This news release raises important and fair questions about how forthcoming agencies purporting to serve the public health should be in detailing relative risk when comparing one perceived societal ill against another. In this case, we are talking about smoking versus smokeless tobacco products including snus, smokeless tobacco and vape.
The source study, which includes a brief content analysis component, is less a traditional medical study and more a philosophy or ethics discussion of the principles involved in withholding or disclosing information to the public that has implications about health benefits and risks.
But the news release fails to be as even-handed as it might be. For example, it points an accusing finger at the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC) and the Mayo Clinic, but fails to get a response from any of them (even though the study itself does include a response from CDC as well as an acknowledgment by ACS that smoking tobacco is more dangerous than using smokeless products).
And it fails to quantify what is known — and not known — about the relative risk of using cigarettes versus smokeless tobacco.
We are aware the stakes are high: with the establishment of addiction, an individual’s exercise of free-will is diminished to choose to use or not to use the substance. Good initial information about the risks of this choice, while it remains a choice, is therefore crucial. If, as is mentioned in the source article, exposure to non-combustible tobacco increased likelihood of addiction to combustible tobacco, then under-stating the risks would be tragic.
The study itself put it best: “If science learned that one type of alcoholic beverage caused 3 in 5 regular users to die prematurely, losing 10 years of life, while another alcoholic beverage caused 95% or even 9.5% fewer premature deaths, consumers would want to know which legal product was which. (With alcohol the especially dangerous item would be banned, but assume that, as with current Food and Drug Administration (FDA) tobacco law, this is impossible.) It would be scandalous, even criminal, to keep such facts from consumers. Yet, such facts are being kept from adult consumers of legal tobacco/nicotine products either by not informing or actively misinforming consumers. It is as if tobacco consumers were blindfolded and not allowed to see dramatic differences in harm from different products.”
The World Health Organization tallies the toll:
No mention is made of the costs of either cigarettes (whose cost has skyrocketed in recent years in some areas) or of smokeless tobacco products. One can argue that that is immaterial when comparing lives saved versus lives lost, but that argument may not carry weight with people who are addicted to nicotine, and trying to figure out how to feed their addiction while limiting their risk.
The news release gives the example that 3 in 5 regular users of cigarettes die prematurely, while smokeless tobacco products cause “massively fewer deaths.”
A news release that is going to focus on risk reduction needs either better quantification of that risk reduction, or a sentence explaining why a more detailed description of the risk reduction is not possible.
It is all well and good to say that smokeless products are far less lethal than cigarettes, but it behooves the news release to point out what, if any, drawbacks they may pose. But this release doesn’t give us any actionable information to show why substitute tobacco products are safer. We are instead told,
“The public is dramatically misinformed about the relative risks of substitutable tobacco and nicotine products. The risk differentials are huge, but this is simply not known by a vast majority of those whose lives are at risk,” adds Sweanor.
The news release needs to tell readers what those risks are so they can make informed decisions about their own use — or not — of smokeless tobacco products. The CDC says the use of smokeless products:
Still relatively new on the scene, but exploding in popularity, vaping delivers many unknown elements and chemicals to the lungs. Compared to Canada and the UK, the US severely lags in safety studies that compare harms from vaping and traditional tobacco products.
The news release tells us that smokeless products cause “massively fewer” deaths than do traditional cigarettes. If that cannot be further broken down, then the news release might at least tell the reader why.
The evidence (as provided in the study but not the news release) relies on previously published reports — primarily completed by the US governemnt — that offer the current understanding of harms from smokeless tobacco (SLT) products. But these are limited and no large-scale comparative studies between SLTs and combustible tobacco products have been undertaken. The release does note that an analysis of the content on the websites of the CDC, Substance Abuse & Mental Health Services Administration (SAMHSA), American Cancer Society (ACS) National Cancer Institute (NCI) and the Mayo Clinic “found three types of examples of information on SLT [smokeless tobacco], but no to modest efforts to inform consumers of the significantly lower risks compared to cigarettes for lifelong users.”
The release did not include any of the quantitative risk reduction data the authors accuse the health organizations of omitting. How is this helpful to an already confused public and public policy makers?
The news release does not take part in disease mongering. The release might have been stronger had it included some figures on the number of people who smoke and how many use smokeless products.
After years of reading stories about how Big Tobacco was behind many studies that questioned the danger posed by traditional cigarettes, a reader can be excused for thinking that, perhaps, the smokeless tobacco industry was funding the work published here. A look at the study shows that that was not the case, but few people reading the news release would get to that point. In cases where the index of suspicion is high, the news release would boost its own credibility if it was explicit that there were no conflicts of interest.
Smokeless tobacco products are clearly the comparable product here and the topic of the release.
Anyone who has been to a drug or convenience store knows that smokeless tobacco products are readily available.
The news release does not establish that this study is an update of an earlier 2003 study that reported similar conclusions.
The news release says that the study authors “found that the Mayo Clinic perpetuated a misrepresentation discovered in 2003 — erroneously informing visitors that smokeless tobacco was as dangerous as cigarettes. The day after the article was released, the Mayo Clinic removed the headline, replacing it with the still misleading statement that smokeless tobacco was ‘not a safe product.'”
The news release does not say why that is misleading.
It adds that “many government websites are actually misleading or under-informing the public” when it comes to learning about the differences in risk among certain types of nicotine products, but offers no examples.
“This in turn helps explain the woeful lack of public knowledge about relative risks, violating basic consumer rights as well as the public health principles of individual rights and health literacy,” it says, but does not tell us just how woeful that lack of public knowledge about relative risks is.