Wednesday, July 1, 2015

Kaiser Permanente’s Not-So-Negative Take on Smokeless Tobacco

Kaiser Permanente might better call itself Kaiser In Transition.

A week ago I noted that the company’s website provides smokers with three grossly incorrect reasons to avoid e-cigarettes (here).  As it turns out, elsewhere on the same site, Kaiser makes a reasonably good case for the harm reduction potential of smokeless tobacco.

“Smokeless tobacco products include chewing tobacco and snuff.  These products are less harmful than smoking cigarettes,” advises the Good Kaiser.  It’s the first-ever admission by an American corporate health giant that smokeless tobacco use is less harmful than smoking.

After this promising start, Kaiser’s advice is less accurate.  They claim with no scientific basis that smokeless tobacco is “just as addictive as cigarettes.”  In fact, there is some evidence that smokeless tobacco has lower dependence than cigarettes (here).

They correctly note that smokeless tobacco is associated with “[w]hite, leathery patches (leukoplakia) that form on the inside of the cheek or on the gum,”  but the claim that these patches turn into mouth cancer is unfounded.  As I explained in a review article in 1995 (abstract here), white patches from smokeless tobacco use are like calluses on the skin; they almost never turn into cancer.  I have in the past refuted two other of Kaiser’s claims, regarding dental diseases (examples here and here) and pancreatic cancer (here and here). 

Kaiser’s discussion of tobacco harm reduction closes with a stunning admission:

“A type of smokeless tobacco called ‘snus’ seems to have much less risk of harm. But it is not clear whether using snus causes no harm or risk.”

This passage is powerful, because it can be reasonably interpreted to acknowledge that the health risks of snus may be minimal to nonexistent.  I hope this marks the beginning of a new era of truthful and accurate descriptions of smokeless tobacco use and its health effects.        

1 comment:

Anonymous said...

Hopefully this will become a mainstay of health insurers, private, mutual and government. Lower premiums for smokers (but not eliminated) who quit but continue using snus instead, with practically a 100% reduction in risk from future nicotine use. Must be excellent business as all insurance is balancing premiums versus risk.