March 13, 2011

Stanton A. Glantz, PhD

Philip Morris still ignoring their own research showing that dual use of smokeless and cigs no safer than cigs alone

Ever since Philip Morris (and other multinational tobacco companies) have gone into the smokeless business, particularly with snus co-branded with cigarettes they have been trying to make claims that promoting smokeless is a good harm reduction strategy.  They have even petitioned the FDA to allow them to make explicit health claims in their marketing.  

One big problem with all this is that the companies are aggressively promoting "dual use," when smokers would use snus when they couldn't smoke cigarettes and cigarettes the rest of the time (hence Marlboro Snus and Camel Snus).   As part of the effort to build this case,  Philip Morris researchers published a paper in Nicotine and Tobacco Research last December that reviewed that available literature and concluded " Overall, the concern about dual use appears to be contradicted by the evidence in the literature that dual use of smokeless tobacco and cigarettes may result in reduction in smoking-related harm as smoking intensity is decreased and smoking cessation increases."

The problem with this conclusion is that when one looks carefully at the actual results, one sees that the confidence intervals (the "margins of error") for the risks of dual use and smoking cigarettes alone overlap, indicating that the actual observed risks are not detectably different for heart attacks, heart disease, cancer, and stroke.   When Pam Ling and I pointed out the inconsistency between PM's conclusions and the actual data in the paper in a letter to the editor in the journal, the PM authors ignored the substance of our criticism and just repeated their conclusions.

There are two conclusions to be drawn from this exchange:   1. People -- especially regulators like the FDA -- still cannot take the conclusions of papers published by or for tobacco companies at face value.  The spin and misrepresentation of results continues.   2.  Our earlier analysis of the likely population impact of promoting smokeless tobacco as a harm reduction strategy that concluded that such a strategy would not have population benefits probably underestimated the risks of dual use, increasing the likelihood that promoting smokeless as a harm reduction strategy would actually increase population-level harm because we had assumed that dual use would be less dangerous than cigarettes alone. 

The actual results in the PM paper show that this assumption was probably wrong and that dual use is as dangerous as cigarettes alone.

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