Spit tobacco is not a quit-smoking solution

Dr. Brad Rodu recommends spit tobacco use as a method to help with smoking cessation (“Smokers need the facts on alternatives,” Ideas, April 19).

This strategy, known as harm reduction, encourages spit tobacco as an alternative to cigarettes because of lower risks for severe health consequences.

Although smoking cessation is very important, spit tobacco is not a safe alternative. There are numerous diseases and illnesses that have been scientifically linked to spit tobacco, including gingivitis, tooth decay, cardiovascular disease and oral, esophageal, pharyngeal, laryngeal, stomach and pancreatic cancer.

The most dangerous of these health issues is oral cancer, which has a mortality rate of 54 percent within five years of diagnosis. The risk for developing oral cancer from spit tobacco has been found to be 14 times greater than the risk in nonusers.

Besides the health risks associated with the use of spit tobacco, there are other concerns with harm reduction. There could be an increase in use among adolescents who think “smokeless is harmless” when it comes to spit tobacco, an overall increase in the use of tobacco by nonusers, and an increase in sales of high-nicotine products that raise the risk for addiction.

In his research, Dr. Rodu has often discussed the effectiveness of harm-reduction programs in Sweden. While Swedish studies have indeed demonstrated decreased smoking levels through the use of spit tobacco, there are several differences between the two countries that make it difficult to compare the United States to Sweden.

First of all, the spit tobacco products are dramatically different. The levels of cancer-causing agents found in Swedish spit tobacco brands are dramatically lower (by as much as 98 percent). Sweden also has a rigorous system of controls over manufacturing and advertising of spit tobacco products. The United States has no regulatory control over spit tobacco and very few restrictions on advertising. The United States and Sweden are not similar when it comes to spit tobacco products and should not be compared for harm reduction purposes.

Dr. Rodu also states that the British Royal College of Physicians has endorsed spit tobacco use for smoking cessation. However, professor John Britton, chairman of the RCP tobacco advisory group, states, “The best thing that a smoker can do for his or her health is to quit all smoking and nicotine use completely. Nicotine products like the patch and gum deliver necessary amounts of the drug to overcome addiction withdrawal without any of the risks of tobacco use.” There are clinically proven options available that do not include any increased risk of cancer that should be utilized rather than other forms of tobacco.

Finally, the author neglected to mention his vested interest in the use of spit tobacco. Dr. Rodu is an endowed professor of tobacco harm reduction. Dr. Rodu’s position at the university and his line of research are directly sponsored by grants from the U.S. Smokeless Tobacco Co. (Skoal, Copenhagen) and Swedish Match — two of the largest spit tobacco manufacturers in the world. He has received millions of dollars in grant funding from spit tobacco companies and has acted as an expert witness for them in product liability lawsuits.

Given the uncertainties associated with Dr. Rodu’s strategy, the World Health Organization and other public health groups have determined that the overall risks associated with spit tobacco do not support the use of a harm reduction strategy.

Decreasing the smoking levels in North Carolina and the United States is very important from a health standpoint. But there are ways that this can be achieved without recommending spit tobacco. We need to decrease tobacco use, period, not replace one tobacco product with another.

Ted Eaves is an adjunct assistant professor at N.C. A&T State University whose research focuses on spit tobacco use and cessation.