SmokeFree Wisconsin Misleading Public about Orbs risk

SmokeFree Wisconsin posted a convincing blog post implying to consumers that Camel Orbs carry a high risk of cancer, based on facts culled from a CDC report on smokeless tobacco.

What SmokeFree Wisconsin fails to tell consumers is that report is based on old-fashioned chew and snuff, NOT newer products such as lozenges, strips, sticks and snus.

Stating simply that "smokeless tobacco contains 28 known, cancer-causing toxins," is misleading and a half-truth. The CDC made this declaration about chew and snuff based mostly on a 2007 WHO report, "Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines." The tobacco products they analyzed were not the refined, fine tobacco used in Orbs and other newer smokeless tobacco products. The same levels of nitrosamines (TSNAs) found in those products have not been found in products such as Orbs and snus.

In fact, in June 2010, the Canadian Non-Smokers' Rights Association endorsed tobacco harm reduction, including the use of products such as Orbs, snus and electronic cigarettes. They released NSRA Harm Reduction Policy Analysis June-2010* which showed the true risks of cancer associated with such products were minimal, if not non-existent. Mind you - this is a report by an organization concerned for non-smokers' rights:

The risk of oral cancer varies by type of smokeless tobacco product and is much greater for dry snuff than for moist snuff. The relative risk of oral cancer from use of dry snuff is 5.9 compared to 1.2 from chewing tobacco and 1.0 from moist snuff.37 A meta-analysis in 2007 concluded that the type of smokeless tobacco used in America or Europe “carries at most a minor increased risk of oral cancer.”38 The Royal College of Physicians has concluded that “the risk of oral cancer associated with use of low-TSNA tobacco products such as Swedish snus is small, and possibly non-existent.”39

The report also warns that comparing products such as snus and Orbs with smokeless chew and snuff are misleading:

When considering studies of the health risks of smokeless tobacco, it is important to distinguish between smokeless products such as traditional spit and chew (in Canada the most popular brands are Copenhagen and Skoal) and Swedish-style snus. Most studies of the health risks of smokeless tobacco use do not make the distinction between snus and other forms of smokeless tobacco.

• Oral cancer

– The risk of oral cancer varies according to the type of smokeless tobacco. Two Swedish studies found no elevated risk of oral cancer from snus use, and the findings constituted the grounds for the removal of the oral cancer warning from snus products in Sweden in 2001.50

• Leukoplakia

– There is a very high rate of leukoplakia development from snus use, much higher than with other forms of smokeless tobacco; however, the lesions are mostly due to irritation and only rarely progress to oral cancer.51

• Heart disease

– There are very few studies of the risk of heart disease from use of Swedish snus that also correct for possible confounding variables, including smoking and exposure to second-hand smoke. Of six studies of risks of heart attack risk among long-term Swedish snus users, only one found an increased risk, and five found no increased risk over never tobacco users.52 A meta-analysis in 2009 of eleven studies, eight in Sweden and three in the US, provides consistent evidence of a small increase in risk of fatal heart attack and stroke, with no evidence of a difference in effect of the smokeless products.

The report goes on to discuss lozenges very similar to Orbs:

Small manufacturer Star Scientific has been selling two forms of dissolvable tobacco product for several years—Ariva, targeting cigarette smokers, and Stonewall, aimed at users of smokeless tobacco. Both products come in the form of a small pellet, slightly larger than a Tic Tac mint.59 

Ariva and Stonewall have levels of TSNAs similar to Swedish snus.60

While the pellets may contain higher amounts of nicotine, the average nicotine user tends to "self-regulate" and would simply use less pellets than they would smoke. The craving for nicotine subsides after exposure, so the user would be less likely to use as many Orbs as they would cigarettes. Additionally, the nicotine content in cigarettes varies just as widely and the low nicotine content in NRTs such as nicotine gums, lozenges and patches make them highly ineffective as a substitute for smoking.

Of course, none of these products should be in the hands of children, but claiming that these products are "not a safe alternative to cigarettes" belies the truth that they are a SAFER alternative to smoking and misleads the public into believing that smokers would not have any health benefit by switching. However, even if these smokeless products still have a 1-2% risk of adverse health effects, that still makes them 98-99% less risky than smoking.

As the Canadian report urges:

The public has the right...to accurate information about the relative risks of using tobacco products and to make choices based on the facts. The current warning on smokeless tobacco products, “This product is not a safe alternative to smoking,” is woefully inadequate as it provides no information regarding relative risks.

