While many American tobacco researchers and policy experts have, of late, moved to endorse reasonable regulation of e-cigarettes and vaping, most persist in condemning smokeless tobacco products, which have been proven to be nearly harmless. It is irrational to support one and prohibit the other, when both are legitimate harm-reduction options for smokers.

The illogic of this dual position is displayed in the work of Dr. Dorothy Hatsukami, a prestigious tobacco researcher, author of 250 published articles and recipient of tens of millions of dollars in National Institutes of Health funding (including $13 million to study reducing nicotine in cigarettes). Hatsukami recently signed a letter to Food and Drug Administration Commissioner Scott Gottlieb and published an article in Tobacco Control.

In the letter to the commissioner, Dr. Hatsukami applauded his “openness to the concept of tobacco harm reduction.”

There is already a considerable body of science and experience suggesting that a harm reduction approach…could yield substantial and highly cost-effective public health benefits…at this time we do not believe that the current regulatory framework for the low-risk nicotine products such as e-cigarettes and smokeless tobacco is appropriate or will deliver the substantial public health benefits we hope and expect FDA’s oversight will bring.

The letter encouraged the FDA to regulate tobacco products according to risk and to “support informed choice through truthful communication of risk.”

However, in her Tobacco Control commentary, Hatsukami took a contrary view, fully endorsing the FDA’s proposed standard for N-nitrosonornicotine (NNN), which I have eviscerated here and here. She wrote: “If [FDA] puts the proposed rule into effect, it would be a significant and important step towards minimizing the harms from smokeless tobacco use.” Surprisingly, she asserted that “the risk for oral cancer is considerably higher for smokeless tobacco users,” and cited a federal study documenting that American men who dip or chew tobacco have no mouth cancer risk.

Notably, other signatories to the Gottlieb letter are genuine tobacco harm reduction advocates who have endorsed the substitution of smoke-free tobacco by smokers. They include Clive Bates of the United Kingdom and Canada’s David Sweanor, who filed a comment labeling the NNN rule “reckless and pointless.” American signatories who are on record about the relative safety of smokeless are Sally Satel (here and here), Kenneth Warner (here and here), David B. Abrams (here) and Raymond S. Niaura (here).

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