Up to snuff?

October 11, 2006 6:16 PM

Helping Smokers Quit: A Role for Smokeless Tobacco? 45 million Americans still smoke, and 438,000 die each year, despite a 40-year intense public health campaign. Apart from 'quit or die', the third neglected option is smokeless tobacco. The linked report by the American Council on Science and Health describes the products and examines the risks.
posted by daksya (50 comments total)

Some key points:

*The term smokeless tobacco refers to tobacco products that are not burned. Instead, most are placed in the cheek or between the lip and gum.

*Cigarette smoking increases a person’s risk of heart disease two- to fourfold. Most studies of smokeless tobacco indicate that it has no influence on heart disease risk.

*Cigarette smoking causes cancer both at sites that come in direct contact with cigarette smoke — including the mouth, nose, throat, and lungs — and at sites that don’t — including the bladder, kidney, pancreas, uterus, cervix, and stomach. Smokeless tobacco, on the other hand, has been associated with only one type of cancer — oral cancer — and the risk of oral cancer associated with the use of smokeless tobacco is less than the risk of oral cancer associated with cigarette smoking.

*The use of smokeless tobacco does not expose other people to tobacco smoke. Although the exact degree of health risk associated with exposure to environmental tobacco smoke is disputed, decreased exposure to “secondhand” smoke would certainly be welcome.

*Overall, the use of smokeless tobacco confers only about 2% of the health risks of smoking. For example, if the 400,000 people who died of smoking-related diseases had instead been using smokeless, the death toll might have
been only 8,000.

*Most people are not aware of the large difference in risks between cigarettes and smokeless tobacco. In 2005, a survey of adult U.S. smokers found that only about 11% correctly believed that smokeless tobacco products are less hazardous than cigarettes. In another survey, 82% of U.S.
smokers incorrectly believed that chewing tobacco is just as likely as cigarette smoking to cause cancer.
posted by daksya at 6:17 PM on October 11, 2006

*The use of smokeless tobacco does not expose other people to tobacco smoke. Although the exact degree of health risk associated with exposure to environmental tobacco smoke is disputed, decreased exposure to “secondhand” smoke would certainly be welcome.

*The use of smokeless tobacco does expose other people to tobacco-laden spit. Although the exact degree of health risk associated with exposure to environmental tobacco-laden spit is disputed, decreased exposure to “secondhand” tobacco-laden spit would certainly be welcome.
posted by lekvar at 6:25 PM on October 11, 2006

From the report:

The safest types are modern products like snus, or Swedish moist snuff, and a host of similar products available in the U.S. Crucially, they satisfy smokers' nicotine addiction and cause negligible health risks of their own. All of these products are held discreetly between lip and gum, releasing nicotine, and because they do not stimulate saliva production there is no spitting.
posted by daksya at 6:27 PM on October 11, 2006

Personally, I'll take a half million dead americans each year over people spitting tobacco everywhere.

But then I'm a cold-hearted asshole.
posted by b1tr0t at 6:30 PM on October 11, 2006

Ah, snus, beloved of scandinavians, mystifying to the rest of Europe. I tried it once or twice, and it made my mouth feel unplesantly tingly and, well, tabaccoy. My mistake may have been trying to drink beer at the same time as snusing, though my scando pals seemed to manage fine. And yes, no spitting required with snus.

Bizarrely and somewhat ironicly, given it's apparently relatively less harmful nature, is that snus is actually banned in the EU for health reasons.
posted by MetaMonkey at 6:33 PM on October 11, 2006

Actually, there are types of snuff that don't require spitting. Think of dime-sized teabags that can be tucked up under the lip.
posted by zennie at 6:37 PM on October 11, 2006

zennie, that sounds exactly like snus (wiki link above).
posted by MetaMonkey at 6:40 PM on October 11, 2006

So, what happens to these juicy teabags after they've been tucked under the lip for a while?

Does a magic snus fairy come and take them away?
posted by b1tr0t at 6:45 PM on October 11, 2006

Interesting, I guess I skimmed too fast. I had a room-mate who used American-style chewing tobacco, and it's permanently prejudiced me against the practice. What mechanism makes snus, erm, spitless?
posted by lekvar at 6:45 PM on October 11, 2006

i'd rather fight than switch.
posted by brandz at 6:46 PM on October 11, 2006

Suns actually have a have a hollow lid where the used snus can be placed after use. They look like cigarette filter sized tea bags. They do give you a nice buzz without any bothersome smoke or spit.
posted by Frank Grimes at 6:49 PM on October 11, 2006

What mechanism makes snus, erm, spitless?

