Public Health

'We Should Not Delay in Allowing Snus to Compete'

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Three new articles in The Lancet reinforce the case for promoting smokeless tobacco as a less hazardous alternative to cigarettes.

A 26-year study of about 126,000 Swedish construction workers, none of whom had ever smoked, found that users of snus (Scandinavian moist snuff) were no more likely than nonusers to get oral cancer or lung cancer. Their rate of pancreatic cancer was twice as high but still substantially lower than the rate among construction workers who smoked. More important, lung cancer accounts for many more smoking-related deaths than pancreatic cancer. Notably, oral cancer, which long has been considered the most serious risk from smokeless tobacco, was not associated with snus use in this study or in earlier research involving Swedes, possibly because Scandinavian-style snuff (which is now available in the U.S.) has lower levels of carcinogens than the traditional American variety.

In another study, Australian researchers calculate that smokers who switch from cigarettes to snus would get almost the same health benefit as smokers who give up tobacco entirely. They find "little difference in health-adjusted life expectancy between smokers who quit all tobacco and smokers who switch to snus." In their analysis, the advantage for quitters over switchers was somewhere between one and five months. "Relaxing current restrictions on the sale of snus is more likely to produce a net benefit than harm," they conclude, "with the size of the benefit dependent on how many inveterate smokers switch to snus."

In an accompanying commentary (available only to subscribers), two prominent American tobacco researchers, Jonathan Foulds and Lynn Kozlowski, agree:

The Lancet papers published today, when added to mounting epidemiological evidence, indicate that we should not delay in allowing snus to compete with cigarettes for market share, and we should be prepared to accurately inform smokers about the relative risks of cigarettes, snus, and approved smoking-cessation medications. In light of all the available evidence, the banning or exaggerated opposition to snus in cigarette-rife environments is not sound public-health policy.

One reason for my interest in the harm-reducing potential of smokeless tobacco is that it pits the "public health" logic of the anti-smoking movement against its blind hatred of everything associated with Nicotiana tabacum. Too many activists and public officials have chosen to misrepresent the relative risks of different tobacco products, discouraging choices that would reduce morbidity and mortality, which is supposedly their goal. In the face of such dishonesty and emotionalism, I'm glad to see that data can still make a difference.

[Thanks to Brad Rodu, who wrote the book on switching from cigarettes to smokeless tobacco, for passing along the articles.]