Although the new study by Boffetta et al found that smokeless tobacco users had a slightly increased risk of fatal MI (RR 1.13) and stroke (RR 1.4) compared to never tobacco users, it found no increased risk for nonfatal MI or stroke among smokeless users (a key confounder that the authors failed to acknowledge in the abstract). More importantly, the study found that the risk of fatal MI and stroke attributable to smokeless tobacco use is far far less than the risk of fatal MI and stroke attributable to cigarette smoking, a key fact that the authors failed to acknowledge anywhere in their article. Combining this study's findings with previously published research on oral and pancreatic cancer risks, the overall risk of premature death among smokeless tobacco users is about 5% of the premature death risk of smoking cigarettes. In other works, cigarette smoking is 20 times deadlier than smokeless tobacco use, and the several million cigarette smokers (in the US and Sweden) who switched from cigarettes to smokeless tobacco have reduced their mortality risks almost as much as smokers who quit all tobacco/nicotine. Any use of nicotine (in smokeless tobacco, cigarettes, gums, lozenges, skin patches and e-cigarettes) increases blood pressure and heart rate (similar to caffeine use), and may explain the findings in this study (as never tobacco users in the controls also don't use nicotine).

I posted a very important scientific and public health comment about this new study around 10AM eastern time today, but it still hasn't appeared on this website as of 1:50PM, long after the vast majority of Join Together subscribers have read the article (without seeing the comment) and have moved on to other activities (thus rendering my comment a waste of my time and energy). Perhaps Join Together staff can explain why they post a misleading article, and then censor objective and polite comments clarifying key scientific and policy information about the issue. If this practice continues, nobody will waste their time to post thoughtful comments, and this website will become irrelevant.

1. I think Bill has a good point, the editors seem to have lit up a bigger fatty than they can smoke. If just one editor is in charge of reading and evaluating all the comments, critics may cry "too narrow", but how many staff members can be tied down to this one guardpost? 2. To the substance: not impugning the study authors or JT, there seems to be a built-in hesitation to "run the numbers" about alternatives to the beloved cigarette. The FDA has a similar mental catch-22 over the e-cigarette-- "not proven safe!" meanwhile not one e-cigarette fatality has hit the headlines since invention (1996) while 50,000,000 died of hot burning overdoses. 3. Research suggestion: let's spend some of that 1998 $208-bil. Settlement money giving every nicotine addict who signs up an e-cigarette with cartridges AND a few tins of Snus, and see what happens to the mortality statistics.