A HEALTHIER FUTURE THROUGH INNOVATION IN BOTH PRODUCTS & POLICY

 By Dr. R.S Mauwjood (Chest Physician)

The war against smoking is one which most countries have waged, but few have had success. The rare victors, like Sweden, have managed to garner their success by trusting in research-backed innovation and adopting policies that facilitate it. Unfortunately, misinformation and social stigma have clogged the arteries of governance in most countries, including Sri Lanka. For instance, the current policy landscape in our country, like many others unfortunately, fails to distinguish between the vastly different risk profiles of various nicotine products, and by grouping all nicotine-based products together, be it innovative goods like oral nicotine pouches which involve no combustion, or archaic goods like cigarettes, policy makers inadvertently create a barrier to off-ramping smokers.

Although many believe such overbearing restrictions to be well intentioned, such an approach denies smokers viable off-ramps from the most dangerous form of nicotine consumption. Hence why countries that have been successful in cutting down their smoking rates, repeatedly propagate that this all-or-nothing (heavy on the nothing) approach to nicotine products, without objectively taking into consideration the substantial scientific research, is extremely counterproductive.

The study

Looking at what research has to say about nicotine pouches as an alternative - the study titled ‘Harmful and potentially harmful constituents’, in two novel nicotine pouch products in comparison with smokeless tobacco and nicotine replacement therapies, asks a simple but important question – what exactly is inside oral nicotine pouches compared to other nicotine products? And more importantly – how toxic are they relative to traditional tobacco-based products?

Think of this study as a chemical audit. Researchers screened 43 compounds across multiple products including nicotine pouches, Swedish snus, moist snuff and pharmaceutical nicotine therapies like gum and lozenges.

38 of the 43 tested compounds were not detected at all in oral nicotine pouches. The pouches contained no measurable nitrosamines or polycyclic aromatic hydrocarbons (PAHs) – two of the most concerning groups of carcinogenic compounds found in tobacco. Nitrosamines and PAHs are essentially the ‘villains of the story’ in tobacco related harm. Their absence immediately places nicotine pouches in a very different risk category from tobacco products.

The paper also referenced toxicology studies showing that in comparison to tobacco products, nicotine pouches were less cytotoxic, had less impact on biological processes and were not mutagenic or genotoxic in testing. In layman’s terms that means it showed far less potential to damage cells or DNA than traditional tobacco products.

Empowering the consumer

The Swedish experiment was to give ‘choice’ to the people. And when given the choice, what followed was not ‘social engineering’, but behavioral economics in action. When given access to lower-risk alternatives and clear public health-messaging, millions of Swedes simply stopped smoking.

Countries like Sweden weren’t afraid to question policy and start open-forum dialogues on the efficacy of the existing legal framework in achieving their ‘proclaimed’ goals. Initiating an evidence-based dialogue would be a good starting point in the campaign against minimizing the health risks of smoking.

The antagonist to the Swedish approach is Britain’s new Tobacco and Vapes Bill and the new normal it will usher in come 1 January 2027. This bill will impose a lifelong smoking ban on anyone born after 1 January 2009. We are often taught to learn from our mistakes and if ‘The Prohibition’ was any indication of what happens when a widely available good is suddenly restricted, it would be reasonable to expect the emergence of black markets, unregulated counterfeits and possibly an even larger health risk than that caused by the existing (regulated) tobacco-based products. As ironic as it is, banning products very rarely makes them unavailable. It only ends up sending the product further underground away from the eyes of safety, compliance and regulation.

Sri Lanka too has over the years mulled imposing similar restriction. Albeit, not on tobacco-based products, but rather on nicotine-based smokeless alternatives, that remain unregulated at present. But, any out-rights ban is indicative of an authoritarian ‘social engineering’ approach to governance as opposed to a ‘socialist democracy’ which Sri Lanka identifies itself as.

A modern, consumer choice and public health driven regulatory framework should be built on the principle of relative risk. It is a fact that different nicotine-based products have different risk and harm levels. While the respective risk/harm levels can be debated, the presence of variation, cannot. This fundamental fact forms the first and largest legitimate, research-backed dent, in the current regulatory framework (and in some countries, the lack thereof).

Not being open minded to these alternatives is synonymous with not being open minded to innovation and progress – a crime Sri Lanka has been guilty of on more than one occasion.