Government’s Abstinence from Smokeless Truth Detailed by Wall Street Journal

The Wall Street Journal on July 21 reported what readers of this blog already know: “Many scientists agree that…smokeless tobacco, including chewing and dipping tobacco, is significantly less harmful than cigarettes.  But rather than encouraging the country’s 37 million smokers to switch to less-risky products, U.S. health officials have so far stuck with an abstinence-only message to the public.”

Journalist Jennifer Maloney underscored the government’s withholding of relative risk information about smokeless tobacco: “Online fact sheets published by the Centers for Disease Control, the Food and Drug Administration and the National Cancer Institute list multiple health risks associated with smokeless tobacco…but give no indication it is less harmful than cigarettes. ‘There is no safe form of tobacco,’ the cancer institute says on its website.”

Scientific research says otherwise.  Although it is impossible to prove absolute safety, dozens of epidemiologic studies over three decades have documented that health risks among American chewers and dippers are not significantly elevated.  Last year, a government study failed to find any mouth cancer risk among men who chew or dip (here). 

The CDC claims that it is unable to provide risk estimates for smokeless users (here, here and here).  Yet researchers from Altria produced them from CDC data; these are seen in the chart above (source here).  Smokeless users’ risks were comparable to those of nonusers of tobacco, whereas smokers had twice the risk of dying.

That Altria was able produce these dramatic results from CDC’s data underscores the government’s refusal to acknowledge the scientific truth about smokeless tobacco’s reduced harm profile. That is irresponsible and contrary to public health interests.

Federal health officials told Maloney, “more research needs to be done on the potential population-level consequences of broadcasting the fact that some tobacco products are safer than cigarettes.” 

Such facts should not be withheld from the American public.  Here is the consequence of public health officials’ persistent obfuscation and mendacity:

There were 8.1 million smokeless users in 2014, according to the National Survey on Drug Use and Health (NSDUH) (here), and 41% of them were also smokers.  This means that 3.36 million Americans are equally comfortable and satisfied using nearly harmless chew or dip, and smoking, which is deadly.  Government data shows that smokers have no idea that they are needlessly putting their lives at risk (here).  Federal agency leaders are aware of the differential risks, but choose not to push that potentially life-saving information to the public. 

The Wall Street Journal is to be applauded for helping to expose this transgression.

To the American Cancer Society: Tell Americans (And the Wall Street Journal) the Truth

Wall Street Journal numbers guy Carl Bialik wrote an article in April about the how the health risks from smokeless tobacco use were distorted and overblown by officials from the American Cancer Society (read it here). Specifically, Bialik pointed out that claims of a “50” fold elevated risk for mouth cancer for smokeless users have no scientific credibility.

The American Cancer Society could not defend continued use of the “50” number, so it immediately put out the white flag of surrender. Bialik wrote that “Dr. Thomas Glynn, director of cancer science and trends for the American Cancer Society, said this week that his organization will no longer use the statistic citing a 50-fold increase in risk.”

It turns out that Glynn was not telling Bialik the truth. The Cancer Society has released its annual booklet, “Cancer Facts and Figures 2010.” (available here) On page 43 under “Smokeless Tobacco Products” is the following text: “The risk of cancer of the cheek and gums is increased up to 50-fold among long-term snuff users.”

As I detailed in an earlier blog post (here), this number is a complete fabrication. Carl Phillips provided other insights about how this number is totally bogus (here).

The American Cancer Society is not telling the truth about the health risks of smokeless tobacco. This is bad enough, but it is disgraceful that the practice persists even after Cancer Society assertions to the contrary.

Wisdom From the Wall Street Journal

I have been engaged in tobacco harm reduction research for over 15 years; during this time I have discussed the subject with numerous journalists. Most of the subsequent news stories have been of marginal quality or even grossly inaccurate, because journalists rarely challenge spokesmen from the American Cancer Society or government health agencies who misrepresent smokeless tobacco as just as dangerous and just as evil as cigarettes.

The Wall Street Journal is the rare exception to the above. In 2006 and 2007, the Journal’s Pulitzer prize winning Kevin Helliker wrote a series of articles on tobacco harm reduction as a critical public health issue. Helliker challenged everyone he interviewed to fully substantiate their positions. The resulting articles remain quite simply the best media treatment on the subject. Two of his articles can be read here and here.

On August 31, R.J. Reynolds Tobacco Company and Lorillard, Inc. filed suit in U.S. district court in Bowling Green, Kentucky to block some of the provisions of legislation giving the FDA regulatory authority over tobacco products. On September 13, the Wall Street Journal editorialized on why the FDA legislation is flawed. One of the major points of the editorial, available here is that the legislation prohibits manufacturers from telling consumers that smokeless tobacco is safer than cigarettes:

“And there's also not much doubt that the new law hinders the ability of tobacco companies to communicate information to consumers, even when that information could lead to less harmful choices. Smokeless tobacco products aren't as dangerous as cigarettes because they contain fewer carcinogens and don't enter the lungs. Yet the law effectively prohibits companies from describing the relative health risks of different products. So a law that backers call a victory for public health actually prevents tobacco companies from informing consumers that switching to smoke-free nicotine products will reduce their health risks. Smokeless tobacco is not risk-free, but a public policy that pretends it is just as dangerous as lighting up is misleading and constitutionally suspect.”

The editorial concludes: “We sympathize with sincere efforts to reduce smoking. But imposing overly broad commercial speech restrictions that impede competition from safer alternatives is the wrong way to advance public health.”