The tobacco harm reduction policies must make a qualitative leap in countries where the number of traditional smokers is still high and focus seriously and convincingly on products with potentially reduced risk, from electronic cigarettes (e-cig) to devices heated tobacco. It is the point that brought together experts, doctors and scientists who gathered in Athens for the fifth scientific summit ‘Tobacco harm reduction: novel products, research & policy’ promoted by Scohre, an independent international association made up of experts and scientists who promote tobacco control and smoking harm reduction. “We need to do more to raise awareness of harm reduction strategies, we need to create more opportunities for the training of health policy experts, regulators and the public. And then we need to support research in this area because we need to eliminate any doubt on the effectiveness of alternative devices bringing data based on scientific evidence “. This was underlined by Ignatios Ikonomidis, professor of cardiology at the University of Athens and president of Scohre, in his opening speech at the event. “The final battle for harm reduction – said Ikonomidis – is not so much about how ‘safe’ the low-risk products are, but whether nicotine can be eradicated or accepted”. Ikonomidis reiterated Scohre’s vision: “Quitting smoking remains the best and most effective intervention in medicine” compared to the harm it can cause “and we must continue the hard work of raising awareness on the negative effects of smoking on every smoker and citizen. when it happens that you repeatedly fail to quit cigarettes, there should be the option of being able to choose less harmful devices, which have benefits for many smokers. ” “According to a research that monitored those who tried to quit after a year – recalled the president of Scohre – 45% abstained from smoking with an improvement in endothelial pathophysiology, 55% who instead had relapses, that is you have not never stopped, had an increase in arterial stiffness “. This is why “we support the reduction of harm from smoking: if we eliminate smoking – he specified – we may also be able to avoid up to 90% of all lung cancers. From Sweden comes the example of snus, wet tobacco in powder for oral use. The male population in that country consumes the same volume of tobacco as their European peers, but half use snus and the death rates for all types of cancer are significantly lower. But we also have the example of the Kingdom Kingdom, where the transition from traditional cigarettes to e-cig devices has had a decisive effect on the reduction of smokers “. By now many studies show how, “after the transition to e-cig, there is an improvement in vascular functions and oxidative stress”. The Greek cardiologist remarked that “the complete switch to e-cig has substantial health benefits compared to continuing with traditional cigarettes” and that “today, based on scientific knowledge, e-cigs are 95% less harmful than smoke, even if this does not mean that they are completely safe. The experts, the health professionals who help smokers in the path to get out, should also support them in the choice of alternative devices at reduced risk “. In 2019, a clinical trial in the UK found that, “when combined with the assistance of a ‘face-to-face’ expert and the use of e-cigarettes, people who wanted to quit were twice as likely to be successful as they were. those who have used other nicotine-based replacement devices, such as gums or patches. ” The speech by Giuseppe Biondi Zoccai, associate of cardiology at Sapienza University of Rome, focused attention on the need to have as much data as possible to make the best choice in harm reduction strategies, “because even low-risk devices can lead to addiction, “he highlighted. “I am a cardiologist and I do not prescribe aspirin as an alternative to the statin, but together. It would be more reasonable to consider the alternatives to cigarettes as something in addition to nicotine replacement treatments (NRT) and not as a substitute – observed Biondi Zoccai – ‘L ‘elephant in the room’ is to create a new generation of addicts to alternative devices. Today, companies are betting on these new products as opposed to cigarettes. My recommendation is to act now on the basis of scientific evidence. There is a lot of research monitoring cardiovascular risks. and randomized trials on reduced-risk devices “. Biondi Zoccai analyzed the situation of harm reduction strategies. “We have a situation where these products are associated with those of tobacco – he explained – Now a challenge that the Italian system should pose is to facilitate free access for patients who want to quit these alternative devices to cigarettes”. Instead, “paradoxically we don’t care about patients when they leave the hospital. The commitment to quit smoking requires intensive follow-up. Modified risk devices are useful in that they can be provided to any patient, they do not require a prescription. “. Marewa Glover, public health expert and director of the Center of Research Excellence: Indigenous Sovereignty & Smoking of New Zealand, took stock of the latest measures the New Zealand government is working on in the fight against smoking. New Zealand’s ‘revolutionary’ choice is to prevent all children born after January 1, 2009 from purchasing any tobacco products. The proposals of the current executive, which are based on the ‘denicotization’ of the country, also provide for a crackdown on the legal sale of smoking products, with a reduction in commercial establishments and a cut in the quantity of nicotine present in cigarettes. A series of measures that would lead New Zealand to be one of the nations with the strictest smoking laws. In fact, “we would also like to intervene on the legal age for smoking, which is now 18, but we would like to raise it annually by 1 year from 2027”, specifies the expert. According to Glover, who is very critical of her country’s restrictive turn, “an approach based on prohibitions is not consistent with harm reduction policies: it is only punitive and will likely increase black market activity and criminal actions”. The principle that, according to the expert, should be followed is that “public health has as its mission to do everything possible to help people improve their situation and allow them to make the best decisions about their health. It is not punitive, but compassionate “. Glover illustrated how “New Zealand’s approach to smoking varies considerably according to income brackets. In 2021, daily smoking among the richest two-fifths of the population was already below 5%, a target that was aimed at” . Finally, the expert reiterates that “denicotization has no scientific evidence, no one can predict what will happen and no one seems to care. The risk – he concluded – is that disinformation is generated on the risks associated with nicotine, the loss of freedom. of the scientific community and the arrival of a liberal paternalism “.
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