Monday, February 1, 2010
Tobacco Harm Reduction in the New York Times
On January 31, the New York Times published an article on tobacco harm reduction written by Duff Wilson and Julie Creswell. It focused on a series of submissions to the FDA by Altria, the parent corporation of Philip Morris and U.S. Smokeless Tobacco.
The article suggests that Altria’s argument for FDA endorsement of tobacco harm reduction is a cynical and insincere strategy: “…by focusing the F.D.A.’s attention on smokeless products, a much smaller but growing industry, Altria and other tobacco companies are diverting regulators’ attention from the source of the real public health problem: cigarettes.”
This post takes a critical look at the Times article.
The piece describes Altria as a “corporate pariah blamed for the deaths of millions of people,” noting that cigarette smoking is addictive and causes disease. Altria and other cigarette manufacturers have acknowledged these facts; they believe that the FDA should oversee a program that fully informs smokers about safer smokeless options.
Tobacco prohibitionists were quoted in the article. Stanton Glantz (University of California at San Francisco): “If you look at how they’re marketing smokeless now, they’re marketing for dual use, and to protect the cigarette market, which is their big money maker.”
By this, Glantz acknowledges that manufacturers are marketing smokeless tobacco to smokers. But Glantz seems to believe that Altria has power to “protect the cigarette market” by keeping smokers from switching entirely to smokeless tobacco. If smokers are informed that smokeless products are vastly safer, many will switch, significantly reducing the 400,000 smoking-related deaths that occur in the U.S. annually.
Gregory Connolly (Harvard University): “[Altria is] taking the FDA debate and making it on smokeless rather than ‘light’ cigarettes, which is where the real harm is.”
Kudos to Connolly for implicitly acknowledging that there is no “real harm” in smokeless tobacco. That is precisely why Altria wants FDA permission to tell smokers the truth.
Wilson and Creswell report that Matthew Myers (Campaign for Tobacco-Free Kids) “argues that there is no evidence that smokeless products are effective tools to help people quit smoking.”
This is utter nonsense. Smokeless tobacco is established as a gateway to smoking cessation for men and women in Sweden, and in Norway. In 2008, I provided the first population-level evidence that American men have quit smoking by switching to smokeless tobacco. Using data from the 2000 National Health Interview Survey, which the CDC uses to estimate smoking prevalence in the U.S., Carl Phillips and I estimated that 359,000 American male smokers had tried to quit by switching to smokeless, and 73% (261,000) were successful, the highest percentage of all methods. In comparison, the nicotine patch was tried by 2.9 million smokers, but only 35% were successful. Of the 964,000 smokers who tried nicotine gum, only 34% succeeded.
As I predicted in an earlier post, Kenneth Warner (University of Michigan) attacked the use of flavors in smokeless tobacco products: “The flavors are designed to attract kids.”
This may be evidence of an overzealous imagination. Tobacco manufacturers are prohibited by law from marketing to children. But prohibitionists are adept at making draconian policies seem palatable by pitching them as “protecting children.” Prohibitionists promote a flavor ban because they know that unflavored smokeless products won’t appeal to many smokers. Banning all flavors in smokeless tobacco makes about as much sense as banning flavors in alcoholic beverages.
Wilson and Creswell avoided discussion of the scientific and medical issues in Altria’s FDA submission, instead focusing on the shrill complaints of tobacco prohibitionists. I suggest that you read the documents, available here; they are accurate and based on scientific and medical literature. I also invite you to read my FDA submission, entitled “Tobacco Harm Reduction: Medical, Scientific and Public Health Rationale”.