Tuesday, August 23, 2011

Safe sex vs. Safe tobacco

In the 1980's, public health groups began campaigning for "safe" sex. These campaigns promoted the use of condoms to reduce exposure to HIV and AIDS and continue to be used today to promote reduced exposure to other dangerous and debilitating sexually transmitted diseases (STD).

Rarely are the public health benefits of reducing health risks via "safe" sex questioned, even though "safe" sex is a misnomer. A 2001 NIH panel of experts examined dozens of studies and found that proper and consistent condom use reduced the incidence of STDs by 18% to 92%, depending upon the disease in question. At best case, that still leaves an 8% health risk for "safe" sex practices. For the human papilloma virus (HPV) - which has been linked to cervical cancer, the fifth most deadly cancer in the world for women - the harm reduction is even less. 

In reality, condoms contribute to "safer" sex, but do not cause sex to be 100% safe. This does not stop public health groups from promoting "safe" sex to the public and the majority of us agree that it's better to be safer, even if it's not 100% safe. Millions are still spent promoting safe sex practices, even though STDs rarely result in death. In fact, it's reported that 80% of those infected with STDs are asymptomatic and not even aware that they are infected. The CDC reports that around 18,000 people with AIDS and approximately 4,000 women with cervical cancer die annually.

On the other hand, the CDC and other health groups report that "tobacco use" (or more specifically, smoking) causes 440,000 deaths annually in the U.S. (including the highly debated second hand smoke deaths.)  Compared to smoking deaths, mouth cancer, the main health warning for smokeless tobacco use, contributes to only 8,000 deaths annually. However, according to the National Cancer Institute, researchers have been unable to determine how many of those deaths are actually caused by smokeless tobacco use. Based on one 1981 study of female chew users in the southern U.S., the NCI reports that "users of smokeless tobacco are at four times the risk of developing oral cancer than non-users." More recent research shows that smoking actually causes twice the risk of oral cancers (compared to smokeless) and factors such as alcohol abuse and dual use of smoking and smokeless seem to have reduced the link to oral cancer caused by smokeless use alone even further. In fact, the scientific research overwhelmingly shows evidence that smokeless tobacco carries very little to no health risks, at or less than 1% compared to never-users.

In spite of knowledge of this widely known research and the ready acceptance of harm reduction practices for less lethal STDs, public health officials refuse to acknowledge the obvious potential health benefits of promoting harm reduction in the form of smokeless tobacco products. In fact, they go out of their way to convince the public (and smokers) that smokeless products are just as deadly as smoking. While condoms, with a contribution of lowering health risks 18% - 92%, are required by the FDA to inform the public that condoms reduce the risk of STDs, smokeless tobacco products are required to display health warnings such as "This product is not a safe alternative to smoking," or "This product causes oral cancer." Rather than informing smokers that switching to smokeless tobacco would reduce their health risks by 99% or greater, the FDA actually prohibits smokeless tobacco companies from informing the public and forces them to misrepresent the comparative risks, causing the 440,000 people who die from smoking annually to believe that they may as well keep smoking.

Additionally, public health groups continue to lobby legislators to limit or outright ban and/or apply unwarranted "sin taxes" to smokeless products such as snus, lozenges, sticks and strips, claiming "no safe tobacco use" and over unfounded concerns that children and smokers will flock to these less deadly products rather than eschew tobacco products altogether. The concern about youth use is particularly comical, considering that banning these smokeless products would leave no competition for cigarettes, leading curious and reckless youths to smoking tobacco instead of using smokeless and increasing their health risks by 99%. Taxing these products to make them just as expensive as cigarettes also removes further incentive for current smokers - who have no intention of quitting tobacco - to switch to smokeless alternatives.

This insane double standard of approving and encouraging harm reduction for less lethal practices and denying them for tobacco must end. The "abstinence only" approach has resulted in smoking quit rates stagnating at 20% and public health efforts to stop smokeless use as an alternative could result in that percentage increasing again as smokeless products are made less available and more expensive for smokers who have already switched. Not only must the "quit or die" approach be rethought, but public health must stop misleading the public about the health risks and start encouraging inveterate smokers to switch. If they can call an 8% health risk "safe" when it comes to sex, then a less than 1% health risk from smokeless tobacco IS a "safe alternative to smoking." The great dream (lie) of total tobacco abstinence must end. Based on the scientific evidence, the time for tobacco harm reduction must be allowed its turn.

Concerned groups such as the Consumer Advocates for Smoke-free Alternatives Association (CASAA) and TobaccoHarmReduction.org are working to promote "safer" tobacco use. For more information on Tobacco Harm Reduction please visit casaa.org.

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