In mid-2024 Drs. Robert Jackler, Pam Ling and others learned that the for-profit medical company Medcape was offering a continuing medical education course on tobacco harm reduction sponsored by Philip Morris International that promoted the industry position that smokers could reduce risk by switching from cigarettes to “less risky” products, such as smokeless tobacco. Most lecturers had long histories of working with tobacco companies to promote the industry’s “harm reduction” agenda. Stopping all tobacco was not presented as an alternative to cigarettes.
Under the resulting pressure, Medscape withdrew the course.
Now, Pam Ling and I have published Historical and political context for Philip Morris International’s continuing medical education courses on harm reduction to put this incident into the broader historical context of how the tobacco companies have been using harm reduction to try and reposition themselves with policy makers and regulators as “part of the solution” as well as to hold on to health concerned smokers through promotion of alternative products.
In addition to these direct goals, this effort to reposition harm reduction has been going on for decades. In particular, we remind readers how the cigarette companies were able to successfully lobby the Institute of Medicine in its report, Clearing the Smoke to accept the view that reducing some of the chemicals a tobacco product exposed users to would be adequate to claim reduced harm. This possibility was written into the 2009 Family Smoking Prevention and Tobacco Control Act (as section 911) and that gave the FDA authority to regulate tobacco products.
Implications for Current FDA Activities
The result is that the FDA has taken the position that if a new product delivers less of some toxicants in “traditional” tobacco products — cigarettes and smokeless tobacco — it is a candidate for a “reduced exposure” claim and the presumption of reduced risk. The problem with this view is that it ignores the fact that that “new” products deliver smoke different toxicants at higher levels than “traditional” products.
FDA’s failure to recognize this fact is why their proposal to lower allowed nicotine is limited to cigarettes and other older products and excludes e-cigarettes and other “reduced exposure” products.
The same logic forms the foundation for FDA’s recent decision to authorize 20 flavors of Philip Morris’ ZYN smokeless product. (In doing so, FDA claims that youth use is a “low” 1.8% in 2024, while ignoring the fact that this is almost twice the 1.1% youth prevalence in 2022.)
FDA needs to move beyond the narrow thinking about what toxicants are important by updating its list of Harmful and Potentially Harmful Compounds (HPHC) that form the basis for its current decision making. Doing so would lead to a more up-to-date assessment of comparative risks of these products and likely lead to fewer being authorized.
Here is the paper’s abstract:
In 2024, Philip Morris International’s (PMI) website stated they support ‘independent’ continuing medical education courses on harm reduction for medical and other healthcare professionals. These courses mirrored industry marketing and political strategies by presenting smokeless tobacco products and e-cigarettes as alternatives to smoking, sometimes without mentioning tobacco cessation. The enactment of the US Family Smoking and Tobacco Control Act gave the US Food and Drug Agency jurisdiction over tobacco products and included the industry’s ‘continuum of risk’ frame, and emboldened tobacco companies to make harm reduction claims about these products, which they had previously avoided for fear of triggering restrictive regulation of cigarettes. Opposition from the medical and public health community in the USA and beyond led one large company that partnered with PMI to offer the US courses to withdraw. The Foundation for a Smoke-Free World (renamed Global Action to End Smoking in 2024) created by PMI also funded a non-profit to develop continuing medical education on harm reduction. US accrediting bodies for healthcare education do not have policies against certifying tobacco-sponsored courses, and there needs to be ongoing vigilance against such efforts around the world as well as efforts to secure policies at accrediting organisations to not accredit such industry efforts.
The full citation is: Ling PM, Glantz SA. Historical and political context for Philip Morris International’s continuing medical education courses on harm reduction. Tob Control. 2025 Jan 3:tc-2024-059015. doi: 10.1136/tc-2024-059015. Epub ahead of print. PMID: 39753359. It is available here.
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