Sweden flipping things and killing people again: “Experts omitted studies showing that snus is dangerous”. Did we now?

Dear all,

Please find a very respectable looking article this morning. Rife in ad-homing some of the best people we have in our field and generally touting obviously coached narratives, in one of Sweden’s most respectable newspapers this morning. It is a bit of a read but at the bottom you will also find my reply to the article translated. Word document of translated article and my reply translated: Translation SvD October 10 2018

By Lovis Kojo, Vendela Wikström Today October 10, in Svenska Dagbladet 06.00 (updated) original article below

https://www.svd.se/experter-valde-bort-studier-som-visar-att-snus-ar-farligt

Experts omitted studies showing that snus is dangerous

Swedish tobacco policy is based on false information about snus, the manufacturers mean. To spread the true image, they started the Snus Commission. But SvD’s review shows that several studies selected by the Commission contain shortcomings. Others have been completely omitted.

– There is no disease burden associated with snus. End of story, says the Snus Commission’s chairman Anders Milton, former chairman of the Swedish Medical Association.

Chief physician Gunilla Bolinder criticizes the Snus Commission. “It sounds like it’s a health organization and that it’s the government that has set it up. But the Snus Commission is the snus industry top to bottom, “she says.

Chief physician Gunilla Bolinder criticizes the Snus Commission. “It sounds like it’s a health organization that it’s the government that has set it up. But the Snus Commission is the snus industry top to bottom, “she says. Photo: Allis Nettréus, Isabell Höjman / TT

Just over two years ago, the then Public Health Minister Gabriel Wikström received a letter with sharp criticism against the work on the new tobacco law. The bill meant stricter regulation of tobacco, including Swedish snus. The letter to the minister stated that the investigation was based on false perceptions of snus and that the proposed measures would adversely affect public health. The government was invited to address the factual evidence attached: a report entitled “The health effects of snus”.

The sender was the Snus Commission. The Snus Commission released its first report just over two months after the proposal for a new law was published. When the Snus Commission was formed, Anders Milton, former chairman and CEO of the Swedish Medical Association, was contacted by the PR agency JKL. This agency has previously had the world-leading tobacco company Philip Morris as a client.

“The snus manufacturers wanted to make the discussion about snus more evidence-based, and JKL asked if I could lead a group for achieving that. I replied that I can do that if they do not preview or influence what we write or who I choose to work with, says Milton.

The Snus Commission also has three more members, including tobacco researcher Karl-Olov Fagerström.

That tobacco industry recruits doctors and researchers is nothing new. When the health effects of smoking became known in the 1950s, Philip Morris employed researchers who were tasked with creating uncertainty about the harmfulness of smoking.

The Snus Commission produces its own reports, but that it is financed by Snustillverkarföreningen, which represents the snus companies, Milton doesn’t see as a barrier (COI) to the fact that he, as a physician, can present factual reports on behalf of it.

– They do not see what we write until the reports are published. So that they would have affected us is completely ruled out. The state also finances the National Board of Health and Welfare through the Public Health Agency, which works against tobacco, he says.

Gunilla Bolinderis a senior doctor who has been praised by the World Health Organization, WHO, for her work against snus. Her research shows several possible health risks with snus consumption. She warns against the image of the snus as a harmless product. That Milton as a high-profile doctor spreads that image worries her.

“That he suddenly stands up as an expert for the Snus Commission, even to the extent of being a chairman, surprises me greatly,” she says.

Bolinder also believes that the name “Snus Commission” is misleading.

“It sounds like it’s a health organization that it’s the government that has ordered it. But the Snus Commission is the snus industry straight up and down.

The Snus Commission’s report “The Betrayal of The Smokers” says that snus is the most effective way to quit smoking. The conclusion is motivated by a survey conducted by the Commission using Ipsos research, where in principle all former smokers who used snus to abandon the cigarettes state that they are still smokeless, but snusers, after five years. But snus is no smoking cessation product, but a transition to another just as serious nicotine addiction, Bolinder claims.

“We do not believe that we are saving Europe as a whole by giving the smokers snus instead of cigarettes. This way of trying to introduce an industry that you still know has unhealthy effects, we in the medical professions don’t think is very attractive.”

At the same time that research has shown that snus use during pregnancy affects the heart rate of the fetus and brain development, and can cause premature birth and induce preeclampsia, the snus industry is investing in more women to start using snus. The Snus Commission advises against snus use while pregnant, but at the same time, it claims that the proportion of women who smoke would decrease if more of them perceived snus as less dangerous.

“It may be very hard for a pregnant mom to stop using snus. She will become batshit crazy from abstinence if she is very nicotine addicted. Then you have a hellish experience in front of yourself when you feel very guilty for using snus” says Bolinder.

In the report “The Health Effects of Snus”, the Commission writes that it reviewed all relevant research on snus from the last 25 years. When we ask Milton about why some studies have been left out, he states there were no more relevant ones. A study may have shortcomings in methodology and design, or the researcher has made incorrect conclusions, he explains.

But when we examine the studies chosen by the Commission, many of them are criticized by other tobacco researchers for containing the above shortcomings, or cite other research that does. One of those studies was made by Lars Ramström, an experienced tobacco researcher who titles himself as a doctor – despite not having a doctorate. (PhD / MD confusion here) NOTE for correction, SvD corrected the text later on the publication date to include the following passage also: When we contact Ramström to ask about the name of his doctoral thesis, we were informed that there is no doctoral thesis as such, he was awarded the doctorate for his work for the WHO in the 1970’s.

