It's not quite like snuff, not quite like smokeless tobacco and quite different from cigarettes. It's called snus, a pulverized moist form of tobacco containing nicotine that is held under the upper lip. The primary advantage over more common smokeless tobacco forms is that less saliva is generated and thus less need to spit.

Proponents of snus are pushing for a lift on the restrictions and warnings that are generally required for tobacco products. They are also requesting classification as a modified tobacco risk product. The Federal Drug Administration's (FDA) eight-member Tobacco Products Scientific Advisory Committee held hearings on the products last week.

The committee hearing was opened by the director of the FDA's Center for Tobacco Products, Mitch Zeller, J.D. He commented that companies were previously free to decide how to advertise tobacco products, but "now it's the FDA who serves as the regulatory gatekeeper, standing between consumers and the companies seeking to make claims about their products."

"Applicants must not only demonstrate that the products, as actually used by consumers, will significantly reduce risks to individual users of those products," Zeller said, "they must demonstrate that they will benefit the population as a whole — taking into account both users and non-users of tobacco products."

Among those testifying to decrease restrictions was Swedish Match North America, Inc., a company involved in the manufacture and distribution of snus products. One of the arguments the company presents is the data on tobacco-related deaths in Sweden.

Swedish Match reports that although Sweden's tobacco consumption is similar to that of other European countries, they have the lowest rate of death attributed to tobacco. The the company considers the higher use of snus products to be a factor.

However, research has shown that long-term use of any form of tobacco poses a risk of cancer. The risk for oral cancers are in the tobacco itself, absent any additives. Smokeless tobacco has been demonstrated to contain more than 25 cancer-related compounds, and no tobacco product can be considered safe for humans.

Snus manufactured in the United States differs from that produced in Sweden. There are additives in the product giving it flavors such as menthol or cherry.

Swedish Match was asking the FDA for changes in the current labeling from, "This product is not a safe alternative to cigarettes," to a less harsh one, "Warning: No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes."

The company was also proposing that warnings about oral cancers, tooth loss and gum disease be eliminated. The entire FDA advisory committee determined that the changing of the labeling could not rely on the company's statements alone. There was concern about the focus only on those diseases related to inhalation smoking.

Thomas E. Eissenberg, Ph.D., Co-Director of the Center for the Study of Tobacco Products, felt that the overall information was not sufficient with the narrow focus on smoking.

"We are demanded to look at the wider range of health risks, and not just those attributable to cigarettes," Eissenberg said.

The committee was not as decisive in their judgement of whether there is a lesser risk to health with the snus products and cast a 4-4 decision. The conclusion? Although smoking may result in more diseases — lung cancer, chronic respiratory disease, COPD, etc. — the data shows that snus is still associated with other diseases such as oral, esophageal, stomach, pancreatic, vascular diseases and stroke.

No one seems to be denying that snus — like all tobacco-related products — is detrimental to overall health. The question now becomes one of how strong a warning is the public entitled to receive.