Old Enemies, New Allies – Radical Rethinking in the Era of Tobacco Harm Reduction
e write as a team of physicians and scientists who have seen too many women and men perish from smoking. Our group is comprised of three Canadian physicians – two pulmonary physicians who are also researchers and professors of medicine, and a critical care expert focused on preventative health.
With this lifelong commitment to saving lives, you can imagine our frustration as we watch too many members of the medical and regulatory establishments stand on the sidelines and allow the death and destruction from smoking to continue – when better options exist. Right now.
We are taking an important step towards changing that. It involves a tobacco company. Please hear us out.
It is estimated that close to 20%i of all deaths in Canada are smoking-related. These smokers are not weak or flawed; 66%ii want to quit and have attempted many times, but their nicotine addiction won’t let them.
We are morally and medically obligated to recognize their addiction and move them to healthier habits. After all, nicotine is safe for the vast majority of adults; it’s the chemicals produced by burning tobacco and inhaling the deadly smoke that cause smoking-related diseases.
The move to healthier options is called “tobacco harm reduction”. It’s logical, compassionate, and could reduce the annual $6.5 billioniii,iv that Canadians spend treating smokers. Alternative nicotine delivery products are available right now – with innovative ones on the way.
Shockingly, many with loud and influential voices are opposed to the benefits of harm reduction. Their resistance is unfounded. It is a confused mix of Victorian morality (“addiction is as bad as the disease”), misunderstood science (“that nicotine causes smoking-related illness”), and knee-jerk hatred of the tobacco industry. While understandable, it is a litany that demands immediate reconsideration, with millions of lives at stake!
Now back to the story of our story. More than a decade ago, we launched a start-up with a mission to create a nicotine delivery system that is decoupled from the cigarette. Clean nicotine using no combustion whatsoever – built on a technology that many of you know from asthma and other inhalers. The inhaler platform is free of all combustion, ash and smell – which is why we chose it.
The funding journey included friends and family, then continued to venture funds. But we ran out of options before we could finish development; the investment community had no guts. Most ran from the words “nicotine” and “addiction”.
Finally, our mission brought us to an investor who was logical but controversial – and, to some, a total sell out. Spoiler alert: we recently signed a collaboration agreement with Philip Morris International (PMI) to rapidly accelerate our product’s development and commercialization.
PMI has declared they are committed to a smoke-free future, renounced their past behaviors, and are investing billions in safer alternatives. They were impressed with the promise and sophistication of our technology and team.
This decision has major personal consequences. Some members of our physician team are dealing with professional ostracism. But first – to anticipate legitimate cynicism – the answer is “yes.” We will make money if this product succeeds – but that means harm reduction is working and lives are being saved.
Over the years, we have collectively published over 700 articles. Now we are banned from publishing in many of the journals because they will not accept research from anyone with a tobacco association. How absurd.
But we are not deterred. With their manufacturing and distribution power – and our lifelong commitment to good science, this strategic collaboration with PMI will get harm reduction products into smokers’ hands more quickly than otherwise. Saving more lives, faster, is what drives us.
We are witnessing an exciting era of innovation as many are working to create better options along the continuum of risk. To accelerate that requires many systems coming together.
We all rely on government bodies to encourage and support innovation; smokers will not be served by imposing yesterday’s frameworks and assumptions on today and tomorrow’s life-saving breakthroughs.
We also need rigorous science to validate that these innovations are doing their job, leaving no room for doubt and cynicism.
PMI has the resources to fund the intensive research required to assess benefits, obtain approvals, and educate consumers. Unfounded fear of nicotine confuses the public and delays the move to healthier choices.
As physicians, there are bright lines we will not cross. We will never do anything to attract minors. We will share, as soon as possible, any negative health consequences about our products. Should PMI stop living up to their commitments, we will always speak out about the gap between promise and performance.
We have seen the devastation smoking has wrought. Our next professional chapter is to be forceful public advocates for the issues we have raised.
We are hopeful but vigilant. With more than one billion lives on the line, it’s worth the effort and the personal cost.