Harm Reduction in a Persistent Smoker

By David J. Riley, MD, FCCP

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Commentary on Tobacco Harm Reduction

New Tobacco Products

Use of the newly introduced tobacco products with claims of reduced harm is not recommended. Little independent research has been done to evaluate these products, and reported results do not show "safer" products compared with conventional cigarettes. Clinicians should be aware of the characteristics of these products, as outlined in Table 2.

Tobacco manufacturers have used two methods that they claim "reduce harm." The first is use of a special tobacco-curing process that leads to reduced levels of tobacco-specific nitrosamines when tested under standard test conditions ("smoking machines"). Advance and Omni are two of the products manufactured using this curing process. Advance is being marketed with the slogan, "All of the taste...less of the toxin"; Omni is advertised as "the first reduced carcinogen cigarette." According to its manufacturer, Advance yields of CO and tar levels are lower than those for three leading brands, but the nicotine content is similar. Omni, according to data collected by its manufacturer, has lower levels of selected carcinogens compared with an unspecified conventional cigarette. This report, however, was limited to only a few of the more than 3,500 known compounds in the cigarette particulate phase, at least 55 of which are known to be potential human carcinogens. No independent yield data have been reported to verify the company's claim, and the levels of other toxins have not been reported.

The second approach involves heating tobacco rather than burning it to reduce release of harmful toxicants. Two products, Eclipse and Accord, use this process, and Eclipse also burns a small amount of tobacco to enhance its "flavor." Company scientists report that under standard smoking test conditions, Eclipse had less tar, nicotine, and CO than conventional cigarettes. However, two independent analyses showed that Eclipse had the same levels of nicotine as conventional brands but higher yields of tar and CO.^16,17 Biological effects of Eclipse have been compared with ultra-low-tar reference cigarettes by scientists supported by the manufacturer.¹⁸ Significant reductions in lower respiratory tract inflammation in humans and in tumorigenic activity in the skin of animals were reported. However, no differences in other bioassays were found. Company scientists reported that Accord contains reduced tar, nicotine, and CO vs a comparison product. Independent analysis confirmed that under standard test conditions, Accord produced minimal CO and less nicotine than usual brands.¹⁹ However, these data are derived from smoking machines that may not reflect true exposure, because smokers can affect cigarette performance to increase yields.

Although some of the newly introduced products could be demonstrated to reduce some tobacco toxicants, these levels likely do not reflect exposures in real life. Carefully conducted clinical and epidemiologic studies are needed to demonstrate an effect on harm reduction. However, it will probably be decades before the impact of these products is demonstrated. Until research on reduced harm is available, none of these tobacco products can be recommended.

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