Instead of chewing a wad, which makes loads of saliva, snus is simply held between the gum and the lip, slowly absorbing into the bloodstream.

Oh, and it isn't necessarily in a tea-bag thing; some snusers lead me to believe that the bag is kind of a beginner thing, real snusers have a tin of tobacco which they roll into balls of the desired size and consistency, before inserting.
posted by MetaMonkey at 6:55 PM on October 11, 2006

I'm betting the spittoon industry is behind all this.
posted by zsazsa at 6:56 PM on October 11, 2006 [2 favorites]

Personally, I'll take a half million dead americans each year over people spitting tobacco everywhere.

Damn straight, it's fucking disgusting. Especially when people have like "coke" bottles they spit into.

Seriously people. If you need nicotine and don't want to smoke there are many more inoffensive ways of getting. Like a patch or gum. You can also get lollipops.
posted by delmoi at 7:00 PM on October 11, 2006

snus is simply held between the gum and the lip, slowly absorbing into the bloodstream.
That's how my room-mate used to take his Copenhagen. Maybe he just liked spitting.
posted by lekvar at 7:02 PM on October 11, 2006

So, what happens to these juicy teabags after they've been tucked under the lip for a while? Does a magic snus fairy come and take them away?

It's also worth pointing out that snus removes the need for filters, which are a significant environmental issue.
posted by MetaMonkey at 7:03 PM on October 11, 2006

snus is simply held between the gum and the lip, slowly absorbing into the bloodstream....

That's how my room-mate used to take his Copenhagen. Maybe he just liked spitting.

Hmm, now that I think about it, the snusers I used to know did do a fair amount of spitting, especially when outdoors. But I think it wasn't quite as necessary, or nearly as voluminous, as with chewing tobacco.
posted by MetaMonkey at 7:09 PM on October 11, 2006

Some people have access (depends on market) to smokeless cigarettes that heat tobacco rather than burn it, yet those are far and away the products that are most vehemently opposed by anti-tobacco advocates.
posted by clevershark at 7:21 PM on October 11, 2006

I experimented with a new product, a lozenge-like thing they called "hard snuff" - no spitting and no waste, it dissolves completely in the mouth - before I quit smoking for the last time (bravado - but so far so good). They certainly took the edge off but in the end I felt like it just perpetuated the addiction (and it didn't change the fact that what I REALLY wanted to do was SMOKE). What I really needed to do was face and master it.

On the other hand, I think that the frequent resistance among anti-tobacco advocates to suppress the fact that smokeless tobacco (and non-inhaling pipe and cigar smoking, for that matter) are much less dangerous than cigarette smoking is pointless and counterproductive. I've been seeing outbreaks of this debate going on sort of quietly for a while now.
posted by nanojath at 7:48 PM on October 11, 2006

those are far and away the products that are most vehemently opposed by anti-tobacco advocates.

Strangely, the statist anti-tobacco advocates are usually those that scream the loudest against abstinence-based sex ed.
posted by Kwantsar at 7:50 PM on October 11, 2006

Some people have access (depends on market) to smokeless cigarettes that heat tobacco rather than burn it, yet those are far and away the products that are most vehemently opposed by anti-tobacco advocates.

I'm not sure it's right to call those "smokeless" exactly... I mean, maybe you can't see the smoke, but there's still something volatilizing. Anyway, there are all sorts of problems with those. First of all, tobacco companies can't make any claim that those things reduce the risks, even though they probably do. The state of Vermont is suing RJ Reynolds for even saying their product "may" reduce risk (granted, tobacco companies don't have the best track records with truth in advertising). Secondly, right now the products are ugly embarrassing monsters with this heater thing that you have to stick the specialized cigarette into; definitely not convenient especially by modern standards. But if you make it cool and attractive, that's also bad because you don't want people to start using it if they don't smoke. Thirdly, there's a population health question in that you don't want people to turn to that product as an alternative to quitting if they would have quit had the product not been available.

Tobacco by itself is not good for you, but it's the act of burning that cooks up most of the toxicant stew that causes most of the health problems. There are thousands of chemicals in tobacco smoke, and most of them haven't been tested in any meaningful way because there are so many. So, smokeless tobacco is almost definitely safer.

