Stephen S. Hecht, Ph.D., co-director of the University of Minnesota’s Transdisciplinary Tobacco Use Research Center, has issued the claim -- based on preliminary data he has yet to publish in a peer-reviewed journal -- that smokeless tobacco is worse than the standard nicotine replacement therapies as a smoking-cessation aid. His reason seems to be simply his (unsurprising) finding that use of smokeless tobacco leaves carcinogen traces in users' urine. But as ACSH has noted repeatedly, just because a substance is detected does not mean that it is necessarily present in very dangerous amounts.
But, as Dr. Hecht is probably well aware, no one has ever suggested that smokeless tobacco is perfectly safe or devoid of carcinogenic potential. What many have suggested is that smokeless tobacco is radically safer than smoking -- and thus that it could be useful as a means of "harm reduction," not total harm elimination. To dismiss any means of harm reduction while some 400,000 Americans die from smoking each year -- contrasted with about 6,000 deaths from smokeless tobacco -- is statistical murder.
Perhaps Dr. Hecht feels, as all of us in the anti-smoking movement do, that ideally people would not be using any form of tobacco at all. Fair enough, but with the conventional medically-approved quit methods having something like a 7% success rate when used individually and only about a 20-30% success when used in combination (the nicotine patch plus gum, Zyban, and therapy), turning current smokers into a 100% nicotine-free cohort doesn't appear to be a plausible option. Switching to smokeless means people remain on nicotine -- which may strike Dr. Hecht or other perfectionists as "cheating" -- but gets nicotine addicts away from by far the greatest hazard of smoking, which is burning tobacco depositing tar in the lungs. The risk of oral cancer from smokeless is real but minuscule compared to the likelihood of developing lung cancer, emphysema, and other conditions if one keeps smoking.
Unless Hecht has a plan to magically increase the efficacy of the standard nicotine replacement techniques -- so that even "inveterate" smokers quit -- we need to start thinking outside the Nicorette box.
Hecht is within his rights to caution that smokeless is not perfectly safe, but he seems to be going an irresponsible step further when he concludes that smokeless is not effective or is less effective than nicotine replacement therapy (NRT) -- he seems to be deliberately presenting the risks of smokeless out of context to make it seem like a dismissible alternative, undermining the whole idea of harm reduction and, implicitly, rejecting the idea of relative risks. He suggests that NRT is "cleaner" than smokeless tobacco -- as if this is a surprise. He suggests that no studies in the U.S. have shown the efficacy of smokeless as a cessation program -- yet he must know the Swedish experience suggests that smokeless could be used this way.
And make no mistake: just because smokeless is not as "safe" as NRT does not mean that it would be less effective as a means of quitting cigarettes. And on balance, the "safest" course of action is the one that gets people off cigarettes.
There is an understandable puritan zeal among some antismoking crusaders: the desire to create a perfect world in which no one uses tobacco in any form. But that zeal should not cause us to forego second-best options when the best is unavailable -- and that zeal certainly should not cause us to misrepresent some options as better than others when common sense suggests otherwise.
Jeff Stier is an associate director of the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com).
