Of course, even if you are better off using reduced-risk nicotine products now, it begs the question about whether you might have been better off still if you had never used it. This is an entirely different important question.
[Note to readers: Some of the content of this particular string creates a fair bit of doubt about whether the author is really who he claims to be. We would like to remind everyone that we strongly encourage open dialogue with those who disagree with us, including anti-harm-reduction advocacy groups, such as the American Cancer Society. It is our experience that these groups are afraid of open discussion where they might have to defend their claims, and they prefer to engage in subterfuge and attempts to censor our work, but we will nevertheless continue to encourage dialog. That said, we will go ahead and respond to this thread based on the assumption that the poster is authentic because even if he is not, *we* are always happy to openly respond to challenging questions.]
I'm just having a hard time understanding how you could possibly say that only 10%-20% of oral cancer patients who use smokeless tobacco are caused by smokeless tobacco. So 80%-90% of smokeless tobacco users who develop oral cancer is not from the tobacco use? The only word that comes to mind is-absurd.
Some of the concepts in epidemiology might be a little confusing to those who are not familiar with the field. Instead of getting technical, let’s substitute a couple of words just to show why that is “not absurd”. 10 to 20% of morbidly obese individuals who drink soda are obese because they drink soda and 80 to 90% of soda drinkers who become morbidly obese are not so because of the soda. Does that still seem absurd to you?
Coincidences happen. The reason we do careful studies that compare multiple groups is that if you pick a particular case in isolation, it may be coincidence. If you checked the pockets of everyone walking past on a sidewalk for dimes dated 1968, a fairly rare occurrence, you would find that after you had checked enough people to come up with enough such dimes, many of them would have been in the pockets of people wearing blue jeans. Mostly this would be coincidence: Some people wear jeans, so some people carrying 1968 dimes wear jeans. It might be that there is actually some small causal relationship (perhaps people wearing business suits are more likely to not carry any change, so people wearing jeans will actually have a slightly higher than average rate of having a 1968 dime), but mostly it will still be coincidence.
Just to make sure, I have to ask whether or not you believe smokeless tobacco is carcinogenic?
There are two words in that question that make it difficult to answer very usefully. The first is "carcinogenic". At the right dose and under the right circumstances, there are very likely few chemicals that cannot cause cancer. What matters is whether the actual dose used in a specific manner by individuals actually causes cancer in a measurable fraction of them. The second challenging word is "believe". While it is widely accepted in modern thinking that all science is subjective to some extent, the common use of that word implies that different opinions about something are equally valid (as is widely accepted for political pluralism), and that we have a choice about what is or is not true. The most useful answer to the question is that the epidemiologic evidence clearly shows that smokeless tobacco does not cause cancer at any level that is great enough to measure; this is not to say that it never causes cancer -- like most every other common exposure to chemicals, it very likely has caused some cancers.
You've already agreed that oral cancer is somewhat rare, so it makes sense to me that most of the users who got cancer would not have developed the disease without the exposure.
Rarity is unconnected to determination of exposure. The lower the incidence the harder it is to be sure what the cause is. If for example there were five equally strong associations with a given condition, if that condition were common then the five or some of the five might be discernible; if the condition were rare, the five might be next to impossible to discover or to disentangle. Ultimately, the question is, why do so few smokeless tobacco users (in the West) get oral cancer at all?
If you were to meet Sean Marsee (Copenhagen user, died at 19 after 7 years of use) before he died or Gruen Von Behren (tongue cancer at 17), would you tell them to their face that it is unlikely smokeless caused their tongue cancer?
Those examples do a nice job of making our point about why scientific research requires comparisons of different populations and not just individual cases. Given that some people use smokeless tobacco and that some people get cancer, there will inevitably be people for whom both of those are true. This does not mean that there is any causal relationship (nor, of course, does this by itself mean that there is not a causal relationship -- it just means that we learn nothing from finding a single case). One thing that is notable about both of those individuals is that they had a version of oral cancer that does not seem to be associated with the behavior that causes most oral cancers, smoking, which strongly suggesting that even if smokeless tobacco does cause some oral cancers, it did not cause these particular oral cancers.
If you were to say that there is a somewhat significant number of smokeless tobacco users who have or will develop oral cancer, but it is still OVERALL safer than smoking, I'd be more apt to believe you. The website gives the overall impression that smokeless is completely harmless....or.. I'm sorry, 99% harmless.
If we say or suggest anywhere in what we have written that smokeless tobacco is completely harmless, please point that out to us, because we would like to make sure to change it. If we use the phrase "99% harmless", please point that out also, since I am not sure what that phrase would even mean. I believe that we repeatedly clearly point out that using smokeless tobacco is about 99% less harmful than smoking.
