Its more about options given than options taken

Imagine the following.

A car company considers offering reinforced side panels as an additional safety component that customers can have for a price. An outside agency steps in and discourages them in part because the cars already have airbags and seat belts. But the overwhelming reason is “people won’t buy them”.

Though in that example, if the company has invested a substantial amount in developing the panels, the not buying could translate into an uncomfortable financial position for the company, the lack of purchase says nothing about the actual value of the panels, or of having that option.

Tobacco harm reduction is about providing those options whether or not people take them. Its more about choice than it is about action. If the alternative actually works (as using smokeless tobacco or e-cigarettes fundamentally lower risk) then it should be available. And whether it works is the more valid measure rather than whether it becomes popular.

Our old “friend” Stanton Glantz is one of the co-authors of a recent paper in Tobacco Control which argues (and not for the first time) against promoting smokeless tobacco as a harm reduction strategy on the basis that it won’t be successful. Not that it won’t save some lives but because not enough people will do it.

Now if Glantz et al believe their conclusions, then they should also argue that trying to get people to quit smoking should be abandoned because not enough of them are succeeding at it.

– Paul L. Bergen

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  • Dave Atherton  On July 29, 2010 at 11:31 am

    I have written this reply at the BMJ.

    “In such an august as the BMJ it is hard to keep a civil tongue when Glantz is posting. One immediately assumes the worst.

    “Conclusions Promoting smokeless tobacco as a safer alternative to cigarettes is unlikely to result in substantial health benefits at a population level.”

    Obviously Glantz is not up to speed on Sweden. It has the lowest incidence of lung cancer in the developed world because so many smokers have switched to snus.

    “Results: There were 172,000 lung cancer deaths among men in the EU in 2002. If all EU countries had the LCMR of men in Sweden, there would have been 92,000 (54%) fewer deaths.” In conclusion it further adds “This study shows that snus use has had a profound effect on smoking prevalence and LCMRs among Swedish men. While it cannot be proven that snus would have the same effect in other EU countries, the potential reduction in smoking-attributable deaths is considerable. ” This study says “the health risks associated with snus are lower than those associated with smoking. Specifically, this is true for lung cancer (based on one study), for oral cancer (based on one study), for gastric cancer (based on one study), for cardiovascular disease (based on three of four studies), and for all-cause mortality (based on one study).”

    The consequences in Sweden are that in the UK LC is running at 64.7 persons per 100,000 and in Sweden it is <30, with 50% of Swedish men switching to snus. Ergo half the LC. My provenance is indeed the anti smoking Cancer Research.

    The conclusions of your paper are wrong.

    http://www.ncbi.nlm.nih.gov/pubmed/16195209

    http://no-smoking.org/dec03/12-26-03-2.html

    http://sjp.sagepub.com/cgi/content/short/37/5/481

    http://info.cancerresearchuk.org/cancerstats/types/lung/incidence/

  • Anon1  On July 31, 2010 at 2:44 pm

    Sly Glantz is a propagandist. That he occupies an academic position is an utter disgrace. It is a terrible reflection on academia in that there are many more like him and with a common derangement. Given his obvious talent for lying, Sly would have easily fitted into the eugenic elite of early-1900s USA and Nazi Germany.

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