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.
2 comments:
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
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!
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