Free Market Solutions in Health: The case of nicotine

Harm reduction is a better strategy than prohibition

Summary:

  • Many campaigners working in the field of public health believe that good health and free market capitalism are irreconcilable. They regard advertising, competition and the pursuit of profit as major causes of unhealthy consumption and view disfavoured industries as ‘disease vectors’. Accordingly, they support political action which limits commercial speech and restricts product development.
  • One consequence of this ‘neo-prohibitionist’ approach is that innovative products are banned under the precautionary principle. The sale of the two least hazardous recreational nicotine products - e-cigarettes and Swedish snus - are banned in many countries despite growing evidence that they can play an important role in reducing the smoking rate.
  • The public health movement is divided between those who support the ‘neo-prohibitionist’ approach and those who support ‘harm reduction’. Opponents of harm reduction claim that safer nicotine products act as a ‘gateway’ to smoking and deter smokers from quitting. However, most evidence suggests that nicotine products have little appeal to nonsmokers and are overwhelmingly used as a gateway from smoking.
  • Arguments made against tobacco harm reduction on health grounds are not compelling. Opposition to e-cigarettes and snus can only be properly understood in the context of longstanding moral objections and anti-industry sentiment.
  • There is evidence that orthodox tobacco control policies are having only a limited effect on smoking rates in Europe. Countries that follow the model of smoking bans, high tobacco taxes and graphic warnings do not have lower smoking rates than other countries. Evidence from Sweden strongly suggests that the harm reduction approach has more to offer than the neo- prohibitionist model.
  • Smokers should not be discouraged or forbidden from switching to vastly less hazardous forms of nicotine use. Unless alternative nicotine products pose significant risks to health, or act as a gateway to smoking, there is no justification for them being heavily regulated or banned. The main beneficiaries of the neo- prohibitionist approach are the incumbent cigarette industry and the pharmaceutical industry. If health is the goal, governments should step back and allow free market solutions to gain popularity. In practice, this means taxing and regulating e-cigarettes as ordinary consumer products and allowing snus to be sold with appropriate and accurate labelling to inform customers of its risk profile relative to cigarettes.
  • The prohibition of safer tobacco products has led to unnecessary deaths in the European Union and elsewhere. It is highly likely that the prohibition and excessive regulation of e-cigarettes will also lead to unnecessary premature deaths. The neo-prohibitionist approach is unjustifiable from the perspective of both personal liberty and population health.
  • Recent developments in the fragmented nicotine industry show that private enterprise can correct market failure long before government failure is even acknowledged, let alone rectified. The interests of consumers are better advanced by the provision of accurate information and free choice than by prohibitions and restrictions on commercial speech.

To read the press release, click here.

Media highlights include coverage in regional radio, Irish Independent, Irish Mirror and Irish Sun.

Current Controversies 45, 2013

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