• 9/26/2006
  • New York, NY
  • Lauren Foster
  • msnbc.msn.com

Big Tobacco had more bad press this week after a US federal judge ruled people who smoked “light” cigarettes in the belief they were safer than higher-tar alternatives could proceed with a nationwide class action.

The news follows a recent study that found the amount of nicotine in US cigarettes rose about 10 per cent between 1998 and 2004, potentially making it harder to quit and easier to become addicted.

The message was clear: smokers are getting more nicotine than in the past and may need additional help in trying to break their powerful nicotine addiction.

In the US, home to 44.5m adult smokers, 70 per cent want to quit and 40 per cent make a serious attempt each year, but fewer than 5 per cent succeed in any given year, according to the National Institutes of Health.

Worldwide, an estimated 5m people die every year from tobacco-related diseases, and health officials predict the annual death toll will double by 2020 if current smoking trends continue.

Faced with these figures, some public health experts are looking more closely at smokeless products, such as Swedish “snus” and traditional moist snuff, as a way to reduce tobacco-related deaths and diseases. They suggest these products are a potentially less harmful way of delivering nicotine.

“Five million deaths worldwide is unconscionable when some of those could be prevented by offering some safer alternatives to smoking, which we know is very dangerous,” said Philip Alcabes, associate professor of urban public health at Hunter College School of Health Sciences.

Tobacco is not deadly, he says, the harm is in the smoke. “The weight of the evidence is quite heavy at this point that there are smokeless products that are far safer than smoking cigarettes,” he said. “Whatever opinion you may have about the moral probity of smoking, from an empirical standpoint people don’t just stop doing something just because you tell them to. If you have a simple way of protecting them, why not use it?”

Brad Rodu, an oral pathologist and professor of Medicine at the University of Louisville, says smokeless products can serve as effective substitutes for smokers who are either unable or unwilling to quit tobacco and nicotine entirely. (Mr Rodu holds an endowed chair in tobacco harm-reduction research funded by two companies that manufacture smokeless tobacco products.)

“The model I envision for nicotine use is much like that for caffeine use: it’s an addictive drug, but right now the difference is the delivery system,” he said. “With nicotine, unfortunately the most common consumption is to burn the tobacco and inhale the smoke, and that is whatconfers high risk after decades of use. Smokeless tobacco use has, at most,2 per cent of the health risks of smoking.”

Mr Rodu and others point to Sweden, where snusis more widely used by men than cigarettes and where men have the lowest rate of lung cancer in Europe. One study showed that the smoking rate among Swedish men fell from 19 per cent in 1996 to 9 per cent in 2004. By contrast, women are much less likely to use snusand their rate of tobacco-related deaths is similar to that in other European countries.

Jonathan Foulds, director of the Tobacco Dependence Program at the University of Medicine and Dentistry of New Jersey, says it is “fairly clear” that people in Sweden who use snusare less likely to smoke and young people who use snusare less likely to start smoking.

Jeff Stier, associate director of the American Council on Science and Health, acknowledges snusis “not 100 per cent safe” and that there are “clearly” risks associated with it, but says they are lower than the risks of smoking cigarettes.

One potential risk is oral cancer, as the products contain carcinogenic chemicals called tobacco-specific nitrosamines. They have also been linked with gum disease, pancreatic cancer, hypertension and increased risk of heart disease.

In the US, the Centers for Disease Control and Prevention take the position that there is no safe tobacco product. And in the European Union, snusis banned, except in Sweden.

Recently, however, the European Commission asked a panel of experts to investigate the possible risks and benefits of snus. snus

Scott Tomar, head of the department of community dentistry and behavioural science at the University of Florida College of Dentistry, says the Swedish experience is “somewhat misrepresented” as other countries show increased use of smokeless tobacco is accompanied by a parallel rise in smoking.