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.]

Comments

[William]

What if Jacob Sullum came up with a topic that mattered. Talk about dreaming.

[John Thacker]

William wants people to get cancer and die!

[Legate Damar]

While I didn't actually RTFA, the fact that the death rate doubles if "all males" are now tobacco users means that half of all males are smokers?

If they had used a comparison over time, then using deaths/person*year rate, your population will enlarge (die less quickly) resulting in a smaller rate applied to a larger number. But unless they did that, really? 50% of US males currently smoke? I find that hard to believe.

[R C Dean]

In fact, "Any possible effects are not evident in Scandinavia."

Gotlandssnus rules. Jakobsson's, too.

[MNN]

I use snuff off and on and where I live they just made the taxes on it go way up(I think).
So stupid why they would want people to not use that instead of cigarettes.

[Oatwhore]

You think cigarettes are gross? Dip is down right disgusting.

[SpongePaul]

Its always been about the cash, never about your health!

[Martin Owens]

What do mere facts matter? The Jihad Against Tobacco has become a cult, a sacrament in the faith of that class of people who aspire to rule us all as benevolent despots. And for some, the Tobacco Taliban offers a profitable and eminent career.

[matt]

oatwhore - modern snuff and dip are two different things entirely

the difference is in the curing of the tobacco. smoking tobacco, as well as dip, chew (and previously) snuff is typically prepared from fire-cured tobacco; the dry heat causes much of the nicotine to pyrolyze (burn at a molecular level) which produces almost all of the carcinogens, collectively known as tobacco-specific nitrosamines, or TSNAs.

todays snuff, including snus, uses steam-cured tobacco. the moisture inhibits the pyrolysis of nicotine into TSNAs; most studies indicate that steam-cured tobacco contains no more than 2% of the total carcinogens of other tobacco products.

snuff is much less likely to "run" than fire-cured tobacco, as there are much less irritants present to irritate the mouth and promote salivation. the small amount that does form (in brands with higher water and salt contents) can be swallowed, with no nausea, irritation of the throat, or any other perceived ill-effects.

To anyone here that's a smoker - snus is available in most parts of america. Next time you're ready to quit smoking, try snus for taking the edge off, after a few weeks or months, you will find it easier to give up tobacco completely.

[R C Dean]

To anyone here that's a smoker - snus is available in most parts of america.

That Camel stuff is, well, shall we say not top-shelf. I've never seen the good stuff here in the states. Personally, I order from buysnus.com.

[matt]

ive tried several varieties of the real stuff, but there's only one i liked as much as the camel. my tastes do seem to be in the minority though...
right now the camel is really cheap in my area, picked up 3 tins for under $4 yesterday. when it goes back to regular price though i'll probably go back to ordering online from sweden

[tomtom]

Anyone know how this correlates to Copenhagen specifically? Is Copenhagen what you mean by the more modern snuff that is not fire cured? I've been dipping religously for almost ten years and my dentist didn't even realize I dipped until I told him. I plan on quitting but I've got to get through law school first.

[Tony]

a moralistic crusade to conquer sin disguised as a scientific quest to conquer disease.

And just coincidentally a boon to the tobacco industry. Totally not related. Definitely it's all that hippie moral crusading.

[Paul]

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.

All this as we teeter on the brink of legalization!

And just coincidentally a boon to the tobacco industry. Totally not related. Definitely it's all that hippie moral crusading.

Yes, Tony, a product legalized will be a boon to the producers of said product. Film at eleven.

[TikiPundit]

Skol! I mean, Skoal!

[Kant feel Pietzsche]

Smokeless is not the benign substance it is made out to be. My grandma died from second-hand chew!

*In an effort to pre-empt the haters, I am kneeling on glass shards to atone for using a "Cable Guy" line*

[ted]

The FDA's health concerns over electronic cigarettes is BS. What the FDA is truly concerned about regarding e-cigs is the attraction of new smokers, and they are willing to create public panic and enforce tight regulation to deter users. The FDA is currently being challenged by the scientific community, which is in favor of e-cigarettes as being a healthier alternative to tobacco cigarettes.

