The strategies of the tobacco industry: from harm denial to harm reduction| Tabaccologia

Article

How is it possible that the sale of the most lethal product on the market today, tobacco, which is responsible for over eight million deaths worldwide and more than seventy thousand in Italy alone every year [1,2], is still permitted? It has been estimated that each cigarette reduces life expectancy by about twenty minutes: a packet is equivalent to almost seven hours of life literally ‘gone up in smoke’ [3]. Yet, unlike dangerous drugs or contaminated food, tobacco has never been withdrawn from the market.

The first scientific evidence of the link between smoking and lung cancer dates back to 1950 [4,5]. In the decades that followed, tens of thousands of studies confirmed the link between tobacco consumption and numerous diseases: cancer, cardiovascular, respiratory and metabolic diseases [1]. Instead of acknowledging the evidence, the tobacco industry chose for decades to deny it, manipulate science and obstruct regulation. Governments, for their part, have often been reluctant to intervene with the necessary firmness: tax revenues from cigarette sales have proved too valuable to be seriously challenged. Until the end of the 20th century, “harm denial” was the industry’s dominant strategy, applied to both tobacco smoking and secondhand smoke.

As evidence accumulated, this position became untenable. The industry then reinvented itself, adopting a new narrative: that of “harm reduction”. The idea was to present new nicotine-based products as “safer” alternatives to conventional cigarettes. This was the case with so-called “light” cigarettes, advertised as less harmful because of their low tar content. In reality, smokers tended to compensate by inhaling more deeply, and the authorities eventually banned the misleading name.

Another attempt was to promote Swedish snus outside Scandinavia. But as early as 1992, the sale of snus had been banned in the European Union because of its harmful effects: increased risk of oral cancer, high blood pressure, cardiovascular problems and very strong addiction due to high nicotine concentrations. The ban was confirmed by the 2014 European Tobacco Products Directive [6].

After these failures, starting in the 2000s, the tobacco industry found itself in deep crisis: anti-smoking laws were spreading in high-income countries, cigarette sales were plummeting, and around 2010, the scientific community even began to discuss a tobacco endgame, i.e., the real possibility of a tobacco-free society [7].

To counter this prospect, multinationals decided to focus entirely on new products: electronic cigarettes and, subsequently, heated tobacco. They bought the leading e-cig manufacturers [8] and launched heated tobacco devices such as IQOS, presented as a “less harmful alternative” to cigarettes [9]. To support this narrative, Philip Morris has invested a billion euros in “dedicated” research by creating the Foundation for a Smoke-Free World, with an annual budget of $80 million. The name suggests a commitment to a smoke-free world, but actually the goal is to fund complacent studies on harm reduction [10]. Not surprisingly, the World Health Organisation has distanced itself clearly, stating that it will never collaborate with the foundation and calling on governments and the scientific community to do the same [11].

The paradox is that, while governments invest very little in independent tobacco research, the industry presents itself as the main funder of tobacco control. The result is a profound distortion of the scientific and political agenda.

Yet the evidence is clear: e-cigarettes and heated tobacco products are not harmless [12,13]. They do not significantly promote cessation and, in fact, represent a gateway to traditional smoking, especially among young people [14-16]. Despite this, these products have benefited from lighter regulations and taxation than traditional cigarettes [9], and industry revenues have begun to grow again.

In recent years, the industry has taken a further step forward by introducing nicotine pouches. These pouches do not contain tobacco but very high concentrations of nicotine salts: precisely because they do not contain tobacco, these products escape many of the regulations and taxes imposed on cigarettes. Presented as “harm reduction” tools, they have been placed on the market without adequate assessment of their risks, which are by no means negligible [17].

Marketing is revealing: advertising messages, colourful packaging, fruity flavours and eye-catching graphics are clearly aimed at younger people. And so, it is Italian teenagers who use these products. The few slogans aimed at smokers border on the absurd: “Take a break without getting off the train”. This is not an invitation to quit, but to consume nicotine even at times when one would not have done so before. The goal is not to help those who cannot quit, but to build a new generation of consumers.

So, what can be done? It is urgent to include electronic cigarettes, heated tobacco and nicotine pouches among the products regulated and taxed in the same way as conventional cigarettes. This would mean at least banning their promotion and advertising by the tobacco industry. Even before that, however, existing laws must be enforced. In Italy, the sale of nicotine-containing products to minors is prohibited, but controls are lax and consumption among adolescents is rapidly increasing.

Without decisive action, the spread of nicotine among young people will continue to accelerate, fuelling addiction and leading many to traditional smoking. Far from a “tobacco-free generation”, we risk facing a new health emergency, particularly among the youngest. And if we do not act now, it may already be too late.

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