Tuesday, June 06, 2006

Killing by the million - and that's just the health campaigners...

World cigarette production is about 5.53 trillion sticks per year. (about 2.4 per day for every single person in the world). This is stabilising as people in developed countries quit and growing populations in the developing world start puffing. According to WHO's tobacco group, death-toll from this is now about 5 million per year, heading for 10 million. With perhaps 1 billion potential premature deaths at stake in 21st Century on current trends. In other words it's huge.

What is absolutely amazing though is that there are forms of tobacco use about 10- 100+ times less hazardous than smoking (ie. chewing, sucking - anything non-combustible) - it's the smoke that really kills. Widespread use of these is why, for example, Sweden has the lowest rates of cancer and heart disease in the world. If the world tobacco market shifted to selling more of this and less cigarettes, millions of premature deaths could be avoided over the 21st Century. But true to form, the well paid and comfortably smug public health community refuses to accept this concept and adopts a counter-productive prohibitionist stance - hoping naively that if people have a choice between quitting and dying, they'll choose to quit. Inconveniently, tobacco is highly addictive, so many wont or can't choose to quit and will
die. So instead of telling the truth about low risk options, there is a conspiracy to lie and mislead (for example, the US Surgeon General told a barefaced lie about it to Congress). In Europe, we even have a directive (2001/37/EC see article 8 and 2.4) that bans the much lower risk products than cigarettes. If there is a reason to be a Euro-sceptic, then this is one of the strongest - deliberate denial of access to products that are much lower risk to people that are addicted to nicotine.

I feel very strongly about this, so last night I met with US Smokeless Tobacco to encourage its new chief executive to make his target market the erosion of the 5.5 trillion unit cigarette category. If he achieved that, I think they'd save more lives than most of their opponents in the public health community. he didn't need much convincing.


philippe said...

What are the risks linked to chewing?
Oral cancer? I understand your argument about people switching to a less dangerous nicotine based product but what about people who start using this product and only this one? Of course the smokeless people claim they only want adults to use their products. But what credibility do they have? As for the well paid health campaigners it is certainly true there can be inertia among the "advocates" and there can be "blind spots". Is associating with people pushing the use of smokeless tobacco a reason for triumph? I can hardly imagine there are no health consequences for chewing tobacco...

philippe said...

Here is the link for the canadian site in favor of smokeless tobacco as a safer alternative to cigarettes:

Clive Bates said...

Actually the risks of oral cancer for most smokless tobaccos are lower than for smoking. But in absolute terms oral cancer risk is much lower than the risks of other cancers - especially lung. Though smokeless tobacco should never be seen as 'safe', it is very much less dangerous. So it plays a harm reduction role. Obviously, quitting completely is the safest course, but not everyone can or will do that.

Anonymous said...

The large and well-respected study conducted in Sweden by Lewin et al. is a must read for all who are concerned about the linkage between smokeless toabcco use and oral cancers. Swedish snus, the product used by subjects in that study, is known to have reduced toxin levels relative to a number of other forms of smokeless tobacco. Lewin et al. found no increased incidence of head and neck cancers among those users, EXCEPT among those who also were heavy alcohol users.

The UK Royal College of Physicians most certainly was not "advocating" for the "smokeless people" when it published its consensus on the role that smokeless tobacco use can play in reducing the death and disease caused by smoking.

In the US there is an entire body of research conducted by Rodu and Cole, and Levy et al, among others, that meticulously lays out out the case for the greatly reduced morbidity and mortality associated with smokeless tobacco use relative to cigarette smoking.

The only "reason for triumph" here is that using this information constructively may begin to reduce the appalling annual death toll caused by cigarettes. Isn't THIS the public health goal?

Matt Georges said...

Hi Clive,
I haven't had time to absorb your smokeless tobacco post in order to try and think of a counter-argument so I wondered instead if you'd accept a suggestion for a future post? I refer you to Andrew Rawnsley's recent article on the "Age War" (http://observer.guardian.co.uk/comment/story/0,,1779848,00.html). Can you bring your acid tongue to bear?


philippe said...

It looks like everybody is getting into smokeless tobacco: i found this info in the Tobacco Control Tribune (ALA):
Philip Morris To Test Market Smokeless Tobacco Product
According to media reports, Philip Morris is set to begin test marketing a new smokeless tobacco product called “Taboka” in July in Indianapolis, IN with potentially a wider roll-out depending on consumer response. “Taboka” consists of tobacco in small pouches that are placed between the cheek and gums. Unlike traditional chewing tobacco or snuff, it is designed as spit-free, intended to attract smokers who find spit-tobacco unappealing or socially unacceptable. This announcement along with the announcement by Reynolds American in April that it will soon test market a new smokeless tobacco product called “Camel Snus” similar to “Taboka” in Portland, OR and Austin, TX indicates a trend towards major tobacco companies moving into the smokeless tobacco market. The danger is that these products will be marketed in such a way as to encourage youth to start using tobacco, and discourage current users from quitting. (Parts excerpted from: John Reid Blackwell, Philip Morris to Test Market Smokeless, Spit-Free Product, Richmond Times-Dispatch, May 3, 2006.)

Anonymous said...

The next nicotine delivery product that the tobbaco companies will come out with will be in suppository form. Well, let me take that back, they've been putting it to us there for years.