One fear is probably that more people might initiate tobacco use because of "safe" smokeless products than actually switch over from smoking. But I think it's hard to argue that even that would be less harmful on overall population health than having everyone smoke, assuming the number of smokers didn't go up.
posted by zennie at 8:02 PM on October 11, 2006

doh

less harmful more harmful
posted by zennie at 8:05 PM on October 11, 2006

The ACSH are corporate shills:

"This rationale seemed to evaporate, however, when the ACSH filed a friend-of-the-court brief in a 1982 lawsuit brought by the Formaldehyde Institute. The suit succeeded in overturning a federal ban on insulation made with formaldehyde, a suspected carcinogen.

"It turns out that the ACSH 's legal brief was paid for by Georgia-Pacific Co., a leading manufacturer of formaldehyde and a member of the Formaldehyde Institute. Georgia- Pacific paid its Washington law firm $40,000 to write the 45-page brief, which ACSH then submitted under its name to a federal appeals court."
posted by Blazecock Pileon at 9:42 PM on October 11, 2006

formaldehyde-filter
posted by punishinglemur at 9:52 PM on October 11, 2006

Blazecock Pileon: Appeal to (mal)authority?

What about the Royal College of Physicians:

Some smokeless tobacco products (such as snus, which is widely used in Sweden) can also provide nicotine in a formulation that is a proven acceptable alternative to cigarettes for many smokers, and although more harmful than medicinal nicotine is much less harmful than cigarettes.

..or a panel of experts published in a peer-reviewed American Association of Cancer Research journal:

In comparison with smoking, experts perceive at least a 90% reduction in the relative risk of LN-SLT use.
(LN-SLT = Low-Nitrosamine Smokeless Tobacco)
posted by daksya at 10:38 PM on October 11, 2006

The RCP link discusses medium-term goals for smoking reduction — not end goals. The second link doesn't work.

In any case, citing the ACSH as an authority on health policy is like citing the Lard Council on why eating a pound of pure lard every day is an acceptable substitute for bacon. They're a joke.
posted by Blazecock Pileon at 10:46 PM on October 11, 2006

Thanks, BP. I was just getting to that.
posted by Mr. Gunn at 11:01 PM on October 11, 2006

Blazecock Pileon: The RCP link discusses medium-term goals for smoking reduction — not end goals.

What's that got to do with this topic? On the relative risk of smokeless tobacco, the RCP statement is pretty unambigious ("much less harmful"), and consonant with the ACSH report.

The corrected 2nd link: http://cebp.aacrjournals.org/cgi/content/abstract/13/12/2035
posted by daksya at 11:34 PM on October 11, 2006

What's that got to do with this topic?

The fact that tobacco companies are astroturfing their snuff as a safe alternative, either through shoddy research or misreadings of said research, perhaps?

Being consonant with a corporate shill is not a good thing, btw.
posted by Blazecock Pileon at 12:57 AM on October 12, 2006

To clarify; the Snus (linked above by MetaMonkey) does not cause spitting. However, if you leave it in long enough, it may eventually start pouring down in to your mouth. At that point, spitting would probably be a good idea.
posted by klue at 3:59 AM on October 12, 2006

The fact that tobacco companies are astroturfing their snuff as a safe alternative, either through shoddy research or misreadings of said research, perhaps?

While I agree that there are very good reasons to be skeptical of tobacco company research, the clinical evidence is strong that using snuff is far, far less dangerous than smoking tobacco. Again, using snuff is not healthy, but you don't get the same type of systemic cardiovascular and pulmonary problems that you do with smoking. Intuitively, it makes sense: You're not pulling all these chemicals into your lungs (huge surface area, fast concentrated delivery into blood, permanent damage to vital organ) but intstead absorbing through the cheek and saliva/digestion (small area of direct contact, slower delivery, smaller chemical wash reaching the blood, immediate damage not in vital organ).
posted by zennie at 5:13 AM on October 12, 2006

The Snus data is very impressive-- if I recall correctly from the last time I looked at it, Sweden has both the lowest smoking rate in Europe and the lowest rate of lung cancer deaths. Yes, more people use snus: but overall improvement of health, has been dramatic.

You can't fake public health data like that-- unless you want to posit a huge conspiracy between the tobacco companies and the Swedish government.

