"Tobacco" is not a synonym for "smoking"
Smoking, not tobacco use, is what causes those 440,000 fatalities. The NEJM should insist on scientific accuracy, even in opinion pieces. Decades of research shows that smokers who switch to smokeless tobacco products have no higher rates of heart attacks, strokes, or any type of cancer than former smokers who gave up all tobacco use.
This research was presented to the FDA as evidence that long-term use of nicotine replacement therapy products would be low in risk. The same research shows that the most effective way to end smoking is to substitute a low-risk alternative source of nicotine for smoking. In the 2000 National Health Interview Survey, pharmaceutical products were successfully used to quit by 0-35% of smokers, while switching to a smokeless tobacco product had a 73% success rate. (Rodu B, Phillips CV. Harm Reduction Journal 5:18, 2008)
Measurement of exhaled carbon monoxide is a definitive test for smoking. Denying employment based on nicotine testing unfairly discriminates against former smokers who switched to a low-risk alternative. It also sends a message to smokers, "You might as well smoke, because we insist on treating you as if you are still a smoker."