UCSF opinion piece calls for tobacco abstinence-only for soldiers. Really?

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ByeBye cigs, Hello e-cigsEveryone agrees that tobacco use is bad for your health. OK that s out of the way. But wishing for an end to nicotine dependence is not the best approach to dealing with this terrible problem. Remember, America has over 40 million smokers (and several million tobacco users of non-combustibles such as chewing tobacco and snus). The CDC reported recently their new estimate of tobacco-related deaths: 480,000 (of which 95 percent or more are caused by cigarettes).

U.S. military personnel use tobacco at around the same rate as civilians (although authors of the New England Journal of Medicine piece take pains to point out the lower usage rate among officers). The authors, led by Elizabeth A. Smith, correctly identify a host of potential health problems, as well as associated logistical concerns (excess time-off for smoke breaks, e.g.), due to tobacco use (again, mostly smoking). They call (in their Perspective piece in the current New England Journal of Medicine: Is It Time for a Tobacco-free Military?) for eliminating tobacco use on military bases, for the good of America s preparedness as well as for the health of the soldiers and sailors military personnel. They point out that despite the underlying expectations for superlative fitness and despite the availability of state-of-the-art tobacco-cessation programs many military personnel still use tobacco ¦., with a tone mixing surprise, shock and disbelief.

A response to their simple-minded approach comes from an old friend of ACSH, Dr. Sally Satel, who wrote in MedPage Today: ...If Congress approves this move, then the service branches should permit the use of snus and electronic cigarettes by smoking recruits who want to serve their country.

Dr. Satel calmly calls out the authors blithe reference to state-of-the-art tobacco cessation with this factual disclaimer: ...there are patches and gum which, by themselves, are of marginal help ¦ It is well-known that the use, singly or in combination, of the various FDA-approved cessation aids succeed in keeping smokers abstinent for the long-term at a rate approximating 15 percent at best. And even Dr. Satel does not address the effort required by our battle-ready soldiers in using the approved methods regularly: patches, gums and we suppose drugs (Zyban, Chantix) which of course have their own significant risks.

Her simple plea is for science-based common sense and some empathy for soldiers and sailors who are already under plenty of stress (the authors cleverly conflate stress-relief from nicotine with ostensible stress caused by it, without evidence of such) to allow smoking cessation without harsh withdrawal by utilizing harm reduction technologies: e-cigarettes and snus.

The authors, most of whom come from the nation s hotbed of anti-e-cigarette hype and propaganda, UCSF, are surely not going to be persuaded by either simple rationality nor by an appeal for mercy for our fighting men and women. They couldn t care less that the military smokers (and chewers) do not deserve to be deprived of their craved substance out of a fundamentalist desire for not just quitting, but quitting the right way. Their antipathy to harm reduction comes from a variety of sources, none of them related to science or health. I certainly agree that anyone is better off without the burden of nicotine addiction, but to simply apply dogma and wishful thinking as a solution, as the NEJM authors do, is not going to be helpful.