Wednesday, April 6, 2016

Centers for Disease Control: Release Smokeless Stats

The U.S. Centers for Disease Control and Prevention (CDC) has for decades published annual estimates of smoking-related deaths, which I have analyzed on occasion (here and here).

It is remarkable that what I refer to as the CDC’s “Big Kill” estimates are delivered with single-digit precision.  For example, the current estimate of smoking-attributable deaths is 480,317 (available here). 

In stark contrast, CDC spokespeople include plenty of dire warnings but no relative risk or other specific information when talking about smokeless tobacco.  For example, a recent agency report claimed that “Exclusive smokeless tobacco users have higher observed levels of exposure to nicotine and carcinogenic tobacco-specific nitrosamines… than exclusive cigarette smokers.” (abstract here).  Implied is the specious message that smokeless may be more dangerous than cigarettes. 

The CDC also asserts that smokeless use “causes cancer of the mouth, esophagus... and pancreas… and increases the risk for death from heart diseases and stroke” (here) – claims based upon cherry-picked or irrelevant studies, in the manner I discussed last week (here).

Despite the fact that the agency has the necessary data, CDC pronouncements about smokeless tobacco never cite numbers or estimates.  In contrast, British researchers last year reported that there were no cancer deaths due to smokeless tobacco in the U.S. and Canada (discussed here).  Clearly, the CDC can calculate deaths due to smokeless tobacco, but the agency chooses not to do so.    

The CDC’s stonewall on statistics has been observed by others.  An astute reader of my blog recently shared this fascinating story (available here):

“It's funny, after coming to this site I was curious so I went to the CDC website to see if they provided any estimates as to the number of deaths attributable to smokeless tobacco usage. I couldn't find anything on their website so I sent them an email. To their credit, they did respond, and said ‘ this time, we do not provide estimates of deaths attributed to the use smokeless tobacco products.’ So I responded and asked them if they might be able to point me to some other source of data for these estimates. And again, to their credit, they did respond, but only to say ‘We are not aware of a source of this estimate.’  Hmmm...I would think if smokeless tobacco was indeed such a plague upon society, that they would at least be able to show some numbers.”

This reader is on target.  The CDC continues to scaremonger about smokeless tobacco while it withholds data that likely shows ST-related deaths at near zero.

Taxpayers can call (800-232-4636) or email (here) the CDC to demand details and sources on the precise dangers of smokeless tobacco use.  Please share any replies as a comment to this post.


Professor Twain said...

Great piece. As a cigar smoker I have also been able to find figures for deaths attributable to cigar smoking. My reading of the papers I can find suggest that primary cigar smokers who smoke less than three cigars per day do not have increased death rates due to CHD,lung cancer, or all cause mortality. Demonizing all tobacco use is a foolish policy.

Brad Rodu said...

Epidemiologic studies show that cigar smoking is associated with lower risks than cigarette smoking, which I discussed in a previous post here:

Anonymous said...

Great post as always Dr. Rodu. The CDC's standpoint remains disappointing at best, providing conclusions with no scientific basis. THR is beyond a theory. This program saves lives and increases the quality of life for tobacco users. Public health agencies are in a position to no longer ignore the years of data supporting this program. To do so is irresponsible and dangerous. Per Dr. Rodu's request, I contacted the CDC to inquire about any data they may have. This is their response.

-F. Chambers

Thank you for contacting the centers for disease control and prevention. Your inquiry concerning mortality attributed to smokeless tobacco use was forwarded by CDC-INFO to the office on smoking and health. CDC only provides estimates on deaths attributed to cigarette smoking. We do not estimate deaths resulting from the use of smokeless tobacco products and we are not aware of a source of these estimates.

Office on smoking and health
National centers for chronic disease
prevention and health promotion.

Anonymous said...

Dr. Rodu, after taking your advice and emailing the CDC, I found their response very telling,

Thank you for contacting the Centers for Disease Control and Prevention (CDC). Your request for information regarding deaths attributed to smokeless tobacco use was forwarded by CDC-INFO to the Office on Smoking and Health.

While there is clear evidence that allows CDC to estimate the population health effect of cigarette use, there are methodological limitations, including in regard to sample size, which impact our ability to calculate comparable estimates for smokeless tobacco. Chapter 12 of the 2015 Surgeon General’s Report ( describes the limitations in establishing estimates on the cause of death for products other than cigarettes. According to the report, this limitation reflects the lack of appropriate relative risks related to tobacco products other than cigarettes. Further, dual use of cigarettes and another product may complicate estimates, particularly if dual use extends to persons in age ranges where most smoking-caused deaths occur. Therefore, at this time, we do not have an estimate or a timeframe to provide.


Office on Smoking and Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention