(Soundbite of "Late Night with David Letterman")
Mr. DAVID LETTERMAN (Host): You know, how many folks smoke cigarettes? Does anybody here smoke cigarettes?
DEBBIE ELLIOTT, host:
It's the time of year that many smokers gear up for that last puff. David Letterman recently poked fun at what has become a controversial subject in the anti-smoking world: whether smokers might be better off trading their cigarettes for smokeless tobacco.
(Soundbite of "Late Night with David Letterman")
Unidentified Woman: There's never been a better time to try Chaw. Packed with the rich tobacco flavor you crave, Chaw is a fun and convenient way to get your fix. At work, in the car, even in bed. And while cigarettes wreak havoc on your lungs, the carcinogens in Chaw primarily attack your mouth, gums and esophagus, leaving your lungs strong and healthy. Chaw is even popular among presidents. It's what's for dinner.
Mr. LETTERMAN: That is Chaw. It's what's for dinner.
ELLIOTT: Letterman is laughing, but the debate is no laughing matter in public health circles, as I've been hearing over the last few years covering the tobacco wars.
Lynn Kozlowski is chair of the department of health behavior at the University of Buffalo, State University of New York.
Ms. LYNN KOZLOWSKI (University of Buffalo, SUNY): I would say there are two clear factions in the public health community, some people who believe that saying anything positive about smokeless tobacco subverts the efforts to get people off tobacco and off cigarettes in general; and I think there's another faction which thinks there are these differential risks and we need to be honest with the public about these differential risks.
ELLIOTT: Now, just to be clear on the risks here, even though smokeless tobacco doesn't pull smoke and all of its chemical constituents into your lungs and make you more susceptible to lung cancer, doesn't it cause other problems? I mean, can't you get mouth cancer from smokeless tobacco?
Ms. KOZLOWSKI: Just as you can from cigarettes. And the evidence is that the risks from cigarettes are greater than for most of the smokeless tobacco products. I mean, I think you have to keep in mind, it's a problem, I think, to be addicted to anything, and certainly smokeless tobacco products are addictive.
Part of the issue is that cigarettes are so very, very, very deadly. It's like killing one in two users prematurely. So you could have a product that's still pretty dangerous that's a lot safer than cigarettes, and I think that's part of the predicament that we're in.
ELLIOTT: The Centers for Disease Control and Prevention reports that just over two percent of Americans use smokeless tobacco products. But in recent years, sales of smokeless tobacco have been on the rise. And it's not all what Letterman calls Chaw or traditional leafy chewing tobacco that we're talking about.
There are new snuff products on the market that package a finely ground tobacco in a little teabag-like pouch. They don't require so much spitting. Even the major cigarette companies are getting in on the action; Phillip Morris with Toboca and RJR with Camel Snus, picking up on the word for the product in Sweden, where Snus, the spitless pellet form of smokeless tobacco is widely used.
Here's a spoof on Snus from the YouTube Web site.
(Soundbite of video)
ANNOUNCER: Sweden is famous for a whole lot of things, such as the elk. The Swedish blonde. The very famous Darlar(ph) pony. And of course, Snus, the smokeless tobacco.
The good thing about Snus is it works just like cigarettes. But without the smoke. Just lace it under your upper lip.
ELLIOTT: Some smokers use the Snus or snuff as an alternative when they can't smoke, say on an airplane or at the office. But a number of public health advocates are now suggesting that smokers switch over completely to smokeless tobacco if they're having trouble giving up cigarettes.
Among them is Bill Godshall, the executive director of SmokeFree Pennsylvania. He says this debate over reduced harm has precedent.
Mr. BILL GODSHALL (SmokeFree Pennsylvania): I think if you looked at another drug addiction issue, heroin addiction, there's a lot of parallels here. Methadone maintenance is found to be far less hazardous than heroin addiction. And within the drug treatment community you had this huge split of people saying, no, that sends the wrong message, that addiction is acceptable. And then there was the harm reduction realists that would say, but we can reduce these people's risks of dying dramatically, and also they're not out stealing to get money for their drug addiction, so society benefits.
And I think the same parallels are with the smokeless issue, because it doesn't create any secondhand smoke.
Dr. STAN GLANCE (University of California, San Francisco): It's a sort of false choice which is being presented.
ELLIOTT: Stan Glance is a professor of medicine at the University of California, San Francisco and a leading anti-smoking crusader. He agrees that smokeless tobacco isn't as deadly as cigarettes, but he doesn't think it's safe to promote any kind of tobacco use.
Dr. GLANCE: Snus is a way to get nicotine without all of the junk you get when you smoke the cigarettes. You get different kinds of junk with the Snus. And it isn't going to cause as much heart disease and lung cancer. There's no question about that.
But if you're saying, well, I'm going to stop smoking cigarettes but I need a way to get nicotine as a bridge to quitting, then you ought to use the nicotine replacement therapy, the pure nicotine products that are available, because those don't bring the kind of emotional cache of tobacco use.
ELLIOTT: Pure nicotine refers to the patches, gum, inhalers and other products designed to wean smokers from nicotine without the disease-causing properties of tobacco.
Dr. GLANCE: There's no reason to get nicotine which is only a little dirty when you can get nicotine which is clean.
ELLIOTT: And that's the position of most of the federal and state public health agencies that fight tobacco use. Federal law even requires that all smokeless tobacco carry one of three warning labels. This product is not a safe alternative to cigarettes. This product may cause mouth cancer. Or this product may cause gum disease and tooth loss.