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Smoking Cessation Vs. Harm Reduction ------04 Former Director (1997-2003), Lars M

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Smoking Cessation Vs. Harm Reduction ------04 Former Director (1997-2003), Lars M THE AMERICAN COUNCIL ON SCIENCE AND HEALTH PRESENTS Dr. Elizabeth Whelan, President ACSH, 1995 Broadway 2nd Floor, New York, NY 10023 ACSH PRESENTS Helping Smokers Quit: A Role for Smokeless Tobacco? by Kathleen Meister, M.A. for the American Council on Science and Health Based on a paper by Dr. Brad Rodu and William T. Godshall, M.P.H. Art Director: Jennifer Lee October 2006 AMERICAN COUNCIL ON SCIENCE AND HEALTH 1995 Broadway, 2nd Floor, New York, NY 10023-5860 Phone: (212) 362-7044 • Fax: (212) 362-4919 URLs: http://acsh.org • http://HealthFactsAndFears.com E-mail: [email protected] This manuscript is a position statement of the American Council on Science and Health. The author gratefully acknowledges the assis- tance of the following ACSH staff who provided critical reviews of content and perspective, especially with regard to the policy sec- TABLE OF CONTENTS tions of the report. Elizabeth M. Whelan, ScD, MPH Gilbert Ross, MD President and Founder Medical/Executive Director Foreword by Sally Satel, MD ------ 01 Executive Summary ------ 02 The author also gratefully acknowledges the following individuals, who provided peer reviews, critical analysis, commentary, and sug- gestions during the development of this review, and whose names Introduction ------ 02 have been listed with their permission: Cigarette Smoking: Scott D. Ballin, JD Carl V. Phillips, PhD It's Even Deadlier Than You Think ------ 03 Tobacco and Health Policy Associate Professor, University Consultant of Alberta School of Public Washington, DC Health Nicotine: Addictive But Not Deadly ------ 03 Edmonton, AB, Canada Clive Bates Smoking Cessation vs. Harm Reduction ------ 04 Former Director (1997-2003), Lars M. Ramstrom, PhD Action on Smoking and Health, Director, Institute for Tobacco UK Studies Smokeless Tobacco Products ------ 04 London, United Kingdom Stockholm, Sweden Health Effects of Smokeless Tobacco ------ 05 Ronald W. Brecher, PhD, DABT, William O. Robertson, MD C Chem Medical Director, Washington Principal, Globaltox: Toxicology Poison Center Does Switching to Smokeless Tobacco Work? ------ 06 Focused Solutions Seattle, WA Guelph, ON, Canada Health Policy Questions ------ 06 David Schottenfeld, MD Emil William Chynn, MD, FACS, Professor Emeritus, School of MBA Public Health, University of Conclusions and Recommendations ------ 08 Medical Director, Michigan IWANT2020.com, Inc. Ann Arbor, MI Appendix: New York, NY Peter G. Shields, MD Examples of Smokeless Tobacco Products ------ 09 Michael Dubick, PhD Prof. Medicine/Oncology, Dir. Senior Research Cancer Genetics/Epidemiology, Pharmacologist, US Army Georgetown Washington, DC Institute of Surgical Research San Antonio, TX Robert B. Sklaroff, MD Elkins Park, PA ACSH accepts unrestricted grants on the condition that it is solely Dwight B. Heath, PhD Department of Anthropology, Jacob Sullum responsible for the conduct of its research and the dissemination of Brown University Senior Editor, Reason its work to the public. The organization does not perform propri- Providence, RI Dallas, TX etary research, nor does it accept support from individual corpora- tions for specific research projects. All contributions to ACSH—a Rudolph J. Jaeger, PhD, DABT, David T. Sweanor, BA (Hon), publicly funded organization under Section 501(c)(3) of the REA (California) LLB Internal Revenue Code—are tax deductible. Consulting Toxicologist, Adjunct Professor of Law and Environmental Medicine Inc. Medicine, University of Ottawa Individual copies of this report are available at a cost of $5.00. Westwood, NJ Ottawa, ON, Canada Reduced prices for 10 or more copies are available upon request. Michael Kunze, DrMed John W. Waterbor, MD, DrPH Professor, Institute of Social Associate Professor of Copyright © 2006 by American Council on Science and Health, Medicine, Medical University Epidemiology, University of Inc. This book may not be reproduced in whole or in part, by Vienna Alabama at Birmingham mimeograph or any other means, without permission. Vienna, Austria Birmingham, AL FOREWORDBy Sally Satel, M.D. smokeless tobacco is far safer than cigarettes. Even mouth cancer is only about one-third to one-half as For decades, public health advocates have champi- likely with traditional chewing tobacco and moist snuff oned harm reduction for people who either can't or products as with smoking. don't want to stop taking health risks. Needle exchange is a classic example. If intravenous drug It is rare to find such a powerful cause-and-effect rela- users get clean needles, the reasoning goes, their tionship in health epidemiology as the one between risk of contracting HIV and spreading it will be snus and reduction