BBC Drops the Ball on Baseball & Smokeless Tobacco

It’s almost baseball season, which means it’s time for anti-tobacco extremists to start grabbing easy headlines.  One especially zealous state lawmaker wants to ban smokeless tobacco by players and fans in all California ballparks (here).  It’s all based on smoke and mirrors, as illustrated in a woefully inaccurate recent BBC story on smokeless tobacco and baseball.

The report includes an erroneous claim that baseball stars Tony Gwynn, Curt Schilling and Babe Ruth died from cancers caused by smokeless tobacco. 

Neither Gwynn’s nor Schilling’s cancer was related to smokeless products, as I have detailed before (here and here).   Reporter Nada Tawfik concedes that “doctors say a link between [Gwynn’s salivary] cancer and chewing tobacco cannot be proven.”  I have previously noted the absence of a scientific link between smokeless tobacco and this cancer type (here).  As for Schilling, he never said he had mouth cancer and not one of his doctors has supported his statement that smokeless tobacco caused his illness.

The BBC repeated the decades-old myth that Babe Ruth suffered from smokeless tobacco-induced mouth cancer.  In truth, Ruth had nasopharyngeal carcinoma, a rare disease caused by the Epstein-Barr virus.  Ruth was a prodigious consumer of cigars and alcohol, but neither are strongly associated with nasopharyngeal carcinoma (discussed here).  He also used smokeless tobacco, which has no link to this cancer type.

Included in the BBC story was a remarkable quote attributed to Dr. Jatin Shah, who runs the Head and Neck Service at New York’s Memorial Sloan Kettering Cancer Center.  Chewing tobacco, he is reported to have said, is “probably more harmful than smoking.”  I emailed Dr. Shah to ask if he had been misquoted.  He responded with a comment on South Asian products, but the BBC’s vast audience has been left with the grossly erroneous impression that American smokeless tobacco is more dangerous than cigarettes.

Thus are myths perpetuated and the public health undermined.     

Dishonoring Tony Gwynn

The loss of American sports heroes is often accompanied by an outpouring of grief.  But the death of San Diego Padre star Tony Gwynn from salivary gland cancer was dishonored by a federal official (here) and other uneducated or unprincipled opportunists (here, here,  here  and here) who used it to further an irresponsible campaign against smokeless tobacco.

The fact is that salivary gland cancer is extremely rare, about 23 cases per million men each year.  Epidemiologic studies have not established a definitive cause, but they show that radiation therapy, alcohol and hair dyes are possible risk factors (more information here).  Tobacco use is NOT. 

Stretching the facts to demonize smokeless products, Brian King, scientific advisor in the U.S. Center for Disease Control’s office of smoking and health, told Fox News, “…with smokeless use, it’s primarily in the oral region, [which is] why we’re seeing a lot of cancers associated with smokeless tobacco around the oral cavity.”

This is completely false.  King surely knows that the vast majority of mouth cancers are associated with smoking, alcohol abuse and/or human papillomavirus infection.  Numerous epidemiologic studies have documented that there is no mouth cancer risk associated with American moist snuff, chewing tobacco or Swedish snus.

In another attack on smokeless tied to Mr. Gwynn’s untimely death, periodontist Dr. Sanda Moldovan took to The Huffington Post with total disregard for science and fact (here).  “Nicotine is a silent killer with any number of different kinds of cancers,” she wailed.  Decades of scientific studies have established that nicotine does not cause cancer at all.  In fact, nicotine is not the cause of any disease related to smoking.

Moldovan claimed that, “As an oral health professional, I see the initial stages of oral, gum, throat and salivary gland cancers all too often,” but this is near impossible unless she defines “all too often” as twice in her entire career.  In a published study using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, I calculated that “If every oral cancer was detected by 1 of the 128,000 general dentists in the United States, then on average each dentist would make 1 diagnosis every 12 years.”

Moldovan is grossly wrong in claiming that “There are even studies that show that smokeless tobacco is more carcinogenic than smoked tobacco!”  A 2004 National Cancer Institute-funded study 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.”   

  

I don’t blame Tony Gwynn for desperately trying to find a cause for the cancer that took his life.  In blaming smokeless tobacco, he was wrong, but that doesn’t attenuate the sense of loss all of us feel when a legend’s life comes to a close.  However, Gwynn’s life and last struggle are dishonored when extremists torture the truth and disrespect science.                                                                                    

Mayo Clinic Misinformation About Smokeless Tobacco

For many years, tobacco “experts” at the Mayo Clinic have tarnished the institution’s name by fabricating misinformation about smokeless tobacco. In a 2004 article about such tactics (available here), I noted that the Mayo website contained this irresponsible, unprofessional and demonstrably false statement: “…smokeless tobacco, also called spit tobacco, has health risks just as severe or even more severe as those associated with cigarette smoking.”

Last week, Jennifer A. Kern, a Mayo Clinic behavioral counselor and former smoker, published a quit-smoking blog entry for the official Mayo Clinic web site, in which she invented new health risks related to smokeless tobacco use (here).

Ms. Kern begins with an explicit acknowledgment that smokeless tobacco is an effective substitute for cigarettes: “Those of us who live in the north are moving into the cooler seasons…it's not uncommon to see people switching tobacco products in order to stay indoors while still getting their nicotine fix. Some folks put down cigarettes and pick up smokeless tobacco products such as chewing tobacco and snuff instead.”

Ms. Kern doesn’t like smokers switching to vastly safer smokeless products, so she tries to convince them not to do so by invoking a “just-as-harmful” theme: “Smokeless tobacco products carry carcinogens, or cancer-causing chemicals, just like cigarettes do.”

Next, Ms. Kern turns to outright fabrication: “In fact, a variety of cancers that can be caused by smokeless tobacco use include: mouth and gum, larynx (voice box), esophagus, and salivary gland, as well as non-oral cancers like pancreas, kidney and penile cancer.”

My readers know that a comprehensive meta-analysis published in 2009 found that smokeless tobacco use is not associated with cancers of the mouth and gum, larynx, esophagus, pancreas or kidney (for a full discussion, click here). But what about salivary gland and penile cancer?

For salivary gland cancer, Ms. Kern may have misread a story involving Tony Gwynn, a former major league baseball player. In early October, Gwynn was diagnosed with cancer of the parotid salivary gland (described here), and he commented that “I haven't discussed that with the doctors yet, but I'm thinking it's related to dipping.” Apparently Gwynn and Ms. Kern are unaware that no epidemiologic studies have linked smokeless tobacco use and salivary gland cancer.

Ms. Kern’s most bizarre claim is that smokeless tobacco use causes penile cancer. According to the National Cancer Institute, penile cancer is extremely rare, occurring in only 1,250 American men each year (here). Penile cancer is strongly related to human papillomavirus infections and lack of circumcision (here). Maybe Ms. Kern was referring to a 1995 report linking penile cancer and smokeless use in India (here), but Swedish and American products have not been implicated in numerous epidemiologic studies.

Someone should counsel Ms. Kern and her employer about the public health imperative of sticking to the facts.