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Smokeless tobacco use carries serious health risks, but it's not as dangerous as smoking, and some people have used it to help them quit cigarettes. That leaves some health experts torn between the desire to see people stop smoking and advocating an alternative that still may be deadly.

The Wall Street Journal reported Sept. 16 that smokers like Kentucky resident Pam Harlan have successfully used smokeless tobacco as an alternative to smoking after years of fruitless attempt to quit smoking. Harlan uses about 15 dissolvable tobacco pellets a day, each of which contains about as much nicotine as a cigarette.

The National Cancer Institute (NCI) has estimated that certain types of smokeless tobacco are about 90 percent less risky to use than cigarettes, and said that offering low-nitrosamine smokeless tobacco as an alternative to smoking would likely increase smokeless use but cut smoking. "This reduction would likely yield substantial health benefits," the NCI report said

Many smokers in Sweden have turned to a powdered version of tobacco called snus to quit using cigarettes. But health experts are unsure whether publicizing such information would lead more smokers to quit or just create more smokeless-tobacco users. Complicating the dilemma is that major U.S. cigarette companies are now moving into the smokeless-tobacco market, which raises suspicions among health advocates -- as does the fact that much of the research on the relative health impact of smokeless tobacco has been funded by the tobacco industry.

"Smokers have a right to be informed of significant harm-reduction options," argued Lynn T. Kozlowski, chairman of behavioral health at State University of New York at Buffalo, in a published commentary. But David Sampson, a spokesman for the American Cancer Society, said, "Smokeless tobacco products are neither a safe substitute for smoking nor an effective method of quitting smoking."

Most smokeless tobacco products sold in the U.S. still have high levels of nitrosamines, the chemicals believed to cause cancer. Low-nitrosamine products like the snus used in Sweden can only be bought online and in a few specialty stores.

Tobacco companies avoid touting any health benefits of smokeless tobacco use, partly out of fear that it could trigger regulation by the Food and Drug Administration (FDA). On the other hand, smokeless-tobacco maker Swedish Match said it would welcome clinical research into the smokeless-versus-cigarettes question, while a spokesperson for U.S. Smokeless Tobacco (UST) said, "We would not oppose [FDA] regulation if it would take into account the differences between smokeless tobacco and cigarettes, including risk."

Congress in 1986 required health warning labels to be placed on smokeless-tobacco packages; about 90 percent of smokers believe that smokeless products are just as likely to cause cancer as smoking.

While that's a misconception, the dangers of smokeless tobacco are serious, including cancer and cardiovascular disease. As one expert put it: "Using smokeless tobacco is dumb. Using cigarettes is dumber."