Smokeless tobacco likely less harmful than failed attempts to quit
smoking
Here in the United States, as in Europe, many health experts are reluctant to tell smokers about the relative safety of smokeless tobacco — or "snuff" as it is often referred to in the United States.
That’s understandable. Tobacco is undeniably bad for you. Smoking is the leading preventable cause of death in the U.S., and is estimated to cause the premature deaths of some 4 million people around the globe every year. But using snuff and smoking are two different things, with
vastly different health consequences.
Appearing at an American Council on Science and Health symposium last year, Dr. Phil Cole, professor emeritus of the department of epidemiology at the University of Alabama at Birmingham School of Public Health, said that as many as half of smokers arguably die
prematurely from their habit while only about one-half of 1 percent of smokeless tobacco users die from the usage of snuff (mainly from oral cancers).
This does not mean that people who are neither smokers nor snuff users should be encouraged to take up smokeless tobacco, of course, but it would clearly be beneficial for smokers to switch to smokeless tobacco if they cannot quit altogether. Nicotine addiction is not going
to go away, but we can at least use smokeless tobacco as a means of "harm reduction."
Cole points to Sweden as an example of a country that has seen an encouraging decline in smoking due in part to increased use of smokeless tobacco. Sweden now has the lowest smoking rate in Europe and has the highest rate of smokeless tobacco use.
The zealous streak so common in public health advocates rebels at the notion of using one vice as the solution to another. There is a great deal of resistance in the U.S., for example, to the idea that moderate drinking may be a more realistic goal than abstinence for some
alcoholics.
The Alcoholics Anonymous model of treatment and recovery, in which even one drop of liquor is considered a relapse, is more puritanical than the harm reduction approach. Puritanical is an apt description, since AA does quite literally grow out of revivalist religion
traditions, complete with calls for admitting that one is powerless to control one’s own life and that it is time to turn one’s life over to a higher power, which is arguably an embrace of weakness of the sort that turns some people into alcoholics.
The world is not neatly divided into things that are all good and things that are all bad, nor is everything either riskfree or instantaneously deadly. It is tempting to think of things that way,
though, which is how we end up living in a world in which, for instance, many people assume their own political party is completely virtuous and the opposing party completely corrupt. It is tempting to think, dualistically, that no good can ever come from marijuana use or that nothing bad can come of using an "allnatural" product.
But inconveniently for our dualistic, absolutist brains, the world usually offers us subtle trade-offs, degrees of risk and benefit, and we do a disservice to public debate by stubbornly pigeonholing things into the All-Good and All-Bad categories. Public health advocates fearful of sending an unprincipled or hopelessly mixed message could always tell people: Quitting tobacco altogether is desirable but using smokeless tobacco instead of smoking is at least an improvement and for
some, perhaps, a preliminary to quitting altogether.
This mixed but reasonable message would be similar to the one now usually sent by health experts in the U.S. when talking to teens about AIDS and condom use: Abstinence is safest, but if you have sex, use condoms. Reasonable though that message may be, it arose as a compromise only after absolutist forces on the left and right failed to get things their own way: Conservatives wanted to tell children that premarital sex is simply wrong and therefore avoid any discussion of
condoms, while the left wanted to avoid moralistic sounding advice about abstinence and encourage condom use. Through a sort of dimwitted dialectical process, they ended up with a wise, harm-reduction-oriented approach.
That may yet happen in the case of tobacco as well. Concerns remain about how to encourage smokers to switch to smokeless tobacco without tempting non-tobacco-users into taking up the habit. In the U.S., where advertisements for smokeless tobacco are common at, for instance,
rodeos heavily attended by impressionable teenage boys, some worry that allowing tobacco companies to tout their products as "safer than smoking" will create an impression of perfect safety — much as ads for "lighter" and "low tar" cigarettes create a false impression of safety.
Still, fear of small risks should not blind us to opportunities for eliminating major risks and thereby improving the human condition. The world tends to get better in increments, not through unrealistic puritanical crusades or sweeping revolutions.
Most smokers and scientists alike would be delighted to snap their fingers and eliminate nicotine addiction. When that doesn’t work, consider a pinch of snuff.
TODD SEAVEY edits HealthFacts AndFears.com for the American Council on Science and Health.
