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Getting tough on snuff.

"A lot of parents are not anymore well-informed than I was."

Betty Ann Marsee's voice was low and even while discussing a subject that has become dominant in her life. She is familiar with death in many forms. A registered nurse at the Valley View Hospital in Ada, Oklahoma, she knows about death personally as well as professionally. Her husband, Condly Marsee, died in 1982--but it was the death of her 19-year-old son, Marvin Sean, February 25, 1984, that led Mrs. Marsee to undertake a crusade which has already gained international notice.

Sean was a bright, handsome teenager, a track star named the outstanding athlete of his high school in Talihina, Oklahoma, in 1983. By the time he died, he had become a grotesque figure who scarcely appeared human. Cancer had destroyed his tongue, his throat and his jaw.

Dr. Carl Hook, who tried vainly to save Sean's life, attributed the cancer to the young man's use of snuff. This form of tobacco, used orally or by inhalation, has been around since the 17th century. Commonly used in the 18th century, snuff (and later chewing or plug tobacco) was the dominant form of tobacco in use in the United States until the 1860s, when pipe tobacco became more popular, only to be surpassed eventually by cigars and then cigarettes. By 1938, cigarettes accounted for half of U.S. tobacco consumption and continued to outstrip other forms of tobacco use.

But in rural America, snuff dipping and tobacco chewing continued, in part because of the danger of fire from cigarettes. And advertising by the tobacco industry has put a new emphasis on so-called "smokeless tobacco" since the federal government began requiring health warnings on cigarettes. Such requirements are not in effect for smokeless tobacco. The moist type of snuff Sean began using when he was 12 is placed in the mouth between the gums and the cheek. His mother said his brands were "Copenhagen" and "Skoal," which carry no health warnings.

"Several months before Sean died, when he thought he would still live, he expressed the hope that he could travel around Oklahoma with Dr. Hook. He wanted to tell young people they should not use snuff and it definitely was bad," Mrs. Marsee said.

"A lot of parents are not any more well-informed than I was. While I had a gut feeling that if cigarettes were dangerous, then snuff lying next to a membrane would be dangerous, I had no definite proof that I could give him," he said. "Teen-agers want proof. I had no absolute proof."

But elsewhere, such proof had been accumulating. In a 1979 study by Arden G Christen, D.D.S., 9 of 14 college athletes who chewed tobacco regularly had a noticeable leukoplakia, a white patch in the mouth often located where the tobacco touches the gum. Many doctors believe this is a pre-cancer condition. Overwhelming evidence of the health problems caused by snuff can also be found in India, where tobacco chewing is a widespread habit. Thirty to 40 percent of the population of India chews tobacco, and 35 to 40 percent of all cancer is diagnosed as oral cancer.

In a study of 10,000 people in India, 33 percent reported having used tobacco in some form. When the frequency of leukoplakia was calculated for those who smoked and chewed tobacco versus those who used no form of tobacco, the difference was striking. Leukoplakia was observed in 9.9 percent of those using tobacco and in 0.03 percent of those not using it. Another study of the incidence of oral cancer among 57,518 industrial workers in India found not one case of oral cancer in those who used no tobacco; for the entire group, the rate of oral cancer was 25 out of 100,000 per year.

After Sean's death, Mrs. Marsee kept thinking about the crusade her son had wanted to wage. She began looking for an attorney willing to be a David in filing a lawsuit against the tobacco-industry Goliath. She found that attorney in Dania Deschamps-Braly.

"I am as capitalist as you can get," Mrs. Deschamps-Braly says. "But sometimes someone sits down and tells you something that sounds so bad, you know there has to be something wrong. I would not have taken the case if I didn't think it had merits."

So the lawsuit to continue Sean's crusade was filed in the Oklahoma Federal Court, Western District, against the U.S. Tobacco Company, the manufacturer of the snuff Sean had used. The $37 million product-liability suit charges the company with selling a "defective and unreasonably dangerous" product. Judge David L. Russell has set the case for trial on his November 1985 docket.

The lawsuit has already attracted news-media interest. Business Week called attention to the case 13 days after it was filed. The Saturday Evening Post carried information about the lawsuit in its July/August 1985 issue. Mrs. Marsee has appeared on network TV programs, including "60 Minutes" and "Hour Magazine," and numerous other radio and TV programs.

"The main purpose of our lawsuit is to acquaint children with the dangers of snuff," Mrs. Marsee said. "I'd like to see a requirements for a health warning on snuff and a ban against advertising by sports personalities. I want to give the children proof that it is not good for them and let them make up their own minds. Let them be informed."

(A similar thought was expressed by Surgeon General C. Everett Koop during a recent interview: "In some cities in this country, as many as 20 percent of high-school students are chewing some form of smokeless tobacco. We know that nationwide, the sales of moist snuff are mounting very rapidly. This is not covered by the same advertising ban that cigarettes are covered by."

Koop said he is concerned because advertisements for smokeless tobacco appeal to young people and use role models they admire. "I'm particularly concerned that the advertisements imply a health benefit when they say "instead of a puff, reach for a chew,'" he said.)

