Letter to Tobacco Commission - Brad Rodu, 2/23/01 10:03AM
UAB SCHOOL OFMEDICINE Department of Pathology
February 13, 2001Mr. William Martin Kuegel
I am a Professor of Pathology at the University of Alabama at Birmingham and a Senior Scientist in the UAB Comprehensive Cancer Center. I have reviewed the Tobacco Commissionís preliminary report entitled "Tobacco Communities at a Crossroad." It is a comprehensive report discussing the concerns of tobacco farmers and public health advocates over the future of tobacco use among Americans and throughout the world. I believe the Commissionís final report would be enhanced considerably by inclusion of a strategy that addresses the interests of all parties: harm reduction involving the substitution of safer tobacco products for cigarette smoking.
It is widely acknowledged that long-term cigarette smoking is associated with a high risk of developing several cancers, cardiovascular diseases and chronic obstructive lung disorders. Contrary to popular misperception, all forms of tobacco are not risky. For example, smokeless tobacco causes neither lung cancer nor other diseases of the lung, and users have no excess risk for heart attacks. Our research documents that the only consequential risk of smokeless tobacco use, mouth cancer, is in fact very small (1,2). In fact, the magnitude of this risk (13 deaths per 100,000 long-term smokeless users per year) is about the same as the risk from automobile use (15 deaths per 100,000 users per year). Our research shows that smokers who switch to smokeless tobacco will live, on average, as long as those smokers who quit nicotine altogether (3). They reduce their risks for smoking-related illness and death, which is the goal of all smoking cessation efforts. Another major health benefit of smokeless use is the elimination of environmental tobacco smoke.
This model for harm reduction is working in Sweden, which in 1999 became the first country in the world to meet the World Health Organization goal of reducing smoking prevalence to under 20% (4). There is a growing awareness in Sweden that smokeless tobacco can be a safe and socially acceptable substitute for cigarette smoking. The Swedish government taxes smokeless at a lower rate than cigarettes (5). In addition, the Swedish government is evaluating proposals to remove warning labels from smokeless products, thus paving the way for their possible introduction throughout the European Union, where they are currently unavailable. The substitution of smokeless tobacco for cigarettes also has been discussed by Swedish scientists at a recent United Nations Symposium (6).
Statistics from the CDC indicate that as many as two million smokers have used smokeless tobacco to quit smoking (7), and our research group has conducted a successful clinical trial of this method. (8). The transition is possible because the spike of nicotine that addicted smokers seek is effectively delivered by smokeless tobacco. Furthermore, newer smokeless products can be used invisibly.
I am aware that cigarettes contain primarily burley and flue-cured tobacco and that smokeless tobacco products are manufactured from fire-cured and air/sun-cured dark tobaccos. Thus, a widespread transition from cigarette smoking to smokeless tobacco use among the nationís 46 million smokers would change the current proportions of tobacco types now grown in the U.S. Tobacco leaf experts tell me that farms throughout most tobacco growing regions in the U.S. have considerable flexibility in the types of tobacco that can be cultivated.
In closing, a harm reduction strategy for tobacco use empowers society to simultaneously address the Commissionís goals of reducing disease caused by tobacco products and ensuring the future prosperity and stability of the American tobacco farmer and tobacco-farming communities.