Thursday, November 19, 2015

FDA and CDC Generate Smokeless Scaremongering

While the FDA and CDC refuse to acknowledge that smokeless tobacco causes almost no disease, agency staff have produced a fresh study (abstract here) showing that smokeless tobacco users have higher trace levels of nicotine and some contaminants than do smokers.  This meaningless finding (explained below) leads to grossly misleading headlines, such as “Smokeless Tobacco More Toxic Than Cigarettes, Study Says” from Time’s Alexandra Sifferlin. (Other recent tabloidish stories from this reporter include “Flavor Science Explains How You Can Hear the Way Your Food Tastes,” “I Tried It: A 6 am No-Booze Dance Party on a Boat,” and “Healthiest Halloween Candy”).   

The media was served up a juicy quote from the FDA’s Brian Rostron, the study’s first author, in a press release (here): “exposure to nicotine and the cancer-causing tobacco constituent NNK were higher among exclusive smokeless tobacco users than exclusive cigarette smokers. This continues to put smokeless tobacco users at risk for adverse health effects, including cancer.”

First, nicotine is not a toxin, and it doesn’t cause any “adverse health effects, including cancer.”  

Second, while the study found higher levels of NNK among smokeless users than smokers, that does not support the claim that “smokeless tobacco users [are] at risk for adverse health effects, including cancer.”  Decades of epidemiologic studies involving millions of Americans show that smokeless tobacco users’ risks are infinitesimal.  British researchers estimate that U.S. smokeless-related cancer deaths are zero.

Third, from 1999 to 2012, the period of the study, trace levels of NNK dropped by two-thirds in smokeless tobacco users.

And finally, the results show that smokeless tobacco users had lower levels of mercury (in their blood) and arsenic (in their urine) than nonusers of tobacco.  In fact, smokers also had lower levels of these metals.  The study authors did not discuss the health implications of these findings.       

Public health officials should focus on meaningful research and provide appropriate scientific context for their findings, rather than scaremonger via the media and deter smokers from transitioning to markedly less harmful smoke-free products.


Clive Bates said...

I might add a further point to your list. Not all smokeless tobacco products are the same - yet they are treated as a single class here (for acceptable statistical reasons). With some snus products, the manufacturers have quite deliberately set out to reduce tobacco-specific nitrosamines like NNK and other contaminants like heavy metals. For example, by developing and applying the Gothiatek standard. Even if lumping all smokeless users together for statistical reason was unavoidable, they could have drawn out likely differences in NNK exposure in the commentary.

The sad thing is that a regulator like the FDA could actually encourage this sort of action by setting standards itself for contaminants. Instead, it seems determined to use arbitrary measurements and sensationalist statements to try to indiscriminately disparage the product. It also seems determined, with astonishing irresponsibility, to encourage the idea that these products are as harmful as smoking when some are likely to be 100 times less risky.

Note: no competing interest

Unknown said...

Dr. Brad, I am just commenting to say that I loved your blog and read almost all your posts.
I am vaping for 1 week now and I haven't touched analogic smelly cigarrets since.
You are doing a great work and thanks for all your impartial information!

Greetings from Brazil!