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The Failed American Anti-Smoking Campaign

Recently Britain’s Royal College of Physicians, one of the world’s most prestigious medical societies, issued “Protecting Smokers, Saving Lives. The report has enormous implications for American tobacco policy, because it represents the first acknowledgment by a health organization that smokeless tobacco is safer than cigarettes. The report states “As a way of using nicotine, the consumption of non-combustible [smokeless] tobacco is on the order of 10-1,000 times less hazardous than smoking, depending on the product.”

The report suggests that some smokeless tobacco manufacturers may want to market their products “as a ‘harm reduction’ option for nicotine users, and they may find support for that in the public health community.” But some tobacco control advocates here in the US wish to deny smokers this life-saving information. They are prohibitionists, obsessed with tobacco abstinence and with a public health strategy: quit smoking or die.

Prohibitionists control the American anti-smoking campaign, and they are not inclined to help inveterate smokers, who are irreversibly addicted to nicotine and can not quit. Prohibitionists stifle innovation by transforming every discussion of tobacco control into a children's issue. Eliminating children’s access to tobacco is important, but the 10 million American smokers who will die over the next two decades are not now children. They are adults.

Prohibitionists offer inveterate smokers only “behavior therapy” and the temporary use of expensive medications (eg gum and patches) that provide insufficient doses of nicotine. This tired quit-or-die tactic has a long record of overwhelming failure. According to the federal Centers for Disease Control, 440,000 Americans die each year from diseases caused by smoking. The toll in Georgia is almost 10,300.

Prohibitionists claim success by pointing to slowly declining smoking rates, but these measures are subject to underreporting (as smokers are demonized) and fluctuation (as smokers try and fail to quit). They do not provide an adequate picture of smoking in society, or of the impact of smoking control efforts. Lung cancer is a far better measure because it is an index of how many smokers die. By this measure the campaign has made little progress in helping the nation’s 20 million inveterate smokers to quit. Lung cancer deaths in the US declined only 2% during the 1990s. Lung cancer deaths in Georgia declined only marginally during the 1990s and remained 8% above the national average.

Prohibitionists acknowledge that nicotine is powerfully addictive, but they deny the reality that nicotine causes none of the diseases that kill smokers. They vigorously oppose telling smokers about nicotine sources such as smokeless tobacco, which is 98% safer than smoking. They ignore the evidence from Sweden where, over the past century, men have smoked less and used more smokeless tobacco than in any other Western country. The result: Swedish men have the lowest rates of lung cancer and of all smoking-related deaths in the developed world. Smokeless use carries half the risk for mouth cancer as smoking, so Swedish men have low rates of this disease as well.

The Swedes have adopted "harm reduction," by substituting relatively safe smokeless tobacco for cigarettes. Our research documents that if all American smokers had instead used smokeless tobacco, annual tobacco-related mortality would be only two percent of the current figure. That’s saving about 430,000 lives per year nationally over in Georgia.

This information does not bring joy to American anti-smoking advocates. Many remain hostile to harm reduction and insist that the only acceptable solution to smoking is abstinence. With stable smoking rates, this is an approach cigarette manufacturers can live with. For more than half of inveterate smokers, it’s an approach they will die with.

The tobacco industry has been under scrutiny for 50 years--and rightfully so. Now, moderate and reasonable persons in the anti-smoking campaign, and the public at large, must scrutinize the anti-tobacco industry and its failed policies and practices. It is time that those policies and practices change.