The potential of smoke-free products to reduce harm for smokers: what does the toxicological evidence say?

There continues to be a high prevalence of smoking in many European countries. In Germany, for example, there are over 20 million smokers, most of whom exhibit little desire to quit. In other countries, the adoption of smoke-free products (SFPs), including e-cigarettes (ECs), heated tobacco products (HTPs), and oral nicotine pouches (NPs), is helping smokers to transition away from cigarettes. In Germany, debate about SFPs primarily focuses on their potential harms to non-smokers, particularly the underage population. This debate seems one-sided: raising concerns alone does not sufficiently inform the 20 million smokers about the comparative health risks of cigarettes and SFPs, an issue increasingly echoed by practitioners and researchers. Instead, the current discourse is dominated by misconceptions, as evidenced by surveys on smokers' perceptions of the relative health risks of cigarettes and SFPs. Considering the gravity of the topic, it is essential to revisit the scientific facts. The growing evidence shows that SFPs, including ECs, HTPs, and NPs, expose users to significantly fewer numbers and lower concentrations of toxicants relative to combustible cigarettes. In vitro studies and biomarkers of harm in SFP users suggest that these lower emissions translate to reduced risks of harm. It is the nature of science that the evidence will never be complete, but the totality of data should be considered when discussing the correct handling of SFPs. At present, these data suggest that SFPs can play a useful role in curbing the individual and societal risks associated with smoking.