Indeed, smokeless tobacco is heavily advertised, and the advertisements are directed toward youth. Sports idols such as Terry Bradshaw, George Brett, Sparky Lyle and Walt Garrison extol the virtues of smokeless tobacco in tobacco-company advertisements. Red Man tobacco calls itself "Pick of the Pros," and the company has even developed an entire line of promotional accessories--patches, caps and shirts bearing the Red Man tobacco logo.

At colleges nationwide, tobacco companies hand out or mail free samples to young people to "help get you started." And in an advertisement titled "Walt Garrison answers your questions about moist smokeless tobacco," Garrison explains to the novice: "Just take a small pinch in your thumb and forefinger and put it between your cheek and gum. Leave it there. No need to chew. The tobacco slowly releases its great flavor, giving you real satisfaction. . . . At first you could feel a slight irritation on the gum, and the tobacco may move around your mouth more than it should. . . . But learning is part of the fun, and these things take practice. Two weeks should make you a pro."

Sean was one of many high-school and even elementary-school youths who use "smokeless tobacco." In the Texas college-athlete study, 6 of the 14 subjects began the habit while in high school, and 3 started in elementary school. Twelve of the 14 admitted that peer pressure was the most important factor in getting them started. A football player said that his high school had an official "High-School Snuff-Dipping Team," and another said that in his hometown a worn, bleached ring outline, the size and shape of a snuff can, on the back pocket of jeans is regarded as a symbol of maturity.

Mrs. Marsee said that in her home cigarettes had been an accepted part of relaxation. "I smoked a pack a week, but when Sean asked me to stop, I did," she recalled of that period when his oral cancer was diagnosed. "Tobacco is an addition, and I found it difficult to stop. But I did."

She believes Sean's death has already made some young people stop and think about the use of smokeless tobacco. "We have had some children who told me they quit, and quite a few letters," she said. But the biggest victory yet has come with the help of the Oklahoma legislature, which has enacted a law that includes snuff with other tobacco products that cannot be sold to a minor. "This legislation is directly because of the Sean Marsee case," said Mrs. Deschamps-Braly.

The bill, championed by Sen. Billie Floyd, will become effective on November 1, 1985. "I am honored to be able to carry this bill, because I think it will help to make the public aware of the dangers of smokeless tobacco," said Senator Floyd.

"I have taught health and physical education at the university [East Central University in Ada, Oklahoma] and have been opposed all along to the use of tobacco products," she continued. "I have been concerned, even before the Sean Marsee case was publicized, about the use of smokeless tobacco by athletes. In our part of the country, smokeless tobacco is commonly used. Why, now tobacco companies are including little prepackaged pinches of snuff called 'bandits' in the large cans. Stores sell them separately, and grade-school kids are coming home with packets of snuff that they've bought at mom-and-pop groceries during lunch. This bill will eliminate the purchase of snuff by grade-school children, and I think that as we discover more and more harmful results from using smokeless tobacco, people will be educated and stop using it."

Mrs. Deschamps-Braly has "gone international" to locate experts who have agreed to testify about the devastating effects of smokeless tobacco.

A partial list includes:

--Dr. Lester Breslow, an epidemiologist and public-health specialist, Division of Cancer Control, Johnsson Comprehensive Cancer Center, UCLA.

--Dr. William Lijinsky, a biochemist with the Frederick Cancer Research Facility, Frederick Cancer Research Facility, Frederick, Maryland.

--Dr. Prakash Gupta, Tata Institute of Fundamental Research, Bombay, India.

--Dr. Kent Westbrook, a head and neck surgeon, University of Arkansas.

--Dr. William Thurman, the head of the Oklahoma Medical Research Foundation and a pediatric oncologist.

--Dr. Jan-Michael Hirsch, the head of oral surgery, University of Goteborg, Sweden.

Dr. Hook, as the treating physician, is also expected to be one of the expert witnesses.

Meanwhile, the plaintiffs have been puzzled by an incident that involved an apparent public-opinion survey. An Ada resident staying at the home of her Oklahoma City relatives answered their telephone. The caller, who announced he was taking a survey, questioned her about who should be held responsible when teenagers use alcohol, salt, sugar, butter, shortening or saffron with damaging results to health.

Then the caller asked whether she thought that tobacco companies should be regarded as responsible if an 11-year-old boy started using snuff. When the Ada resident disclosed her personal knowledge of the Marsee case, the questioner said he thought he was calling Oklahoma City, not Ada, and hung up.

Betty Marsee is making sure that Sean's memory is kept alive--for in the memory of his tragic death, there is hope that other children may be saved from the life-threatening dangers of snuff.

Concerned readers can receive a copy of the Oklahoma bill making it illegal to sell smokeless tobacco to minors and a copy of our "Snuff Out Snuff" poster for posting in school locker rooms and other areas frequented by young boys. Other items available on the dangers of smokeless tobacco are reprints of an earlier Saturday Evening Post article and a television script from the Christian Broadcasting Network's "LifeCare Digest" program. If you would like to receive any of these materials, send a tax-deductible donation of any amount to "Snuff Out Snuff," Children's Better Health Institute, Box 567, Indianapolis, Indiana 46206.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1985 Gale, Cengage Learning. All rights reserved.

Article Details
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Title Annotation:tobacco and oral cancer
Author:Myers, Hortense
Publication:Saturday Evening Post
Article Type:Interview
Date:Sep 1, 1985
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Next Article:Binding up the wounds.

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