by Dr. Matthew Holman
Nearly 50 years ago, Tennessee made history. In 1977, it became the first state to require child car seats — a simple act of harm reduction that saved lives and set an example for the nation. Harm reduction isn’t complicated; it’s the same principle behind buckling a seat belt or applying sunscreen. It doesn’t eliminate risk, but it makes life safer. And today, that same commonsense approach can help us address one of the most significant public health challenges we face: smoking.
Dr. Robert Smith Sanders, a pediatrician in Murfreesboro, led the yearslong fight for Tennessee’s child passenger safety law. Once the law was passed, child fatalities plummeted. Within a decade, every other state had followed Tennessee’s lead. That’s the power of harm reduction: practical, evidence-based measures that save lives.
According to the Centers for Disease Control and Prevention (CDC), nearly half a million Americans die every year from smoking-related disease, making cigarette smoking the nation’s leading cause of preventable death. We’ve made progress, but it has been uneven. Just as Dr. Sanders fought for years to change minds on child safety seats, today’s fight is ensuring that smokers have access to — and are aware of — better alternatives to combustible cigarettes.
From September 14–17, scientists from around the world will gather in Knoxville to share the latest research on tobacco harm reduction. These conversations matter because they help translate scientific findings into practical strategies that have the potential to save lives.
Just as Tennessee once led the way on child safety, PMI’s U.S. businesses are working to lead on tobacco harm reduction. PMI has invested more than $14 billion worldwide in building a smoke-free future — developing better options for legal-age adults who smoke.
The U.S. Food and Drug Administration (FDA) has already authorized all 20 Swedish Match ZYN nicotine pouch products currently sold in the U.S., acknowledging that ZYN helps many adults who smoke or use smokeless tobacco switch completely. Our other major smoke-free product, IQOS, heats tobacco instead of burning it — producing no smoke, ash, or fire — which significantly reduces exposure to harmful chemicals compared with combustible cigarettes. Two versions of IQOS have been FDA-authorized as “appropriate to promote public health.”
Still, challenges remain. Many physicians have not yet been exposed to the latest science on smoke-free alternatives and therefore feel limited in what they can recommend to their adult patients who smoke. Regulators, including the FDA, will need to take additional steps to make harm reduction as effective in the U.S. as it has been in other countries.
The lesson is clear: Harm reduction works, but only if we commit to it. Tennessee showed what’s possible with child car safety nearly five decades ago. Today, we have the same opportunity with smoking. Let’s seize it.
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Dr. Matthew Holman is Chief Scientific and Regulatory Strategy Officer at PMI U.S. and former Director of the Office of Science at the FDA’s Center for Tobacco Products.
