Intended for healthcare professionals

Rapid response to:

Head To Head

Should doctors advocate snus and other nicotine replacements? Yes

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39479.427477.AD (Published 14 February 2008) Cite this as: BMJ 2008;336:358

Rapid Response:

NO to Smokeless, Spitless Tobacco - SNUS - It's the KIDS..

We are in agreement with Sir (Dr.) Alexander Macara in that doctors
should not advocate the use of SNUS - NO..

"There is no evidence smokeless tobacco can help people quit smoking.
There are no studies we would consider sufficient." Dr. Terry Pechacek,
Associate Director of Science at the Centers for Disease Control Office on
Smoking and Health. (SNUS the BUMP, Nordic Reach (The Scandinavian
Lifestyle Quarterly}, No.17 Volume XIX, 2007, p53).

Also, "There is no
scientific evidence whatsoever that smokers are able to switch to
smokeless tobacco and remain switched," Dr. Thomas Glynn, the Director of
Cancer Science and Trends at the American Cancer Society (The Independent,
October 9, 2007) The vast majority of inveterate (long established, deep-
rooted, in-grained) tobacco smokers that refuse to quit will not learn the
art of SNUSing, i.e., the placement of the pouch (tea-bag) in a particular
location within the mouth and sucking on the bag for 30 minutes without
any movement. Murray Kessler, Chief Executive Officer of UST, Inc - the
world's leading producer of moist smokeless tobacco products - tells us
that 9 of 10 smokers that try smokeless tobacco reject the product.
(Reuters Consumer and Retail Summit in New York, June 20, 2006)

Dr.
Britton was soundly defeated in a debate on the topic of the use of SNUS
by Dr. Lewis Keir at the first National Conference for the British
Association for Stop Smoking Practitioners in Manchester on September 26,
2007. As pointed out by Dr. Britton himself, "It's their (tobacco
companies) job to sell as much tobacco as possible, so they will be
targeting non-smokers rather than current ones, that's the worry."
(SmokeFree Birmingham) The initial test marketing of SNUS in the states by
traditional cigarette companies has failed and these companies are either
removing the product (e.g., Taboka Tobaccopaks - Philip Morris) or calling
for more education and public awareness. Many more reasons to reject SNUS
and uphold the EU ban can be found at http://news.snus.biz . The primary
reason for upholding the ban is the same as it was back in 1992 when it
was created - Our Children.

ERROR: sentence can be found in the Macara paper - against SNUS. He
(Macara) acknowledges that smokeless tobacco is less addictive than smoked
tobacco - THIS IS NOT TRUE.. Smokeless tobacco is NOT less addictive than
tobacco smoking, in fact nicotine blood levels last longer and may even be
higher when using smokeless tobacco (the pH of the smokeless tobacco is
usually adjusted upward to increase absorption of nicotine from the oral
cavity). (Maximum levels of nicotine were similar but, because of
prolonged absorption, overall nicotine exposure was twice as large after
single exposures to smokeless tobacco compared with cigarette smoking
(Benowitz et al., Clin Pharmacol Ther. Jul;44(1):23-8, 1988)

Competing interests:
None declared

Competing interests: No competing interests

19 February 2008
Samuel Garten
scientist
Ralph Victor Falkner
tobaccowatch.org, 27616, USA