In Brief

About one-quarter of American adults--or 47 million people--smoke cigarettes. Seventy percent of them want to quit but each year only 3 percent succeed.

Can modified tobacco or pharmaceutical products reduce the health risks of smoking? According to Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction, a report issued by the Institute of Medicine (IOM), products developed to lessen the risk of disease by reducing exposure to toxic chemicals are scientifically feasible, but more research is needed to determine if these products decrease the incidence of tobacco-related disease.

The U.S. Food and Drug Administration (FDA) asked the IOM to provide a framework to assess "harm-reduction" products that allow smokers to continue to smoke. The research committee--made up of several psychologists and physicians--looked at a variety of products which might allow the user to smoke but smoke less, such as antidepressants, nicotine gum, patches, inhalants, nasal sprays and modified tobacco or cigarette-like products designed to deliver smaller amounts of toxicants.

"The report didn't evaluate specific products or strategies, it laid out scientific standards about how they can be assessed," says study director Kathleen Stratton, PhD.

The committee recommended that the products be tested in the exact way people would use them, noting that in similar situations behavioral changes can erase the intended benefits of certain products--for example, smokers who inhale deeper and smoke more after switching to low-tar, low-nicotine cigarettes.

The overall effects of "harm reduction" on the general population must be studied, the report notes. "For example, whether or not these products would influence more or less people to quit smoking," Stratton says. The report calls for a comprehensive surveillance system to track and assess how the introduction and marketing of these products would affect public health.

New biomedical and behavioral research is needed to determine the health effects of these products, the committee found. Animal, clinical and population studies could address the health outcomes of modified tobacco products. And, the committee called for careful regulation, based on scientific evidence, of these products, in addition to research and public health surveillance.

Finally, the committee stressed the need to make harm reduction a component of a comprehensive national approach that includes the prevention of smoking initiation and relapse, as well as the promotion of smoking cessation.

"Harm reduction through the use of cigarette-like products or pharmacological products is feasible--though these strategies that include continued smoking are not really proven to reduce tobacco-related disease," says Stratton.

--J. DAW