in lung cancer incidence and mor- reduced. tality. The other best example, it turns out, is the dan- ger of cancer posed by smoking itself. Repeat: from Smoking is another dangerous addiction. While there smoking, not from nicotine per se. is no denying that public education has done some good, more than 40 million Americans continue to Public health experts have for years endorsed harm smoke. We must face the fact that a smoke-free coun- reduction as a pragmatic last resort for hard-core sub- try is a pipe-dream. stance users. For heroin they advocate needle exchange and even supervised distribution of heroin So what about harm-reduction for committed smok- itself. For problem drinkers they have suggested ers? Unfortunately, the smoking-cessation lobby drinking in moderation. In Seattle, new public housing wants nothing to do with it. Its “experts” insist on programs for homeless alcoholics allow drinking in pushing a quit-or-die philosophy even in the face of the privacy and safety of their own apartments – a overwhelming evidence that there already exists a controversial move that is based on the tenet of harm life-saving alternative to cigarettes: smokeless tobac- reduction: that relative safety can accrue to the user co. and society even if he or she does not relinquish an addiction. The safest types are modern products like snus, or Swedish moist snuff, and a host of similar products It is ironic that much of the public health community available in the U.S. Crucially, they satisfy smokers' accepts such radical accommodations for people nicotine addiction and cause negligible health risks of addicted to intoxicants but resists the use of smoke- their own. All of these products are held discreetly less tobacco to treat an addiction that afflicts a far between lip and gum, releasing nicotine, and because greater percentage – and causes far more suffering they do not stimulate saliva production there is no from disease and death. spitting. Significantly, the blood levels of nicotine obtained with smokeless are higher than those asso- In documenting the evidence on the relative benefits ciated with gum or a patch; this is why smokeless has of smokeless tobacco as compared to smoking, this such a powerful anti-craving effect. report serves another invaluable function: It makes the powerful case that most of what people believe Even better, there is no smoke. they know about the product is outdated, wrong or both. Lamentably, the public has been subject to a And this is key. Tobacco smoke, with its thousands of vast miasma of misinformation, generated, some- toxic agents, can lead to cancer, heart disease and times deliberately, by anti-tobacco zealots and, per- emphysema. Eliminate the smoke, and you signifi- haps unwittingly, by the U.S. Department of Health cantly reduce the risk. To put it bluntly: it's the smoke, and Human Services. stupid. Reducing the harm from cigarettes depends on This comprehensive and indispensable monograph responsible science. One can ponder the political from The American Council on Science and Health agendas driving the anti-smokeless lobby, but what- presents the latest epidemiological findings on ever their motives, distorting the truth about smoke- smokeless tobacco and offers wise policy recommen- less tobacco is a grave disservice to millions of dations. The authors draw on an impressive archive American smokers. This clearly written and exhaus- of Swedish data, which is both long-ranging and tively researched monograph is a potent antidote to much-replicated. bad science and a life-saving prescription in itself. Although 40% of Swedish men use tobacco products, the same rate for men in the other 14 countries in the Dr. Satel, a psychiatrist, is a resident scholar at the European Union, Sweden has the lowest rate of lung American Enterprise Institute. She is a widely-pub- cancer by far. Why? Largely because of snus. What’s lished expert in addiction and harm reduction. more, over 20 epidemiological studies show that 1 EXECUTIVE SUMMARY According to the Centers for Disease Control and modern smokeless tobacco products. It reviews Prevention, about 45 million Americans continue to the epidemiologic evidence for low health risks smoke, even after one of the most intense public associated with smokeless use, both in absolute health campaigns in history, now over 40 years old. terms and in comparison to the much higher risks Each year some 438,000 smokers die from smok- of smoking. The report also describes evidence ing-related diseases, including lung and other can- that smokeless tobacco has served as an effective cers, cardiovascular disorders, and pulmonary dis- substitute for cigarettes among Swedish men, who eases. consequently have among the lowest smoking- related mortality rates in the developed world. The Many smokers are unable – or at least unwilling – report documents the fact
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