5 May 2004

Nicotine without soot, etc. Can it be safer to chew?

Chewing tobacco - is it better than smoking?

http://bmj.bmjjournals.com/cgi/content/full/328/7444/885
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http://www.nytimes.com/2004/04/06/health/06ESSA.html

Dear Colleagues,

Two recent items have focussed on reduced tobacco harms. A BMJ article has looked at the logic in cutting down the numbers of cigarettes smoked, reduced-tar products, switching to pipes or cigars, use of ‘smokeless tobacco’, use of nicotine replacement while still smoking and finally, the use of oral tobacco wads (‘snus‘) as used in Sweden.

This article opens the possibility that some effort to reduce harms may inadvertently do the opposite. ‘Low tar’ cigarettes are in general also ‘low nicotine’ products, so people might even smoke increased numbers of cigarettes, or inhale more deeply in an effort to get more nicotine. Likewise, cutting the number of cigarettes may lead to deeper inhalations and thus potentially more harmful smoke exposure.

Dr Sally Satel, in an opinion piece in the New York Times supports the harm minimization benefits of ‘snus’ which she believe should be a choice for smokers. Despite an incidence of oral cancer, the overall risks are apparently much lower than the many dangers faced by tobacco smokers. Satel quotes enviable statistics from Sweden where the product takes up half the market. It is banned in most other countries.

It would seem that at the very least we should support limited availability of the product to examine it acceptability, benefits and dangers in the Australian situation. I vote that NSW be first to lift the current ban on wad tobacco and carefully investigate the consequences.

comments by Andrew Byrne ..