I read with interest the open letter from Dr. Brad Rodu to Sen. Obama in the June 22 Perspective section ("Quitting ins't that easy"). In this open letter, Dr.Rodu advocated the use of smokeless and spit tobacco (which I will refer to only as spit tobacco) to reduce the cravings of nicotine addiction and reduce the harm from cigarettes. He minimized the risk from spit tobacco in his comments.
As a physician who has spent my professional career helping those with nicotine addiction, I would like to offer an alternative view. Using spit tobacco for smoking cessation is an area of controversy among anti-tobacco advocates. Many of us who have cared for patients with their tongues or half their jaws removed because of spit tobacco would not advocate its use. Moreover, UST, Philip Morris, RJ Reynolds and other producers of spit and smokeless tobacco are marketing flavored packets designed to attract and addict young people. And many spit tobacco products deliver more nicotine than cigarettes.
While I support using a variety of techniques for smoking cessation for my patients, I would suggest that a safer method than spit tobacco is using approved nicotine replacement such as patches, gum and lozenges. In fact, the most recent update of the CDC Guidelines for Smoking Cessation doesn't recommend use of spit tobacco but does recommend the use of combinations of nicotine replacements, such as patches plus gum, finding that the results were as good as using other pharmacologic therapy. And the cost is comparable to using spit tobacco. Moreover, all smokers have access to the national quit line (1-800-QUITNOW) and many states provide nicotine replacement therapy for those who can't afford it or whose insurance doesn't cover it.
I would urge all smokers trying to quit to use a proven approach which is safer than spit tobacco.