Harm Reduction vs. Abstinence: U.K. and U.S. Take Very Different Approaches to E-Cigarettes

By Perry, Susan | MinnPost.com, April 8, 2016 | Go to article overview

Harm Reduction vs. Abstinence: U.K. and U.S. Take Very Different Approaches to E-Cigarettes


Perry, Susan, MinnPost.com


United States and England have staked out widely diverging positions on whether electronic cigarettes help or hinder the goal of reducing tobacco smoking -- positions that reflect longstanding differences between the countries in their approaches to treating drug addiction in general, according to a provocative "Perspectives"commentary published Thursday in the New England Journal of Medicine (NEJM).

"In England, where leading medical organizations regard nicotine alone as relatively benign, the pressing need to reduce the risks for current smokers frames the debate, [while] the overwhelming focus in the United States is abstinence," write the commentary's authors, which include Amy Fairchild, a historian of public health policy at Columbia University in New York City.

Minimizing harm

Public health officials in England and throughout the rest of the United Kingdom have, in general, taken a "harm-reduction" approach toward e-cigarettes, Fairchild and her colleagues point out.

In 2015, Public Health England (PHE), part of that country's health department, published a report -- written by a prominent tobacco-addiction researcher -- that claimed e-cigarettes are 95 percent less harmful than traditional, combustible cigarettes.

"It recommended that smokers who cannot or will not quit smoking tobacco try e-cigarettes and expressed great concern that the public perceived the two products as posing equal risks," write Fairchild and her colleagues.

The PHE report also emphasized that e-cigarettes are a relatively low-cost tool for reducing smoking and, thus, could help address the challenge of health inequalities related to smoking and helping people quit.

Not all medical officials in the U.K. agreed, but 12 prominent public health organizations, including Cancer Research U.K. and the British Lung Foundation, issued a press release in support of the PHE report when it came under attack.

Even the influential British anti-tobacco organization Action on Smoking and Health (ASH) applauded the PHE's report, Fairchild and her co-authors note.

That wasn't so unexpected, however. A year earlier, the chair of ASH had told a reporter for the Guardian newspaper that "it would be a public health tragedy if smokers were discouraged from switching to electronic cigarettes and vapers were encouraged to go back to smoking because they don't understand that vaping is a lot less harmful than smoking. That really would cost lives."

A consistent approach

"As dramatic as the report's recommendations appear to be, they build on the United Kingdom's long-standing commitment to harm reduction," write Fairchild and her colleagues.

As far back as 1926, they point out, England's Ministry of Health had not only concluded that drug addiction was an illness that needed to be treated by physicians, but it had also recommended that low doses of drugs be used during treatment to prevent withdrawal symptoms. …

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