All tobacco is not equally harmful

Your recent editorial endorsed a tax increase on tobacco products other than cigarettes, but it was based on some sweeping statements that are not scientifically accurate or credible ("The 'other' tobacco tax," Jan 20).

You stated: "Tobacco is linked to an estimated 6,861 deaths in Maryland each year … the American Lung Association reports." The Lung Association actually reported that smoking caused these deaths. The distinction is critical because your case for raising OTP taxes is based on the presumption that all tobacco products are equally risky: "Experts say all forms of tobacco are considered harmful to human health no matter whether they are smoked, puffed, chewed or otherwise ingested. Smokeless tobacco, for instance, is often linked to oral and esophageal cancer."

In fact, smokeless tobacco use is 98 percent safer than smoking. While smokeless may be "linked to oral and esophageal cancer," the specific risks are well established in the scientific literature, and they are minuscule. In 2009, a comprehensive review published calculations showing how smokeless tobacco use might have changed cancer deaths among American men in 2005, when 104,737 in the U.S. died from seven cancers directly attributable to smoking. If all smokers had instead used smokeless tobacco, the number would have been 1,102. The risks from smokeless tobacco are so low that, even if all American men had been users, there would have been 2,298 cancer deaths, only 2.2 percent of the number attributable to smoking.

Smokeless tobacco use is vastly safer than smoking, so it is not "foolish public policy" for smokeless taxes to be lower than those for cigarettes. The emerging awareness of smokeless as a cigarette substitute is not just an industry ploy, it has been endorsed by two prestigious medical organizations, the British Royal College of Physicians and the American Association of Public Health Physicians. The Royal College concluded "...that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved."

Brad Rodu, Louisville, Kentucky

The writer is endowed chair of tobacco harm reduction research at the University of Louisville's James Graham Brown Cancer Center.

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