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Stephen Strasburg attempts to quit smokeless tobacco

Mon, Jan 31, 2011

Oral Cancer News

Source: www.washingtonpost.com
Author: Adam Kilgore

Like any other high school kid, Stephen Strasburg wanted to emulate the major league baseball players he watched on television. He mimicked their actions down to the last detail. He rolled his pants up to reveal high socks, wore wristbands at the plate and, during downtime, opened tins of chewing tobacco and pinched some in his lower lip.

Years later, having developed a powerful addiction, Strasburg regrets ever trying smokeless tobacco. Last fall, Tony Gwynn – his college coach at San Diego State and one of those players he grew up idolizing – began radiation treatments for parotid cancer, a diagnosis Gwynn blamed on using smokeless tobacco.

In the wake of Gwynn’s cancer diagnosis, Strasburg has resolved to quit smokeless tobacco while he recuperates from Tommy John surgery. He doesn’t want to face the myriad health risks borne from tobacco use, and he doesn’t want kids who want to be like him to see him with a packed lower lip. Strasburg conflates many activities with dipping, and he has yet to eradicate the habit. But he is determined he will.

“I’m still in the process of quitting,” Strasburg, 22, said. “I’ve made a lot of strides, stopped being so compulsive with it. I’m hoping I’m going to be clean for spring training. It’s going to be hard, because it’s something that’s embedded in the game.”

Smokeless tobacco has long been entrenched in baseball. In the 1980s, wads of it bulged in batters’ cheeks. More recently, tins of what players call “dip” form circular outlines on players’ back pockets. Managers, players and coaches use it occupy time during the lulls of a game and to feel the rush of nicotine it provides, a momentary buzz of energy that many come to believe – erroneously – benefits their performance.

The habit carries a steep risk. Smokeless tobacco can lead to several forms of mouth cancer that require a series of disfiguring surgeries; many patients have their entire jaw removed. The juices swallowed contain heavy metals and can lead to esophageal and pancreatic cancer, two of the direst cancers to treat. White, precancerous lesions appear on the lips. Gums recede. Teeth become discolored and loosen.

“It’s nasty stuff,” said Gregory Connolly, a Harvard professor who has lectured major league players and testified before Congress on the ills of smokeless tobacco. “There’s no other way to look at it.”

For two decades, there has been a fight to educate players on the danger and eradicate smokeless tobacco from baseball, both for the health of players and for the health of children who watch and idolize them. Several congressional hearings, including one last April, have addressed the issue. Major League Baseball has urged players to not use it when on camera. Since 1993, all tobacco products have been banned in the minor leagues on fields, in clubhouses and during team travel. It’s also banned in college and in every significant amateur association.

And yet, experts say, the usage among major league players has remained steady. Roughly 33 percent of major league players, Connolly said, use some form of smokeless tobacco, a rate that has remained stagnant. More dispiriting, its use has risen among young males. The only significant increase of any tobacco product over the last five years, according to Connolly and other advocates, has been the use of smokeless among youths. It has increased to 25 percent, compared with 16 percent of the general population.

“It hasn’t changed that much,” says Joe Garagiola, his voice dripping with a frustration bordering on depression. Garagiola, a former player and major league executive, chewed himself as a player in the ’40s, believing, as so many players still do, that chewing tobacco is a rite of passage. He quit after his daughter asked if he was going to die. Later in life, he watched his friend Bill Tuttle, a former major leaguer, lose his jaw and then succumb to cancer caused by spit tobacco.

For two decades, Garagiola campaigned against smokeless tobacco in baseball. He gave speeches during spring training. He testified before Congress. At his home in Arizona, he keeps a box full of newspaper stories, fact sheets and advertisements for smokeless tobacco.

He still pleads with players to not put tins in their back pocket, a possible example for kids. The dearth of progress is difficult for him to bear.

“I’m to the point where you’re ready to put up the flag and say, ‘You win,’ ” Garagiola said. “The frustration is so deep. There’s nothing I can do about it. It hurts me. It really does. If baseball would just simply say we are banning tobacco from the field – but no. It’s a collective bargaining piece.”