In every debate over harm reduction drug policies-- whether it relates to needle exchange, providing naloxone to revive overdose victims, or anything else studied so far-- opponents claim that the harm reduction measures will stop people quitting and attract new users, thereby actually increasing harm.

The data has repeatedly shown the opposite-- but that doesn't stop the arguments continuing to be made.
posted by Maias at 5:52 AM on October 12, 2006

I quite like snus. At first I was salivating quite a bit, but I got used to the local infusion of nicotine (and the slight saltiness) so saliva production was held to a minimum.

If you swallow snus-infused saliva, your throat will get all tingly, though. There might be different grades with varying amounts of nicotine (I've seen someone get nauseous from it).

American 'chewing tobacco,' even used like snus (no chaw'n), induced a lot more saliva than snus for me.
posted by porpoise at 7:54 AM on October 12, 2006

In every debate over harm reduction drug policies-- whether it relates to needle exchange, providing naloxone to revive overdose victims, or anything else studied so far-- opponents claim that the harm reduction measures will stop people quitting and attract new users, thereby actually increasing harm.

The data has repeatedly shown the opposite--

Even during the low-tar cigarette fiasco in the US, quit rates didn't drop. I think they went up, in fact. The problem with low-tar (lite, ultra-lite, "smooth taste" etc) is nicotine is in the tar, so people smoked more low-tar cigarettes to get the same fix. It was a public health disaster, but not because of quit rates.

I think there's a real question about how many people would actually switch from cigarettes to snuff if they knew it was safer. All we talk about is nicotine, but there's more to smoking addiction than just nicotine... if that were the case people could take pills instead of lighting up.

There are people who argue that the slow transfer rate of nicotine from snuff is less addictive than the spike of nicotine you get from cigarettes. Sounds good, but I'm not sure the data is there yet. It would be bad if people tried snuff that had a higher nicotine content, and then went back to cigarettes and increased their smoking to get the higher dose. But maybe that type of situation wouldn't be common.

If anyone's really interested, check out the Legacy Tobacco Documents Library compiled by UCSF. There are millions of tobacco industry documents there.
posted by zennie at 8:26 AM on October 12, 2006

zennie: There are people who argue that the slow transfer rate of nicotine from snuff is less addictive than the spike of nicotine you get from cigarettes. Sounds good, but I'm not sure the data is there yet.

Actually, there is.

Blazecock Pileon: The fact that tobacco companies are astroturfing their snuff as a safe alternative, either through shoddy research or misreadings of said research, perhaps?

Where's your proof that the research on smokeless tobacco is shoddy or being misread? If I understand your attitude correctly, anything put out that is not anti-tobacco or not as anti-tobacco as expected by anyone is automatically suspect, since you discount the RCP as well the estimations by expert tobacco epidemiologists, who are from organizations like National Institute of Health, American Cancer Society, Johns Hopkins University, Columbia University...etc
posted by daksya at 8:49 AM on October 12, 2006

I never understood why smokers just don't switch to the gum. You can bring it into work, on airplanes, etc... No actual smoke to do badness with your lungs, clothes, nearby people. What's the problem I'm missing? Maybe a smoker can enlighten me.
posted by gummo at 10:43 AM on October 12, 2006

daksya: Actually, there is.

The Foulds 2003 paper (second FPP link) has this to say:

Given the pattern of nicotine absorption described above there can be no doubt that snus is dependence forming in much the same way as other forms of tobacco consumption. There is some evidence that the dependence potential of nicotine and other psychoactive drugs is related to their speed of delivery to the brain and so one would expect snus and other non-inhaled forms of nicotine delivery to be proportionately less addictive than inhaled tobacco smoke. However, there is clear evidence that users of products with snus-like nicotine delivery profiles develop cravings and nicotine withdrawal symptoms when attempting to abstain, and find it difficult to quit. While snus probably does not produce stronger nicotine dependence than smoking, it has just minimal, if any, advantages over cigarettes or other smokeless nicotine delivery products in terms of its lower potential to induce dependence. In fact, its high nicotine delivery and hence dependence potential (relative to most other non-smoked delivery modalities) may be a critical factor enabling it to compete with the more rapidly absorbed nicotine from smoked tobacco.

