Tobacco Documents Online

Smokeless Tobacco: a Lifesaver or a Marketing Opportunity?. In their January 12, 2003 opinion piece in the Birmingham News, Drs. Brad Rodu and Philip Cole laud the recent report of tobacco policy by Britain's College of Physicians because it acknowledged that smokeless tobacco was less hazardous than cigarette smoking. They celebrate the "even bolder statement" in the report that some smokeless tobacco manufacturers may want to market their products "as a 'harm reduction' option for nicotine users, and they may find some support for that in the public health community." However, Drs. Rodu and Cole neglect to list the many questions and concerns raised in that report about this smokeless tobacco marketing strategy, including: • How can the use of smokeless products as a 'starter' product for young smokers be minimized? • How can the risk of unintended consequences (eg reduced cessation) be minimized?; and • What options are there to 'promote' smokeless tobacco as a much safer alternative to smoking, without promoting tobacco use per se? Apparently, Rodu and Cole are not troubled by the absence of answers to these questions, or by the complete lack of evidence that smokeless tobacco is a feasible or effective method of quitting smoking. In reality, we have no evidence that allowing smokeless tobacco manufacturers to make explicit health claims about their products, as advocated by Rodu and Cole, will reduce the prevalence of cigarette smoking. To the contrary, available evidence in the United States suggests that people are far more likely to switch from smokeless tobacco use to cigarette smoking than to switch from cigarette smoking to using smokeless tobacco. In fact, US men are more likely to use both cigarettes and smokeless tobacco than to quit smoking completely and switch to smokeless tobacco. It is possible that smokeless tobacco has actually kept more smokers from quitting than it has helped. It is unclear how ubiquitous advertisements extolling the virtues of smokeless tobacco somehow will not reach children and teenagers. Smokeless tobacco is freely available to adults in the United States, yet we have not seen the widespread adoption of these products by smokers who want to quit. What we have witnessed over the past 30 years is that aggressive marketing of these products led to their massive uptake by young males, a large proportion of whom subsequently progressed to cigarette smoking. Rodu and Cole claim that Sweden's low rate of lung cancer provides evidence of successful adoption of a "harm reduction" strategy. How, Sweden has a rather unique history that largely accounts for that country's lung cancer experience: Sweden managed to avoid involvement in World War II, a seminal event for the United States and most of Europe. Among the other effects of that devastating war, WWII fueled the largest increase in cigarette consumption in US history, particularly among servicemen. Sweden escaped that experience. The lung cancer experiences of Sweden and the United States since the 1950s largely reflect the countries' different histories. Interestingly, lung cancer rates are dropping in many counlries that have adopted tobacco control policies but have

negligible use of smokeless tobacco, including the UK, whose lung cancer rotes equal Sweden's within the next decade. Rodu and Cole also neglect to note that Sweden has instituted many tobacco control policies in the past decade, including clean indoor air pohcies and restrictions on tobacco advertisement, that are largely responsible for that country's recent declines in smoking. Finally, Rodu and Cole neglected to note that Swedish studies have found that smokeless tobacco plays a very minor role in quitting smoking, and that most of the growth of smokeless tobacco use has been among young people but most smoking cessation occurs among middle aged and older persons. Even in Sweden, the role of smokeless tobacco as a means of reducing smoking remains questionable. Responsible and ethical practice of medicine and public health demands that we base our recommendations on sound science. Many people in the medical and public health communities want to see credible evidence that a suggested treatment actually works before they advise their patients or the broader community to try it. Rodu and Cole label such people "prohibitionists." The overwhelming majority of the public health community is very skeptical in allowing US Smokeless Tobacco Co. and other tobacco manufacturers to establish health policy while those same companies work behind the scenes to undermine effective tobacco product regulation. Drs. Rodu and Cole appear far more trusting of the smokeless tobacco industry and its motives. Perhaps that trust is the result of the strong financial ties that bind them to the smokeless tobacco industry, including a $1.2 million grant from US Smokeless Tobacco Co. and employment as an expert witness for that company in product liability lawsuits. While we share the concern expressed by Drs. Rodu and Cole over the devastating public health impact of smoking, we cannot condone an unregulated experiment on human populations designed by tobacco manufacturers and promoted by their paid supporters.

negligible use of smokeless tobacco, including the UK, whose lung cancer rotes equal Sweden's within the next decade. Rodu and Cole also neglect to note that Sweden has instituted many tobacco control policies in the past decade, including clean indoor air pohcies and restrictions on tobacco advertisement, that are largely responsible for that country's recent declines in smoking. Finally, Rodu and Cole neglected to note that Swedish studies have found that smokeless tobacco plays a very minor role in quitting smoking, and that most of the growth of smokeless tobacco use has been among young people but most smoking cessation occurs among middle aged and older persons. Even in Sweden, the role of smokeless tobacco as a means of reducing smoking remains questionable. Responsible and ethical practice of medicine and public health demands that we base our recommendations on sound science. Many people in the medical and public health communities want to see credible evidence that a suggested treatment actually works before they advise their patients or the broader community to try it. Rodu and Cole label such people "prohibitionists." The overwhelming majority of the public health community is very skeptical in allowing US Smokeless Tobacco Co. and other tobacco manufacturers to establish health policy while those same companies work behind the scenes to undermine effective tobacco product regulation. Drs. Rodu and Cole appear far more trusting of the smokeless tobacco industry and its motives. Perhaps that trust is the result of the strong financial ties that bind them to the smokeless tobacco industry, including a $1.2 million grant from US Smokeless Tobacco Co. and employment as an expert witness for that company in product liability lawsuits. While we share the concern expressed by Drs. Rodu and Cole over the devastating public health impact of smoking, we cannot condone an unregulated experiment on human populations designed by tobacco manufacturers and promoted by their paid supporters.