In today's edition of the medical journal The Lancet, two reports and an editorial deal with the question of the health effects of snus, a form of moist snuff or smokeless tobacco. A little background is in order first: perceived as a dangerous carcinogen -- a falsehood encouraged by our Surgeon General and zealous anti-tobacco advocacy groups -- smokeless tobacco (ST) has been banned from Australia and the EU, except for Sweden. And yet, the clearly lethal tobacco-delivery device known as the cigarette is widely available almost everywhere.
Some groups -- including ACSH -- have advocated a freer approach to allowing makers of ST to tell adult smokers who are addicted to nicotine that ST might be one product that can help them quit smoking.
One of the Lancet reports is by a group from Australia's University of Queensland. The authors attempted to estimate the net health effect on that population of allowing marketing of snus in Australia. Their conclusion was that making snus available would most probably result in improved public health, as more Australians would be able to quit cigarettes. "Current smokers who switch to using snus rather than continuing to smoke can realize substantial health gains," conclude the authors.
Even more significantly, a group from Sweden's Karolinska Institute evaluated the actual tobacco-use-related risk of several cancers among over 100,000 male construction workers over the period of 1978 through 1992, with follow-up through 2004. Their findings confirmed other studies that Rodu and Godshall summarized in the ACSH-supported paper referred to above: there was no increased risk of oral cancer among ST users, as compared to non-tobacco users. Further, there was no increased risk of lung cancer -- no surprise, perhaps, but still of note. There was a small increased risk of pancreatic cancer, but even that was significantly less than that caused by smoking cigarettes.
An editorial by Drs. Jonathan Foulds and Lynn Kozlowski says it all: "It is a perverse public health policy that makes an addictive drug widely available in its most harmful form, yet bans or fails to properly inform consumers of availability of that drug in a much less harmful form." They call upon regulators to level the playing field in the marketing of tobacco products, making snus more available and enhancing warnings about deadly cigarettes. They point out that there are 1 billion people now addicted to cigarettes (and the nicotine they deliver) -- and over 40,000,000 of these people are right here in the U.S.
The time is past for anyone to argue that smokeless tobacco poses enough serious health risks that its use as an aid to cessation should be censored. This is especially true because of the abysmally low success rates of quitting utilizing the other methods that are approved and available. The message to addicted adult smokers now -- "quit nicotine completely or die" -- must be changed to encompass medical reality, and the sooner the better. Many lives are at stake.
Gilbert Ross, M.D., is Executive and Medical Director of the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com).
See also: ACSH's booklet and new brochure on smokeless tobacco.
