Smokeless Alternative to Smoking

New York Times | April 6, 2004 | Sally Satel, M.D.

[at bay]

For decades, public health advocates have championed harm reduction for people who cannot stop taking health risks — or do not want to. Needle exchange is a classic example. Intravenous drug users get clean needles because, the reasoning goes, contracting and spreading AIDS is worse than making heroin use a little easier.

But harm reduction for hard-core smokers is another matter.

At issue is a form of smokeless tobacco, a popular Swedish product called snus (rhymes with loose) that satisfies smokers' nicotine addiction with negligible health risks of its own. But to many foes of smoking, it is not a lifesaver, but the devil's instrument.

Snus, moist oral tobacco, comes in a tiny tea bag. It sits discreetly between lip and gum. Because it does not stimulate saliva production, there is no spitting. Even better, there is no smoke.

"It is the tobacco smoke, with its thousands of toxic agents, that leads to cancer, heart disease and emphysema," said Dr. Brad Rodu, a pathologist at the University of Alabama at Birmingham.

Eliminate the smoke, and you significantly reduce the risk.

Snus, a Swedish version of snuff, is especially attractive to smokers because it produces nicotine levels comparable to smoking. Gum and the patch administer too little nicotine to reliably prevent craving and withdrawal symptoms.

The health benefits are impressive. Forty percent of Swedish men use tobacco products. Yet Sweden has the lowest rate of lung cancer by far. Why? Largely because of snus, which represents half of all the tobacco that Swedish men use. (The other half smoke.) Snus has not caught on with women.

Smoking opponents should herald snus. But instead, the very notion of harm reduction inflames them.

"It's like trying to play God trading oral cancer for lung cancer," said Dr. Gregory Connolly of the Massachusetts Tobacco Control Program.

Over 20 epidemiological studies show that smokeless tobacco is far safer for mouth cancer than cigarettes. Even traditional smokeless products bring one-third to one-half the risk. Users of snus, which contains low levels of tobacco-specific nitrosamines, a carcinogen, incur a risk of developing oral cancer no greater than nonsmokers, the journal Tobacco Control reported last year.

What about gateway effects? Clearly, if using smokeless tobacco turns people on to nicotine and they "graduate" to smoking, it fails as a public health strategy. But Sweden has the best record of smoking reduction in Europe. Moreover, the proportion of current smokers who are former snus users is far less than the proportion of snus users who once smoked.

[at bay]

Dr. Dean Edell has been saying this for years--greatly reduce the risk by not lighting it. Snuff was popular a lot longer than cigarettes have been. As a delivery system it's a lot safer. Too bad it lost out to a far deadlier delivery system. And one that affects anyone within the exhaler's reach.

Well apparently the Swedish men have changed. Who knows how it might catch on. Might be easier than making the chimney act a raison d'etre (whoops, French, still I can't think of a synonym).

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[Arkinsaw]

I successfully quit smoking several months ago with the aid of the gum. Once I got on the gum I realized that I could stay on the gum forever. No smoke and it was cheaper. I finally started biting the gum in half and slowly substituting it with Trident until completely off.

[Esther Ruth]

Darn, I thought this was going to be about those candy cigarettes we had when we were kids.

[angry elephant]

My husband quit smoking in 1981. In 1992 he started chewing cigars for five years. He quit that, but in January of 2003 he was diagnosed with small-cell throat cancer, one of 18 cases ever diagnosed. They killed the throat cancer but it migrated to his liver and he passed away in February 2004 after various chemo therapies. Of course, no one knows whether his five-year chewing experience caused the rare form of throat cancer, but it is suspicious. Small-cell cancer is more closely linked to smoking than other cancers, but it is generally in the lung.

[DestroytheDemocrats]

I quit two years ago. I actually would have just switched to gum permanently. I like the stuff, but it is too expensive. I hate cigarettes now but sometimes I miss the gum.