Dr. Benowitz stops short of advocating smokeless tobacco, yet again

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Dr. Neal Benowitz, a professor in the Department of Medicine at the University of California, San Francisco, and a member of the Tobacco Products Scientific Advisory Committee, acknowledges that use of smokeless tobacco (ST) could reduce harm to smokers if they switched to the products entirely. He reviewed the literature and found, surprisingly, total agreement with our approach: ST is not a risk for cardiovascular disease and is only a minimal risk for pancreatic cancer (far less than smoking).

However, consistent with his published statements, Dr. Benowitz remains concerned that promoting ST use would increase health risks in the overall population. Writing in the journal Clinical Pharmacology and Therapeutics, he alleges that the availability of ST would result in dual use of ST and cigarettes, thus resulting in fewer people quitting smoking.

While ACSH s Dr. Gilbert Ross concedes that smokers on the path toward quitting often temporarily become dual ST and cigarette users, he also points out that approximately 70 percent of current smokers want to quit. He asserts that if they tried snus a form of ST consisting of ground tobacco packaged in small sachets and placed between the lips and gum and neither chewed nor spit they would find it easier to quit smoking. If a smoker uses ST to curb his nicotine craving during a long flight or while at work, says Dr. Ross, then he ll probably be more likely to use the product again to quit in the future. Therefore, Dr. Benowitz s objection to dual use is irrelevant, since it s expected that, when switching from cigarettes to snus, there will almost always be a period of time when both products are jointly used until you can quit smoking altogether. Further, such academic objections ignore the main issue: How can we, in public health, help America s 45 million smokers quit more effectively than the current inadequate methods allow? Those who object to harm reduction ignore that issue and resort to pointing out hypothetical risks.

Even Dr. Benowitz states that, compared to cigarettes, snus is associated with a far lower risk of cancer, cardiovascular disease, and lung disease. Though ST does contain some of the carcinogenic chemicals found in cigarettes, the products are still orders of magnitude safer, since they don t expose users to the products of combustion as smoking cigarettes does.

Snus use among young men in Norway and Sweden is as high as 30 percent, and Dr. Benowitz acknowledges that the absence of increased cancer risk (other than pancreatic) in these snus users argues against a role of nicotine in causing or promoting cancers in general. Upon reading this passage, Dr. Ross says he was astounded to see that Dr. Benowitz is basically agreeing with ACSH by acknowledging the lower relative risk of ST use compared to cigarettes. He adds, Yet unfortunately, Dr. Benowitz couldn t just stop there. Instead, he pulls a bait and switch: At the end of his editorial, he comes down against recommending ST as a smoking cessation aide.