1. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 1 Tobacco Harm Reduction  Buyer/Hagan/Burr v. Kennedy/Waxman  A Public Health Perspective  Live Video Presentation to TMA Meeting, Williamsburg, VA, May 18, 2009

2. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 2 Joel L. Nitzkin, MD, MPH,DPA, Chair, Tobacco Control Task Force American Association of Public Health Physicians

3. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 3 Tobacco Harm Reduction  Background o Public Health Perspective o Deaths due to Tobacco Products  Opposition to Harm Reduction  The Two Proposed Bills  AAPHP Recommendations  JLN Contact Information  AAPHP web site; tobacco issues page

4. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 4 Public Health Perspective  Future illness and death from tobacco products  Near-term (next 30 years) – current smokers  Far-term – current and future teens

5. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 5 Deaths Due to Tobacco Products  Cigarette smokers o 400,000 per year o Major causes Lung Cancer Other Lung Disease Other Cancer Heart Disease  Environmental Tobacco Smoke o 38,000 per year (lung cancer and heart disease)  All Other o Less than 10,000 per year (other cancer)

6. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 6 Deaths due to Tobacco Products  The problem is cigarettes o (not other tobacco products)  The problem is products of combustion o (not specific chemicals in tobacco) o (smoking also kills non-smokers)  Safe cigarette probably not possible

7. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 7 Options for Reducing Deaths from Cigarettes  Cessation  Harm Reduction o (smokers switching to less hazardous products to maintain their nicotine addiction)

8. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 8 Smoking Cessation  Spontaneous quit rates o About 3% per year o Almost all “cold turkey”  With counseling and NRT’s o Increases rate to about 5% (when measured 1 year post-intervention)

9. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 9 Harm Reduction  Switching from cigarettes to snus or alternative nicotine delivery products (sticks, strips, e- cigarettes, etc)  Eventual reduction in risk – 99% or better  Lives saved over first 20 years – about 50% o Increased risk of death in smokers continues 5-15 years after quitting o Of 8 million smokers who will die of a tobacco-related illness over next 20 years – 4 million could be saved by harm reduction (AAPHP projection)

10. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 10 The Case Against Harm Reduction  Most people do not believe risk reduction 99% or better  Should we encourage use of products that will kill 400 to 4,000 people per year?  Will marketing reduced risk products addict more teens to nicotine?  Will that addiction lead more teens to cigarettes?  No research to “prove” the efficacy of harm reduction in the United States  Concept of “Tobacco Free Society”

11. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 11 Kennedy/Waxman (as seen by AAPHP)  Focused entirely on teens; totally ignores current smokers  Gives image, but not substance of effective federal regulation  De-facto ban on new reduced risk products (new = after 2/15/07)  Favors Altria/Philip Morris  Promotes concept of reduced exposure cigarette  Does nothing of substance to reduce teen tobacco use  Some version of this bill will become law

12. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 12 Buyer/Hagan/Burr (as seen by AAPHP)  Focused on current tobacco users (largely ignores teen initiation of tobacco use)  Minimal regulation of marketing  Criminalizes youth, lets store owners off with token penalties  Even-handed re tobacco industry stakeholders  No chance of becoming law

13. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 13 AAPHP Recommends multiple amendments to Kennedy/Waxman  Favor harm reduction  Eliminate concept of reduced exposure cigarettes  Reduce restrictions on regulatory agency  Add graphic warnings to cigarettes  Authorize federal agency health education, surveillance and research  Agency other than FDA  Address illicit and contraband products

14. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 14 Joel L. Nitzkin, MD, MPH, DPA  Chair, AAPHP Tobacco Control Task Force  (504) 899-7893  (800) 598-2561  Cell (504) 606-7043  Jln-md@mindspring.com Jln-md@mindspring.com  New Orleans, Louisiana

15. 5/18/09 TMAAAPHP Tobacco Control Task ForceSlide 15 AAPHP Tobacco Issues Page  www.aaphp.org www.aaphp.org  Click on “tobacco issues”  Multiple background and policy documents