Substituting with smokeless tobacco saves lives, research suggests

That is the message Brad Rodu, D.D.S., professor of medicine at the University of Louisville (UofL) School of Medicine and the Endowed Chair in Tobacco Harm Reduction at UofL's James Graham Brown Cancer Center, delivered at the Annual Meeting of the American Association for the Advancement of Science Feb. 18. Rodu spoke at the session, "Harm Reduction: Policy Change to Reduce the Global Toll of Smoking-Related Disease."

"Quit or die: That's been the brutal message delivered to 45 million American smokers, and it has helped contribute to 443,000 deaths per year, according to statistics from the Centers for Disease Control and Prevention," Rodu said. "The truth, however, is that total nicotine and tobacco abstinence is unattainable and unnecessary for many smokers."

Rodu's presentation, "Transforming Tobacco Use: The Potential of Tobacco Harm Reduction," was based on his almost 20 years of research. His work shows that smokers can greatly reduce their risk of disease and death by replacing smoking products with e-cigarettes or modern, spit-free smokeless tobacco. These products provide a much safer alternative for those smokers who are unable or unwilling to quit smoking because they continue to deliver nicotine without the harmful effect of smoking.

"Nicotine is addictive, but it is not the cause of any smoking-related disease. Like caffeine, nicotine can be used safely by consumers," Rodu said.

Decades of epidemiologic research bear out Rodu's findings. While no tobacco product is completely safe, smokeless products have been shown to be 98 percent safer than cigarettes. In the United Kingdom, the Royal College of Physicians reported in 2002 that smokeless tobacco is up to 1,000 times less hazardous than smoking, and in 2007, further urged world governments to seriously consider instituting tobacco harm reduction strategies as a means to save lives.

To see the proof of what tobacco harm reduction can do, look to Sweden, Rodu said. "Over the past 50 years, Swedish men have had Europe's highest per capita consumption of smokeless tobacco as well as Europe's lowest cigarette use. During the same time, they also have the lowest rate of lung cancer than men in any other European country."

In the United States., steps have been made to document the value of tobacco harm reduction. In 2006, a National Cancer Institute-funded study estimated that if tobacco harm reduction was "responsibly communicated" to smokers, 4 million would switch to smokeless tobacco. The American Council on Science and Health -- which organized Rodu's session at the AAAS Annual Meeting -- concluded in the same year that tobacco harm reduction "shows great potential as a public health strategy to help millions of smokers."

Rodu is well aware of the controversy his research findings generate. Opponents of any use of nicotine delivery products maintain that smokeless tobacco puts the user at great risk for oral cancer, a position not supported by research.

"The risk of mouth cancer among smokeless tobacco users is extremely low -- certainly lower than the risk of smoking-related diseases among smokers," he said. "The annual mortality rate among long-term dry snuff users is 12 deaths per 100,000 and the rate among users of more popular snus, moist snuff and chewing tobacco is much lower. For perspective, the death rate among automobile users is 11 per 100,000 according to a 2009 report from the National Highway Traffic Safety Administration. Compare those to the rate among smokers: more than 600 deaths per 100,000 every year."

"The data clearly show that smokeless tobacco users have, at most, about the same risk of dying from mouth cancer as automobile users have of dying in a car wreck."