The tobacco industry has become synonymous with deception. Numerous reports, books, documentaries, and lawsuits have explored the depth and breadth of Big Tobacco’s lies minimizing the health impact of its products, while working to addict new generations of users for profit. The industry’s latest tactic of selling “harm reduction” is no different. It’s sadly ironic the industry seeks to profit from the very health crisis it created—and furthers—by deceiving the public into believing it sells new “less harmful” nicotine products to help people quit smoking.

True harm reduction efforts are public health-led, evidence-based, controlled interventions that promote safety and dignity to reduce the harm of dangerous drug use. Harm reduction is not achieved by industry-manufactured, harmful commercial products sold on the open market for profit. Individual and community solutions have always been central to legitimate harm reduction strategies. In no genuine harm reduction approach does the very industry that produces the harmful drug also financially benefit from measures allegedly designed to reduce the drug’s harm.

Unmasking the tobacco industry’s harm reduction messaging can be challenging, but the truth hiding behind its deception is fundamental to advancing commercial tobacco control efforts. The next time you hear a statement like, “[E-cigarettes, nicotine pouches, any other new nicotine product] are less harmful than cigarettes and they help people quit smoking,” you can respond with the truth:

  • Companies that sell commercial tobacco products are motivated by profit, not public health

    The tobacco industry has always been “in the business of selling nicotine.” For-profit enterprises, by definition, are motivated by the desire to increase profits and improve the value of shareholder investments. Historically, the industry spent considerable time and money engineering cigarettes to maintain just the right level of nicotine to addict consumers and prevent them from quitting the product. The tobacco industry will continue to sell cigarettes, consistently their most profitable product, for as long as possible because they are cheap to produce and most efficient at creating and sustaining addiction to nicotine. In essence, the industry continues to create the very problem it offers to “solve” through the sale of “less harmful” products.

    The gulf between the industry’s marketing expenditures on cigarettes versus e-cigarettes perfectly illustrates this point. While tobacco product manufacturers publicly claim to favor moving customers from cigarettes to “less harmful” products, the industry continues to pour billions of dollars into the marketing of cigarettes. In fact, marketing spending per cigarette pack sold has continued to rise over the past few decades. In 2021, Reynolds American and Altria, the nation’s only two remaining large cigarette manufacturers, along with seven e-cigarette companies, spent about $859.4 million marketing e-cigarettes. That same year, Reynolds American and Altria spent $8.06 billion marketing cigarettes, almost ten times more than all nine companies spent marketing e-cigarettes. While those nine companies sold approximately $2.67 billion of e-cigarettes in 2021, Reynolds American and Altria sold $4.96 billion of cigarettes. Cigarettes are marketed more heavily by a factor of ten and sales are double that of e-cigarettes. If tobacco companies truly sought to move customers to new “safer” products, their marketing dollars would match their purported motives. The industry’s business model has always centered profit, not health.

    The tobacco industry has a long history of trying to mitigate consumer health concerns—and corresponding declines in cigarette sales—by deceptively marketing supposed product “improvements.” This was the impetus for the invention of the cigarette “filter” (which filters nothing) and so-called “light” and “low tar” cigarettes (designed to deceive testing machines, not improve health). Marketing e-cigarettes, nicotine pouches, and other nicotine products under the banner of “harm reduction” is fully aligned with this longstanding tactic. When nicotine users feel that a product is less risky, they are less motivated to quit nicotine altogether and will continue buying products that bolster the industry’s bottom line. Tobacco companies, as peddlers of nicotine, will always market new products that maintain nicotine addiction over cessation. Ending the cycle of addiction for a user would be bad for business and sound the death knell for the industry. That is why the tobacco industry is “building [its] future on less harmful, yet satisfying alternatives to smoking” rather than ending the sale of nicotine altogether.

  • E-cigarettes, nicotine pouches, and other new products have not been proven to help people stop smoking

    The largest group of e-cigarette users is people who are both smoking and vaping (called “dual use”). Among dual users and exclusive cigarette smokers, consumption of cigarettes is about the same. In other words, of those who attempt to use e-cigarettes to quit smoking, an alarming number continue smoking while they also use e-cigarettes. Most dual users tend to smoke more often than they use e-cigarettes. Even worse, in the long term, people using both products are shown to end up more dependent on cigarettes, not less. A recent study on nicotine pouches revealed a similar pattern of continued dual product use and the failure of nicotine pouch use to increase the likelihood of quitting tobacco products.  

