Question of the Week

Is there a safe way to consume tobacco?

Mon, 23rd Sep 2013

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kalind asked:

Is snus a safer alternative to smoking cigarettes?


Hannah -   So, what are the relative harms of nicotine containing products?  Are patches more dangerous than e-cigarettes?  Is snus safer than smoking?  We crack into the data with Professor Nutt.

David N. -   Hello.  My name is David Nutt.  I'm a Psychopharmacologist from A cigaretteImperial College in London and I'm also Chair of the Independent Scientific Committee on Drugs. 

Weíve recently done quite a detailed analysis of the relative harms of different nicotine and tobacco containing products.  We use this new technique of multi-criteria decision analysis. This is our analysis to try to understand relative harms of drugs and to make more rational, sensible decisions throughout what we do with drugs including tobacco.

Hannah -   Well, heís perfectly placed to provide the answer to this Question of the Week then!

David N. -   Some people often say that snus as itís known in Sweden and it is popular in Sweden, is that safer than cigarettes.  Recent data suggests that snus is about 20 times safer than cigarettes.  There are many reasons to this.  The first is, itís actually especially prepared form of tobacco that has taken out most of the carcinogens that are added to tobacco and cigarettes to make them smoke better.  The second, it that smoke does not get into the lungs or carbon monoxide that damages the heart.

Hannah -   So, snus is considerably safer than smoking cigarettes, but what about electronic cigarettes which vaporise nicotine and deliver it to the lungs?

David N. -   So, these also look to be very much safer than conventional cigarettes and possibly, even safer than snus itself.

Hannah -   And what about the passive risk of e-cigarettes for those around the smoker?

David N. -   The current situation with e-cigarettes is that we think they have a much lower propensity to affect other people as well as for the user.  They havenít been extensively studied, but you certainly donít get the contamination of the air, the carcinogens that you get from smoked cigarettes.  Whether there's enough nicotine floating around to actually cause a degree of pharmacological action on, people in the vicinity is not yet known.  Iíll be surprised if they have anything like this bigger problem as what passive smoking is to current cigarettes.


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Some years ago a Texas judge ruled that a cigarette is an inherently defective product since it is not essential to life in the short term, and its only known longterm effect is to kill you.

There is no doubt that not smoking is the safest alternative to smoking, and not inhaling carcinogens by any route is probably safer still.

On the other hand, whose life is it? It is of no legitimate concern to anyone else what you stuff up your nose or in your veins, as long as it doesn't harm or offend anyone else, or make you behave badly. So I guess the correct answer is, who cares?  alancalverd, Tue, 24th Sep 2013

I'm finding it hard to think of anything which "doesn't harm or offend anyone else, or make you behave badly".

RD, Tue, 24th Sep 2013

Snuff. And most illegal drugs. Compared with alcohol and cigarettes, most banned substances are pretty harmless to others. alancalverd, Tue, 24th Sep 2013

I found the distinction between snus and dipping tobacco (also known as snuff in the USA) to be quite interesting.

Apparently there is no spitting with the snus...  I would think that would at least make it more pleasing to others around the one using it.

The snuff does carry a high risk of mouth & throat cancer, and also apparently bladder cancer (concentrated byproducts of smoking and chewing).

The snus must have enough removed to make it significantly safer.

As mentioned in the article, smokeless cigarettes may give the nicotine does with a lower risk, although time will tell if they bring other risk factors with them.

As others have mentioned, the safest tobacco is that that is left on the shelf. CliffordK, Tue, 24th Sep 2013

In a public health system, like NHS, if a substance-abuser user puts themselves in hospital, other people, (mostly not self-inflicted), will have to wait longer for treatment and suffer more as a result, i.e. the drug-abuse has knock-on effects which harm other members of society.

No man is an island , ( although Pavarotti was almost big enough  ) RD, Wed, 25th Sep 2013

Same applies to a careless driver, drunk who falls downstairs, failed suicide, prat with chainsaw, broken leg....but we don't ban cars, beer, razor blades, garden tools, skis....

Long-term head injury patients are mostly self-inflicted: falling off horses, motorbikes, or roofs. These patients cost a fortune to keep alive, whereas a druggie with a bad high can usually go home in a few days.

So who do you think deserves priority treatment, and who should be refused on grounds of selfinfliciton? The weasel word is "abuse". Nobody talks about chainsaw abuse, or excessive horse riding. Why not? alancalverd, Wed, 25th Sep 2013

My point was that people who intoxicate themselves do harm others in the process,
in response to your condition  ...

As I mentioned previously I can't think of any activity which would satisfy those conditions,
( including your skiing and horse-riding examples ).

An health insurance system where people paid proportionally more if they went out of their way participate in hazardous activities would cover the horsey-types and chainsaw-jugglers.
This could include a fat-tax : ( the obese paying more towards health care costs ). 

As for who "deserves priority treatment" IMO the ambulance should not race to respond to a heroin OD, (you did ask). RD, Wed, 25th Sep 2013

How did we get so far off of tobacco?

Ahh, I found some statistics.

In a 2006 European study, the risk of developing lung cancer was:0.2% for men who never smoked (0.4% for women)
5.5% for male former smokers (2.6% in women)
15.9% for current male smokers (9.5% for women)
24.4% for male ďheavy smokersĒ defined as smoking more than 5 cigarettes per day (18.5% for women)

That is HUGE.
One quarter of the heavy smokers develop lung cancer (not mentioning other complications).  Hard to compare that to traumatic brain injuries from bicycle commuting.

I hate the idea of censoring things that give people enjoyment... but do people truly enjoy smoking? CliffordK, Thu, 26th Sep 2013

Unfortunately some of us do, indeed, enjoy smoking. It's unhealthy and antisocial, without a doubt, so many non-smokers don't enjoy smokers. Good on 'em; it's not my favorite characteristic of old Skyli either. Habit and Addiction are a very nasty and tenacious mix.

But when I'm not pulling on a cancer-stick I often go back to the old question of whether tobacco and alcohol would be banned if they were newly discovered narcotics - even coffee (but not tea. Anything but that!). Skyli, Fri, 27th Sep 2013

because everyone knows it is dangerous, so discussion is pointless

since it is voluntary, pointless, expensive and dangerous, one must assume that those who do it derive some pleasure from it. Like skiing. alancalverd, Fri, 27th Sep 2013

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