A Smokeless Alternative to Quitting

NY Times ^ | April 6, 2004 | SALLY SATEL, M.D.

[neverdem]

COMMENTARY

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.

In short, snus has largely been a pathway away from smoking, not vice versa. Dr. Lynn T. Kozlowski of the biobehavioral health department at Penn State, found that more than three-fourths of men from 18 to 34 who used smokeless tobacco never went beyond it to cigarettes or had used cigarettes before using smokeless products.

Swedish snus and brands of compressed tobacco like Ariva, Exalt and Revel are available in this country but are hard to find. Most smokers have never heard of them, and many doctors are unfamiliar with the products.

The government, rather than clearing the air, is muddying it. Last year, the surgeon general, Dr. Richard H. Carmona, told Congress, "There is no significant scientific evidence that suggests smokeless tobacco is a safer alternative to cigarettes." This is simply wrong in the case of smokeless tobacco in general, and snus in particular.

"Tips for Teens" from the Department of Health and Human Services answers the question, "Isn't smokeless tobacco safer to use than cigarettes?" with an emphatic — and erroneous — "no."

"I suppose you could argue that shooting yourself in the leg poses less of a health risk than shooting yourself in the head," a former president of the American Dental Association, Dr. D. Gregory Chadwick, said. "But do we really need to have that discussion?"

Yes, we do. Experts have for years endorsed harm reduction as a pragmatic last resort for addicts, because they are convinced of the relative safety that accrues to the user and society.

No one disputes that quitting is optimal. But that is not practical in every case. Snus in particular, and smokeless tobacco in general, provide clear, lifesaving advantages over smoking that antitobacco activists refuse to acknowledge.

Sally Satel is a psychiatrist and a resident scholar at the American Enterprise Institute.

[neverdem]

PING

[Support Free Republic]

---

	Donate Here By Secure Server Or mail checks to FreeRepublic , LLC PO BOX 9771 FRESNO, CA 93794 or you can use PayPal at Jimrob@psnw.com
STOP BY AND BUMP THE FUNDRAISER THREAD- It is in the breaking news sidebar!

[risk]

I thought this was an article about an alternative to nuclear weapons.

[metesky]

Because it does not stimulate saliva production, there is no spitting.

Hey, if I can't make a killing being the new cuspidora king, I ain't interested!

Ah, my fedora,
Don't spit on the floor-a,
Spit in the cuspidora,
That's what it's for-a!

[Jaysun]

I once was a smoker and can attest to how hard it is to stop. I tried lots of things that didn't work - including nicotine gum (that gum is a rip off - it won't stay lit long enough for even one tiny puff).

I finally took the advice of a friend and tried an unconventional approach. His recipe for success was as follows:

First, place your ashes and butts in a jar until it's about 50% full. Second, put enough beer into the jar to cover the ashes and butts. Third, place in the sun for at least a week. Finally, stop smoking. Every time you crave a cigarette just grab the jar and smell it for as long as you can.

I puked so much in the first few days that I lost 40 pounds, but the trick worked. It made cigarettes revolting to me. I discovered that it also works on several other things. My sister used the method to cure herself of anorexia nervosa. My coworker claims that he has used "the jar" to stop one of his kids from picking his nose, and the other from a nasty toenail biting habit. I plan on researching this phenomenon further so that I can write a book. I've already picked out a name, "The Jars of Life"

[MEG33]

ROFL!

[Izzy Dunne]

I once was a smoker and can attest to how hard it is to stop.

I once was a smoker ane it was easy to stop - so easy that I did it 15 or 20 times !

;->

Sounds like you found a way to do it - Great. Perhaps you can market it (I can see the infomercial now...)

[fdsa2]

Good article!

As obiter dicta I can reveal that the Swedish membership in the EU was conditioned with a permission to market and sell snus in Sweden. In June/July the ban on marketing snus within EU will be on the council agenda.

[moonman]

ROFLMAO

A jar of picked buggars and a jar of bit-off toenail clippings... yuck! Maybe if the toe nail clippings also include the jam, it wouldn't be too bad. LOL

[Possenti]

But you're wasting beer!

Seriously, quitting is the hardest thing for me. Over the years I tried the patch, gum, and even hypnosis.

I'd be willing to try this "snus" stuff, as long as it didn't make me sick like chewing and snuff.
I swear I turned green when I tried it. No thanks...

[Ragtime Cowgirl]

Lol!

I smoked for years.

Still love the smell, but have no desire to start again.

Couldn't quit until our troops went to Afghanistan. Then had to make some tiny sacrifice, just to thank them in my heart...sounds so corny, but it worked.

Cheap - and quick. Smoked my last cigarette on New Year's Eve, 2001.

Thank you, troops!

[Bloody Sam Roberts]

...a popular Swedish product called snus (rhymes with loose)...

Snus also rhymes with møøse.

Nø, realli, it does.

[Jaysun]

Sounds like you found a way to do it - Great. Perhaps you can market it (I can see the infomercial now...)

The only way I'll do an infomercial is if I can work with that loud mouthed guy that always wears sweaters and pretends to "talk your price down" at the end of the show:
ME: Mike, you get TWO jars for $49.95
MIKE: Aww...Come on we need a better deal...riiiggght audience?
ME: Mike, you're a hell of a salesman. You could sale alcohol free beer to an Irishman. I tell you what, I'll sell you not one, not two, but THREE JARS for $19.95
MIKE: Whoooaaa! They could use this deal as psychiatric test...because anyone who refuses this should be in a straight jacket!
ME: And if you promise to tell a friend, I'll throw in this mailbox repair kit absolutely free
MIKE: (having seizures educed by disbelief)

[Jaysun]

A jar of picked buggars and a jar of bit-off toenail clippings... yuck! Maybe if the toe nail clippings also include the jam, it wouldn't be too bad.

I didn't really put a lot of thought into the buggars and toenail clippings until now....ewwww! Sweet Sassy Molassy, that makes me shudder!

[Jaysun]

Seriously, quitting is the hardest thing for me. Over the years I tried the patch, gum, and even hypnosis.

Seriously, the patch didn't work? That's what did it for me. The patch and I'd also chew the gum (they said that it's dangerous - too much nicotine - ho hum) until my mouth would go numb. It worked for me.

[daylate-dollarshort]

I'm torn between smoking and quitting.

I just got released from the hospital yesterday evening after 56 days confinement. My heart condition arrived as a complete and total surprise. I've never had any prior indication of trouble.

Had a pain in the chest after retiring to bed. Not a severe pain, just enough to prevent sleep. I decided to go to the ER and bam! -transferred to a large hospital facility in an neighboring community. Seven by-passes and five major surgeries later I made it home.

All the Dr's involved agree that I never had a heart attack, no MI, no heart damage. All also agreed that if there had been no intervention I would have succumbed to a massive heart attack within a very short time.

What apparently saved me WAS that I smoked. Something called the "Smoker's Paradox.

Seems as though smokers survive heart attacks better than non-smokers with 22% of smokers dying from the heart attack compared with 33% of non-smokers dying. Has something to do with carbon monoxide levels, stiffer lungs, less prone to pulmonary conjestion and lower blood pressure.

While I found this facinating It doesn't help me make my decision to quit or not. I am not currently smoking (though the cravings are eating me up).

This has been the most frightening experience of my life. I hope to continue to recover but it's awfully easy to get discouraged.

[mcshot]

1,000 Atta-girls to you.
Now that's healthy Patriotism.
mc

[Capriole]

a nasty toenail biting habit

A WHAT??

[Dog Gone]

I wonder how these products differ from Skoal Bandits. It sounds like the same thing.