Cutting Through The Smoke Why Science Matters More Than Ever

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TOBACCO use remains one of Asia’s most pressing public health crises. The region is home to more than half of the world’s one billion smokers and accounts for four million tobacco-related deaths every year.
Beyond the staggering human cost, the economic burden of smoking runs into trillions of dollars, straining already fragile healthcare systems.
While governments have tried traditional tobacco control measures, such as warning labels, taxation, and quit smoking public campaigns, their impact has been limited. The prevalence of smoking continues to climb, especially in South and Southeast Asia.
What is urgently needed is not more of the same, but a pragmatic and medically grounded approach: harm reduction.
Why medicine matters
Speaking at the 2025 Asia Forum on Nicotine, Prof Dr Rohan Sequeira, Consultant Cardio Endocrinologist, emphasised the central role of medical science in shaping harm reduction policy:
“Most of the policies for tobacco harm reduction have been based on good medical science behind it. The UK did that with their public health initiative where they showed that vaping is 95% safer,” he said.
“Sweden has data which has shown that the incidence of oral cancer in that country has come down a lot. They are one of the best examples in the world where harm reduction can show to reduce or decelerate the medical issues associated with usage of tobacco.”
He underscored that while nicotine is addictive, it is not the main cause of cancer, diabetes, cardiovascular disease, or other chronic conditions.
He explained that multiple researchers have shown that nicotine is not the main reason for causing harm.
“It’s the combustion of tobacco or the use of unprocessed tobacco which causes 7,000 toxic chemicals which cause the multiple issues associated with health-related issues with tobacco usage,” he added.
A wake-up call: Millions of lives at stake
Prof Dr Sequeira presented projections that illustrate the scale of lives that could be saved if Asian countries were to adopt THR policies.
“If a country like China would adopt a THR policy, the number of lives saved in 5 years would be 1.5 million,” he said.
“In 10 years that would go up to 5 million. In 20 years that would go up to 15 million. And in 30 years it has the potential to reduce the deaths of 30 million people in a single country.”
He described these projections as a powerful warning: “Now this should be a wake-up call to policy makers. It should be a wake-up call to governments and more than anyone it should be a wake-up call to THR advocates that we are not in the wrong.
“We are fighting the good fight. We’re looking at harm reduction and we’re looking for people to have a better quality of life.”
The path forward
For Asia, the epicentre of tobacco harm, the stakes could not be higher. The evidence is clear: combustion causes the harm, and medically guided harm reduction strategies can save lives at scale.
As Prof Dr Sequeira concluded, the medical community has a duty to step forward:
“Harm reduction can save lives and I think we should really step up our push to looking at governments looking at it from a medical point of view.”
If medicine leads, and policymakers act on the evidence, Asia has the opportunity to save tens of millions of lives over the next generation. ‒  Focus Malaysia

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