By Lisa Seachrist Chiu
Snuffing Out Smoking
Some advocates of smokeless tobacco say it's a safer alternative to cigarettes. But should it be promoted?
By Lisa Seachrist Chiu
Inveterate smokers are the focus of a controversial idea: that they switch to smokeless tobacco to reduce the more harmful aspects of smoking while still getting the nicotine that sates their cravings. The impetus for such a strategy is experience in Sweden, where packets of moist snuff known as snus—it rhymes with moose—have contributed to one of the lowest smoking rates in the world.
That’s not to say snus is harmless, even though it contains far less of the cancer-causing tobacco-specific agents, known as nitrosamines, found in cigarette smoke. Using snus doubles the risk of pancreatic cancer compared with the risk for people who’ve never used any tobacco product. Still, some people have begun to view products like snus as a means to reduce the toxins inhaled from smoking.
Jonathan Foulds, the director of the tobacco dependence program at the University of Medicine and Dentistry of New Jersey School of Public Health, in New Brunswick, maintains it isn’t appropriate for health professionals to advocate the use of tobacco products to their patients when medicinal forms of nicotine replacement, such as patches, gums and nasal sprays, are readily available, safer and have been proved effective. However, he also doesn’t believe it was appropriate for former Surgeon General Richard H. Carmona to testify before Congress in June 2003 that the use of smokeless tobacco is not a safe alternative to cigarettes. “I don’t think that we should be lying to people and telling them that smokeless tobacco is as risky as cigarettes,” says Foulds.
“Low-nitrosamine smokeless tobacco products are at least 90 percent safer than smoking cigarettes,” says Foulds. “It is just reasonable to me that you would let the public know that smokeless tobacco is less harmful by far than smoking.”
American smokeless tobacco does not have the same risk profile as Swedish snus, however, says Dorothy Hatsukami, a professor of psychiatry and an adjunct professor of psychology and epidemiology at the University of Minnesota in Minneapolis. “Plus, we don’t have any idea what toxicants are in the products because they are completely unregulated by [the Food and Drug Administration (FDA)],” she says. “In Sweden, the manufacturers voluntarily adhere to a low nitrosamine standard” and low standards of other toxicants as well.
Even if proposed legislation passes to give the FDA the authority to regulate the tobacco industry and to force companies to disclose the contents of tobacco products, Hatsukami questions whether the U.S. would realize the low smoking rates seen in Sweden.