Saturday, November 12, 2005

As anti-smoking advocates promote the Great American Smokeout this month, ABC News is making an impressive effort to educate the public about the dangers of cigarette smoking and about ways to quit.

The series correctly portrays nicotine as powerfully addictive. ABC’s Dr. Tim Johnson has it right: “there is no more addictive substance than nicotine. It is harder to take control over the nicotine addiction than to take control over heroin, cocaine or alcohol.” What Dr. Johnson didn’t say is that nicotine does not cause cancer, or any other smoking-related illness. In fact, nicotine itself is no more dangerous than caffeine, another addictive drug consumed safely by millions of Americans.

Most smokers don’t know this; research released earlier this month found they wrongly believe nicotine causes cancer. In fact, it is tobacco smoke, with thousands of toxic agents, that leads to cancer, heart disease and emphysema. Eliminate the smoke, and tobacco users eliminate virtually all of the risk.

Unfortunately, the entire series so far simply repeats an outdated and unsuccessful strategy by an intellectually bankrupt anti-smoking campaign, now more than 40 years old.

The campaign’s irrational message to smokers: Quit tobacco and nicotine entirely — or die. The reality for the 400,000 dead American smokers last year: Abstinence wasn’t attainable.

The campaign’s cessation efforts have failed because they offer addicted smokers behavioral therapy, with tips like “Keep your hands busy — doodle, knit, type a letter;” “Cut a drinking straw into cigarette-sized pieces and inhale air;” “Keep a daydream ready to go” (all from a 1993 National Cancer Institute smoking cessation manual). Such advice has little effect on adult inveterate smokers because they need nicotine.

The campaign offers smokers nicotine replacement such as nicotine gum and patches, but only temporarily. In addition, these products are expensive and provide too little nicotine to prevent craving and withdrawal. They are ineffective.

A recent review of over-the-counter nicotine medications revealed their success rate is 7 percent, which the authors characterized, fancifully, as “efficacious” and “modest.” In the real world, 7 percent “success” is an abject failure.

The ABC series should inform smokers there is another way to quit. It’s called tobacco harm reduction, and involves permanent replacement of cigarettes with less harmful, smoke-free forms of tobacco and nicotine. Medical research shows smokers can achieve almost all of the health benefits of quitting smoking without quitting tobacco.

Modern smokeless tobacco products contain nicotine in addictive doses to satisfy smokers’ cravings. University research has documented that smokers who switch to smokeless tobacco reduce their risk for all smoking-related illnesses, including oral cancer. On average, smokers live 8 years less than those who never used tobacco; smokeless users lose just 15 days. Statistically, smokeless users have about the same risk of dying as automobile users.

Britain’s Royal College of Physicians, one of the world’s most prestigious medical societies, agrees: “As a way of using nicotine, the consumption of noncombustible [smokeless] tobacco is on the order of 10-1,000 times less hazardous than smoking, depending on the product.” The RCP made an even bolder statement, acknowledging some smokeless tobacco manufacturers may want to market their products “as a ‘harm reduction’ option for nicotine users, and they may find support for that in the public health community.”

Modern smokeless tobacco products not only deliver the nicotine kick smokers crave, they can be used invisibly. They are available as wafers or small tobacco pellets the size of breath mints; some completely dissolve during use, leaving no tobacco residue.

Data from Sweden show smokeless tobacco can easily substitute for smoking. Over the last 50 years, Swedish men have consistently had the lowest smoking rate and the highest smokeless tobacco rate in Europe.

For example, in 2004, the smoking rate among men 18-24 in northern Sweden was an astounding 3 percent. The World Health Organization statistics reveal Swedish men have the lowest rates of lung cancer — the sentinel disease of smoking — among 20 European countries.

In the U.S., smokeless tobacco is already helping many quit smoking. Statistics from the Centers for Disease Control and Prevention (CDC) show 1.5 million to 2 million former smokers have already chosen this option.

The ABC News Web site promises the series will take a “comprehensive look at one of the nation’s leading killers.” No look is truly comprehensive unless it provides American smokers with information on all options to quit.

Brad Rodu holds the Endowed Chair in Tobacco Harm Reduction Research and is a professor of medicine at the University of Louisville. Jeff Stier is associate director of the American Council on Science and Health in New York.

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