Advertisement
The PLoS Medicine Debate

The PLoS Medicine Debate The PLOS Medicine Debate discusses important but controversial issues in clinical practice, public health policy, or health in general. Debates will be commissioned from two or more authors with differing points of view.

See all article types »

Should the Health Community Promote Smokeless Tobacco (Snus) as a Harm Reduction Measure?

  • Coral E Gartner,
  • Wayne D Hall,
  • Simon Chapman,
  • Becky Freeman
  • Published: July 03, 2007
  • DOI: 10.1371/journal.pmed.0040185

Reader Comments (3)

Post a new comment on this article

Is it about tobacco or about harm reduction?

Posted by plosmedicine on 31 Mar 2009 at 00:12 GMT

Author: Maggie Brown, MS, ELS
Position: Production editor
Institution: PLoS
E-mail: mbrown@plos.org
Submitted Date: August 16, 2007
Published Date: August 17, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Harm reduction as an approach to substance addiction/abuse is not limited to tobacco, and the debate is similar in other areas of application, such as alcohol abuse, drug addiction, sexual behavior, etc.: is harm reduction really effective in reducing harm or does it encourage harmful behavior?

The reality is that many people can't or won't stop risk behavior. Shouldn't they too be entitled to support and treatment (in the form, say, of education, needle exchange programs, or condom distribution). Are these people to be denied information and material support which, on an individual basis, might actually help them, on the basis of the possibility that such help might perpetuate the risky behavior? That seems unproductive at best.

A similar debate is ongoing about different models of sexual harm reduction among adolescents. Both abstinence-only and abstinence-plus programs encourage abstinence, but the "plus" programs recognize the reality that many teens do have sex and they need information and support to protect themselves.

Harm reduction as a distinct public health approach is not about simply encouraging users to use less or switch to a different drug. It entails ongoing support and education of participants, and one of its hallmarks is recognition of factors that contribute to risk behavior such as social inequality, cultural differences, and coexisting conditions that may preclude or undermine abstinence. While protocols may vary, well-designed harm reduction approaches to risky behavior are gaining credence in social, behavioral, and medical sciences.

There is no substitute for quitting and living a perfectly healthy life, but when that is an impossible goal, harm reduction is a reasonable alternative.

Some freely available internet resources for more information:

Wikipedia entry on harm reduction: http://en.wikipedia.org/w...

The Open Society Institute: http://www.soros.org/init...

The Harm Reduction Coalition: http://www.harmreduction....

The US Centers for Disease Control Community Outreach for Drug Users: http://www.cdc.gov/outrea...

The Guttmacher Institute on different sexual behavior programs for adolescents: http://www.guttmacher.org...

Competing interests declared: I work for PLoS. The opinions I express in this blog are my own.