    Dual use is uniquely bad. Cigarettes and e-cigarettes are harmful on their own, but the toxicants and carcinogens found in each product are not identical, so dual use exposes the user to a greater number of harmful constituents. Dual use of e-cigarettes and cigarettes also increases the risk of COPD, a debilitating lung disease, and exacerbates the risk of mental health issues. Even people who switch entirely from cigarettes to e-cigarettes tend to experience higher rates of stroke than those who continue to smoke cigarettes.

  • E-cigarettes, nicotine pouches, and other new products are not safe or harmless

    The tobacco industry understands and exploits the difficulty people have in assessing risk when it comes to health. Marketing efforts that characterize e-cigarettes and other nicotine products as “less harmful” seek to create the perception they are significantly less harmful than they are. How harmful these products are cannot be measured in theory or in isolation, but rather depends on how people use them, who is using them, and how they’re marketed and regulated. Using e-cigarettes, regardless of whether you’ve ever smoked cigarettes, can damage lung tissue over time and increase the risk of heart disease and heart attack. Despite these documented harms, the full extent of the negative long-term health effects of using new nicotine products is not yet known. Instead of waiting for scientific data on the long-term health impact of products, public health traditionally applies a preventive approach—the “precautionary principle” (or “better safe than sorry”) —to minimize risk and protect consumers.

    There is certainly enough information at this point to know that new nicotine-containing products are dangerous. Nicotine is not a benign drug. Comparisons to other drugs like caffeine are incredibly deceptive. Nicotine use, whether from cigarettes, e-cigarettes, or other products causes significant harm. Nicotine is a powerful stimulant and a vasoconstrictor. The use of nicotine can have detrimental effects on the brain of adolescents and young adults, cause severe damage to developing fetuses, and increase risks of miscarriage, premature birth, low birth weight, and sudden infant death syndrome. High amounts of nicotine in products such as nicotine pouches can have an adverse impact on oral and dental health and increase the risk of cardiovascular disease and cancer.

    Finally, the addictive nature of nicotine causes and sustains harm in and of itself. Addiction, like other diseases, disrupts the normal, healthy functioning of an organ in the body with serious harmful effects. Addiction is a medical disorder that affects the brain and changes behavior. As far back as 1988, the U.S. Surgeon General identified nicotine as addictive as heavily regulated drugs such as heroin and cocaine, and more difficult to quit. A robust body of evidence has shown that nicotine dependence is disproportionately found among those most vulnerable to addiction, including young people, lower income populations, and those coping with behavioral health issues, such as mental illness and substance use challenges.

  • The tobacco industry’s version of “harm reduction” is deceptive and dangerous

    Cigarette smoking is the leading preventable cause of death, disease and disability in the United States, causing more than 490,000 deaths each year. This devastating toll is due to the federal government’s failure to end the manufacture and sale of cigarettes as soon as their extraordinary harm was revealed decades ago. Instead, largely because of industry influence, cigarettes have continued to be sold as an ordinary consumer product, contrary to science, ethics, and common sense.

    Over the years, the tobacco industry has lobbied hard to evade regulation and keep its most profitable—and dangerous—consumer product on the market. Only because the most harmful product, combustible cigarettes, can be sold legally does the industry have room to market other dangerous, unapproved nicotine products as “less harmful.” Unfortunately, industry pressure continues to pay off. The FDA recently authorized flavored e-cigarettes and nicotine pouches to be sold under a unique modified review process only for new tobacco products (Premarket Tobacco Product Application - PMTA) that similarly refers to the extreme harm of combustible cigarettes to determine whether new products can be sold. In any other circumstance, new drug products like e-cigarettes and nicotine pouches would have to undergo the FDA’s rigorous drug approval process to determine their safety and efficacy before entering the market—a standard they could never meet. In sum, permitting additional harmful, unapproved nicotine products to be sold to remedy the government’s failure to ban cigarettes is both backwards and dangerous.  