Check this out for more information:
http://ecigfdapropaganda.blogspot.com/

[R C Dean]

Anyone know how this correlates to Copenhagen specifically? Is Copenhagen what you mean by the more modern snuff that is not fire cured?

Copenhagen, and really all American-style snuff, used to be fire-cured. I think they are beginning to mix fire- and steam-cured (which is how Euro-style "snus" is made), though I really couldn't say.

[Wade]

5 years ago, I would have probably been thrilled to have "snus" come on the American market even though I had previously tried a dip of it from a Danish grad student 25 years earlier and thought it tasted like ass hair. As it was, I finally manned up and quit a 27 year addiction to smokeless tobacco cold turkey and have never regretted it. It's not a moral issue so much as whether you still want to keep your face.

[Justin Templer]

Jacob Sullum,

Thank you for a breath of fresh air. I smoked for 38 years and when I quit 9 months ago I had reached 2-3 packs a day. I quit by switching to Swedish snus bought over the internet.

I just hope sanity prevails if and when PACT legislation is voted on in this session of Congress. It would be immense disservice to public health if the purchase of snus is outlawed via the internet before it has a chance to establish itself in the marketplace as an alternative to cigarettes.

I know most of the public is ignorant and confuses snus with dip. With snus there is no spitting, no spit bottles or "mudjugs". If you met me on the street you wouldn't even know I was using it.

Thanks again for bringing some sanity and for educating the public about the reduced harm of smokeless tobacco products.

[Steven]

I think the issue is that it is not a safe alternative to smoking, and it will not end your nicotine addiction, and may even create more nicotine addicts.

[Patti]

Been reading all I can about Snus, spitfree smokeless tobacco, as the Camel mellow made it possible for me to quit a 34-year 30 cigarette a day smoking habit...I use 3 to 5 8mg of nicotine portions a day, and I feel so much better. I was going to be in the Clinical Trial on Snus up in Daytona Beach, but was disqualified as I have had anaphylactic drug reactions before. I therefore decided I would do my own personal "clinical trial' lol...and it worked where patches, gum and chantix failed!

[james]

Camel snus helped me stop smoking just about without effort. I smoked a pack and a half a day for 23 years. I had those subliminal urges to light up but no nicotine fits. I had to keep a portion of Camel frost in almost all the time. Been ordering something called General Original Portion online. It is very good tasting stuff 1 can lasts me like 3 or 4 days compared to 1 can a day of camel. NO SPITTING! So nobody even knows you are doing it. Smokers if you really want to stop this is how you do it.

[Mitch Embry]

I also quit smoking using real Swedish snus not the crappy American Camel SNUS (although there is a euro version Camel Snus made by JTI that is made to Swedish standards and is pretty good.) I quit smoking the first day of using snus and never looked back. I had failed in every previous attempt to quit. There are many varieties of snus which makes it a fun product to use as you never get stuck on one brand or bored with the taste like smokes.

This is the way to quit smoking or dipping. Just remember snus is nothing like American chew or dip, forget everything you know about that stuff it does not apply to snus. A good place to start reading about snus is http://www.snuscentral.org , swedishsnus.com, or snuson.com

Just remember Camel SNUS and Marlboro Snus are not really snus and is not a valid representation of real Swedish snus.

[David]

In order to start off your smoking cessation regimen with chantix, the Pfizer manufactured quit smoking drug, you need to buy chantix from authentic chantix drug stores.

[don]

Thank you for your posting.
I do agree with less carcinogens being consumed, and of course you are actually freebasing the nicotine into your body, so there does seem to be less risk. But, the findings are still far from final.
Getting involved in a clinical study to help get to the findings would be helpful.

[don]

Thank you for your posting.
Lots of people smoke for different reasons and finding people who use SNUS and other smokeless tobacco would be helpful for our clinical research.

[anders]

I agree with Hamling 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)." Find more at http://www.swedsnus.com