CMAJ should be advocating subsidizing smokeless tobacco

This August 30th, it was reported that an editorial in the Canadian Medical Association Journal was advocating that provincial drug plans should pay for smoking cessation drug therapies.

Not a bad idea.

If the official position is that smoking increases costs to public health and that cessation is an investment that would more than reduce those costs then why not. I would have preferred however that these experts would have either done their homework or at least have given us the benefits of their up to date knowledge of what works in this area to suggest subsidizing the most effective means to date of reducing the health costs associated with using nicotine.

Recent research indicates that cold turkey is more effective than pharmaceutically enhanced quitting. And while I don’t think that subsidizing pharmaceuticals undermines unassisted quitting, it does seem a little odd to send monies toward these already quite lucrative products. However, since it is quite possible that for some individuals pharmaceuticals can make a difference, why not. Whatever path is followed, someone is going to profit, so profit itself cannot really be much of an issue.

But if you are going to subsidize one very profitable industry (that is pharmaceutical nicotine products) why not subsidize the one that is even more effective. Despite electronic cigarettes helping smokers in great numbers in America and Britain, we cannot really expect them to endorse those since they are for the present and foreseeable future outlawed in this country. However, smokeless tobacco is still legal, and has been found to be much more effective in getting people to quit than pharmaceuticals. And there are none of those reports of suicidal impulses associated with some of the pharmaceutical alternatives.

This could be effected simply by a price differential and some good information and the market would take care of it. But if you are willing to send more money to pharmaceutical coffers why not as well pay for smokeless tobacco for smokers to try.

If what you really care about is a drop in the disease rates, it makes perfect sense.

-Paul L. Bergen

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  • Joel L. Nitzkin, MD  On September 1, 2010 at 6:03 pm

    Readers of this news and opinion might be interested in a number of documents posted on the web site of the American Association of Public Health Physicians (; Tobacco Issues Page). The ones of greatest interest should be the October 2008 Harm Reduction Resolution and White Paper, with literature review, now supplemented with a July 2010 update. These documents make the case for a tobacco harm reduction initiative based on informing smokers they could achieve 98% of the benefit of quitting by switching to one of a number of very low risk alternative tobacco/nicotine products.
    Also on this web site are two petitions we sent to FDA in February re E-cigarettes. The first makes the case for reclassifying them from “drug-device combination” to tobacco product. The second urges correction of erroneous and misleading statements made at the July 22, 2009 E-cigarette press conference.

  • rothenbj  On September 3, 2010 at 7:27 am

    Paul, it’s a great idea. However, I can not imagine that governments and their agencies have lied so long about smokeless that it would be extremely difficult to now do an about face and not only recommend, but subsidize smokeless use.

    I personally am so unhappy with the fact that I may have easily quit smoking some 25-30 years ago had I realized that 1. It provided me with what I got from smoking cigarettes 2. It was, as you wrote, 98% safer than cigarettes and 3. That a product like Swedish snus was spitless and quite satisfying.

    I say may easily, because the physiology effects of tobacco are met with Swedish snus but the Electronic cigarette sure helped me with the hand to mouth habit. I still use it in social settings where a cigarette would have been normal, but very low to zero nic works now.


  • […] But to return to the point at hand which is that this health oriented organization moaning about how concerned they are about tobacco associated outcomes and then deciding only to endorse solutions that are politically correct and not include those that could save many lives. It seems that only smokers who quit are worthy of consideration. (For more on CMAJ see here and here). […]

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