01 Aug 2003 Reducing Tobacco Risks With Smokeless Tobacco, by James P. Gelfand
Despite the Surgeon General’s warning, anti-smoking campaigns, anti-smoking regulations and over 440,000 smoking-related American deaths annually,1 approximately a quarter of American adults still smoke cigarettes. For approximately 40 percent of them, an addiction to nicotine keeps them puffing.2
Their addictions won’t let them stop smoking, and alternatives are less than enticing. Many wannabe ex-smokers don’t want a prescription for Zyban pills, nasal sprays or nicotine inhalers. Nicotine gums and patches fail 93 percent of the time and cost more than a pack of smokes.3
Behavioral therapies can be more comical than helpful. A National Cancer Institute manual suggests physicians tell patients to “keep your hands busy – doodle, knit, type a letter,” or “cut a drinking straw into cigarette-sized pieces and inhale air” or “keep a daydream ready to go.”4
The lack of a practical non-smoking solution to nicotine addiction is related to the incidence of lung cancer. Unfortunately for nicotine addicts, the medical community presents smokers with largely ineffective treatments and a simple choice: quit smoking or die.
Dr. Brad Rodu, a professor of pathology at the University of Alabama, is championing another way to reduce smoking-related deaths: “smokeless tobacco.” These products contain nicotine with virtually none of the dangerous substances or attributes related to smoking cigarettes.5 Cigarette smoke contains more than 40 carcinogens not contained in green tobacco.6
Smokeless tobacco suffers from the stigma of the disgusting black chew popularized by cowboys and baseball players – a product that increases the need to spit and causes mouth cancer – but modern smokeless tobacco products are nearly invisible.
Smokers can switch to tiny dissolving tablets that can be stuck inside their cheeks and are considered 98 percent safer than cigarettes.7They don’t cause lung cancer, heart disease or emphysema. The risk of mouth cancer is less than half that associated with smoking.8
These products, like Star Scientific’s Ariva “cigalets,” do not require chewing or spitting and can be discreetly used in an office or anywhere smoking is not permitted.
“We’re talking about saving more than 400,000 lives a year,”9 says Rodu, who has been advocating a realistic alternative to smoking since the early 1990s.
Why haven’t we already heard about the new smokeless tobacco? There are risks associated with it, but who could argue that these risks are not dramatically preferable to the perils of smoking?
According to Dr. Elizabeth Whalen, president of the American Council on Science and Health, anti-smoking activists are not willing to consider harm-reduction strategies for tobacco use and nicotine addiction.
“We absolutely agree that smokeless tobacco is substantially safer than smoking,” she explains “but [opponents] are pathologically against tobacco.”10
Whalen has experienced substantial backlash from anti-smoking activists for comments like these; she’s often accused of working for the benefit of companies that create profits from cancer and death.
“I have to wonder about the people who won’t consider harm reduction for smokers,” she says. “Are they against the killing or are they just against the profits?”11
Dr. Sally Satel, a practicing psychiatrist and lecturer at the Yale University School of Medicine, concurs. She believes many opponents of smokeless tobacco innovations are simply anti-corporate activists.
Ralph Nader, for instance, created a parody company called “Licensed to Kill,” which mocked tobacco companies by asserting it had “the explicit purpose of manufacturing and marketing tobacco products in a way that kills over 4.9 million people worldwide annually.”12
“It’s a Naderite opposition to industry in general,” Satel says. “It’s as if you can’t really be anti-smoking unless you are anti-industry.”13
In a society in which it is considered permissible to offer methadone to heroin users and clean needles to drug addicts, it is reasonable to promote smokeless tobacco as an alternative to cancer-causing cigarettes.
Anti-smoking activists need to ask themselves if their hostility to corporate profits is more important than preventing cancer and premature death.
James Gelfand is a research associate for The National Center for Public Policy Research, a Washington, D.C. think tank.
1 “Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Economic Costs – US, 1995-1999,” Morbidity and Mortality Weekly Report 51(14):300-303, Centers for Disease Control and Prevention, Atlanta, Georgia, 2002.
2 Dr. Brad Rodu and Dr. Philip Cole, “Nicotine Maintenance for Inveterate Smokers,” Technology, Volume 6, 1999, pp. 17-21.
3 Dr. John R Hughes, Dr. Saul Shiffman, Dr. Peter Callas and Dr. Junji Zhang, “A Meta-Analysis of the Efficacy of Over-the-Counter Nicotine Replacement,” Tobacco Control, Volume 12, 2003, pp. 21-27.
4 “How to Help Your Patients Quit Smoking,” Pub. No. 93-3064, National Institute of Health, Bethesda, Maryland, 1993.
5 Dr. Klaus D Brunnemann, Dr. Jianping Qi and Dr Dietrich Hoffmann, “Aging of Oral Moist Snuff and the Yields of Tobacco-Specific N-Nitrosamines (TSNA),” American Health Foundation, Valhalla, New York, 10595, June 22, 2001.
6 “Chemical Research in Toxicology,” Vol. 14, No. 7, 2001.
7 Dr. Brad Rodu, “An Alternative Approach to Smoking Control,” The American Journal of the Medical Sciences, Volume 308, 1994, pp. 32-34.
8 Dr. Brad Rodu and Dr. Philip Cole, “Tobacco-Related Mortality,” Nature, Volume 370, 1994, p. 184.
9 Interview with Dr. Brad Rodu, July 2, 2003.
10 Interview with Dr. Elizabeth Whalen, July 2, 2003.
12 “Licensed to Kill, Inc. – About Our Company,” available at http://www.licensedtokill.biz/about.html as of July 28, 2003.
13 Sally Satel, “Can Smokeless Tobacco Reduce the Health Consequences of Smoking?” forum presentation, American Enterprise Institute, Washington, D.C., June 25, 2003.