We are afraid the Tobacco Harm Reduction problem (in relation to smokeless products of the Swedish SNUS type) is not soundly posed: either by its opponents or proponents, because they seem to ignore the existence of two great continents.

As stressed in a previous comment on another paper of this journal [1], tobacco harm reduction (Snus, Eclipse cigarette, E-cigarettes, etc.) is very important [2].

Smokeless tobacco is so ancient and widespread in Asia and Africa that replacing it, not with nicotine "replacement" gadgets (expensive and inefficient) but, with cheap Snus -or just cleaner forms of the existing local products (often poorly prepared)- would save millions of lives right now. This is why we enthusiastically suggested its promotion, not only for American, Oceanian or European users but, above all, for Asians and Africans [3].

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[1] Comment (25 Feb 2010): "Medicalisation of Tobacco Isssues and Tobacco Harm Reduction"
http://www.plosmedicine.o...

[2] Chaouachi K. Harm Reduction Techniques for Hookah (shisha, narghile, “water pipe”) Smoking of Tobacco Based Products. Med Hypotheses 2009 Oct;73(4):623-4.
http://dx.doi.org/10.1016...

[3] Sajid KM, Chaouachi K, Mahmood R. Hookah smoking and cancer. Carcinoembryonic Antigen (CEA) levels in exclusive/ever hookah smokers. Harm Reduct J 2008 24 May;5(19). doi:10.1186/1477-7517-5-19
http://www.harmreductionj...