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Archived Comments for: Deconstructing anti-harm-reduction metaphors; mortality risk from falls and other traumatic injuries compared to smokeless tobacco use

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  1. Harm Reduction Debate

    Jon Ebbert, Mayo Clinic

    19 May 2006

    I read your article with great interest. I believe that your insight is refreshing. As a primary care clinician with an interest in treating tobacco users, I submit that the largest apparent barrier to recommeding smokeless tobacco as a harm reduction strategy is the ethical obligation to first, do no harm. We have to ask ourselves if we can equate the inaction on reducing harm (i.e., not recommending ST to smokers) to the recommendation of a potentially harmful product as a treatment option. If a patient comes to a physician for treatment and s/he recommends a "therapy" (in this case ST), the ingredients for which are kept a secret by the industry with an unknown safety profile and with no regulatory oversight, is not the patient within their right to hold the physician responsible for any harms that come to them from the use of that product? Recommeding ST to a patient appears to be, at best, bad clinical medicine and, at worst, medical malpractice. If that's true for a clinician, wouldn't that also be true for health care advocates and researchers who advocate the same? I agree the debate is poisoned and we need to thoughtfully consider and hear all sides to this debate. It sometimes appear that we are putting the cart before the horse in this debate. We are recommending it as a potential "therapy" with a total lack of evidence that is has any long-term benefit for getting patients to stop smoking.

    Competing interests

    None declared.