SmokeFree Wisconsin apparently believes that Wisconsin consumers do not deserve the same right.

If SmokeFree Wisconsin is truly concerned about nicotine products getting into the hands of children, they should also warn parents of another candy-like nicotine product. This product is white (Orbs are brown) and looks EXACTLY like a Tic Tac. They even have those "quitting sucks" commercials with a shark attack and other humorous scenarios that kids think are funny.

Meet the Nicotrette Mini:

Nice "trick" SmokeFree Wisconsin.



*NOTE: The NSRA Harm Reduction Policy Analysis June-2010 also has positive comments on E-cigarettes. I highly recommend reading this report for many facts about tobacco harm reduction.

SmokeFree Wisconsin not about public health

In a recent blog post, I addressed a recent blog post by SmokeFree Wisconsin regarding smokeless tobacco products.

After a few readers questioned the logic of refusing to do "less harm" in promoting the use of smokeless tobacco over smoked tobacco, the author replied,

Our priorities include proving for smoke-free environments, increasing the price of tobacco, and ensuring there is a strong, comprehensive tobacco prevention and control program.

To serve those priorities we partner to collect data, data which indicates that smokeless use is already on the rise in WI. We use data which shows that the burden of tobacco is NOT reduced by the use smokeless products.

We are not exposing smokers to any risks. We pass policies, we don't do treatment.

Smokeless is not less harmful. Period.

So, where is the goal of protecting public health in this statement?

Where is the accountability that in setting policies, they affect public behavior?

Since when did it become "the burden of tobacco" over the burden of smoking and it's affect on public health?

Where is the science that proves that smokeless is not less harmful than smoking? There is plenty of science that proves the greatest exposure to toxins and carcinogens is in the smoke - we see it in the news and in public statements from groups such as the American Lung Association and the American Cancer Society.

If what SmokeFree Wisconsin says is true about smokeless tobacco, wouldn't the opposite also be true? That smoking is no more dangerous than smokeless tobacco? So why the need for indoor smoking bans, if the smoke isn't the real danger?

In its policy to put eradicating any tobacco use as a priority over getting people to quit smoking, SmokeFree Wisconsin completely ignores valid, scientific research and urges people who use tobacco products to continue to use only its most dangerous form - smoking.

Because if smokeless tobacco is no less dangerous, why switch from smoking?

SmokeFree Wisconsin Doesn't Believe in Reducing Harm for Smokers

In a May 6, 2010 blog post, SmokeFree Wisconsin applauded the new, larger warnings on smokeless tobacco products.

That would have been fine and dandy, if not for these comments by the author:

This product is not a safe alternative to cigarettes. This product can cause mouth cancer This product can cause gum disease and tooth loss....

and

The implication here is that you can dance the night away with Snus in your mouth and never have to go out for a cigarette and miss you favorite song.

I couldn't help but comment and surprisingly, my comment was accepted for once:

And WHY that is a bad thing? If they are using snus (which is scientifically shown to be up to 98% less dangerous than smoking tobacco) instead of smoking, wouldn't that be better for the smoker's health? Especially if they would already be smoking?

I understand you want everyone to avoid tobacco products completely, but that isn't going to happen. If offered the choice between deadly tobacco smoke and the far safer smokeless tobacco products, why lie to them and tell them smokeless products are just as bad? All you are doing is (encouraging) the use of a far deadlier product, because people will think they may as well keep smoking.

Granted, we don't want kids to start using tobacco products, but by misrepresenting the comparative safety of smokeless alternatives, you are exposing actual smokers to far greater risks.

The author's reply:

The studies of which you refer are in reference to Swedish Snus, a product which is entirely unlike American made Snus. Moreover public health has a duty and responsibility to "do no harm." The ethics which guide the profession do not promote "doing less harm."
Thanks for your comment.

And my comment back (we'll see if it gets posted):

No offense, Erich, but baloney.

If that were the case, public health wouldn't advise people to use low-fat and sugar-free foods - they'd be telling them not to eat it at all. People would be told not to drive at all, because seatbelts would only "do less harm" and aren't 100% safe.

Reduced harm/risk has been around for years in foods and other public health and safety, why not tobacco?

To tell people to just keep smoking, because smokeless tobacco isn't 100% safe make no sense. I know you want people to quit altogether, but that isn't what is happening with over 20% of the U.S. population who still smoke. By making smokers believe that smokeless alternatives are no safer than smoking, they will just keep smoking, while they could have been breaking their habit of smoking and reducing their health risks.

