Snuff Treatment

Lying in the name of public health

A recent study by researchers at the U.S. Centers for Disease Control and Prevention found that the most popular brands of smokeless tobacco in this country are the ones with the highest levels of readily absorbed nicotine. For the researchers, the finding was an opportunity to once again mislead the public about the hazards of oral snuff.

"Consumers need to know that smokeless tobacco products…are not safe alternatives to smoking," said co-author Patricia Richter of the CDC's Office on Smoking and Health. "The amount of nicotine absorbed per dose from using smokeless tobacco is greater than the amount of nicotine absorbed from smoking one cigarette."

No one claims smokeless tobacco is completely safe, but it is indisputably safer than cigarettes—by a very wide margin. Obscuring this fact, as the public health establishment routinely does, leaves smokers with the impression that they have nothing to gain by switching to snuff, when the truth is that they can dramatically reduce their risks, as University of Alabama oral pathologist Brad Rodu has been pointing out for years.

Richter's nicotine comparison might lead unwary readers to believe that using smokeless tobacco is more dangerous than smoking cigarettes. Yet nicotine itself plays little or no role in the diseases associated with smoking.

Nicotine does not cause lung cancer or other respiratory illnesses. And according to a 1999 editorial in the Journal of the American College of Cardiology, "the epidemiologic and experimental data suggest that nicotine absorbed from smokeless tobacco, nicotine gum or transdermal nicotine is not a significant risk factor for accelerating coronary artery disease or causing acute cardiovascular events."

Like chewing nicotine gum or wearing a nicotine patch, using smokeless tobacco does not involve inhaling combustion products, the main source of smoking-related hazards. Oral cancer is the only well-established life-threatening danger associated with smokeless tobacco, and even that disease is twice as common among cigarette smokers.

Furthermore, as an article in this month's issue of the journal Tobacco Control explains, the oral cancer risk does not show up in studies of smokeless tobacco users in Sweden, where the typical curing, processing, and storage methods result in lower concentrations of carcinogens. The authors argue that "the availability of snus [Swedish-style oral snuff] appears to have contributed to the unusually low rate of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence."

In the same issue, British anti-smoking activist Clive Bates and five European scientists note that "Sweden has the lowest levels of tobacco-related mortality in the developed world by some distance." They call upon the European Union to lift its misguided ban on snus, which applies in all member countries except Sweden.

Bates and his co-authors estimate that snus and some American smokeless tobacco products "are at least 90% less hazardous than cigarette smoking." They argue that it is "ethically wrong to actively deny users the option to reduce their risk in this way," calling the E.U. ban a triumph for the "health professional's authoritarian insistence that the only valid choice for smokers is to quit or die."

The same attitude underlies false statements about smokeless tobacco by American public health officials. A set of "Tips for Teens" from the Department of Health and Human Services, for instance, answers a flat "no" to the question, "Isn't smokeless tobacco safer to use than cigarettes?"

In congressional testimony last June, Surgeon General Richard Carmona likewise insisted "there is no significant evidence that suggests smokeless tobacco is a safer alternative to cigarettes." Perhaps Carmona is simply misinformed, in which case Congress should not turn to him for expert guidance on health-related matters. But surely some of his advisers know better.

Someone, in other words, is lying to us in the name of public health. The rationale is that, even though switching to smokeless tobacco might make sense from the perspective of an individual smoker, awareness of this alternative ultimately could lead to more tobacco use.

Given the huge difference in risk between cigarettes and snuff, a net increase in tobacco-related disease is highly unlikely. More to the point, the decision to tell the truth should not depend upon a collectivist calculus by public health functionaries accustomed to treating people like a herd of cattle. Individuals should have access to accurate information about health risks, even when the government's nannies do not trust them to use it properly.