    Analogies to harm reduction strategies in public health are thus misleading when it comes to commercial tobacco. Traditional harm reduction strategies related to drug use typically involve a prohibited (or prohibited use of a) substance (such as heroin or opioids) where the federal government has taken steps to comprehensively restrict the public’s access to the drug. Harm reduction strategies in that context address the harms of addiction caused by the peripheral, inappropriate, or illegal use of such drugs. As just one example, methadone, an FDA-approved drug, is administered in a clinical environment in prescribed doses to treat opioid addiction. A user visiting a corner store and buying an e-cigarette off the shelf is hardly similar. The sale of additional addictive nicotine products by tobacco companies as a supposed offramp to their original (more dangerous) product is not harm reduction. In fact, the most similar activity to controlled use of methadone in a clinical environment would be visiting a treatment specialist to receive a prescription for an FDA-approved cessation drug and behavioral counseling.  

    The tobacco (and nicotine product) industry uses “harm reduction” as a marketing tactic, not a public health strategy. It publicly concedes cigarettes are unacceptably harmful to the health of customers, then conveniently offers another profit-making product as the solution to this problem. If the industry were serious about harm reduction, it would not be promoting the sale of addictive “alternative” products, but would submit clinical data and apply to the FDA for approval of its products as nicotine replacement therapy drug products for smoking cessation. The industry—comprising corporations accountable only to shareholders—instead pursues the most profitable activity, which is manufacturing and selling the most profitable product, the cigarette, unless or until it is forced to discontinue sales.

  • If we want to reduce harm, we need to invest in cessation, not new commercial tobacco products

    Market-driven, corporate “harm reduction” strategies to address nicotine dependence are inherently suspect. Despite misleading industry claims, the best way to quit smoking is to work with a trained medical professional who will help find the best combination of pharmacotherapy, counseling, and FDA-approved drugs that are safe and effective for quitting. This proven strategy is the most effective way for people to end nicotine addiction, and to do so safely.

    It is important to carefully assess any research studies that purport to show e-cigarettes are as good or better than FDA-approved cessation drugs at helping people quit. These studies often compare the results of e-cigarettes to nicotine replacement therapy (NRT), but not other approved cessation drugs, and deliberately omit comparisons of quit rates for smokers who seek help from certified treatment specialists. When FDA-approved medications are used under the supervision of medical professionals, smokers quit at a significantly higher rate than people who use medications on their own or who turn to other commercial tobacco products.

    People who use tobacco products deserve cessation support and nicotine dependence treatment that is safe and effective at helping them quit the use of highly addictive nicotine products, rather than unsafe, unregulated consumer products that are designed to sustain nicotine addiction and lead to more socially acceptable nicotine use behavior. Proven FDA-approved strategies for nicotine dependence treatment are more effective cessation tools than unproven products promoted by an industry with a long history of using misinformation and the public health language of harm reduction to promote dangerous products for its own economic benefit. Substituting one addictive nicotine product for another and running the risk of dual use or new generations becoming addicted to nicotine products is not an effective or ethical way to address nicotine dependence.

  • We can reject the industry’s narrative of reducing harm and work to end the harm of commercial tobacco

    The industry’s narrative of harm reduction relies on an implicit assumption; harm is unavoidable and all we can do is mitigate it. Fortunately, the sale of cigarettes (and other harmful tobacco products) in our country is not an inevitability. The harm caused by commercial tobacco products is one that can be prevented entirely. Commercial tobacco products are manufactured with the backing of a multi-billion-dollar industry that makes money by selling harmful products that have no beneficial use. If cigarettes were invented today, no government on Earth would allow them to be sold. Why should we let this industry continue to prey on people?

    We need to stop the harm, not reduce it. The federal government has failed to protect the public by taking steps to eliminate combustible cigarettes. But communities and governments can resist an industry that profits from harm and remove its products from the marketplace. Every state and many local governments have the authority to end the sale of commercial tobacco products in their jurisdictions. Numerous state and local commercial tobacco policy approaches have a proven track record of improving public health and reducing harm. State and local policymaking is key to turning the tide and ending the commercial tobacco epidemic.