I'm not talking about encouraging non-smokers to use smokeless tobacco - that'd be irresponsible.

I'm talking about COMMITTED SMOKERS, who are already pumping 4,000 toxic chemicals and 60 carcinogens into their bodies and can't or won't quit. If they won't quit smoking, can you really argue that it isn't the duty of public health officials to alert them to the fact that smokeless products lack up to 98% of those chemicals and carcinogens found in tobacco smoke? (And we know it's the SMOKE, otherwise indoor bans would include smokeless tobacco. Or is this "TobaccoFree Wisconsin" now?)

How is that any different from telling someone to use low-fat products, which aren't as good as abstaining altogether, but at least LESS detrimental to their health?

Not informing smokers that many smokeless tobacco products are up to 98% safer than smoking is like telling a morbidly obese person that they may as well eat Ben and Jerry's, because low-fat yogurt still has "some fat."

I guess it's pretty much self-explanatory. These smokefree "public health" groups are no longer about real public health or even about the "smoke." They are about tobacco abstinence - PERIOD. And it doesn't matter who gets hurt in their rush to force that ideal. How many smokers will die because these groups refused to "do less harm?"

The argument against encouraging committed smokers to switch to reduced harm products, because they can't encourage "doing less harm," holds no water. Seatbelts, helmets, low-fat and reduced calorie foods - are all products meant to do "less harm" to or reduce harm for the user. Doctors regularly prescribe treatments that are risky or dangerous in the hope to save a patient's life. If it were not for the use of deadly chemicals, which make the patient extremely ill and could kill them, many cancer patients would not be survivors today.

So don't try to tell me that public health cannot reconcile itself with "doing less harm."

Smokefree Wisconsin Continues Endangering Smokers

It seems that Smokefree Wisconsin has finally woken up and realized that electronic cigarettes (personal vaporizers) are not a plot by Big Tobacco to hook kids on nicotine, yet they continue their campaign of lies and misinformation about the devices.

In a post dated 1/20/10, they comment on the recent ruling in the case of Smoking Everywhere vs. FDA:

A statement from the Campaign for Tobacco-Free Kids said, "In ruling today that the U.S. Food and Drug Administration may not regulate electronic cigarettes as drugs or medical devices, U.S. District Judge Richard Leon has ignored decades of precedent and put America's consumers at unnecessary risk."

This statement couldn't be more true. Electronic cigarettes are not being marketed as tobacco products they are being marketed as cessation devices or as some sort of healthier alternative to smoking.

Not only have they done a complete 180 on electronic cigarettes being a Big Tobacco product, now they claim e-cigs are drug devices, make cessation claims and a danger to consumers.

This statement couldn't be any LESS true and puts the health of millions of ex-smokers using the devices at risk.

What is Smokefree Wisconsin's true goal here? To improve the health of Wisconsin residents by getting smokers to quit smoking or to eliminate all forms of nicotine?

If Smokefree Wisconsin truly cared about consumers, ie. smokers, they would worry first about reducing smokers' exposure to the true danger of nicotine addiction - SMOKE - and then worry about nicotine addiction.

Judge Leon ruled that the electronic cigarette companies have absolutely NOT been marketing the product as cessation devices, although many consumers of the product have reported that, while they still consume nicotine, they have ceased smoking tobacco to do so. Leon also rebuked the FDA for it's actions, stating that treating a reduced harm product as a drug product is absurd:

To treat as a drug any tobacco product that merely claims to be a healthier alternative would effectively nullify the provisions relating to modified risk tobacco products, which represent Congress’s implicit acknowledgment that those products were outside of FDA’s jurisdiction prior to the Tobacco Act. Moreover, it would create the absurd result that certain tobacco products-like...electronic cigarettes-would be exposed to the more onerous regulatory burdens for drugs and devices merely because they claim to be healthier alternatives to traditional tobacco products.

Judge Leon also refused to fall for the FDA's and other organizations' claim that electronic cigarettes are a danger to consumers:

Given the particular facts and circumstances of this case, I am not convinced that the threat to the public interest in general or to third parties in particular is as great as FDA suggests. Together, both Smoking Everywhere and NJOY have already sold hundreds of thousands of electronic cigarettes, yet FDA cites no evidence that those electronic cigarettes have endangered anyone. Nor has FDA cited any evidence that electronic cigarettes are any more an immediate threat to public health.

Now, that is a statement that couldn't be more true.