A growing number of anti-smoking researchers and public health advocates are adopting a tack that not long ago would have been considered heresy: suggesting that hard-core smokers who can't kick the habit would be better off switching to new smokeless tobacco products.
With slogans such as "Spit-free" and "For when you can't smoke," these products differ markedly from the messy snuff and chewing tobacco stereotypes associated with your granddaddy's spittoon or certain pro baseball players' stuffed cheeks.
They are clean, discreet, last about 30 minutes and come in mint, wintergreen and other flavors. Some go down easily, dissolving much like a breath mint, while others look like tiny tobacco-filled teabags, tucked into the side of the mouth and discarded like chewing gum.
Though no one is calling the products "safe" -- any tobacco that has been cured contains some carcinogens -- numerous epidemiological studies have shown that smokeless tobacco is far less likely to cause any type of cancer, including oral cancer, than cigarettes.
For The Record
Los Angeles Times Thursday June 17, 2004 Home Edition Main News Part A Page 2 National Desk 1 inches; 53 words Type of Material: Correction
Smokeless tobacco -- An article on smokeless tobacco products in Monday's Health section referred to the federal Centers for Disease Control and Prevention as being part of the U.S. Surgeon General's Office. Both the CDC and the Office of the Surgeon General are part of the U.S. Department of Health and Human Services.
For The Record
Los Angeles Times Monday June 21, 2004 Home Edition Health Part F Page 8 Features Desk 1 inches; 54 words Type of Material: Correction
Smokeless tobacco -- An article on smokeless tobacco products in the June 14 Health section incorrectly referred to the federal Centers for Disease Control and Prevention as part of the U.S. Surgeon General's Office. The CDC and the Office of the Surgeon General are part of the U.S. Department of Health and Human Services.
"If someone can't quit smoking, there is no question that smokeless is much safer. It doesn't cause heart or lung disease, and if it does cause cancer, it does so at a much lower rate," said Dr. Neal Benowitz, a professor of medicine at UC San Francisco and director of its cancer center's Tobacco Control Program.
Gary Giovino, director of the Tobacco Control Research Program at the Roswell Park Cancer Institute in Buffalo, N.Y., agreed. "If everybody who smoked used these instead, there would be less disease."
Many Americans may be unaware that most scientists and researchers say that smokeless tobacco is less hazardous than cigarettes in causing deadly disease. That's not surprising. For years, some private and government medical organizations have disseminated outdated information on the subject. For instance, the Mayo Clinic in Rochester, Minn., recently acknowledged that information on its website was incorrect and would be revised.
Though some information on the Centers for Disease Control and Prevention's website was modified after one prominent researcher protested it, the agency, part of the U.S. Surgeon General's Office, takes the position that "there is no safe form of tobacco" and that there "is no significant evidence that suggests that smokeless is a safer alternative to smoking," spokeswoman Karen Hunter said.
Some tobacco researchers contend the misinformation hinders individuals from making educated decisions about whether to switch to smokeless products. "I think it's not scientific and is a deception," said Lynn Kozlowski, who heads Pennsylvania State University's biobehavioral health department. "What the studies show is that in the U.S., smokeless causes oral cancer but that cigarettes are even more likely to cause oral cancer."
With names that include Ariva and Stonewall, both made by Star Scientific Inc., and Revel, made by the U.S. Smokeless Tobacco Co., which also makes the Copenhagen and Skoal brands, the new products have been rolled out in a few U.S. cities and are also available from their manufacturers' websites. They promise to deliver the nicotine fix smokers crave and take the edge off the physiological urge to light up.
Although the nicotine in cigarettes is powerfully addictive, it is the cigarette smoke -- not the nicotine -- that delivers the killer punch, possibly producing as many as 60 known carcinogens and about 5,000 other chemicals. Studies show that many people still believe that it is the nicotine that is the harmful element.
Brad Rodu, an oral pathologist at the University of Alabama, said nicotine should be treated more like caffeine: as an addictive drug that can be used safely. (His "tobacco harm-reduction" research is funded by a five-year grant from U.S. Smokeless.) "We would have smokers understand the nicotine addiction can be separated from the smoking."
Sweden's experience with smokeless tobacco is one of the forces giving momentum to this harm-reduction campaign in the U.S. Over the last 40 years, a large percentage of Swedish smokers -- primarily men -- have switched from smoking cigarettes to using a moist snuff product called "snus." Sweden's cancer rates for men, including oral cancer, have declined and now are the lowest in Europe.
In contrast, cancer rates for Swedish women -- few of whom have made the switch from cigarettes to snus -- remain as high as rates for most other European women.
Nevertheless, snus is outlawed by the rest of the European Union countries, while cigarettes are widely sold and remain quite popular, an irony not lost on some European healthcare providers. In a December 2002 report titled "Protecting Smokers, Saving Lives," Britain's Royal College of Physicians concluded that "the consumption of noncombustible tobacco is on the order of 10 to 1,000 times less hazardous than smoking, depending on the product."