March 13, 2020

Which way for potentially less harmful alternatives to cigarettes?

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Debate is raging globally around smoke-free alternatives, such as e-cigarettes, which are being presented by tobacco companies as safer options for smokers.

On one hand, cigarette manufacturers offer these alternatives as less risky, scientifically cleared substitutes with potential to cut well-documented health effects of consuming tobacco and nicotine. On the other hand, anti-tobacco activists favour a campaign that advocates for total cessation. According to the World Health Organization (WHO), the safest approach is to use neither conventional nor e-cigarettes.

Caught in the crosshairs are smokers, estimated at about 1 billion globally, according to WHO statistics.

That smoking is recognized as a global public health issue, is not in dispute. It has been linked to heart and respiratory diseases, as well as enhanced risk of lung cancer. It is in addressing this challenge that the two camps’ opinions differ sharply.

Philip Morris International is a vocal proponent of safer alternatives. The firm has proactively committed to a ‘smoke-free future in the tobacco industry’ with a plan to stop manufacturing tobacco by the year 2030 and instead promote less harmful alternatives. “Over the last decade, we’ve spent more than USD 7 billion in research, product and commercial development, production capacity, scientific substantiation and studies on adult smoker understanding. We want to switch at least 40 million men and women who would otherwise continue to smoke to our smoke-free products by 2025” argues Dr. Moira Gilchrist, Philip Morris International’s Vice President of Strategic and Scientific Communications.

Dr Gilchrist cites the Japan case, where a drop in cigarette sales can be linked to introduction of heated tobacco product that contains natural tobacco and nicotine and produces steam instead of smoke. The product that is already available in 52 markets globally has seen 10 million smokers switch to it.

British American Tobacco has also announced plans to invest in a plant to manufacture nicotine pouches for the Kenyan market, in an effort to reduce smoking-related risks.

Meanwhile, there has been no conclusive study disputing the safety of smoke-free devices. The closest was research by University of California’s scientists Stanton Glantz and Dharma Bhatta which concluded that conventional cigarettes and vapers carried similar risk, with increased likelihood of a heart attack when both are used.

The study was later retracted by the Journal of American Heart Association, where it had been published, on account of ‘misleading data’ that did not consider some information on tobacco and health from a relevant population assessment survey. The retraction followed sustained pressure by various scientists and academics, disputing the findings, even after it became a major news item. 

“The editors are concerned that the study conclusion is unreliable. The editors hereby retract the article from publication in Journal of the American Heart Association,” read the journal’s statement retracting the study.

“We can try to learn from this, and it takes several forms. For researchers and the people who fund and publish research, it means not just doing more research, but doing good research, subject to rigorous, critical review. It also means doing open research; it is possible that if the initial data was publicly available, the flawed analysis may not have made it to publication in the first place. It means being aware of ‘hot stuff bias,’ where topics that get a lot of media attention attract more bad science than those that are less on the radar”, stated Jamie Hartmann-Boyce, senior researcher, health behaviors, at University of Oxford.

Regarding safety of e-cigarettes, WHO says that while it is still too early to understand long term effects of use or exposure, non-smoking consumers who use them have double chance of smoking conventional cigarettes.

Tobacco manufacturers disagree, insisting that whatever decision is taken should not only be based on sound science that stresses harm reduction, but also be people-centric, considering adult smokers’ preferences. They counsel that smokers’ decisions need to be guided by information.

“The best choice is to quit altogether, but every adult smoker in the world who does not, should have access to accurate information on significantly less harmful alternatives,” explains Dr Gilchrist, arguing that smoke-free products are not entirely risk-free, since they contain nicotine, which is addictive but is not the primary cause of smoking-related disease.

As this debate rages, Africa is struggling with steadily rising cases of non-communicable diseases, some related to tobacco smoking. Yet, in many countries, there are many deaths from preventable diseases. While it complicates choices for the government, it also makes a case for prioritizing focus to ensure investment in healthcare infrastructure and disease management.

By Gragory Nyauchi is an Advocate practising in Nairobi. Reach him by email on or visit his firm’s website”

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