Wednesday, 12 May 2010

Talking sense on smokeless

Several recent news articles have flagged up the madness of prohibiting less hazardous tobacco products like snus, dip and (if you can call it a tobacco product) the e-cigarette.

From Forbes:

Antismoking crusaders treat all tobacco products as equally lethal. They aren't. The smokeless varieties--nicotine strips, lozenges, snuff, chewing tobacco and the like--are dramatically less harmful than traditional cigarettes. Yet Washington prohibits companies from marketing smokeless products as a safer alternative. This is murderously foolish.

It's difficult to argue with this, but that doesn't stop the intensive care contingent of the anti-smoking lobby trying. The usual cliche is to say that switching from cigarettes to safer alternatives is like jumping from the 30th floor of a building instead of the 35th. This is garbage. In the case of smokeless tobacco products, it's more like climbing out of a ground-floor window. People who know much more than me about these things say that these products are at least 99% safe. 

From the Wall Street Journal:

The experience of another effort to induce American smokers to switch clouds the picture for Terry Pechacek, associate director for science in the Centers for Disease Control and Prevention's office on smoking and health. He recalls that many smokers switched to low-tar cigarettes beginning in the 1960s, under the mistaken belief they were safer. "We need to be careful not to repeat this experience," says Dr. Pechacek. Public-health officials, he adds, are reluctant to advocate any form of tobacco use. "We do not need to make the American public guinea pigs."

But the American public already are guinea pigs, Mr Pechacek. They are guinea pigs in an experiment to rid the country of a plant that has been used as a extremely popular recreational drug for thousands of years. No one knows how such an experiment is going to end, but the omens from history are not good.

The comparison with low-tar cigarettes is, in any case, a dubious one. Apart from the fact that there is ample evidence that the high-yield cigarettes of the 1960s were more hazardous than today's brands, there is no knowing how many people would have quit if tar yields had remained high. I suspect not too many. More importantly, cigarettes of whatever strength are not analogous to snus, smokeless and e-cigarettes—there is a vast difference in risk.

The New York Times Freakonomics blog gets to the nuts and bolts of the issue in characteristic style. 

Offer a life raft and more people will jump off a sinking ship. Many will be saved, but some will drown off the life raft.

Mandatory seat belts do this—lives are saved, but people also drive faster and more accidents occur.

Sex education does this—there are fewer pregnancies per sexual encounter, but more sexual encounters are undertaken.

Unemployment insurance does this—it is a life raft for the working, but it attracts people into the workforce who are more likely than others to be unemployed.

I’ll bet that snus, like the other examples, will reduce the total damages of the risky behavior, but more people will engage in the behavior because they expect its costs to be lower.

As Carl V. Philips said in Liverpool two weeks ago, reducing risk is likely to increase usage. Let's not pretend otherwise. The question is what the overall impact on public health? Smokeless tobacco reduces risk to the individual and it reduces the risk in population terms. So what's not to like?


jonathan said...

It is a fact that in Sweden the male smoking prevalence is 15% (and was before its smoking ban) and 35% of the adult population either smokes or uses snus. Snus is less popular among women and a higher percentage of women smoke than do men. Sweden has the lowest male smoking prevalence and the lowest incidence of lung cancer in the developed world - way lower than the rest of Europe. Pancreatic and oral cancers, which the anti-smoking industry freqently claims are caused by snus use, are no more common than in the rest of Europe. (See CRUK statistics on lung, oral and pancreatic cancers). The inescapable conclusion is, that by supporting a ban on snus availability in the UK, anti-tobacco activists are indirectly increasing the number of premature deaths from tobacco use.

Fredrik Eich said...

"Mandatory seat belts do this—lives are saved, but people also drive faster and more accidents occur." - I would be interested to see the evidence for that!

Snowdon said...


Can't find the exact references, but wikipedia has some details about 'risk compensation'. In the UK, seat-belts made drivers more reckless, resulting in more pedestrian fatalities:

A subsequent study of 19,000 cyclist and 72,000 pedestrian casualties at the time suggests that seat belt wearing drivers were 11-13% more likely to injure pedestrians and 7-8% more likely to injure cyclists. In January 1986 an editorial in The Lancet noted the shortfall in predicted life-saving and "the unexplained and worrying increase in deaths of other road users"

According to the Durbin-Harvey report, commissioned by the Department of Transport following passage of the law, an analysis of fatality figures before and after the law shows:

-a clear increase in pedestrian, cyclist, and rear-passenger fatalities in collisions involving passenger cars

-no such increase in casualties in collisions involving buses and goods vehicles, which were exempt from the law

Anonymous said...

Anti-smokers are more than happy to use smokers as guinea pigs for their RIP experiment (fire safer cigarettes. They say they might save a few people from fires but haven't bothered to measure the increased risk from changing smoking technique. Smokers will get much more smoke rather than lose most with sidestream burn off much like roll your own cigs which might be up to 30% more harmful.

No studies, risk assessments, nothing yet millions of smokers forced to swap - no choice.

timbone said...

Isn't it strange how 'science' changes with fashion. I remeber in the 1970's little slips in cigarette packs which offered advice, including 'Try switching to a lower tar brand'

Anonymous said...

So, is there any evidence that the introduction of filters and lower tar brands decreased the incidence of lung cancer? Honestly, it's hard to see through the disinformation from the anti-smokers these days. For example, they are perfectly willing to lump 100-day smokers in with 10-day smokers as far as risk is concerned. What to believe?

Fredrik Eich said...

I wonder if one effect (a small effect) of seat belt laws is that higher risk taking drivers survive more crashes and therefore increase the probability of then killing other people. Before the seat belt law a portion would kill themselves and in doing so would reduced the number of miles driven by high risk drivers. So the law is not just causing some risk compensation but also preserving high risk takers.

Fredrik Eich said...

Looking at this
Annual fatalities per thousand motor vehicles currently
registered, Great Britain 1926 to 1997.
one would think that the seat belt laws (Front 1983 and rear 1991) made only a little overall difference.