Statement on the NIH ‘Consensus’ Report on Tobacco Harm Reduction

Published October 12, 2006

(Chicago, Illinois – October 12, 2006) Yesterday, the National Institutes of Health released its State of the Science conference statement on tobacco use: prevention, cessation, and control. It’s available at and will appear in the upcoming issue of Annals of Internal Medicine.

The following statement addressing that report can be attributed to Joseph L. Bast, president of The Heartland Institute, a 22-year-old nonprofit, nonpartisan public policy research group. To arrange for an interview with Bast or for more information about The Heartland Institute, contact Michael Van Winkle, media relations manager, at 312/377-4000, [email protected].

“The National Institutes of Health conference statement on tobacco use is only eight pages long, followed by another nine pages listing the M.D.s, M.P.H.s, R.N.s, etc. who participated in the process.

“The report is typical government work, a statement of politically determined objectives followed by a superficial review of programs and research, ending with a call for ‘more research,’ ‘more effective strategies,’ ‘more collaboration,’ etc. What is particularly disappointing about this report, though, is the way it addresses the important debate over whether smokeless tobacco products can help smokers who want to quit.

“The report begins by asserting the success of smoking cessation aids and tactics other than smokeless tobacco products, but then contradicts itself by admitting there is a lack of evidence, few smokers use the preferred products and counseling services, and the success rate for smokers who try to quit (5 percent) is dismal.

“The discussion of smokeless tobacco products is brief (just one talking point of six, and then four brief action items as part of the final point), superficial, and deeply skeptical. For example, it says newer smokeless products ‘may’ be safer than older products (they obviously are); ‘may’ be targeted to young people, athletes, and women (no way to know); ‘may’ be more appealing to nonsmokers (well sure, they are less harmful to the user and less annoying to surrounding people than smoking).

“The possible health risks of smokeless tobacco are recited without quantification (they are very small) or comparison to active smoking (dramatically less).

“While much research on smokeless tobacco products was submitted during the hearings, the conference report cites only two ‘fair-quality observational studies,’ one claiming male adolescents in the U.S. who use smokeless tobacco are more likely to recall having seen ads for the product (no surprise), and another showing adolescents and young adults who used smokeless tobacco are more likely to be smokers four years later (but of course this does not demonstrate causation). Neither study addresses the most important issues in the debate.

“‘Scandinavian studies’ are simply dismissed as not being relevant to products or users in the U.S. With snus (a form of smokeless tobacco) being widely used in Sweden by ex-smokers, causing a steep drop in lung cancer rates for that country, it is incredibly dishonest to simply ignore the largest and best-studied natural experiments in the use of smokeless tobacco to help smokers quit.

“The report’s discussion of smokeless tobacco ends with a call for ‘high-quality studies comparing smokeless tobacco with proven pharmacologic and behavioral cessation interventions,’ which is (and should be well understood to be) a bad joke. Millions of people choose to use smokeless tobacco products, ‘proving’ they appeal to smokers. Many fewer choose to use expensive and bad-tasting nicotine replacement therapy products. What, exactly, would a study comparing the two populations prove?

“The recommendations call for more research on the impact of marketing of smoke-free products, better measurement of ‘the levels of nicotine and other toxins’ in smokeless products, evaluation of ‘advantages and disadvantages of regulating smokeless tobacco in a manner similar to medicinal nicotine,’ and ‘assess the risks of cancer and other diseases related to current smokeless tobacco products.’

“Those recommendations underwhelm. Research on marketing is a deep hole for dumping in money and time to prove absolutely nothing. Conservatives study advertising to try to link violence and sex on TV with such ‘outcomes’ as teenage pregnancy and crime. Liberals do it to link ads for tobacco products and fast food with kids’ habits and obesity. The sole purpose is to demonize industries and their products. It’s nonscientific, irrelevant, and driven entirely by ideological agendas.

“Better measurement of the content of smokeless tobacco, another recommendation, might be a good thing, though categorizing nicotine with ‘other toxins’ shows the knee-jerk Puritanical motivation of the authors of this report. Nicotine is no more harmful than caffeine, which one can only assume is next up on the substance banners’ hit list.

“Regulating smokeless tobacco the same way as medicinal nicotine would be absolutely the wrong direction to go. I don’t believe it was suggested or even hinted at by any of the papers or presenters at the NIH hearing I attended. Smokeless tobacco products show promise as a way to help smokers quit because they are enjoyed by customers as an alternative to both smoking and medicinal nicotine. Rather than regulating smokeless tobacco products into failure, medicinal nicotine ought to be deregulated so it can imitate smokeless tobacco’s success.

“Assessing the cancer risk of smokeless tobacco is a good idea … but why, then, did the panel ignore all of the evidence submitted to it showing the cancer risk of smokeless tobacco is tiny compared to active smoking? The message is that the science really doesn’t matter, and that more of it will simply be ignored or spun to ridiculous heights to support the anti-tobacco agenda.

“In short, this report is a virtually complete whitewash of the evidence and even the debate taking place on the use of smokeless tobacco products as smoking cessation aids. All the distinguished scientists and doctors whose names appear on the document ought to be ashamed of themselves.”

Joseph Bast is president of The Heartland Institute and author of the new book, Please Don’t Poop in My Salad (and other essays opposing the war against smoking). He can be contacted at [email protected].