By Gilbert Ross, M.D.
Posted: Saturday, October 4, 2008

LETTER
Publication Date: October 4, 2008

This letter first appeared in October 4-10, 2008 issue of The Lancet (Vol. 372, No. 9645):

Epidemiological data indicate the heightened efficacy of smokeless tobacco in helping nicotine addicts to switch from their dangerous addiction to smoking to the much less harmful nicotine delivery from moist smokeless tobacco -- e.g., snus.

One review of this subject was supported by my organisation, the American Council on Science and Health.2 This review details the Swedish experience, where a substantial proportion of male smokers switched to snus with attendant declines in smoking-related morbidities.

Given the admittedly abysmal quit rates associated with the best of the current aids discussed in the Seminar -- the one-year success rate is in the 20% range -- Hatsukami and colleagues should have devoted at least a paragraph to the subject of harm reduction with smokeless tobacco, rather than ignoring it altogether.

Those who oppose the use of tobacco in any form adhere to the party line: all tobacco is dangerous, so why substitute one addiction for another? In fact, the health risks of smokeless tobacco are at least an order of magnitude less than those of cigarettes, and thus if a substantial portion of smokers could be switched to less harmful smokeless tobacco and weaned off cigarettes...


Gilbert L. Ross, M.D.
Executive and Medical Director
American Council on Science and Health
New York


See also: ACSH's publication Helping Smokers Quit: A Role for Smokeless Tobacco?