Curt Schillings’ Public Service Announcement Is a Major League Blooper

Major League Baseball is airing a public service announcement with retired pitcher Curt Schilling claiming “I have oral cancer” and linking that condition to his long-term use of chewing tobacco (here).  The 60-second spot, produced by MLB and the Professional Baseball Athletic Trainers Society, will be shown in baseball stadiums and on the MLB Network.

The PSA, however well-intentioned, is unsubstantiated and grossly misleading. Schilling and MLB squander a chance to impress adults and youths about the hazards of smoking, alcohol and human papillomaviruses (HPVs, sexually-transmitted viruses causing throat cancer and cervical cancer in women) and instead perpetuate smokeless tobacco myths.

Schilling has been blaming smokeless for his cancer for two years, but neither he nor his doctors have presented any evidence to support the claim and there is, in fact, good reason to question its accuracy. 

Mouth cancer is extremely rare.  The most common risk factor is smoking, which can increase chances ten-fold.  Smokers who drink alcohol are at even higher risk, and alcohol abuse alone raises the odds about four-fold.  Another significant cause of tongue and throat cancer is HPVs (here). 

While Schilling attributes his cancer to chewing tobacco, one’s odds of developing mouth cancer from this habit are about the same as those for a person who neither smokes, drinks nor has an HPV infection – roughly one or two in 100,000. 

One should ask: Did Schilling actually have mouth cancer?  It’s highly unlikely.  He says his cancer was discovered after he found a lump in his neck.  This indicates that it was almost certainly located in his throat and that it had already spread to a lymph node.    

Throat cancer is not associated with smokeless tobacco use.  It is, however, strongly linked to smoking, heavy alcohol use and infection with HPV. 

The MLB is irresponsible in airing a PSA based on the mere (and likely misguided) opinion of a layman.  Public health campaigns should be founded on verified medical and scientific information.

San Fran and Cal Smokeless Bans: They’re Yawners

The Campaign for Tobacco Free Kids and other anti-tobacco groups have persuaded the city of San Francisco to ban smokeless tobacco in municipal sports venues (here).  The ordinance takes effect in January 2016, but neither athletes nor fans will likely feel its effect.

CTFK president Matthew Myers wants smokeless products banned everywhere; last week he convinced the California Assembly to pass a state-wide ballpark ban (here); the bill is pending in the state senate.   

If Myers and ballpark barons really wanted to protect children, they wouldn’t let fans drink alcohol and drive.  Most venues sell alcohol; San Fran’s AT&T Park offers beer, wine, Irish coffee and 4,000 parking spaces.      

To be effective, ballpark bans would require full-body searches, including mouth exams, at the gates.  A game’s worth of snus or moist snuff pouches can fit in a zip-lock bag and be tucked in a pocket or purse.  Placement inside the upper lip virtually eliminates spitting, making use of the product invisible.  Even slo-mo replays won’t expose players’ enjoyment of these products on the field.

Laws should not be broken, but as with the failed American experiment of Prohibition a century ago, ballpark bans on smokeless tobacco will only spark civil disobedience.

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.     

Distorting Tobacco Facts to Sway Major League Baseball

Tobacco prohibitionists have for many years pressed Major League Baseball (MLB) to ban player use of smokeless tobacco. Despite decades of misinformation from advocates like Joe Garagiola (example here), many ballplayers still use smokeless products. The U.S. Congress entered the fray in April, when House Health Subcommittee Chairman Henry Waxman convened a hearing to browbeat baseball executives for failing to implement a ban. Witnesses pitched a barrage of misinformation. I responded in this blog (here and here).

More misinformation flowed on November 19, when the presidents of ten organizations dedicated to tobacco prohibition called on the commissioner and the director of the MLB players’ association to ban smokeless tobacco use. Their rationale for a ban was wholly unscientific; earlier this week I wrote the commissioner and the MLB association to set the record straight. The text of my letter follows:

December 6, 2010

Mr. Allen H. (Bud) Selig
Commissioner
Major League Baseball
245 Park Avenue, 31st Floor
New York, NY 10167

Mr. Michael Weiner
Executive Director
Major League Baseball Players Association
12 East 49th Street, 24th Floor
New York, NY 10017

Dear Commissioner Selig and Mr. Weiner:

On November 19, 2010, the presidents of ten organizations dedicated to tobacco prohibition wrote you “…to urge Major League Baseball and the Major League Baseball Players Association to prohibit the use of all tobacco products, including smokeless tobacco, by players, coaches, managers, and other team personnel, at all Major League Baseball venues.” The letter (available here, hereafter referred to as Myers et al.) contains distorted and inaccurate statements about the health risks of smokeless tobacco.

I am a professor of medicine, and I hold an endowed chair in tobacco harm reduction research at the University of Louisville. I have conducted research for two decades on the health effects of smokeless tobacco use, and I believe you are entitled to know what tobacco research and policy experts consider an indisputable scientific fact: the health risks from smokeless tobacco use are so low that they are difficult or impossible to measure with modern epidemiologic methods.

Myers et al. make unsupported allegations that smokeless tobacco causes a litany of cancers. They cite no scientific evidence for their claims, because the risks are either barely measurable or completely nonexistent. In 2009, a comprehensive analysis (Reference 1) of all available epidemiologic studies documented that smokeless tobacco users do not have significantly elevated risks for ANY of the cancers listed by Myers et al.

Myers et al. also claim that “Tobacco use is the number one preventable cause of death in the United States.” This is grossly misleading, as it combines smoking’s dramatic fatality figures with the far more benign use of smokeless tobacco (2). For example, the U.S. Centers for Disease Control and Prevention estimate that over 400,000 Americans die every year from smoking-attributable diseases (3), but the comparable number attributed to smokeless tobacco use is so low that the CDC has never attempted to provide an estimate. American Cancer Society Vice President Emeritus Michael J. Thun participated in a 2004 study concluding that “…smokeless tobacco 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.” (4)

The use of smokeless tobacco may be a legitimate topic of discussion between Major League Baseball and the Major League Baseball Players Association. However, the facts about smokeless tobacco vs. cigarettes should not be twisted to satisfy an anti-tobacco agenda or to influence public health policy.

Please do not hesitate to contact me if you would like more factual information on this important subject.

Sincerely,

Brad Rodu
Professor of Medicine
Endowed Chair, Tobacco Harm Reduction Research

References

1. Lee PN, Hamling JS. Systematic review of the relation between smokeless tobacco and cancer in Europe and North America. BMC Medicine 7: 36, 2009. Available here.

2. Rodu B, Godshall WT, 2006. Tobacco harm reduction: an alternative cessation strategy for inveterate smokers. Harm Reduction Journal 3:37. Available here.

3. Centers for Disease Control and Prevention. Smoking-attributable mortality, morbidity, and economic costs (SAMMEC). Available here.

4. Levy DT, Mumford EA, Cummings KM, Gilpin EA, Giovino G, Hyland A, Sweanor D, Warner KE. The relative risks of a low-nitrosamine smokeless tobacco product compared with smoking cigarettes: estimates of a panel of experts. Cancer Epidemiology Biomarkers and Prevention 13: 2035-2042, 2004.