Is smokeless tobacco really safer?

If you got ’em, snuff ’em.

North Carolina lawmakers have finally agreed to a statewide ban on smoking in most bars and restaurants and Gov. Perdue cheerfully signed the legislation into law last week.

This is a big deal in the land of the golden leaf and was until recently about as likely around here as a blizzard in July.

Tobacco has meant a lot to this state. It still does.

But it is inherently dangerous, not only to smokers, but to those unlucky enough to be near them.

Smoking also is smelly, unclean and disgusting. How could anyone ever have considered inhaling noxious chemicals, then blowing them back into the faces of others, socially acceptable?

Even so, many smokers insist they’ve been burned. Nonsmokers have a right to choose where they eat and drink, they say. They can choose not to patronize hazy bars and eateries.

Smokers have a right to choose as well. Maybe now they’ll choose to quit. Maybe the sheer frustration of finding somewhere to light up will make them throw up their hands … give up, quit, desist. And stop standing alone in the cold, doing something they know is bad for them.

But even that part of the equation is a source of controversy.

At issue is an approach called “harm reduction.”
Harm reduction proponents say one viable path to quitting smoking ought to be a lesser evil: smokeless tobacco products.

But can’t smokeless tobacco kill you just as dead as cigarettes?

Well, yeah, they concede, but smokeless tobacco is less likely to be fatal. And smokers can wean themselves off cigarettes by switching to other products such as snuff and chewing tobacco.

Brad Rodu, an oncology professor at the University of Louisville, argued passionately in these pages that smokeless tobacco provides a nicotine fix without causing smoking-related diseases. “Unlike cigarettes, smokeless doesn’t cause lung cancer, heart disease or emphysema,” he wrote. “The health risks from smokeless are only about 1 to 2 percent those of smoking. Statistically, lifelong smokeless users have about the same risk of dying from that habit as automobile users have of dying in a car wreck.”

Further, smokeless tobacco does not produce smoke, hence it eliminates the dangers of secondhand smoke.

Don’t reach for that pouch of chew just yet.

Smokeless tobacco contains at least three known carcinogenic agents: N-nitrosamines, polycyclic aromatic hydrocarbons and radioactive polonium 210. It increases the threat of various oral cancers. It also has been associated with esophageal, pancreatic, prostate and kidney cancer, possibly even heart disease, says Dr. John Spangler of the Wake Forest University School of Medicine.

And when it does kill, it can do so with a vengeance.

Even for those who survive, it can leave behind scars and disfigurement, including the removal of all or part of the jaw and the loss of the ability to chew, smile, swallow or kiss.

Further, it already appeals to young people. According to the National Cancer Institute, smokeless tobacco use already is most common among adults ages 18 to 25.

Promoting it as a safe alternative could encourage even more use by young people.
Coincidentally, the company formerly known as Philip Morris, Altria Group, sees smokeless tobacco products as an integral part of its growth strategy. Altria Chief Executive Michael E. Szymanczyk told shareholders last week that the company’s recent acquisitions and emphasis on smokeless products placed it in a “strong position” for long-term growth. Those alternatives include chewing tobacco and moist snuff known as “snus,” some marketed under the popular Marlboro brand.

Forgive me if I’m not impressed.

Neither is Wake Forest’s Spangler, who directs tobacco intervention programs at the medical school. “Those who argue in favor of smokeless tobacco as a means to quit smoking —an ‘alternative’ to cigarettes, if you will — ignore the fact that there is not a shred of scientific evidence showing, in a randomized, controlled clinical trial setting, that smokeless is effective in helping patients quit smoking,” Spangler says.

“This is the level of evidence that the FDA requires before a drug company can market a drug. We should insist on that level of evidence before we start pushing a product that is already known to be unsafe.”

Harm reduction can be an effective approach in some cases — for example, providing clean needles to drug addicts to help control the spread of AIDS. But not in this instance, when other, safer alternatives such as nicotine patches are readily available.

Those who are considering going smokeless should chew on that first

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