posted by Elaine Keller
The truthful statements in Justin Rohrlich’s story Smokeless Tobacco Advocate Rails Against ‘Frauds, Extremists, Liars’ were based on a two-hour-and-ten-minute phone interview with Smokefree Pennsylvania’s Bill Godshall. (How Rohrlich managed to gather so much information from Godshall in such a short phone call escapes me, but I digress.)
As a representative of one of the “Frauds, Extremists, Liars,” Danny McGoldrick, the Vice President of Research for the Campaign for Tobacco-Free Kids, was invited to comment, probably with the intention of bringing “balance” to the story.
To make any sense whatsoever of McGoldrick’s statements, you need the trANTZlator that Carl recently introduced for the common Anti-Nicotine and Tobacco Zealot (ANTZ) phrase, “smoking cessation.” Anyone who applies the common meanings of the words “smoking” and “cessation,” would think it is obvious that this phrase refers to the stopping (i.e. “cessation”) of the inhaling and exhaling of smoke.
*Gong* Wrong. When ANTZ people say “smoking cessation”, what they really mean is the act of stopping the use of any form of nicotine. Get it? Smoking = nicotine. Nicotine = smoking.
This is how Danny McGoldrick managed to testify at a legislative hearing on Tobacco Harm Reduction (THR) in Oklahoma with a straight face:
“…if the tobacco companies want to promote smokeless tobacco or anything else as a smoking cessation product, they can do this through the Food and Drug Administration like other cessation products by demonstrating with science that their products are a safe and effective way to quit smoking.”
“If the evidence is anywhere near what they claim, this should not present a problem for them,” he told the panel of lawmakers.
“There’s no evidence that people use smokeless tobacco to quit.”
There’s that bugaboo that Carl discussed in two previous posts: There is never no evidence (Part 1) and There is never no evidence (Part 2.) McGoldrick’s claim is nonsense from a scientific perspective.
If by “quit,” McGoldrick means “quit inhaling smoke,” it’s hard to believe that a man who holds the title of “Vice President of Research” was unable to track down any of the following articles, published in peer-reviewed scientific journals.
Effect of smokeless tobacco (snus) on smoking and public health in Sweden: “Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence.”
Is Swedish snus associated with smoking initiation or smoking cessation? “We investigated whether Swedish snus (snuff) use was associated with smoking cessation among males participating in a large population based twin study in Sweden. Snus use was associated with smoking cessation but not initiation.”
Randomized, placebo-controlled, double-blind trial of Swedish snus for smoking reduction and cessation: “Swedish snus could promote smoking cessation among smokers in Serbia, that is, in a cultural setting without traditional use of oral, smokeless tobacco.”
The association of snus and smoking behaviour: a cohort analysis of Swedish males in the 1990s: “We found clear associations between the two habits. For the younger cohort (age 16-44 years), snus use contributed to approximately six smoking quitters per smoking starter attributable to snus. For the older cohort (age 45-84) there were slightly more than two quitters per starter.”
These are far from the only published scientific evidence that snus can be used for smoking cessation. If what McGoldrick really meant was that it is unlikely or unknown whether snus can be used for nicotine cessation, that’s another story. But what he said was “smoking cessation.” So either he is lying about there not being any evidence, or he is extremely incompetent at his job.
Even respected government agencies are guilty of using “smoking” and “nicotine” interchangeably, and therefore misleading the public. All FDA-approved “smoking cessation” products are aimed at a goal of nicotine cessation. There are three problems with this approach: 1) It doesn’t work for over 90% of smokers that try to quit, 2) It isn’t necessary to become abstinent from nicotine to achieve smoking abstinence, and 3) Smokers who switch to a low-risk alternative enjoy the same health improvements as those that used nicotine abstinence to stop smoking.
There are many published scientific reports on the beneficial health effects of switching to smokeless tobacco.
Smokeless tobacco: a gateway to smoking or a way away from smoking: “Sweden has low rates of smoking and a lower rate of respiratory diseases and lung cancers by comparison to other developed countries.”
Health risks of smoking compared to Swedish snus: “Although few in number, these seven studies do provide quantitative evidence that, for certain health outcomes, the health risks associated with snus are lower than those associated with smoking. Specifically, this is true for lung cancer (based on one study), for oral cancer (based on one study), for gastric cancer (based on one study), for cardiovascular disease (based on three of four studies), and for all-cause mortality (based on one study).”
Lung cancer mortality: comparing Sweden with other countries in the European Union: “There were 172,000 lung cancer deaths among men in the EU in 2002. If all EU countries had the LCMR of men in Sweden, there would have been 92,000 (54%) fewer deaths.”
Summary of the epidemiological evidence relating snus to health: “After smoking adjustment, snus is unassociated with cancer of the oropharynx (meta-analysis RR 0.97, 95% CI 0.68-1.37), oesophagus (1.10, 0.92-1.33), stomach (0.98, 0.82-1.17), pancreas (1.20, 0.66-2.20), lung (0.71, 0.66-0.76) or other sites, or with heart disease (1.01, 0.91-1.12) or stroke (1.05, 0.95-1.15). No clear associations are evident in never smokers, any possible risk from snus being much less than from smoking. “Snuff-dipper’s lesion” does not predict oral cancer. Snus users have increased weight, but diabetes and chronic hypertension seem unaffected. Notwithstanding unconfirmed reports of associations with reduced birthweight, and some other conditions, the evidence provides scant support for any major adverse health effect of snus.”
Again, the above are just examples. Anyone can access PubMed’s search system and find many more studies.
Rohrlich’s story states, “Danny McGoldrick just can’t wrap his head around the idea of Big Tobacco’s collective conscience telling it to guide people to smokeless for their health.”
Actually, what McGoldrick can’t wrap his head around is the concept of how Tobacco Harm Reduction works. Or perhaps he just doesn’t want to.
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Why should we consider smokeless tobacco products or even e-cigarettes as smoking cessation tools? These products are made not as a means to quit but as a means to help quitters deal with the adverse effects of nicotine abstinence coming from smoking cessation. Why people don’t stop smoking? Because they are addicted to nicotine. Do we expect e-cigarette relieve this addiction? No. But it provides an alternative method of obtaining nicotine without all the adverse effects coming from the smoke. This is in my opinion the correct place of these products in the market.
Please stop talking about a dubious “nicotine addiction”. Nicotine in patches in not addictive. Nobody is addicted to a product. To become an addiction, there needs a repetitive behavior linked to some sensations (generally with a product or a device, not always).
People are addicted to the sensations provided by smoking, and at a lower level by snusing or vaping. Not at nicotine alone. This is precisely why smokers don’t use nicotine patches more than once.
Presumably that was a response to the previous comment, rather than the post itself (which never uses the word “addiction”).
The real problem with the term is much deeper than debates about which products or chemicals are “addictive”. The real problem is that such debates cannot be resolved without a scientific definition for “addiction”, and there is no such accepted definition; the word describes an “I know it when I see it” type of notion, and application of it varies a lot by the “I” in question. There are common colloquial understandings of the word, which tend to not apply to the experience of most tobacco/nicotine users. There are uses of it as a convenient shorthand in scientific contexts, but this is really not wise because it hides the fact that there is no scientific definition. And, of course, there are uses of the word as an epithet — basically name-calling.
But ultimately, there is no accepted concrete definition, so it makes little sense to try to argue about whether something fits this (non-existent) definition.
Chemical addiction is a reality for sure. However, i agree that it is not the unique way by which addiction to smoking develops. The matter is much more complicated, and, as Prof Phillips mentions, the term is usually used for convinience rather than explaining the phenomenon.