The Scientific Rationale
According to the CDC, 46 million Americans smoke, and 419,000 of them die annually from smoking-related illnesses such as heart and circulatory diseases, lung cancer and emphysema. The price smokers pay in terms of reduced life expectancy is staggering. We reported in a 1994 paper published in Nature that lifelong smokers live an average of eight years less than do nonusers of tobacco.
Contrary to a popular misperception, all forms of tobacco are not equally risky. Smokeless tobacco causes neither lung cancer nor other diseases of the lung, and users have no excess risk for heart attacks. In fact, the only consequential -- but infrequent -- adverse health effect of smokeless tobacco use is oral cancer. In 1981, writing in the New England Journal of Medicine, Dr. Deborah Winn and colleagues established that smokeless tobacco users are four times more likely to develop oral cancer than are nonusers of tobacco. However, this relative risk is only about one half the relative risk of oral cancer from smoking.
In Table 1 we compare directly the annual mortality of 46 million smokers with an equal number of smokeless tobacco users. The number of deaths from smoking is almost 70 times higher than the number from smokeless tobacco use. In terms of life expectancy, the smokeless-tobacco user loses only about 15 days on average, compared with the eight years lost by the smoker.
Disease
|
Smokers
|
Smokeless Tobacco Users
|
Cancer
|
151,000
|
6,000
|
(Mouth Cancer)
|
(11,500)
|
(6,000)
|
Heart and Circulatory
|
180,000
|
0
|
Respiratory
|
85,000
|
0
|
Miscellaneous
|
3,000
|
0
|
Total
|
419,000
|
6,000
|
Years of Life Lost
(Average)
|
7.8
|
0.04
|
Note: Table adapted from:
- Centers for Disease Control. Cigarette smoking-attributable mortality and years of potential life lost -- United States, 1990. Morbidity and Mortality Weekly Report 42: 645-649, 1993.
- Rodu, B. An alternative approach to smoking control. The American Journal of the Medical Sciences 308: 32-34, 1994.
- Rodu, B., Cole, P. Tobacco-related mortality. Nature 370: 184, 1994.
Another major health benefit: smokers who switch to smokeless tobacco produce no passive smoke to harm others. The American Heart Association estimates that 40,000 Americans die annually from diseases related to second-hand smoke. No one dies from the secondary effects of smokeless tobacco use. Thus, this proposal could be recommended solely on the basis of lives saved through the elimination of the effects of passive smoking.
These published facts are, insofar as we are aware, unrefuted. But a transition to smokeless tobacco is not merely a scientifically based strategy of smoking cessation; it is already a practical reality. |
