Program urges smokers switch to smokeless tobacco
In the smoker-heavy state of Kentucky, a cancer center is suggesting something that most health experts won't and the tobacco industry can't: If you really want to quit, switch to smoke-free tobacco.
The James Graham Brown Cancer Center and the University of Louisville are aiming their "Switch and Quit" campaign at the city of Owensboro. It uses print, radio, billboard and other advertising to urge smokers to swap their cigarettes for smokeless tobacco and other products that do not deliver nicotine by smoke.
Supporters say smokers who switch are more likely to give up cigarettes than those who use other methods such as nicotine patches, and that smokeless tobacco carries less risk of disease than cigarettes do.
"We need something that works better than what we have," said Dr. Donald Miller, an oncologist and director of the James Graham Brown Cancer Center, which supports the effort along with the University of Louisville. "This is as reasonable a scientific hypothesis as anybody has come up with and it needs to be tried."
The campaign runs counter to the prevailing opinion of the public health community, which holds that there is no safe way to use tobacco. Federal researchers, however, have begun to at least consider the idea that smokers might be better off going smokeless.
The National Cancer Institute at the National Institutes of Health says on its website that the use of all tobacco products "should be strongly discouraged," and that there is "no scientific evidence that using smokeless tobacco can help a person quit smoking." But this year it approved funding for a study that might provide some of that very evidence.
"Switch and Quit" is directed by Brad Rodu, a professor of medicine at the University of Louisville. He analyzed the 2000 National Health Interview Survey and found that male smokers who switched to smokeless tobacco were more likely to quit smoking than those who used nicotine patches or gum.
"Americans are largely misinformed about the relative risks. ... They think smokeless tobacco is just as dangerous," Rodu said. "This level of misinformation is an enormous barrier to actually accomplishing tobacco-harm reduction because if people believe that the products have equal risk, there's not a real incentive."
The program is funded through Rodu's research money, which includes grants from the tobacco industry. Grants through the University of Louisville are unrestricted, which the program says "ensures the scientific independence and integrity of research projects and activities."
"There's absolutely no influence whatsoever," Rodu said. "I decide, along with my colleagues, how we use the money, for what projects, and this is entirely the case. I would not have a situation where there was some control over the kind of projects I undertake."
Tobacco companies want to market more smokeless tobacco and other cigarette alternatives to make up for falling cigarette sales. Some have introduced "snus" — small pouches like tea bags that users stick between the cheek and gum — and dissolvable tobacco — finely milled tobacco shaped into orbs, sticks and strips.
But they're barred by federal law from explicitly marketing them as less risky than cigarettes — at least for now. That means the "Switch and Quit" program can do something the tobacco industry itself cannot: claim that smokeless tobacco has a health benefit when compared to smoking.
The program says smoking kills about 220 adults a year in and around Owensboro. The state of Kentucky, a leading tobacco grower, has the nation's highest smoking and lung cancer rates.
Owensboro and the surrounding area consume about 3 million cigarettes a week, according to the program. That amounts to well over a pack for every man, woman and child in the community of about 115,000 people.
Owensboro resident Vernon Goode had smoked for about 10 years before he recently traded his Marlboros for dissolvable tobacco tablets. The campaign didn't inspire him to quit, but he said he thought it was a good idea.
"I was just wanting to quit because, you know, I could feel it in my lungs," Goode said. "I'll smoke a cigarette every once in a while, but not very often. I want to quit altogether and I'm just using this right here as I guess what you'd call a stepping stone."
The Owensboro program has raised concerns among some in the public health community who say organizers are claiming smokeless tobacco is a healthier alternative to smoking without approval from the Food and Drug Administration.
A 2009 law gives the FDA authority to evaluate health risks of tobacco products and approve those that could be marketed as safer than what's currently for sale. None have been given the OK yet. The FDA also plans to regulate electronic cigarettes, battery-powered plastic and metal devices that heat a liquid nicotine solution in a disposable cartridge, creating vapor that users inhale.
Matthew Myers, president of the Campaign for Tobacco-Free Kids, called the program "a giant experiment with the people of Owensboro without rules or guidance designed to protect individuals from experimental medicine."
Smokeless tobacco isn't a safe alternative to cigarettes, according to the Centers for Disease Control and Prevention. Health warnings on the products required by the FDA state the same thing.
However, some studies, including a 2007 report from the Royal College of Physicians in London titled "Harm Reduction in Nicotine Addiction," suggest that some smokeless tobacco products are about 90 percent less harmful than cigarettes.
"The worst that you can say about smokeless tobacco is that it's the lesser of two evils," said Dr. Randall Thomas, an oncologist with the Owensboro Medical Health System. The health system, the community's largest employer, is going smoke-free in 2013 and is offering Rodu's program as one of a variety of quit-smoking tools for its employees.
"I don't think we have any problem in telling a person that drinks a six-pack a day that if they could cut it back to two beers a day or two drinks a day that their health risks are greatly reduced," Thomas said. "Finding a way to let people have their nicotine that carries less risk, it's the realistic solution."
The Owensboro program doesn't suggest pharmaceutical nicotine replacement gum or patches. That's because they are regulated to provide very small doses of nicotine and are recommended for only a short period of time, while smokeless tobacco can be used as long as a smoker needs, Rodu said.
Myers, of the Campaign for Tobacco-Free Kids, said more research is needed before anyone should suggest that the nation's 46 million smokers would be better off using smokeless tobacco. In the meantime, he said, there are a host of FDA-approved products that can help people give up smoking.
"There's a right way and a wrong way to determine whether smokeless tobacco can and should be marketed as a way to help people quit," Myers said.
The National Cancer Institute approved funding earlier this year for a nationwide 1,250-person study to look at whether being given a snus product changes the habits of smokers who are not motivated to quit.
The tobacco industry sees smokeless tobacco as its future, said Matthew J. Carpenter, a psychology professor at the Medical University of South Carolina who is conducting the yearlong study.
Carpenter said the snus study will examine what smokers do when given smokeless tobacco. He won't look at the health effects, or advise smokers to use the snus to quit.
"They are probably safer than conventional cigarettes, if for no other reason than you're not burning anything, you're not smoking anything, you're not inhaling any smoke," he said.
"If you compare it to conventional cigarettes, they're probably a little bit better. If you compare it to quitting, they're absolutely worse."
Michael Felberbaum can be reached at http://www.twitter.com/MLFelberbaum.