Public Health

What If All Smokers Used Smokeless Tobacco Instead?


A new review of 89 studies confirms that the cancer risk associated with smokeless tobacco is tiny when compared to the cancer risk associated with cigarettes. The authors, British biostatisticians Peter N. Lee and Jan S. Hamling, find that "an increased risk of oropharyngeal cancer is evident most clearly for past smokeless tobacco use in the USA, but not for Scandinavian snuff." In fact, "Any possible effects are not evident in Scandinavia." Recent U.S. studies find smaller risks than older ones, indicating that American smokeless tobacco is becoming more like Swedish-style oral snuff (snus), which has substantially lower levels of carcinogens. Lee and Hamling estimate that if all male cigarette smokers in the U.S. had used smokeless tobacco instead, the number of tobacco-related cancer deaths among them would have been 1 percent of what it actually was in 2005 (about 1,100 vs. 105,000). If the entire male population (including those who have never smoked) used smokeless tobacco, the number of tobacco-related cancer deaths would have been something like 2,100, or 2 percent of the actual number.

This comparison highlights the absurdity of the main "public health" objection to promoting smokeless tobacco as a harm-reducing alternative to cigarettes. Opponents of this strategy claim to be worried that it could lead to more tobacco-related mortality in the long run if it attracts nonsmokers to smokeless tobacco. But Lee and Hamling's numbers indicate that if a significant percentage of smokers switched to oral snuff, the tobacco-related death toll would be smaller than it is now even if every nonsmoker in America started using oral snuff too. By the professed standards of public health, which seeks to minimize morbidity and mortality, this is a no-brainer. As with the opposition to electronic cigarettes, something else is going on here: a moralistic crusade to conquer sin disguised as a scientific quest to conquer disease.

The entire text of Lee and Hamling's study, which appears in BMC Medicine, is here (PDF). More on smokeless tobacco here.

[Thanks to Brad Rodu for the link to the study, which he discusses in detail here.]