The
Military Health System and the Defense Health Agency last November published a
grossly misleading article on their website titled, “Quit the spit: Smokeless
tobacco no better than lit” (archived article here). After I educated Air Force officials, the
article was removed. Here is the story.
The
piece wrongly asserted that smokeless tobacco (ST) use is equally harmful as
smoking:
“…putting
in a dip or a chew can cause as much harm as
lighting up cigarettes... ‘A lot of the effects smoking has on the body –
causing blood vessels to narrow raising blood pressure and causing several
cancers – are
the same for smokeless tobacco,’ said
Air Force Col. Thomas Moore, a preventive medicine doctor and in charge of
health promotions for the Air Force Medical Support Agency... ‘You’re really not gaining
anything by giving up cigarettes just
to put in a load of chew,’ said Moore.” (emphasis added)
In
a November 18 email I advised Colonel Moore of the article’s numerous errors:
“These
passages send the clear, unmistakable and completely false message to military
personnel that smokeless tobacco use is just as dangerous as smoking.
Numerous scientific studies published over the past twenty years provide
indisputable evidence that smokeless tobacco use is vastly safer than
smoking. For example, a 2002 report by the British Royal College of
Physicians (here), one of the
world’s oldest and most prestigious medical societies, stated ‘As a way of
using nicotine, the consumption of non-combustible [smokeless] tobacco is on
the order of 10-1,000 times less hazardous than smoking, depending on the
product.’
“Your
just-as-dangerous message may be considered a breach of medical ethics. A
2004 study (here) authored by a panel
of international tobacco research and policy experts concluded: ‘…[smokeless]
products pose a substantially lower risk to the user than do conventional
cigarettes. This finding raises ethical questions concerning whether it
is inappropriate and misleading for government officials or public health
experts to characterize smokeless tobacco products as comparably dangerous with
cigarette smoking.’
“Members
of our armed forces put their lives on the line every day. The Military
Health System and the Defense Health Agency should show them respect by giving
them truthful information about tobacco use. There is a lot at
stake. In another 2007 report (here) the Royal
College concluded ‘...that smokers smoke predominantly for nicotine, that
nicotine itself is not especially hazardous, and that if nicotine could be
provided in a form that is acceptable and effective as a cigarette substitute,
millions of lives could be saved.’
“I
urge you to promptly retract the article or issue a substantial revision to
reflect the indisputable evidence that smokeless tobacco use is vastly safer
than smoking. Please let me know if I can provide any additional
information to facilitate this action. I appreciate your prompt response
to my request.”
In
the absence of a response, I sent a similar email to U.S. Air Force Surgeon
General Mark Ediger. This generated a reply
from Major General Roosevelt Allen, Jr., Director of Medical Operations &
Research in the Office of the Surgeon General.
He wrote that I was “correct in stating that current scientific evidence
clearly delineates different levels of health risk associated with the various
forms of tobacco use,” and he promised “to see if it is possible to post a clarification
of the article on the Health.mil site.”
At
General Allen’s request, I supplied a portfolio of published medical articles
on ST and tobacco harm reduction.
Sometime
in February, the offending article was removed from the military website. It is evident that senior Air Force health
officials recognized that the Defense Health Agency’s article was indefensible,
given the vast difference in risks involved in smoking and ST use. I am hopeful that this awareness will
translate into a rational tobacco policy at the Department of Defense and
beyond.
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