What am I missing? It seems to me that you protect yourself by saying smokeless can cause cancer at a very low level but very few people get it. But when specific examples are brought up of users developing the disease you say "coincidence!". So you're "protected" on both ends of the argument.
Furthermore, I understand that you are targeting smokers to switch. I agree wholeheartedly that smokeless doesn't carry the same risks as smoking. However, with regards to oral cancer, I'm still not convinced.
We are happy to try to clarify and to educate any reader. But as you noted yourself, you are not really our target audience. More importantly, your health concerns and anxiety seem to outweigh any benefit you might obtain from using tobacco. If you can quit nicotine, then you should. We are certainly not trying to convince you, someone who does not smoke, to use nicotine in any form.
Also, another side note. When I dipped tobacco, the part of my oral cavity that I worried about most was my tongue. I developed more sores there that any other part of mouth.
I understand your worries. If I had sores on my tongue I would worry too. But worries (and sores) are not the same things as cancer. It is not uncommon for smokeless tobacco users to develop some local responses to irritation (which is why it is recommended to vary the site of the packets) but studies have not born out that these develop into anything of concern. See the recent Studies on Smokeless Tobacco Use entry in this forum for a relevant reference.
One more thing: If the USTC were smart, they would have the TSNA levels regulated by the government. If I knew for sure that the TSNA levels of Copenhagen could be reduced and was reduced to the lowest possible level, I would be more inclined to keep using the product. I know you've stated that levels are lower than ever before, but they are still much higher than most other products. ...and also without government regulations the USTC have none and don't deserve the trust of the public. With that being said, it is hard to trust an organization funded by them.
There are a lot of discussions about regulation going on right now. ASTER is not directly involved with those (let alone with company marketing) -- we stick to science and education. The science on this point, by the way, does not support the claim that the differences in levels of TSNAs among currently popular Western products have any health implications. [For readers not as familiar with this topic as Anonymous is, TSNAs are a group of chemicals in tobacco that are widely believed to cause cancer in sufficient concentrations, though limitations of research methods make it impossible to really establish the accuracy of that belief one way or another.]
If after you did your studies and you found smokeless tobacco not to be a reasonable alternative to smoking, would you have website stating your conclusions? I doubt it.
Sometimes lay people and anti-tobacco advocates (you are presumably one or the other of those) do not understand how honest scientists conduct themselves: Whatever our studies on this or any other topic show, we report that. Many anti-tobacco advocates seem to be so focused on hating tobacco that they stop being concerned about public health, and thus perhaps find it easy to accuse others of doing the same. Those of us who are concerned about public health would, of course, be quick to inform people about any change in the scientific knowledge that suggested that they make a particular change in their behavior (it is too bad that the American Cancer Society and others do not feel the same way).
Has the USTC ever funded a research project that didn't produce results favorable for their company? I doubt that as well.
There is not a company in the world that has had the opportunity to fund a substantial amount of independent research that has not funded research that produced results the company found to be unfortunate. That is the nature of scientific research that you may not understand: If it is real science, then the results are not known in advance, so they might prove to be bad news. Your choice of the word "favorable" suggests another mistaken (practiced cynical, or perhaps just naive) impression: Most people at most companies (including at smokeless tobacco companies and pharmaceutical companies -- despite the bad press that they often get) care about providing good products, and especially want to know about any problems with their products. Thus, if good research shows something bad about a product, most people at most companies would still consider it "favorable" in the sense that it is better to know the truth, even though it turns out that this truth is unfortunate.
Moist snuff is the most popular form of orally-used smokeless tobacco in North America and parts of Europe. Because moist snuff use conveys lower risks for morbidity or mortality than does cigarette smoking, its use has been proposed as a tobacco harm-reduction strategy. This article critically reviews new and published epidemiologic evidence on health effects of moist snuff and its patterns of use relative to smoking in the United States, Sweden, and Norway. The available evidence suggests that: (1) moist snuff is a human carcinogen and toxin, (2) increased promotion of moist snuff has led to increased sales in those countries, (3) the uptake of moist snuff in these three countries during the past several decades has occurred primarily among adolescent and young adult men, (4) increased prevalence of snuff use has not been associated consistently with a reduction in smoking initiation or prevalence, (5) moist snuff use apparently plays a very minor role in smoking cessation in the U.S. and an inconsistent role in Sweden, (6) U.S. states with the lowest smoking prevalence also tend to have the lowest prevalence of snuff use, (7) there are no data on the efficacy of snuff as a smoking-cessation method, (8) the prevalence of cigarette smoking is relatively high among people who use snuff, and (9) snuff use is more consistently associated with partial substitution for smoking than with complete substitution. The evidence base for promotion of snuff use as a public health strategy is weak and inconsistent.
PMID: 18021914 [PubMed - in process]