A Smokeless History Lesson For Vaping Advocates

E-cigarettes are under siege by federal health authorities and NGOs, aided and abetted by countless university researchers funded generously by the National Institutes of Health (here).  Many of their tactics were introduced 35 years ago.  Here, in brief, is the story of smokeless. 

The American anti-smokeless campaign started on March 26, 1981, when Deborah Winn, Ph.D., reported in the New England Journal of Medicine that the relative risk for oral cancer among powdered dry snuff users was 4, a risk she described as "exceptionally high".  In reality, that risk translated to a mere 12 deaths per year among 100,000 long-term users (For perspective, compare this with the contemporary annual U.S. death rate of 10 per 100,000 users of automobiles, here).  Winn studied only the use of powdered dry snuff, not the moist snuff and chewing tobacco that the vast majority of American smokeless tobacco consumers prefer.  She later acknowledged in two obscure scientific publications – a 1983 IARC report (here) and the 1986 Banbury Report 23 from Cold Spring Harbor Laboratory – that her study involved only dry powdered snuff, but her omission of that critical detail in the initial article set the stage for condemnation of all smokeless products as health hazards (discussed in detail here). 

Winn also falsely inflated the moderate relative risk of 4 to a startling and unsubstantiated 50 (explained in detail here).  The fifty fabrication was adopted by public health agencies and associations worldwide, and continues to pollute the web sites of the American Cancer Society (here) and the State of Kentucky (here), among many others.

The office of the Surgeon General of the United States has been tarnished by the campaign to demonize smokeless products.  Surgeon General Richard Carmona grossly distorted the facts when he testified before Congress in 2003, saying “there is no significant evidence that suggests smokeless tobacco is a safer alternative to cigarettes.”  I also testified at that hearing (here) and published in the Washington Times the following week an op-ed dismantling Dr. Carmona’s testimony (here).  It was another Surgeon General, Antonia Novello, whose 1994 false claim, “The majority of our experts predict an oral cancer epidemic if the current trends in spit tobacco use continue,” (here) prompted me to enter the field of tobacco harm reduction. There was never any basis for that prediction, and it was never realized. 

Major medical institutions have damaged their credibility by spreading misinformation about smokeless tobacco.  These include the Mayo Clinic, the Legacy Foundation, the National Cancer Institute (here) and others.  Other examples of this scientific travesty were described in a comprehensive review of tobacco harm reduction penned by William Godshall and me in 2006 (here).

Today, e-cigarettes are attracting growing support from public health proponents who recognize their value as safer alternatives for cigarette smokers.  It is consternating, however, that some of these experts persist in demonizing smokeless tobacco products whose relative safety is supported by dozens of irrefutable epidemiologic research studies. 

Surgeons General Say the Darndest Things About Tobacco

Acting U.S. Surgeon General Boris Lushniak recently tweeted, “@OxfordWords #Vape may be #WOTY but the increase in never-smoking youth using e-cigs is a not a trivial story.”  The tweet referred to the Oxford English Dictionary’s having designated “vape” as the word of the year, and reflected a CDC report claiming that e-cigarette use among children had increased in 2013.  The prevalence of e-cig use among youth who had never smoked was 0.3%. 

Tobacco use by youth is never trivial, but in taking an extreme position, Dr. Lushniak was acting in the tradition of previous surgeons general.

In December 1992, Surgeon General Antonia Novello announced: “The majority of our experts predict an oral cancer epidemic beginning two or three decades from now if the current trends in spit tobacco use continue.” (here).  That was shocking news for many, including this oral cancer expert.  As an oral pathologist for 15 years at Emory University and the University of Alabama at Birmingham – deep in smokeless tobacco country – I had made microscopic diagnoses in hundreds of oral cancer cases (almost all smoker/drinkers), and I had assisted in the treatment of hundreds more.  Over time, I had become increasingly bothered by the disconnect between the dogma I taught my medical and dental students (that smokeless tobacco was a death sentence for oral cancer) and what I had experienced in practice (that smokeless tobacco was almost never listed as a behavior on the pathology request forms, the rare exception being powdered dry snuff).

Dr. Novello’s announcement was the catalyst for my research, which led to my first journal articles in 1994 (here and here), and my book, “For Smokers Only”, in 1995.  (An updated version with a new chapter on e-cigarettes is now available in print and as an audiobook here).   

I testified at a 2003 Congressional hearing on tobacco harm reduction (available here), at which Surgeon General Richard Carmona also testified. (Dr. Carmona is today an NJOY director and chair of its scientific advisory committee.)  In that hearing Dr. Carmona said, “there is no significant evidence that suggests smokeless tobacco is a safer alternative to cigarettes.”  I subsequently noted in a Washington Times editorial (here) that the surgeon general had ignored decades of published research and the findings of Britain’s esteemed Royal College of Physicians.

Dr. Carmona so blundered in supporting a ban on all tobacco products that Bush administration officials had to backtrack.  “This is not the policy of the administration,” White House spokesman Scott McClellan said, adding that Dr. Carmona’s comments reflected his views alone.

The surgeon general occupies one of the most trusted positions in American medicine. The individual holding that post should speak the truth about safer cigarette substitutes, today and always.