Is Smokeless Tobacco Effective in Reducing Cigarette Smoking and Tobacco-Related Harms?

Member Commentary by Brad Rodu

Published in the Newsletter of the Society for Research on Nicotine and Tobacco, February/March 2005

Tobacco harm reduction is based on two straightforward propositions:

• Smokeless tobacco (SLT) use is vastly safer than smoking.
• Smokers have a fundamental right to information about safer tobacco products, and health professionals have an ethical mandate to provide it.

      It is clear from recent SRNT listserve debates that some members dismiss any research that is even remotely supported by the tobacco industry (in my case recent support apparently even taints my earlier unfunded studies as well).  But many are open to independent research.  That exists, in the form of three recent publications – entirely untarnished by tobacco industry funding.        
      The first is a review of the cardiovascular effects of SLT by Dr. Kjell Asplund (1), now the Director-General of Sweden’s National Board of Health and Welfare and an international cardiovascular disease expert.  Funded entirely by Swedish research foundations, Dr. Asplund conducted an extensive review of epidemiologic and laboratory studies relevant to SLT use and cardiovascular disease risk.  He concluded that “In all, the use of SLT (with snuff being the most studied variant) involves a much lower risk for adverse cardiovascular events than smoking does.”
      The second article reviewed the scientific evidence for the adverse health effects of SLT as claimed in brochures from prominent health organizations such as the American Lung Association, the American Cancer Society, the American Academy of Otolaryngology, the American Dental Association, and the National Cancer Institute (2).  The study was conducted by investigators from epidemiology, dentistry, psychology and the Comprehensive Cancer Center at the University of Alabama at Birmingham, and it was funded by the National Cancer Institute.  The investigators asked a simple question: Are the claims regarding adverse health effects of SLT use supported by scientific evidence? 
Here are some of the claims regarding SLT, followed by the researchers’ assessments:

• Pharynx and larynx cancer.  (The scientific evidence: no relationship.) 
• Lung cancer.  (Scientific evidence: inadequate.)
• Stomach cancer.  (Scientific evidence: not persuasive.)
• Kidney cancer. (Scientific evidence: no association.)
• Esophageal cancer.  (Scientific evidence: not persuasive.)
• Pancreatic cancer.  (Scientific evidence: inconclusive.)
• Breast cancer.  (Scientific evidence: none.)
• Bladder cancer.  (Scientific evidence: none.)
• Bad breath.  (Scientific evidence: none)

      What is the study’s most surprising finding?  Virtually all of the four dozen brochures examined by the UAB researchers claimed unequivocally that smokeless tobacco use causes oral cancer.  The scientific evidence: not decisive.  The investigators concluded that “Many brochures overemphasize the risk of oral cavity cancer, reaching beyond the scientific data.”
            Finally, a new study, funded by the National Cancer Institute and co-written by prominent tobacco researchers, emphasizes the differential risks of SLT use versus smoking (3).  The authors recruited an international panel of eight epidemiology experts (from institutions such as University College London, University of Vienna [Austria], Johns Hopkins University, Georgetown University, Columbia University, the American Cancer Society and the National Cancer Institute).  The panel concluded that modern smokeless tobacco products have only 5-9% of the health risks of smoking. 
The report’s concluding sentence comments on the inappropriate campaign of misinformation by anti-tobacco extremists:
“This finding [substantially lower risks of smokeless products] raises ethical questions concerning whether it is inappropriate and misleading for government officials or public health experts to characterize smokeless tobacco products as comparably dangerous with cigarette smoking.”
Brad Rodu
Professor, Department of Pathology
Senior Scientist, Comprehensive Cancer Center
University of Alabama at Birmingham
Disclosure: www.smokersonly.org
References:

1. Asplund K.  Smokeless tobacco and cardiovascular disease.  Progr Cardiovasc Dis 45: 383-394, 2003.
2. Waterbor JW, Adams RM, Robinson JM, et al.  Disparities between public health educational materials and the scientific evidence that smokeless tobacco use causes cancer.  J Cancer Educ 19: 17-28, 2004.
3. Levy DT, Mumford EA, Cummings KM, et al.  The relative risks of a low-nitrosamine smokeless tobacco product compared with smoking cigarettes: estimates of a panel of experts.  Cancer Epidemiol Biomarkers Prev 13: 2035-2042, 2004.