Knowing that the Centers for Disease Control (CDC) has the
means to calculate deaths due to smokeless tobacco – a statistic that is likely
to be near zero – I encouraged readers (here) to call the agency at 800-232-4636
or email them (here) to
demand data and sources on the precise dangers of smokeless tobacco use.
Three of my blog readers requested this information from the
CDC and shared the agency’s responses.
Brenden Rudnick made the first request (here)
in March, after reading one of my blog entries.
The CDC replied:
“...at this time, we
do not provide estimates of deaths attributed to the use smokeless tobacco
products…We are not aware of a source of this estimate.”
Another reader, F. Chambers, reported a similar response on
April 21 (here):
“We do not estimate
deaths resulting from the use of smokeless tobacco products and we are not
aware of a source of these estimates.”
On April 22, reader Rob advised that the CDC had a more
elaborate excuse:
“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 (here) describes the limitations in establishing estimates on the cause of
death for products other than cigarettes…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.”
These excuses are unacceptable. The CDC has all the data it needs to make
informed estimates. Here is proof: Dr.
Michael Fisher, a scientist at Altria, used CDC data to calculate the following
tobacco use risks, an analysis he presented at a recent tobacco research meeting
(here).
Adjusted Risks* for Tobacco Users in National Health Interview Surveys | |||
---|---|---|---|
Tobacco Use | All Causes of Death | All Cancers | Heart Diseases |
Exclusive Smokeless | 1.05 (0.90 – 1.23) | 1.05 (0.77 – 1.43) | 0.94 (0.70 – 1.28) |
Exclusive Smoking | 2.17 (2.09 – 2.26) | 3.08 (2.84 – 3.33) | 1.98 (1.85 – 2.13) |
Dual Use | 2.34 (1.80 – 3.02) | 2.78 (1.89 – 4.10) | 1.76 (1.03 – 3.01) |
Former Smoking | 1.35 (1.30 – 1.40) | 1.64 (1.52 – 1.78) | 1.21 (1.13 – 1.29) |
Former Smoking, Current Smokeless | 1.38 (1.14 – 1.67) | 1.62 (1.13 – 2.31) | 1.62 (1.16 – 2.25) |
*Compared with never tobacco use | |||
The headline here is that the risks for exclusive ST users
are not significantly different from those for never users. In other words, ST users had ZERO excess
risks for all causes of death, all cancers and heart diseases. The rest of the estimates are significantly
elevated. Note that, by Dr. Fisher’s
calculation, the risks for dual users are not very different from those for exclusive
smokers. Also note that the risks for former
smokers who use ST are about the same as those who quit altogether; both were
lower than smokers.
By continuing to obfuscate about the existence and
implications of it smokeless risk data, the CDC is failing in its mission to
promote public health. Worse, by supporting the false claim that smoke-free
products are just as risky as cigarettes, the agency denies smokers vital and
persuasive reasons to quit.