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The concept behind
vaccines must have sounded suicidal when it was first proposed: You
protect yourself against smallpox by infecting yourself with smallpox?
The thinking
behind a new approach to smoking may likewise sound lunatic: The surest
cure for tobacco use is tobacco use. But at this point in the fight
against cigarettes, maybe a crazy idea is worth a try.
Everyone knows
smoking is deadly, killing more than 400,000 Americans a year. The
American Cancer Society predicts that given prevailing trends, more than
a billion people around the world will die of smoking-related illnesses
in the 21st Century.
Some will be
innocent bystanders. Recently, the surgeon general of the United States issued a report
describing secondhand smoke as "a serious health hazard that can
lead to disease and premature death in children and non-smoking
adults."
Given the evidence
that has been piling up for more than 40 years, you would think
cigarettes would be about as popular as skydiving without a parachute. In
fact, the number of Americans who smoke (46 million) is more than double
the number who watched the highest-rated game of last year's World Series
(20 million).
Even with all of
our medical and psychiatric advances, the chief effect of
smoking-cessation methods is to relieve smokers of their money. Fewer
than 5 percent manage to quit in any given year. Expanded use of such
programs, the National Institutes of Health reports, would only double or
triple the success rate--leaving 85 percent or so still pounding their
coffin nails.
Fortunately, there
is another option. It involves replacing smoked tobacco with smokeless
tobacco. And judging from the experience in Sweden, it works.
I'm not talking
about old-fashioned chewing tobacco and snuff, which involve more
expectoration than most Americans want to do--or watch.
Modern smokeless tobacco comes
in tiny pellets or packets that eliminate the need for spittoons but
provide a reliable dose of what smokers crave: nicotine. And nicotine,
though addictive, is safe enough to be sold over the counter. Snus, as it is known, can bring about huge changes.
Swedish men use tobacco at about the same rate as men in the rest of the
European Union.
The difference is that instead of lighting it
on fire and inhaling the fumes, they generally prefer to stow it
discreetly between
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lip and gum. Since 1986, reports University of Louisville cancer scientist
Brad Rodu, the smoking rate among Swedish males
has gone from 19 percent to 9 percent.
That brings us to one
of the best-kept secrets in public health: If everyone who is addicted to
cigarettes were addicted to smokeless tobacco instead, millions of lives
would be saved. An article in the prestigious medical journal The Lancet
concludes that snus (rhymes with juice) is "certainly much less
harmful" than cigarettes, and that for some smokers it may be
"an effective aid to quitting."
It's true that
smokeless tobacco, like smoking, can cause oral cancer. But it doesn't
cause the many other deadly diseases associated with cigarettes,
including heart disease, stroke, lung cancer and emphysema. In 2002, Britain's Royal College
of Physicians announced that "the consumption of non-combustible
tobacco is on the order of 10 [to] 1,000 times less hazardous than
smoking." It also doesn't produce that deadly secondhand smoke.
A lot of smokers
might be happy to trade their cigarettes for snus, if they only knew the
comparative risks. But most people have the fatal misimpression that
there is nothing to gain. And the federal government is curiously intent
on preserving their ignorance. Surgeon General Richard Carmona insists that "smokeless tobacco is not a
safe alternative to cigarettes."
This is like
saying that driving a Volvo is not a safe alternative to riding a motorcycle
without a helmet. Neither activity is 100 percent risk-free. But one is
far safer than the other, and the same is true of smokeless tobacco and
cigarettes.
Public-health
zealots pretend that the only alternative to smoking is complete
abstinence from tobacco. Gilbert Ross, executive and medical director of
the American Council on Science and Health, says this approach is
"condemning 45 million people to quit or die." Every year,
hundreds of thousands of people end up with Option No. 2. Things might be
different if the government would mandate a new statement on each package
of cigarettes: "Switching
from cigarettes to smokeless tobacco reduces your risk of death and
disease."(emphasis added)
It's not a perfect solution. But it would keep a lot of people
alive until a perfect solution comes along.
- Steve Chapman member Tribune
editorial board
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