From cancer research to the tobacco company, that’s a real shift in strategy. Why Sascha Nussbaum, Head of Scientific
FOCUS online: Better than smoke-free alternatives is not to smoke. That’s undisputed, isn’t it?
Sascha Nussbaum: Philip Morris has positioned itself very clearly here. If you don’t smoke, you shouldn’t start. If you smoke, it’s best to stop. However, if you are a smoker who does not quit, you should consider switching to non-combustion alternative nicotine products such as e-cigarettes or tobacco heaters.
These alternative products work without combustion, which is the main cause of the release of harmful substances in cigarettes. In this way, the intake of harmful substances can be significantly reduced, although these alternatives are not free of harmful substances or risks, and they still contain nicotine, which causes or maintains dependence.
You have researched immunology for ten years and are a cancer specialist. In presentations such as “Vaccines against Cancer,” you have recommended quitting smoking to avoid homegrown causes of cancer. Now you feel like you have switched sides. Why?
Nussbaum: I don’t see a contradiction, on the contrary! As you can see from my long-standing research topic of vaccines, I have always been a big advocate of prevention. In the area of cancer, the greatest potential lies in the avoidable health risks that have to do with our lifestyle. And smoking is still the number one priority. What many people don’t know is that quitting smoking brings a real benefit to statistical life expectancy, even at an advanced age. Mathematical models from universities and ourselves show that switching to non-combustion alternatives can also have a positive effect on disease statistics, even if quitting smoking is and remains the ideal solution.
How can you stop smoking with nicotine replacement in the form of patches, nasal sprays, chewing gum or tablets?
Nussbaum: The methods recommended in medical guidelines for quitting cigarette smoking include, broadly speaking, nicotine replacement preparations, drugs that inhibit the effects of nicotine, and behavioral therapies. As the gold standard, experts recommend a combination of nicotine replacement products and behavioral therapy. Problems with these methods: They are only accepted as the method of choice by very few smokers, they are also only effective in a minority of attempts to quit smoking and their costs are not widely reimbursed by health insurance companies. The real problem, however, is that the majority of smokers are currently not motivated to quit smoking, as our own surveys and a study by the University of Düsseldorf repeatedly confirm. For this large group of smokers, switching to non-combustion alternatives could at least offer the possibility of drastically reducing their intake of pollutants. Comparative studies and international market data show that alternative nicotine products can significantly reduce cigarette smoking, even among long-time smokers.
What exactly do you mean by smoke-free alternatives?
Nussbaum: Smokeless alternatives are nicotine products that do not require a combustion process and therefore no smoke. Smoke is created by combustion and is composed of gaseous components, liquid droplets and solid suspended particles. Burning a cigarette produces smoke that contains more than 6,000 chemicals, 250 of which are known to be toxic or carcinogenic. What many people don’t know is that nicotine, the most widely known molecule in cigarette smoke, does not itself cause cancer, although it has an addictive effect and is not risk-free.
Smoke-free alternative products include, for example, e-cigarettes, which usually vaporize a liquid containing nicotine, tobacco heaters, which only heat tobacco instead of burning it, or nicotine pouches, which are placed under the upper lip in order to absorb nicotine through the mucous membrane. Due to the lack of combustion, these products release an average of 95% (tobacco heaters) to 99% (e-cigarettes, nicotine pouches) fewer harmful substances than cigarettes. Philip Morris has tested this for its products according to international standard methods and according to WHO lists of harmful substances. They are not free of harmful substances or risks, and they still contain nicotine. Therefore, they are definitely not recommended for non-smokers! However, for smokers who would otherwise continue smoking, they can represent a significantly reduced pollutant alternative compared to the worst option – continuing to smoke cigarettes.
How can alternative nicotine products help you quit cigarette addiction? Is there a gradual weaning?
Nussbaum: Dependence on cigarette smoking is based on the effects of nicotine as well as on rituals and habits that have been learned in connection with smoking. The more than 10 million women and men who are not motivated to quit smoking could continue to consume nicotine through alternatives that are combustion-free and therefore significantly reduce pollutants, without having to completely forego habits such as the “smoking break” or the enjoyment aspect.
Maintaining rituals is viewed critically by those for whom only the ideal solution of quitting smoking is acceptable. At the same time, many studies confirm the role of enjoyment and rituals in switching to combustion-free alternatives. In other words, if the substitute product is less attractive than the cigarette, people will stick with smoking.
With a smoke-free alternative, can the dose be gradually reduced and thus ensure that smokers quit?
Nussbaum: In principle, this is possible for all alternative nicotine products, just like for cigarette smoking, by gradually using these products less often. But this is difficult for many people – not only because of an addiction to nicotine, but also because of learned rituals and habits. With e-cigarettes, depending on the manufacturer and type of use, it is possible to switch to liquids with lower nicotine concentrations or nicotine-free versions.
