Origins of tobacco harm reduction in the UK: the 'Product Modification Programme' (1972-1991).
To better understand the current embrace of long-term nicotine maintenance by British governmental agencies and tobacco harm reduction by several leading British public health organisations, describe the context and deliberations of the UK's first formal tobacco risk reduction programme: 'Product Modification'.METHODS
Analysis of previously secret tobacco industry documents, news archives and Parliamentary debate records.RESULTS
From 1972 to 1991, the British government sought to investigate safer smoking through the 'product modification programme'. The Independent Scientific Committee on Smoking and Health (ISCSH) advised the British government on these efforts and collaborated with the tobacco industry, with which government then negotiated to determine policy. The ISCSH operated from four industry-backed premises, which contributed to the ISCSH's support of safer smoking: (1) reduced toxicity indicates reduced risk; (2) collaboration with the tobacco industry will not undermine tobacco control; (3) nicotine addiction is unavoidable; (4) to curtail cigarette use, solutions must be consumer-approved (ie, profitable). These premises often undermined tobacco control efforts and placed the ISCSH at odds with broader currents in public health. The product modification programme was abandoned in 1991 as the European Community began requiring members to adopt upper tar limits, rendering the ISCSH redundant.POLICY IMPLICATIONS
Endorsements of reduced harm tobacco products share the same four premises that supported the product modification programme. Current tobacco harm reduction premises and policies supported by the British government and leading British public health organisations may reflect the historical influence of the tobacco industry.