When the FDA eventually looks at low-risk alternatives to cigarettes, it will ask experts at the National Cancer Institute for advice on relative risks. Dr. Deborah Winn, a 30-year veteran provider of misinformation about smokeless tobacco (evidence here and here), will be the NCI’s lead authority. Regrettably, Dr. Winn has proven incapable or unwilling to distinguish the risks related to combustible and smoke-free tobacco.
I recently reviewed Dr. Winn’s testimony before the House Subcommittee on Health. All 3.5 hours of this tirade against smokeless tobacco is available (here). Her appalling disregard of facts was highlighted in the following exchange (occurring at about 1 hour 57 minutes) with Congressman Steve Buyer:
Buyer: I’m trying to reconcile a couple of comments...you acknowledge that there is a continuum of risk within tobacco products…smoking to smokeless, pharmaceutical to quitting…a continuum of risk, you acknowledge that, correct? From very high risk to very low risk, you acknowledge that?
Winn: Um, quantitating it at high or low, they all have risks.
Buyer: You acknowledge that there’s a continuum of risk, from very high risk to very minimal risk, you acknowledge that?
Winn: Very high risk to moderate risk.
Buyer: To moderate risk? So if I can with proven science say that there is a product on the market that would remove 99% of the nitrosamines, you would define the 1% as moderate?
Winn: Um…all smokeless tobaccos have some risk of health effects.
Buyer: That’s correct. I concur with that. Now let me go back and acknowledge this. Let’s not play games. Do you acknowledge that there is a continuum of risk, from very high risk to very low risk, to the health effects with the use of tobacco products?
Winn: Some tobacco, for example, chronic obstructive pulmonary disease...
Buyer: All right, all right, I’m not going to quibble with you...because it appears that if you will not even acknowledge that there’s a continuum of risk, then you’re placing yourself in the camp of complete abstinence. Now I will concur with you that tobacco products are not healthy. I concur with that. But to ignore that there is a continuum of risk from very high risk, cigars, to very low risk, which would be a product…Let me ask it this way…If you are able to put a product on the market that reduces the nitrosamines, does that eliminate, then, health risks?
Winn: What causes us concern under those circumstances is the population effect that might be influenced by people smoking and adopting a smokeless tobacco product.
Buyer: Do you acknowledge that if I can reduce the nitrosamines in a product, that I can reduce the risk?
Winn: There’s no epidemiologic evidence that shows that that is the case. It’s certainly important that nitrosamine levels be reduced.
Buyer: So, are you saying to me then, that an Orb or a Stick that has 99% reduced nitrosamines is just as harmful as smoking a cigar? That’s what your statement is saying.
Buyer: And you concur with that?
Winn: Um, assessing nitrosamine levels or reduced nitrosamine products is under the purview of the FDA. So I would…
Buyer: Great. Your staff just gave you that so you could read it. But just answer the specific question.
Winn: We don’t know that there is any level of nitrosamines known to be safe.
Buyer: [Laughs] Wow. So you are unwilling to recognize the differentials of risk within tobacco products. That’s what I’m hearing from you. You do not acknowledge that there is differential risks among tobacco products?
Winn: There is a continuum of risk.
Buyer: Thank you, thank you. We got there, didn’t we? We got there. There is a continuum of risk. Now why is that important? It’s important because, as a country, those who are advocates of an abstinence approach are locking us in to a system of failure…
This is a harbinger of what will transpire as abstinence-only federal nannies slowly tighten the regulatory noose around snus and other smokeless alternatives to cigarettes. Even worse, Congress is losing the only member who understands tobacco harm reduction, and has the courage and integrity to challenge the misinformation spewing from prohibitionists. Steve Buyer will not stand for re-election in 2010, which is a terrible setback for American smokers.