By Elizabeth Whelan, Sc.D., M.P.H.
Quit or die.
That's the message cigarette smokers get from the public health community.
But in fact, smokers who have trouble quitting have some rarely mentioned alternatives to total abstinence from tobacco: it s a method of intervention called tobacco harm reduction.
Some 450,000 Americans die prematurely each year because they smoke. Yet if cigarette smokers would just switch to safer products, we could cut the yearly number of tobacco-related deaths to 10,000 or less.
Tobacco harm reduction converts smokers to these safer products reduced-risk nicotine products thus curtailing their smoking without forcing them to give up the nicotine they crave. And this is key. Nicotine, while highly addictive, is not in itself harmful. Cigarette-related diseases are caused by the inhalation of smoke specifically, the products of combustion. The nicotine in cigarettes is not what causes cigarette-related diseases.
Given that, there are a number of harm reduction options:
Products called snus and pellets allow nicotine to be absorbed through the mouth. When the nicotine has been absorbed, the user simply discards the small, teabag-like sachet of snus; the pellets dissolve without any residue. Neither of these options involves the dipping and spitting associated with chewing tobacco which, unfortunately, is still what most people think of when they hear the words smokeless tobacco.
Although there is a prevailing belief that oral uses of tobacco cause mouth and throat cancer, there is very little evidence to support such a claim. Whatever health risks might be posed are truly minimal compared to cigarette smoking.
Observations in Sweden, for instance, confirm the relative health benefits of snus. There is a major disparity in smoking rates between Swedish men and women. For the last 50 years, lung cancer mortality among Swedish women has been among the highest in Europe; not surprisingly, many Swedish women smoke cigarettes. Conversely, most Swedish men who use tobacco use snus, causing them to have the lowest rate of lung cancer among men in the European Union.
The electronic cigarette, or e-cigarette, is another option for smokers who would like to quit. E-cigarettes are battery-powered devices that vaporize a mixture of propylene glycol (an FDA approved substance), water, nicotine, and flavorings. They are activated when the user inhales and gets a dose of nicotine in the process. New and very sophisticated forms of the e-cigarette are now in development stages at major tobacco companies who, regardless of their past duplicity, see the writing on the wall as fewer Americans smoke and more and more try to quit.
What snus, pellets, and the e-cigarette have in common is that they are clean nicotine delivery systems. They give smokers the nicotine they crave, minus the devastating health consequences of smoking.
Given the efficacy and safety of these life-saving methods, you might assume the FDA and traditional anti-smoking groups would be singing the praises of harm reduction methods, encouraging smokers to make the switch.
But they are not. Indeed, they actively reject the use of snus, nicotine pellets, and e -cigarettes, instead repeatedly asserting there is no safe alternative to smoking. The result of this rejection of harm reduction? Hundreds of thousands of smokers die unnecessarily each year.
Dr. Whelan is the president and founder of ACSH.