Tuesday, January 26, 2010

Safe vs. Safer

Today I got into a disagreement with a couple of coworkers about tobacco use.  I work in an office where many people smoke cigarettes.  A few of these smokers and a couple non-smokers were giving another coworker a hard time because, while he had recently stopped smoking cigarettes, he still enjoys getting a nicotine fix through the use of chewing/snuff/lip/smokeless tobacco.  I made the comment that I was glad he made the switch because chewing tobacco is safer than smoking cigarettes.  They couldn't believe I would say such a thing.  For every attempt I made to defend my case, they gave me a reason they believed chewing was just as bad.

"It's still tobacco," they told me.  (Yes, but it is relatively safer to use than cigarettes.) 

"They put glass in the tobacco."  (This is an urban legend that is the cousin to the "razor blades hidden in candy" that gets passed around every Halloween).

"Spitting is gross." (Yes, yes it is, but that has nothing to do with the relative safety of its use).

The more I tried to convince them, the deeper they dug their heals in and, it seemed, the stronger they clung to their belief.  So while I was on my lunch break, I thought about how I could explain it better.  When I got back from lunch, I asked one coworker these three questions:
  1. Would you agree that two similar activities can both be dangerous/hazardous/unhealthy, but one can be "safer" than the other?  (example:  riding a bike with a helmet vs. riding a bike without a helmet; driving a motorcycle vs. driving a car; etc.) -- She agreed.
  2. With that in mind, which would you consider safer, chewing nicotine gum or a smoking a cigarette? -- She sheepishly conceded that nicotine gum is safer.
  3. With that in mind, what is the difference in "safety" between chewing nicotine gum and using smokeless tobacco?  -- She couldn't come up with a difference.
I told her that I am not arguing that using smokeless tobacco is healthy.  I am not arguing that it is "safe".  I am arguing that it is a safer way to get a nicotine fix than lighting up a cigarette.

The bias that the women in my office and our society as a whole, have against smokeless tobacco frustrates me.

If I were to tell someone that I drink three to five beers a week, they wouldn't flinch.  If I tell someone that I drink three to five caffeinated sodas a day, nothing.  If I brag that I've never smoked marijuana (I've actually never even held it.  The closest I've been to a doobie was when two guys were smoking one about 20 feet away from me last summer at a Dave Matthews Band concert) they often wonder what rock I've been living under.

Should I then admit to them that I use smokeless tobacco daily, and have done so for the past ten years, you'd have thought I had admitted to being a dog-fight promoter.  Even though most people who "know" me have no idea I chew, have never seen me "spit", and up until that point, thought I was a "great" guy, they often think less of me because of this habit.  Chewing tobacco carries with it a stigma.  I'm either a hick, a cowboy, or a baseball player because I chew.

But the fact is, I have an "addictive" personality, and I made a conscious decision that if I was going to become addicted to something, smokeless tobacco was the lesser of many evils, because, of the things I could have or am addicted to, it is one of the mildest and least unhealthy.