That review paper has Karl Fagerström's name attached, which is a plus for credibility on this point. The widely-used Fagerstrom Nicotine Dependence scale is named after him.
posted by zennie at 10:49 AM on October 12, 2006

Ok, so they might account for the slower dispersal rating. What about the increase in Nicotine per dose? I used to chew Cope and its snuff variant when I played ball, and a wad of that garbage seemed to be at least three or four cigarettes worth of satisfaction, if you will. Is oral cancer really a preferable end result? I'd agree with BCP, this seems like propaganda for smokeless products and little more.

I quit chew, then I started smoking years later, and I quit that. It was substantially more difficult for me to kick the chaw, and I attribute that to the higher dose, slower delivery timeframe. You can huff a cigarette down in no time, but a dip really lingers in your maw for quite a long time. I'd posit that my addiction was obviously related to the drug delivery, but the context of the ritualized consumption methods was so vastly different it had an impact all the way to the end.

Also, I've never seen anyone vomit immediately after smoking their first cigarette. 80% of the people I've witnessed taking their first dip have blown chunks before they even get half of it tossed out of their mouth. I'm not sure what I'd attribute it to, but it's testament enough for me that neither action is a prime delivery method for any substance.
posted by prostyle at 11:05 AM on October 12, 2006

"Light" cigarettes are *not* harm reduction-- they turned out to be the opposite. Harm reduction cigarettes would have to be *high* nicotine, not low-- because with low nicotine cigs, people just suck in more smoke to get the same amount of nicotine. What you want is less harm per hit of nicotine.

So the fact that light cigarettes didn't work says nothing about the overall effectiveness of harm reduction strategies because they miss the basic idea: you have to offer something *less* harmful!!!!

This is probably why tobacco harm reduction gets a hard time because either in bad faith or by mistake, the tobacco company's attempts at it have been misguided.

And I repeat, the Swedish data is truly impressive-- less smoking, less mortality.
posted by Maias at 11:23 AM on October 12, 2006

FYI. From the third link:

Phillips is the director of and Guenzel was (at the time of writing) employed by the non-profit research institute, Center for Philosophy, Health, and Policy Sciences, Inc. CPHPS is the recipient of an unrestricted gift from U.S. Smokeless Tobacco Company for support of research of Dr. Carl V. Phillips. This research was investigator-initiated. USSTC did not influence the content or see the study results before they were publicly released. Phillips and Wang have received consulting fees from USSTC related to litigation. Phillips is the recipient of an unrestricted research grant from USSTC at the University of Alberta where he will soon be employed.

Kinda blows this study outta the water don't ya think?
posted by Jeff_Larson at 12:00 PM on October 12, 2006

prostyle: Is oral cancer really a preferable end result?

Smokeless products confer a lower risk of oral cancer. From that panel paper, "Median mortality risks relative to smoking were estimated to be .. 15% to 30% for oral cancer."

I'd agree with BCP, this seems like propaganda for smokeless products and little more.

For anyone suggesting that smokeless products have a comparable risk profile, cite evidence.
posted by daksya at 12:03 PM on October 12, 2006

For anyone suggesting that smokeless products have a comparable risk profile, cite evidence.

Having worked years ago in an oncology ward, I would say oral cancer, any kind of cancer, is serious news.

When it is a symptom of a particular behavior that can be avoided...

I really can't begin to imagine why this post exists, other than to promote smokeless tobacco over many other and much safer addiction-reduction therapies.

Certainly, opening the thread by quoting a corporate shill like the ACSH raises a red flag for me.
posted by Blazecock Pileon at 1:07 PM on October 12, 2006

Maybe ACSH is suspect; I don't know anything about them. But that doesn't negate the fact that lots of clinical evidence supports the idea that smokeless is less hazardous than cigarettes.

Compare the CDC fact sheet for cigarette smoking to the one for smokeless products. Which has the longer list of related diseases? Which affects more systems? I don't think anyone needs to be an expert to see which poison would be better to pick.

I do not advocate either one, but to equate dipping to smoking is nonsensical to me. It's like saying that tackling an angry dog is the same as tackling an angry grizzly, because they both have teeth. If people are going to engage in risky behavior, for whatever reason, should they really be led to believe that all options are equally risky? That seems plainly unethical.
posted by zennie at 1:44 PM on October 12, 2006

I don't think anyone needs to be an expert to see which poison would be better to pick.

.
posted by Blazecock Pileon at 1:54 PM on October 12, 2006

I never understood why smokers just don't switch to the gum.

