Where There's No-Smoke Products, There's Fired Up Opposition
Jul 25, 2007, 15:16
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Your article "Smokeless Tobacco's Bet Lights Fire Under Foes" (Business, July 11) fails to provide the proper context to evaluate the harm-reduction potential of smokeless tobacco products. Any analysis of harm reduction must include an examination of individual and population-level harm. At the individual level, there is no doubt that a pack-a-day smoker who completely switches to smokeless tobacco will reduce the risks associated with tobacco use. But at a population level, where policy gets made, the marketing behavior of the industry must be considered. Here is where the experts' reservations come into play. Many smokeless products seem to be marketed to keep smokers smoking while undermining cessation efforts and policy interventions such as smoke-free air laws. Claims for smokeless products such as "Anytime. Anywhere." are designed to encourage use in social or work settings where it is illegal to light up. Some experts fear that this so-called situational use of smokeless tobacco will reduce the incentive health-concerned smokers might have to quit. Why? Because the temporary use of a smokeless product could serve as a bridge to get the smoker from their last cigarette to their next cigarette. Consistent with this, a recent Citigroup survey of tobacco sellers concludes that smokeless use will supplement, rather than replace, smoking: "The trade believes that snus [a line of "spit-free" smokeless tobacco products] will be consumed in addition to cigarettes. Given the increased bans on smoking, snus products seem like an obvious substitution." At a population level, dual use of cigarettes and smokeless tobacco could actually increase overall harm if it perpetuates cigarette use in smokers who might otherwise have quit tobacco use entirely. The Journal used one comment in a long interview with me to imply in this article and one in March ("The Case for Smokeless Tobacco," Personal Journal, March 27) that switching to spit tobacco is a reasonable alternative to quitting tobacco use entirely. There is no sound evidence that switching to smokeless products is as or more effective than the many proven methods for quitting, such as nicotine replacement, antidepressants, behavioral counseling and, for many people, cold turkey. Smokers who use these products to postpone quitting, by assuaging their nicotine craving in settings where smoking is prohibited and then lighting up wherever possible, will greatly increase their risk of lung cancer and other smoking related diseases by prolonging the duration of their smoking. The last time U.S. tobacco companies aggressively marketed smokeless products they stimulated a large increase in use of these products among adolescent males but very little switching among smokers. If the manufacturers of these products are truly committed to health, why don't they reduce the nitrosamine content in all smokeless products to the lowest level feasible and support FDA regulation that bans unproven health claims? If we aren't going to ban tobacco outright, let's get beyond the medieval arguments that all tobacco is "bad," and let's start having a serious, transparent dialogue on how to ensure that consumers and the public understand the risks and relative risks of all tobacco and nicotine products. Regulation coupled with competition can be a win-win solution. If done correctly, in the end, public health wins, consumers win, tobacco growers win, and responsible and accountable tobacco and pharmaceutical companies win. Let's hope that if and when this legislation is considered in the House it will be done openly, transparently, and democratically as promised by the new House leadership when it took power in January.
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