A Long Journey on Tobacco Road, Vindicated

“Current public health policies offer smokers only two choices: to continue to smoke despite knowledge of adverse health consequences, or to quit, which often proves very difficult.

“In a review of the avoidable causes of cancer, Doll and Peto observed that ‘No single measure is known that would have as great an impact on the number of deaths attributable to cancer as a reduction in the use of tobacco or a change to the use of tobacco in a less dangerous way.’  Unfortunately, the second part of this observation has not received attention.  Because smokeless tobacco causes far fewer and considerably less serious health effects than does smoking, it should be promulgated as an alternative to cigarettes for smokers unable or unwilling to overcome their nicotine addiction.”

Brad Rodu DDS, Professor, University of Alabama at Birmingham

July 1, 1994 

An Alternative Approach to Smoking Control.  American Journal of the Medical Sciences Volume 308: pages 32-34. (here)

“Thus, both the 35-year-old non-user of tobacco and the smokeless-tobacco user will live on average to be 80.9 years of age compared with 73.1 years for the smoker.  Only 67% of smokers will be alive at age 70, compared with more than 87% of smokeless-tobacco users and nonusers of tobacco.

“…abstinence is not the only approach to reducing tobacco-related mortality: for smokers addicted to nicotine who would not otherwise stop, a permanent switch to smokeless tobacco could be an acceptable alternative to quitting.”

Brad Rodu DDS and Philip Cole MD, DrPH, Professors, University of Alabama at Birmingham

July 21, 1994

Tobacco-related mortality.  Nature Volume 370: page 184. (here)

“Among these and many other opportunities, there’s probably no single intervention, or product we’re likely to create in the near future that can have as profound an impact on reducing illness and death from disease as our ability to increase the rate of decline in smoking.

 “We need to redouble efforts to help more smokers become tobacco-free.  And, we need to have the science base to explore the potential to move current smokers – unable or unwilling to quit – to less harmful products, if they can’t quit altogether.”

Scott Gottlieb MD, Commissioner, US Food and Drug Administration

May 15, 2017

Remarks to FDA Staff (here)

Vaping in the U.K.

Comedian-cum-philosopher Stephen Colbert has opined, “Facts matter not at all. Perception is everything.”  Actual British researchers have gone a step further, finding that, with e-cigarettes and vaping, perception changes behavior.

British health authorities have consistently told smokers the truth about vaping since 2011 (here, here, here and here), while American officials, in their pursuit of a “tobacco-free society” or a “tobacco endgame,” have emphasized the negative, or simply perpetuated untruths and urban myths. 

Survey data in the U.K. and U.S. demonstrate that truth-telling results in more accurate perceptions about vaping than do obfuscation and scaremongering (here).  Now, a survey from the U.K.’s Action on Smoking and Health (ASH) (here) shows that favorable perception translates into positive behavior.

In this case, facts do matter.  The U.K. vaping population has ballooned, from 700,000 in 2012, to 2.9 million this year.  Importantly, the majority (52%) are former smokers – a sharp contrast to American data showing that most vapers are current smokers (here).

Within these encouraging U.K. figures are reasons for concern.  First, the prevalence of vaping is currently 5.8%, which is only a 12% increase since 2015.  This suggests that e-cigarette use may be leveling out.  With some nine million Brits smoking today (here), vaping momentum will have to grow in order to drive down smoking.

A major barrier to the success of e-cigarettes is misinformation (here).  The ASH report documents that 22% of smokers believe that e-cigarettes are more or equally harmful than cigarettes – a 9% increase from four years ago.  Anti-vaping propaganda, discussed here, may be a contributing factor.  Interestingly, 16% of smokers who tried but don’t use e-cigs said they would try them again if they were sure they were safe to use.

The ASH report also documents that e-cigs don’t work for all smokers.  Of smokers who tried but no longer use e-cigarettes, 25% said the devices didn’t feel like smoking, and 20% said they didn’t help with cravings.  Smokers should be given access to a range of safer smoke-free substitutes, including smokeless tobacco and heat-not-burn products, in order to help them quit their deadly smoking habit.   

         

Sticking to the Facts On E-Cigarettes & Nicotine Medicines

A dentist colleague notes that the American Dental Association was one of 28 medical societies that signed a letter to the FDA in opposition to a change in the deeming date for e-cigarettes (here):  “Changing this date would significantly weaken FDA’s ability to take prompt action to protect children from thousands of fruit and candy flavored e-cigarettes and cigars, including products in flavors such as cotton candy, gummy bear and fruit punch that clearly appeal to kids.”

Ironically, nicotine medicines also come in appealing flavors, like cinnamon surge, fruit chill, fresh mint, spearmint burst and white ice mint (here).  Evidently, marketers of both product categories view flavoring as a necessary and effective device to attract adult smokers.

While e-cigarettes are often tagged with groundless or exaggerated claims of health threats, my colleague cites specific health issues associated with nicotine medicines, as reported by a reputable clinical drug information service:

Adverse Effects that Occur Greater than 10% of the Time:

Headache (18% to 26%), Mouth/throat irritation (66%), dyspepsia (18%), cough (32%), rhinitis (23%).

Adverse Effects that Occur 1% to 10% of the Time:

Acne (3%), Dysmenorrhea (3%), flatulence (4%), gum problems (4%), diarrhea, hiccup, nausea, taste disturbance, tooth abrasions, back pain (6%), arthralgia (5%), jaw/neck pain, nasal burning (nasal spray), sinusitis, withdrawal symptoms

Adverse Effects that Occur Less than 1% of the Time:

Allergy, amnesia, aphasia, bronchitis, bronchospasm, edema, migraine, numbness, pain, purpura, rash, sputum increased, vision abnormalities, xerostomia

Adverse Effects For Which the Frequency is Not Defined:

Concentration impaired, depression, dizziness, headache, insomnia, nervousness, pain, aphthous stomatitis, constipation, cough, diarrhea, gingival bleeding, glossitis, hiccups, jaw pain, nausea, salivation increased, stomatitis, taste perversion, tooth abrasions, ulcerative stomatitis, xerostomia, rash, application site reaction, local edema, local erythema, Arthralgia, myalgia, paresthesia, sinusitis, allergic reaction, diaphoresis.

Any of these adverse effects could be needlessly exaggerated to condemn nicotine medicines, but they aren’t.  Nicotine can be consumed safely in gum, patches or vapor products.