Harm reduction and potentially reduced-risk products
Why could certain tobacco and nicotine products be potentially reduced risk compared with conventional cigarettes?
We’ve long been clear about the fact that conventional cigarettes pose serious health risks and the only way to avoid those risks is not to use them.
It is now widely acknowledged that most of the harm associated with smoking is down to the toxicants in the smoke produced when the tobacco in the cigarette is burned.
So, products that don’t burn tobacco could have the potential to produce fewer and lower levels of toxicants compared with conventional cigarettes.
Despite the serious health risks, many people continue to smoke conventional cigarettes.
No tobacco or nicotine product is 100% safe and anyone wanting to be totally risk free shouldn’t use them.
However, the principle of harm reduction is that, compared with continuing to smoke conventional cigarettes, it is better to switch to products that could be potentially reduced-risk.
Our commitment to harm reduction is reflected in our Transforming Tobacco ambition, which includes offering adult smokers a range of potentially reduced-risk products.
We have developed a five-step framework to evaluate the reduced-risk potential of some of our potentially reduced-risk products (PRRPs), relative to smoking cigarettes. We are open about our research and we publish the results of our studies on our bat-science website and submit them to peer-reviewed scientific journals.
We will conduct two 12-month clinical studies to assess how reductions in exposure may result in reduced long-term health risks for both vapour products and THPs. We aim to receive first results in 2019, and publish these in 2020.
There is also a growing body of independent reports addressing this topic. Here’s a summary of some of our own research, as well as details of studies conducted by independent health and scientific organisations.
A series of tests conducted by BAT scientists1 assessed the reduced-risk potential of glo – which heats rather than burns tobacco – compared with conventional cigarettes.
Using data from chemical and biological tests, our scientists assessed glo in terms of the number and levels of toxicants in the aerosol that it releases and the biological impact on human and other cells in a laboratory compared with cigarette smoke.
The tests found that toxicant levels in vapour from glo were significantly reduced compared with smoke from a conventional reference cigarette2. They also showed that glo vapour, compared with cigarette smoke, had a much reduced or no biological impact on cells in a laboratory, depending on the test3.
We will embark on further research into the impact of aerosols on consumers as well as the surrounding environment, and publish the results over 2019.
In 2017, we also completed a short-term clinical study on glo in Japan involving 180 participants. The results of this study indicated that when smokers switched completely from conventional cigarettes to glo, their exposure to certain smoke toxicants was significantly reduced and, in some cases, the reductions observed were comparable to those seen in people who had quit smoking completely3.
Although long-term tests are needed, taken together the results of the studies suggest that glo has the potential to be reduced risk compared to smoking conventional cigarettes.
We have conducted further research around population modelling in Japan, looking at the large scale impact of THP use nationally and will publish the results in due course.
We will also conduct a long-term in-vitro study of human cells exposed initially to tobacco smoke and then switched to either glo emissions or air, and publish the results in 2019.
Our separate analysis of glo iFuse has revealed no detectable difference between the vapours produced by glo iFuse and an e-cigarette3.
Independent research into THPs includes a study commissioned by the UK Department of Health4 in 2017 which found that people using THPs are exposed to around 50-90% less of the “harmful and potentially harmful” compounds compared with conventional cigarettes.
In 2018, a Public Health England (PHE) report5 looked at current research on THPs and, while highlighting the need for more research, found that “compared with cigarettes, heated tobacco products are likely to expose users and bystanders to lower levels of particulate matter and harmful and potentially harmful compounds. The extent of the reduction found varies between studies.”
The PHE report added: “The available evidence suggests that heated tobacco products may be considerably less harmful than tobacco cigarettes and more harmful than e-cigarettes.”
We’ve developed a framework of scientific tests to assess the reduced-risk potential of vapour products, relative to smoking cigarettes. Our series of scientific papers for Vype ePen, published in 20176, provide a comprehensive dossier of scientific data on this vapour product.
The results of our studies provide evidence that suggests Vype ePen has the potential to be reduced risk compared with conventional cigarettes.
Our preclinical studies demonstrated the relatively simple composition of Vype ePen vapour compared with conventional cigarette smoke – with significantly less of certain tested toxicants in Vype ePen vapour7.
Further tests indicated that the vapour has a much reduced or no biological impact on human cells in the laboratory, compared with conventional cigarette smoke, depending on the test used7.
Our clinical studies showed that Vype ePen vapour delivers nicotine to the user as efficiently as smoke from conventional cigarettes – an indicator of whether the product may provide adult smokers with a satisfactory alternative to a cigarette.
There have been a number of independent reports and studies on vaping. In 2017, the British Medical Association published a position paper on e-cigarettes8, in which it said: “There are clear potential benefits to their use in reducing the substantial harms associated with smoking, and a growing consensus that they are significantly less harmful than tobacco use.”
A review by Public Health England5 in January 2018 concluded that: “Based on current knowledge, stating that vaping is at least 95% less harmful than smoking remains a good way to communicate the large difference in relative risk unambiguously so that more smokers are encouraged to make the switch from smoking to vaping. It should be noted that this does not mean e-cigarettes are safe.”
Similarly, a review by the National Academies of Sciences, Engineering and Medicine9, a US-based organisation of leading researchers which analysed the results of more than 800 identified peer-reviewed scientific studies, concluded that “while e-cigarettes are not without health risks, they are likely to be far less harmful” than conventional cigarettes.
Oral tobacco and nicotine products provide a further opportunity for smokers to switch to potentially reduced-risk products. There are indications that the use of oral tobacco and nicotine products such as snus has had a positive effect on lessening the impact of smoking on public health.
Having been in use for decades, there is well-established epidemiological evidence to determine the long-term health risks of these type of products. A number of independent health studies have shown Swedish-style snus to be significantly less harmful than smoking.
Moist snuff also demonstrates potential reduced risk compared with smoking, but can have a wider potential range of toxicant emissions compared with snus.
Nicotine replacement therapy products are widely accepted as being less harmful than conventional cigarettes.
We’ve begun our largest and most complex PRRP studies to date, examining risk indicators among adult smokers who continue smoking, switch to glo or stop smoking completely. We expect to publish the initial results later in 2019.