Leader Blues

Friday, July 14, 2006

EDITORIAL >> Fight against smoking

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 nonsmoking 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 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 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 10-1,000 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.”