Well, as an ex-smoker, two things. The first is that smoking is a habitual addiction that is very tied to the specific behavior - the tactile and oral feel of cigarettes, the feel and taste and smell of inhaling smoke. I know the taste and odor of tobacco smoke are generally overpowering and noxious to the nonsmoker or naive smoker, but they are manna to the pathetic addict. Cigarettes are not merely a nicotine delivery system, they are a lifestyle choice. The act of inhalation is very reinforcing for the addict. Wedging a chunk of gum in your cheek just doesn't cut it.

The other thing is, inhaling cigarette smoke creates a massive, sudden influx of nicotine. Oral products and the patch by contrast deliver a relatively small dose over a longer period of time. It takes the edge off but it doesn't really replace smoking.

There are those who essentially switch to gum, though - they never make the transition to giving up nicotine entirely. I've known one and of a couple others, I presume it's not that uncommon.
posted by nanojath at 2:04 PM on October 12, 2006

Jeff_Larson: Kinda blows this study outta the water don't ya think?

Nah. Lots of perfectly good research is brought to you by corporate evil.
posted by zennie at 2:55 PM on October 12, 2006

And here's some that has nothing to do with corporate evil, showing that Sweden has the lowest smoking rates in Europe and that snus has contributed substantially to public health there:

ABSTRACT
Objective: To review the evidence on the effects of moist smokeless tobacco (snus) on smoking and ill health in Sweden.

Method: Narrative review of published papers and other data sources (for example, conference abstracts and internet based information) on snus use, use of other tobacco products, and changes in health status in Sweden.

Results: Snus is manufactured and stored in a manner that causes it to deliver lower concentrations of some harmful chemicals than other tobacco products, although it can deliver high doses of nicotine. It is dependence forming, but does not appear to cause cancer or respiratory diseases. It may cause a slight increase in cardiovascular risks and is likely to be harmful to the unborn fetus, although these risks are lower than those caused by smoking. There has been a larger drop in male daily smoking (from 40% in 1976 to 15% in 2002) than female daily smoking (34% in 1976 to 20% in 2002) in Sweden, with a substantial proportion (around 30%) of male ex-smokers using snus when quitting smoking. Over the same time period, rates of lung cancer and myocardial infarction have dropped significantly faster among Swedish men than women and remain at low levels as compared with other developed countries with a long history of tobacco use.

Conclusions: Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence.
posted by Maias at 3:01 PM on October 12, 2006

Maias: that study is my second link.

Blazecock Pileon: Having worked years ago in an oncology ward, I would say oral cancer, any kind of cancer, is serious news.

And smokers who switch reduce their risk of oral cancer appreciably.

I really can't begin to imagine why this post exists, other than to promote smokeless tobacco over many other and much safer addiction-reduction therapies.

It's not the addiction per se that's the main problem, but the concomitant health impact of gross consumption. This post exists to showcase that a much safer product is consistently portrayed by American health interests as equally dangerous, thus depriving the smokers who can't quit, of awareness of a less harmful habit, but that may be easire to switch to and maintain than medicinal nicotine. The Swedish experience is a large-scale public testimony to that effect. Most smoking-related deaths are attributed to cardiovascular conditions and lung cancers, not oral cancer.
posted by daksya at 4:32 PM on October 12, 2006

I think Nanojath is right. Perhaps it is conditioning, but the feeling of drawing in smoke (in small amounts) is part of the satisfaction of smoking for me. Neither patches nor gum nor snuff is a complete substitute, because there is no feeling of breathing in smoke.

I would never switch to smokeless tobacco, because it disgusts me even more than the smell of stale cigarette smoke. Gum or patches, perhaps, but when I have quit in the past (and been successful for four years straight), it's been without nicotine replacement therapy.

I plan to quit again come the New Year (lame, I suppose, but better then than never), and I don't think smokeless tobacco will be part of my strategy.
posted by owhydididoit at 5:06 PM on October 12, 2006

While there's undoubtedly an incentive for tobacco companies to promote alternative consumption methods to inhalation, there's also an incentive for pharmaceutical companies to promote their nicotine replacement products as the only alternative, assisted by access to television advertising. (Have you seen how much a box of Commit lozenges costs? Fifty-eight dollars. And they instruct you to go through two boxes a month. I'd like to know the markup on that.)
posted by holgate at 8:35 PM on October 12, 2006