Twisting the truth: How the tobacco industry misleads the public through harm reduction

Sir,

The recent perspective¹ by Chakma and Allen on tobacco harm reduction published in March issue of the Indian Journal of Medical Research, brings critical attention to a pressing public health issue. The authors have made a commendable effort in bringing light to the concept of harm reduction as a longstanding strategy employed by the tobacco industry since the 1860s, an issue that demands urgent attention within the realm of public health. The article clearly argues that, despite industry claims, modern nicotine devices don’t help people quit or significantly reduce health risks¹. The perspective underscored the lack of transparency by tobacco companies in disclosing the elevated levels of particulate matter and other harmful constituents present in product content and emissions. Furthermore, it examined the potential risks of hepatotoxicity, cardiotoxicity, and broader adverse cardiovascular effects associated with the use of emerging and novel tobacco products¹. However, while the perspective is well articulated, there are a few other facts that should be known to the readers about ‘harm reduction’ from the perspective of tobacco control.

The tobacco industry uses the term ‘harm reduction’ to regain influence, improve its image, and protect profits, not out of real concern for health². By promoting products like e-cigarettes and heated tobacco as safer options, the ‘deceptive’ industry tries to appear responsible, while deliberately ignoring the health risks and addictiveness of these products. There is no strong evidence that these products replace cigarettes or lower health risks without attracting young users. Still, the industry pushes them through media, policymakers, and scientists³. The industry exploits loopholes in the legislation and falsely depicts tobacco use as legitimate and normal, especially among youth^3,4. In several jurisdictions, harm-reduction products are not classified as tobacco products in the same way as traditional cigarettes⁵. As a result, these products are often exempted from tobacco control regulations that primarily target combustible tobacco⁵. The tobacco industry takes advantage of this regulatory gap to bypass restrictions such as advertising bans, flavour limitations, and public smoking prohibitions⁵. The tobacco industry has increasingly relied on misinformation and digital marketing to influence public perceptions of harm reduction, often to further its own interests. One such example of this is greenwashing, which involves using eco-friendly imagery and language to create the false impression that certain tobacco products are less harmful or addictive⁶. This tactic distorts public understanding of the risks associated with tobacco use, leading individuals to underestimate the dangers of these products⁶. Alongside this, the industry continues to use misleading descriptors such as ‘organic’, ‘natural,’ and ‘additive-free’ to imply that these emerging novel products are safer, despite the lack of a scientific basis for such claims⁷. Research has shown that these terms significantly reduce consumers’ perceived risk and increase interest in these products, especially among the younger population. Disclaimers and warning labels do little to counteract these misperceptions⁷.

Lately, the tobacco industry has introduced flavours in newer and emerging tobacco products. Flavours can create the perception of being less harmful alternatives and more appealing, which encourages youth to initiate them along with the traditional tobacco products. This increased attractiveness can lead to greater experimentation, initiation, and ongoing use, while also potentially lowering the motivation to quit among existing users⁸. Further, flavours increase exposure to toxic substances and heighten the addictiveness of the products, especially among young people. Even short-term exposure to common tobacco flavourings like vanillin, menthol, cinnamaldehyde, and eugenol can cause inflammation and reduce nitric oxide in blood vessel cells, which may lead to poor blood vessel function, a risk factor for heart disease⁹. At higher levels, some flavours can also cause cell damage and oxidative stress⁹. These risks highlight the critical need for strict regulation of flavoured tobacco products to protect public health.

In 2019, the Government of India took a bold initiative to ban e-cigarettes and similar products under the Prevention of Electronic Cigarettes (Production, Manufacture, Import, Export, Transport, Sale, Distribution, Storage, and Advertisement) Act (PECA), which is commendable¹⁰. To ensure more effective enforcement of PECA, it is important to create clear implementation guidelines that outline the steps, responsibilities, and rules for everyone involved. These guidelines should address challenges in enforcement, offer practical solutions, and allow for regular updates to keep up with new trends in the tobacco market. Additionally, there is a pressing need for stronger policies specifically targeting flavour bans. Furthermore, there is a need to strengthen efforts under Article 9 and 10 of the WHO Framework Convention on Tobacco Control (FCTC), which calls for the regulation of the contents and emissions of tobacco products and raising awareness through clear public disclosure of their harmful constituents¹¹.