But, people who hate tobacco use have a hard time wrapping their minds around that concept.  Oral snuff is less unhealthy than smoking a cigarette.  Our government health officials are even a part of the spin game when it comes to smokeless tobacco.  As this 2003 Reason Magazine article explains:
A recent study by researchers at the U.S. Centers for Disease Control and Prevention found that the most popular brands of smokeless tobacco in this country are the ones with the highest levels of readily absorbed nicotine. For the researchers, the finding was an opportunity to once again mislead the public about the hazards of oral snuff.
"Consumers need to know that smokeless tobacco products...are not safe alternatives to smoking," said co-author Patricia Richter of the CDC's Office on Smoking and Health. "The amount of nicotine absorbed per dose from using smokeless tobacco is greater than the amount of nicotine absorbed from smoking one cigarette."
No one claims smokeless tobacco is completely safe, but it is indisputably safer than cigarettes—by a very wide margin. Obscuring this fact, as the public health establishment routinely does, leaves smokers with the impression that they have nothing to gain by switching to snuff, when the truth is that they can dramatically reduce their risks, as University of Alabama oral pathologist Brad Rodu has been pointing out for years.
Richter's nicotine comparison might lead unwary readers to believe that using smokeless tobacco is more dangerous than smoking cigarettes. Yet nicotine itself plays little or no role in the diseases associated with smoking.
Nicotine does not cause lung cancer or other respiratory illnesses. And according to a 1999 editorial in the Journal of the American College of Cardiology, "the epidemiologic and experimental data suggest that nicotine absorbed from smokeless tobacco, nicotine gum or transdermal nicotine is not a significant risk factor for accelerating coronary artery disease or causing acute cardiovascular events."
Like chewing nicotine gum or wearing a nicotine patch, using smokeless tobacco does not involve inhaling combustion products, the main source of smoking-related hazards. Oral cancer is the only well-established life-threatening danger associated with smokeless tobacco, and even that disease is twice as common among cigarette smokers.
Furthermore, as an article in this month's issue of the journal Tobacco Control explains, the oral cancer risk does not show up in studies of smokeless tobacco users in Sweden, where the typical curing, processing, and storage methods result in lower concentrations of carcinogens. The authors argue that "the availability of snus [Swedish-style oral snuff] appears to have contributed to the unusually low rate of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence."
In the same issue, British anti-smoking activist Clive Bates and five European scientists note that "Sweden has the lowest levels of tobacco-related mortality in the developed world by some distance." They call upon the European Union to lift its misguided ban on snus, which applies in all member countries except Sweden.
Bates and his co-authors estimate that snus and some American smokeless tobacco products "are at least 90% less hazardous than cigarette smoking." They argue that it is "ethically wrong to actively deny users the option to reduce their risk in this way," calling the E.U. ban a triumph for the "health professional's authoritarian insistence that the only valid choice for smokers is to quit or die."
So, here we are, in the year 2010, where every person and their dog knows that cigarettes are extremely unhealthy, even deadly, but our government continues to refuse to concede the middle ground and admit that smokeless tobacco is a safer alternative to smoking cigarettes.  And, there is no way a mainstream media outlet would concede the middle ground because it goes against the populist template that "tobacco is bad".  So, we continue on, with many people ignorant to the fact that there is a safer way to get a fix of nicotine because no one will make the distinction between "safe" and "safer".


  1. What you spend little time mentioning is that chewing is much more "community-friendly". I don't have to suffer from second hand smoke when you chew. I might have to deal with a bunch of nasty dip cups hanging around but...

  2. This post seems like a grouping of fictional "science" and personal denials used to facilitate your not feeling bad about continuing with a nasty habit. There is a reason tobacco has a stigma. Additionally, I think the "science" in this post is the weakest part of your argument and therefore you essentially have no argument. -Rach

  3. Eric,

    I am a professor of medicine and hold an endowed chair in tobacco harm reduction research at the University of Louisville. I consider your post an exceptionally accurate and perceptive description of how smokers and smokeless users are misunderstood and mistreated by American society.

    It is widely understood by tobacco research and policy experts that smokeless tobacco use is vastly safer than smoking. In fact, the health risks from smokeless use are so low that they are barely measurable with modern epidemiologic methods. My research suggests that the risk of dying from using smokeless tobacco for a lifetime is similar to the risk of dying in an automobile accident.

    As you demonstrated, modern products require no spitting and can be used invisibly in any social situation.

    You are welcome to review the strong scientific and policy rationale for tobacco harm reduction at www.smokersonly.org and at rodutobaccotruth.blogspot.com

    Brad Rodu
    Professor of Medicine
    University of Louisville

  4. Brad Rodu- So you do your research with grant $ from the tobacco manufacturers. Then in that case, I totally believe you. Annette Lundy