Ban would mean bargain
Tobacco has not been banned in the majors, Garagiola and other experts say, because MLB and the players’ union view smokeless tobacco as a collective bargaining issue rather than a health issue. The players’ association will not yield to a ban without a concession, and the league has been unwilling to cede anything to implement a ban.

The next round of collective bargaining will take place this year, before the current Basic Agreement expires Dec. 11. Some momentum for a ban has gathered. During a House Energy and Commerce Committee Hearing, Rep. Henry Waxman (D-Calif.) called for baseball to ban all tobacco at the park. “Millions of young fans are exposed on a daily basis to the use of smokeless tobacco by their heroes,” Waxman said during the hearing.

In November, 10 anti-tobacco organizations, including the American Cancer Society and the Campaign for Tobacco-Free Kids, sent a letter to Commissioner Bud Selig and MLB Players Association head Michael Weiner urging a ban. “There is an unmistakable urgency for the players and team management to address this issue now,” the letter read.

“As a matter of policy, we don’t speak publicly about what we’re going to propose at the negotiating table,” MLB Executive Vice President Rob Manfred said. “What I will tell you is that smokeless tobacco remains a significant concern to Major League Baseball. Generally, our minor league policy reflects where we’re we’d like to be.”

“Despite its long-standing use throughout the history of the game, the union discourages the use of smokeless tobacco and has worked with the Commissioner’s Office to help make players aware of the health risks associated with these products,” Weiner said in a statement. “We have discussed this issue with players in anticipation of our upcoming collective bargaining negotiations.”

Weiner declined to address follow-up questions through a spokesman, not wanting to elaborate on a bargaining position.

Connolly drew a parallel between steroid testing and banning tobacco. Immense public scorn eventually pressured the players’ association into accepting tests for performance-enhancing drugs. Smokeless tobacco, meanwhile, has been left largely unregulated at the major league level. Connolly recalls reading a cover of Sports Illustrated decrying the use of steroids in baseball. On the back cover was an advertisement for a smokeless tobacco company.

“I looked at it and said, ‘This is insane,’ ” Connolly said. “If you’re looking at drugs, what is the most-abused drug by major league baseball players? It’s smokeless tobacco. There’s no question. What has the potential to do more harm to American kids in terms of addiction? It’s smokeless tobacco. It’s not steroids.”

Quitting has side effects
Smokeless tobacco use in baseball persists, in part, because of its powerful addictive quality. The rush or buzz players feel, studies have shown, is not actually a burst of energy, but rather a means to ease withdrawal symptoms.

Spit tobacco uses a different delivery system than cigarettes. Its high concentration of nicotine reaches the brain through mucous membranes in the mouth. In level of addiction, smokeless tobacco is more similar to cocaine than cigarettes, experts say.

And so quitting leads to a battery of side effects – sleep disruption, upset stomach, depression, headaches, lack of concentration. It is nearly impossible to play baseball under such conditions, which makes quitting during the season untenable and strengthens tobacco’s grip on players. Using may not help performance, but quitting certainly hurts.

“When they use again, they feel better and their performance is better,” said Thomas Glynn, an expert with the American Cancer Society. “But it’s not the smokeless that is helping. It’s the absence of withdrawal symptoms.”

Strasburg, then, has chosen the right time to quit. He will not have to worry about his performance for the Washington Nationals until the very end of 2011 at the earliest, and more likely until 2012. “He’s in a good position right now,” Glynn said. “If he can use this time to quit, it’s a good opportunity for him – and for any people who admire him.”

Strasburg has decided to quit as much for himself as for the countless kids who have watched him become one of baseball’s most recognizable players.

“I was one of those kids that picked it up based on seeing ballplayers do it,” Strasburg said. “It’s not a good thing, and I don’t want to represent myself like that. That’s one of the big reasons. Another reason is, when I do have kids, I don’t want my kids to be like that, too.”

Strasburg stressed that his decision to quit is an individual choice. He wants to set a good example for children who watch baseball, not necessarily set a directive for teammates.

“I’m not going to sit here and be the spokesperson for quitting dipping,” Strasburg said. “I’m doing it for myself. I’m not saying anything about anybody else – it’s their personal choice. For me, it’s the best decision.”

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