I hope I'm not the only one whose eyebrows go up when we call a 12% daily smoking + daily snuff use rate a "rare" event.   As you know, in contrast, the pharmaceutical industry touts a 7% six-month OTC NRT quit smoking rate as being "effective."  

If I'm reading these numbers correctly, 36% of Swedish snuff users smoke, we're looking at a national male daily tobacco use rate of 28%, and for some as yet unexplained reason this proposed harm reduction remedy appears to discriminate against saving the lives of Swedish women (a 3% use rate). 

Are these really the statistics we'd wish upon the world?  I'm curious, do we know if the 36% who both smoked and used oral tobacco were included in the health risk assessment?  It seems a bit curious that we'd have 12% daily smokers + daily snuff users and no mention of lung cancer.  Dual delivery health risks would appear to be a natural consequence of snuff as a harm reduction measure and if snus is to be awarded credit for lower risks then shouldn't it likewise be discounted by those who continue to smoke while using it.

I've yet to meet anyone within tobacco control who isn't out to save lives.  It appears to be our common bond.  I battled my entire life to break free and after a dozen serious failed attempts (four of them NRT) I simply gave up and surrendered.  I'd like to be wrong but after having done smoke for so long I simply can't imagine that any of you would have been able to have convinced me to accept cleaner delivery while I still had a dream of quitting.  It would have taken teasing with some pretty sweet chemical candy.  

But maybe after I'd bottomed out and surrendered my dream of ever breaking free.  Maybe then a harm reduction message could have had an impact.  But I hope you each appreciate that that's when the real magic often happens.  

It was then that I began to drop my denial guard built of years of outright lies, minimizations, rationalizations and a small mountain of blame transference.  I no longer needed a wall to hide behind because it was then that I fully accepted the fact that I would die still hooked.  Then at three-packs-a-day, probably sooner than later.

It was strangely comforting to know I'd never attempt quitting again.  I no longer needed to hide, change channels when smoking was mentioned, or tune out during conversations that turned to my smoking. I now fully accepted who I was.  It only took a couple of months of living on the bottom before slowly opening eyes  began to learn just how serious things really were.  

I still don't know what made me do it but I typed "quit smoking" in a search engine and immediately discovered an entire world of online support and cessation information that my denial would never have permitted me to see.  That was May 13, 1999 and two days later I was an ex-smoker who has never taken another puff.

If tobacco control did have an excellent harm reduction campaign, how many would it cause to reach for cleaner nicotine delivery instead of cessation after bottoming out?  I simply cannot imagine having been denied these six years and the amazing sense of prolonged mental quiet and calm that arrived within 90 days of ending what was once an endless nicotine/dopamine/adrenaline roller-coaster ride. 

Smoking risks of dying aside, I do wish more of you would place greater weight and stock in a human being spending their entire life chasing nicotine's two-hour chemical half-life.   It's hard work and today it deprives almost a billion of knowing their real neuro-chemical self.   

Imagine being in the back yard stealing an unearned dopamine aaahhh reward sensation within five minutes of your mother's death.  Imagine nicotine induced adrenaline releases never again allowing you to know long extended periods of mental quiet and calm.  Imagine spending the balance of your life adding the onset of early chemical withdrawal from the alkaloid nicotine atop every stressful acid producing event like throws your way. 

I know each of you mean well but in my mind’s risk-benefit analysis your theory keeps producing vastly more harm than good.  I promise to keep an open mind but after seeing two decades of pharmaceutical industry marketing declare studies it knew were not blind to be blind, I'm going to be a pretty hard sell.  

Regards,

John 

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