• 7/12/2003
  • Sarasota, Florida
  • Brad Rodu, D.D.S.
  • The Sarasota Herald Tribune

OCF Note: This article only appears here because of the absurdity of its author’s perspective. This is an editorial comment By Brad Rodu DDS, which appears in this paper. It is not a news article. See OCF editorial note at end.

Dr. Richard Carmona, the U.S. surgeon general and the Bush administration’s primary adviser on the nation’s public health, demonstrated that he is sadly ill informed about the nation’s No.1 health problem, cigarette smoking, during testimony at a recent House Energy and Commerce subcommittee hearing.

Carmona’s first blunder was his contention that “There is no significant scientific evidence that suggests smokeless tobacco is a safer alternative to cigarettes.” Carmona rejected decades of published research and the prestigious British Royal College of Physicians, who reported last year that smokeless tobacco products are “on the order of 10 to 1,000 times less hazardous than smoking.” Surely Dr. Carmona knows that cigarette smoking is a major risk factor for lung and other cancers, heart diseases and emphysema, resulting in 440,000 deaths annually in the United States. But he doesn’t seem to appreciate that smokeless tobacco use carries no risk for lung cancer, heart disease, or emphysema. The only consequential risk for long-term smokeless use is mouth cancer. Fifty years of research prove that even this risk is very low (less than half that associated with smoking). In fact, smokeless tobacco use is about as safe as automobile use. That’s 98 percent safer than smoking.

Saying that smokeless tobacco is as dangerous as cigarettes is more than a blunder. It is an uncaring message to smokers from America’s number one doctor: Quit or die. With stable smoking rates, this is an approach cigarette manufacturers can live with. For more than half of inveterate smokers (those who simply cannot quit), it’s a prescription they will die with.

Carmona’s second blunder was his support for banning tobacco products. Asked if he “would support banning or abolishing all tobacco products,” Carmona responded, “I would at this point, yes.” This marked the first time a surgeon general has called for outright prohibition, and he sent would-be supporters running from the Hill. Even the Campaign for Tobacco-Free Kids, which has shown little interest in helping inveterate adult smokers, couldn’t support Carmona. Its spokesman commented that “We would all like to see a tobacco-free world … (But) we can’t just take away their tobacco.”

Carmona’s boss can’t be happy; Bush administration officials responded quickly with disclaimers. “That is not the policy of the administration,” commented Bush spokesman Scott McClellan, saying that Carmona’s comments represented his views as a doctor. But Carmona’s views as a doctor are just the point. He occupies one of the most trusted positions in American medicine and in American government.

The Bush administration should do more than distance itself from these dangerous and irresponsible positions. It should direct Carmona to read the dozens of scientific papers on tobacco harm reduction. It should direct him to review the evidence from Sweden that smokers can quit by substituting smokeless tobacco.

Finally, it should require that he tell American smokers the truth about all available options for quitting. After all, the 10 million smokers who will die over the next two decades are, in a very tangible way, his responsibility and his legacy.

Brad Rodu, D.D.S., is a professor in the department of pathology at the University of Alabama at Birmingham School of Medicine.

OCF editorial note: I wonder how many people, who read Brad Rodu’s editorial regarding the relative safety of smokeless tobacco vs. inhaled tobacco and subsequently die of an oral cancer, or live the rest of their lives physically or emotionally disfigured by surgeries and treatments for it, he would like to take responsibility for? After all, he’s asking the surgeon general to take responsibility for those affected by his comments and positions. Picking and choosing your statistics to make a point can be done by anyone. Certainly an argument can be made that by eliminating the deaths (as a result of lung cancer) from inhaled tobacco would reduce tobacco related deaths, since spit tobacco is not associated with these diseases. But you can reduce a portion of those saved lives by the addition of new deaths of individuals who will lose their lives to oral cancer, or another tobacco related illness instead. I wonder what Rodu’s motivation to go on the attack against Carmona and in support of tobacco is? As a doctor, would he not like to see a tobacco free world? It kills millions every year around the world. The costs of treating tobacco related disease are staggering. The human toll in suffering these diseases would be reason enough to rid ourselves of tobacco. Apparently Rodu would not, since he calls Carmona’s desire for a tobacco free world his second blunder. And the Bush administration’s disclaimers? What do you expect from an administration that uniformly favors big business over the public good? Why not suggest an alternative non-tobacco nicotine replacement instead of another form of tobacco with its associated deaths? For a dentist to take this position, which would likely make oral cancer, periodontal disease, etc. more prevalent, is an embarrassment at best. This dentist’s priorities are grossly misplaced. Suggesting chewing tobacco as a nicotine supplement because it is not linked to heart disease or lung cancer is a joke. It is linked to different diseases, some as remote as pancreatic cancer, let alone the obvious one of oral cancer. It is particularly telling that he does not mention in this article (or others of his) alternative nicotine replacement possibilities, such as nicotine inhalers or nose drops to aid in cessation. These would certainly help those that he dramatically states would have “to quit or die.” Of course as a doctor he knows about these things, but seems to have forgotten to mention that there are alternatives to spit tobacco as a nicotine replacement. There is even a tobacco free chew made from black tea and nicotine… essentailly a replacement therapy without the carcinogens ( Blue Whale)… did he suggest this? No. If he wasn’t personally vested in the tobacco side of things, he might mention that it is not “quit or die”, it is replace the nicotine with a safer alternative like nicotine inhalers, with the long term goal of quitting the addiction altogether. Yes, doctor, let’s just increase the rates of oral cancer in the US instead. Absurd is the only word that comes to mind. Although perhaps not so absurd… if your funding is coming from the tobacco companies themselves.

In 2006 OCF was contacted by Rodu and his associates complaining that calling his perspectives and comments absurd was uncalled for, and I should “take care” when critical of others scientific work. Let’s be clear here. Rodu wrote an editorial here, not a peer reviewed scientific study. In it he calls the surgeon general’s comments a blunder. He puts words in the surgeon general’s mouth like “Quit or Die”, a sensationalized phrase that Carmona never made to attempt to make Carmona look uncaring, or worse. He is promoting something that in this very piece he states, “The only consequential risk for long-term smokeless use is mouth cancer. Fifty years of research prove that even this risk is very low (less than half that associated with smoking).” I don’t know about others, but 50% of the risk of smoking is pretty damn high, and he would have us increase the number of Americans with oral cancers by getting people to switch to spit tobacco. That statement is absurd. He is certainly entitled to his perspective and words. Likewise, I choose to call his perspective absurd in my editorial of his Op/Ed piece. Is he the only one allowed to make a characterization of their personal viewpoint in writing?