Wednesday, March 13, 2013

American Dental Association Improves Mouth Cancer and Smokeless Tobacco Brochures

I have been critical of the American Dental Association’s distribution of misinformation about smokeless tobacco and tobacco harm reduction (discussed here and here).  New ADA brochures on mouth cancer and smokeless tobacco show significant improvement  over their past publications.

The new pamphlet on mouth (and throat) cancer (here) accurately describes the disease as occurring “…most often in people who smoke cigarettes, cigars, or pipes and drink heavily (30 drinks or more per week).  That combination is estimated to cause the majority of mouth and throat cancers diagnosed in the United States.  Here are some additional risk factors:

• “Current research shows that some types of human papillomavirus (HPV) can cause throat cancer, which affects the base of the tongue and tonsils. HPV is very common— many people have the virus in their bodies and don’t even know it.

• “People who often spend long periods of time in the sun are at higher risk for lip cancer.” (emphasis in the original)

The brochure mentions one other risk factor, “a diet with too few fruits and vegetables,” but this is relevant mainly for people in developing countries, not in the U.S.

The new brochure on smokeless tobacco (here) drops many of the unscientific allegations that appeared in earlier versions and focuses a good deal on cessation.  Mouth cancer goes unmentioned, which is appropriate, given that the risk is so low. 

Still, the brochure is flawed.  Here are some questionable statements:

1.  “One can of smokeless tobacco has as much nicotine as 60 cigarettes or three packs.”  This is about as meaningless as claiming that one bottle of bourbon has as much alcohol as 19 cans of beer.  Just as responsible drinkers modulate their alcohol intake when using different products, smokeless users and smokers modulate their nicotine intake based on the products they use, attaining nearly the same peak nicotine blood level regardless of the source.  In comparing product nicotine levels, the ADA demonizes nicotine, which, while addictive, is not a major factor in any smoking-related illness.

2.  “Smokeless tobacco … has over 3,000 chemicals, including 28 cancer-causing substances.”  This is technically accurate but meaningless. One could also make the factual statement: “Coffee has over 1,000 chemicals, including 21 cancer-causing substances.” (here)  Any food or drink is composed of thousands of chemicals, some of which are or may be carcinogens.  Focusing on these is a scare tactic, described by renowned biochemist Bruce Ames as “hysteria over tiny traces of chemicals that may or may not cause cancer.” (here). 

3.  “People may think that smokeless means harmless, but nothing could be further from the truth.”  No credible tobacco harm reduction scientist or advocate claims that any tobacco product is absolutely safe; suggesting otherwise is nothing but a straw-man argument. 

The truth about smokeless is readily apparent: A wealth of scientific data show that smokeless means almost no measurable health risk.


Anonymous said...

I work in tobacco prevention in fly over land. A few months ago, I was asked by our oral health and cancer program managers to work on a campaign regarding smokeless and oral cancer. Lots of other people got behind the project. I started to draft up the usual talking points and then stopped. I sent emails to some experts in the field and found out that the risk is extremely low. I cancelled the project.

The other significant problem here is that the science doesn't appear to be reaching a lot of people in public health government agencies and otherwise. I'm about ready to leave Twitter if I hear one more unfounded claim. Yes, we public health folks are the worst offenders. We refuse to do the research and instead rely on what the rest of the pack is saying. It's frustrating, but more so, it's embarrassing when you find out you've been spewing the same nonsense as everyone else.

Anonymous said...

The brochure mentions one other risk factor, “a diet with too few fruits and vegetables,” but this is relevant mainly for people in developing countries, not in the U.S.dubiln 2 dentist