Anti-Smokers Inch Toward Pandora's Box of Snuff
A recent New York Times story about new smokeless tobacco products from U.S. companies suggests the American Cancer Society's attitude toward such products is evolving. For years the ACS, like other anti-smoking groups, has deliberately obscured the fact that oral snuff is far less hazardous than cigarettes and resisted calls to promote it as a safer alternative. Now Thomas Glynn, the ACS's director of cancer science and trends, concedes that Swedish-style snuff (a.k.a. snus) "may be less harmful than other smokeless tobacco products and cigarettes," adding, "The question is, 'Why not suggest that people switch to them?' That's a very tempting argument, but it is a Pandora's box. There's a lot we don't know about. The products could encourage people to continue smoking who ordinarily would have quit."
Glynn is still not being completely forthright. First, there's no "may be" about it: Smokeless tobacco is indisputably much safer than cigarettes. Second, while Swedish methods produce oral snuff with lower levels of certain carcinogens than the old-style American process, all forms of smokeless tobacco are much less hazardous than cigarettes. The difference in risk between different kinds of oral snuff pales in comparison to the huge difference in risk between oral snuff and cigarettes. Third, studies of tobacco use in Sweden indicate that snus is a substitute for cigarettes, one of the main reasons smoking rates there, especially among men, are substantially lower than elsewhere in Europe. The main effect has been to reduce cigarette consumption, not to "encourage people to continue smoking" by giving them an alternative source of nicotine in environments where smoking is prohibited, which presumably is what Glynn has in mind. There's no reason to think the latter effect would be so dramatic in the U.S. that it would outweigh the reduction in smoking-related illnesses among smokers who switched from cigarettes to snus. In any case, the same objection could be raised against Nicorette gum or other alternative nicotine sources.
According to the "public health" logic that supposedly governs organizations like ACS, promoting snus as an alternative to cigarettes is a good idea if, on balance, it reduces morbidity and mortality. If they believe in their own professed principles, they ought to support such a "harm reduction" policy. My own view is that anti-smoking groups and (especially) government agencies should tell the truth about the relative risks of different tobacco products and let people make their own choices, regardless of what those choices might turn out to be.
ACS is at least moving closer to telling the truth. In December 2004, when I wrote a column about this issue, the group's Web page on smokeless tobacco said: "Some people believe that using smokeless tobacco is safer than smoking. This is not true." That was not true. The current version of the page says:
While some people have suggested that cigarette smokers should switch to spit tobacco, most medical experts recommend quitting use of all tobacco products. Numerous clinical studies have shown that nicotine replacement therapy (such as nicotine patches, nicotine gum, etc.) can help people to quit smoking.
While using snuff and chewing tobacco may be less lethal than smoking, there is no evidence to support claims that these products are as safe and effective as nicotine replacement in helping smokers to quit.
Smokeless tobacco is cheaper than other forms of nicotine replacement, it delivers levels of nicotine closer to those smokers are used to, and in the form of Swedish-style snus it poses negligible health risks. As for whether it is as effective as nicotine gum or patches (which are not all that effective to begin with), why not let smokers decide for themselves?
