor, Professor, Chair of the Advisory Committee, University of Ottawa, Center for Health Law, Policy and Ethics, who has contributed for over 30 years to global public health efforts related to tobacco, brought up a critical point: how far can bans and regulations go without being counterproductive?

David Sweanor pointed out that throughout history, bans on products deemed harmful have rarely been effective in the long term and have often had disastrous consequences. The lawyer gave as examples the bans on coffee in the Ottoman Empire and the prohibition of alcohol in the United States. In both cases, attempts to completely eliminate the products through law enforcement have not only failed, but have also led to the development of illegal markets, further endangering public health.

Prohibition or regulation? A moral or public health issue?

Similarly, current policies on tobacco and related products risk repeating the same mistakes. Although combating traditional smoking is a global public health priority, Sweanor argues that banning smokeless alternatives such as nicotine patches and heated tobacco can be a barrier to smokers who cannot quit nicotine.

Prohibition is rarely a viable solution, especially when it comes to behaviors deeply ingrained in society, such as tobacco use. The question is whether these smokeless alternatives, which are considerably less harmful than traditional cigarettes, should be strictly regulated or even banned. In many countries, bans on these products are justified based on fears that they might attract new users or perpetuate nicotine addiction. However, Sweanor points out that this kind of approach misses a key factor: many smokers fail to quit using traditional methods and need realistic alternatives.

In this context, a complete ban on low-risk products risks pushing smokers to the black market or to cigarettes, which remain the most dangerous forms of nicotine consumption. History shows that when products are banned, they don’t just disappear. For example, alcohol prohibition in the US did not eliminate alcohol consumption, but only moved production and distribution out of state control, creating more problems than solutions.

The alternative to science-based regulation

Instead of drastic bans, David Sweanor and other experts advocate balanced regulation based on scientific evidence. Smokeless products, while not completely risk-free, are significantly less dangerous than traditional smoking. There is scientific evidence that smoke-free alternatives can play a significant role in reducing the risks to which smokers are exposed.

A relevant example is Sweden, which has adopted risk reduction strategies by promoting snus, nicotine sachets that are placed under the upper lip. In Sweden, the smoking rate has fallen to 5.6%, making it the lowest in Europe, significantly reducing smoking-related cancers. This success shows that, through appropriate regulation, low-risk products can contribute to improving public health without resorting to radical bans.

Where is the limit? Public health policies and individual rights

Another aspect discussed during the summit is that related to individual rights. Sweanor pointed out that using the force of the state to impose moral views on the behavior of individuals is not only ineffective but also dangerous. Public health policies must find a balance between protecting the health of the population and respecting freedom of choice. Therefore, regulation, not prohibition, may provide the optimal solution.

Proper regulation of smokeless products involves both setting clear safety standards and educating the public and health professionals about these options. Studies show that there is a significant lack of knowledge among medical personnel regarding the potential of these products. By properly training doctors and health care providers, a framework can be created in which smokers have access to the best information and can make informed decisions about their health.

In conclusion, banning smoke-free alternatives is not only an ineffective policy, but also counterproductive from a public health perspective. As David Sweanor emphasized at the summit, a regulatory and science-based approach that provides realistic solutions for smokers is essential to significantly reduce the harm caused by smoking. Public health policies must focus on risk reduction, not drastic bans. The right to choose safer alternatives is essential in the global effort to combat the devastating effects of smoking.