Many of the studies that the Commission uses are also either sponsored by the snus industry or referring to studies that are. One researcher cited has performed studies when an employee of Swedish Match. – There is hardly any research available Swedish snus in this area. So you have to look at what’s available, and if what is written is reasonable or not, “says Anders Milton.

We find that a study by two Swedish tobacco researchers such as Milton refers to when he writes that snus does not cause cancer in the mouth and throat, afterwards, have later been reviewed in Tobacco Control, an international journal that examines the consequences of tobacco use.

Scott Tomar, who conducted the review, is a senior dentist, doctor and researcher in Florida focusing on tobacco and oral health. He discovered that the researchers to the study had erroneous conclusions from the data. While the results showed a significantly increased risk of oral cavity for people who use snus – the researchers concluded the opposite.

“What incentives can researchers have to reduce the discovery that smokers who never smoked were almost five times more likely than non-users to develop head and neck cancer, exclude that from the abstract and use a very confusing analysis to dispel a relationship?” “ Is it possible for research funding from the Swedish tobacco industry could play a role?” “Shortly after the publication of this report, the scientist became spokesman and researcher for Swedish Match.” “Maybe it’s a coincidence?” says Scott Tomar.

Another study by the Swedish oral and maxillofacial surgeon Jan Hirsch shows 16 cases where elderly men who used snus for many years suffered from cancer under the lip. this is not included in the Commission’s report. According to Milton, this is because it was not included in the medical journal The Lancet’s summary of research on snus, the one used by the Commission.

“There is no disease burden associated with snus. End of story. This is certain. You may think that’s too bad, but it is what it is.”

In February 2017, a report covering five studies with 54,500 snus users received a great deal of media attention. It showed that the risk of type 2 diabetes increases by 40 percent if you use five cans per week and 70 percent if one can per day.

On its website, the Commission comments on the report. The commission comments that the authors of the studies did not find any connection between snus and diabetes in their previous research. The Commission also highlights that high BMI adds a significantly greater risk for diabetes, than heavy snus use. The conclusion of the research – that using a can of snus per day could equal the risk increase for type 2 diabetes as smoking a pack of cigarettes per day, is not mentioned by the Commission.

The Commission’s reports are extensively used in the snus industry’s public perception work, and have all been sent to athe members of Parliament. The reports have been highlighted in media, and Milton has also talked about the Commission’s work to the Norwegian Parliament.

The goal is obvious, he means; “The public must be informed that snus is not dangerous.”

“The only thing we say is this: say it like it is. If the Swedish authorities had been truthful, then there would never have been any reason to give me this assignment. It’s that simple,” says Milton.

The new tobacco law was scheduled to be processed after the election. (Nope, it was scheduled for before summer recess but EU went apeshit as the snus parts were too soft – translator’s comment)

Members of the Snus Commission:

 Anders Milton, Chairman of the Snuskommission. Formerly Chairman and then CEO of the Swedish Medical Association. Has also served as Chairman of SACO and in the Swedish Red Cross

Christina Bellander, journalist, former EVP for MTG AB and responsible for business development on TV4. Board member of, among others, New Wave Group AB, Mittmedia AB, Knowledge Sweden Education Sweden AB and Sveriges Utbildningsradio AB.

Karl-olof fagerström, lecturer and researcher about tobacco and nicotine. He has also founded a company that sells smoking cessation products, and he joined Nicorette. 

Göran Johnsson, former chairman of IF Metall, former member of the Social Democrats Executive Committee, former member of Volvo Group Executive Board and former chairman of SVT.

 

My reply this morning to the authors of the article

 

Good morning!

Oh boy, I was surprised at reading this article on the subway home from leaving child at school. Oh boy! Oh boy! Oh boy!

I even read the title wrong first. I read the title as it probably should be:

Experts omitted studies that show that snus is not dangerous

(Bolinder, Giljam, Galanti, Larzon, Glantz, Chaloupka, Gupta, Sinha, Malone, Antoniewics – etc.).

Much of the Swedish research is derived from a giant health cohort that was made in 1971-1994, the so-called construction worker cohort. Foreign researchers have sued Karolinska to demand access to the raw data in order to reproduce studies and compare results. KI has refused, and Higher Administrative Court ultimately awarded a researcher the right to extract the material, but at the same time also awarded the Karolinska Institute the right to deliver the material in a format completely unusable for the purpose. This cohort is also often called “the revolving door cohort” because the (100% anti-harm reduction in tobacco) researchers that do get accesses the material includes or excludes parts of the cohort a little depending on what results they want to show.

I attach two scientific articles by Hirsch that might be interesting for you to check again. For example the one with 16 patients with cancer at the snus location, you might want to check with Hirsch how many years it took them to collect the 16 cases among Sweden’s approximately one million snus users? The article further states quite clearly that these are basically all cases throughout all of Sweden during the collection period.

Over time, the Swedish calculations is that smokers die (of smoking) a rate of about 1.2% per year. During the period 2010-2012 the figure from the Swedish National Board of Health and Welfare was 11,881 per year in Sweden’s approximately 1 million smokers (Registry data on the harmful effects of tobacco smoke, Socialstyrelsen, 2014).

Let’s pretend that all Hirsch cases were reported as new cases in just one year, then we decide that these are all from precisely just those people who used or began using snus around 1960 and were still alive in the early 2000’s – then that gives 16 cases of cancer caused by snus among the 375,000 snus users who used snus but did not smoke ca 1960.

This gives 16 / 375,000 = 0.0000426 which means0.0024%.

Thus, in this extreme worst case, 1 person gets a cancer in the mouth from snus for every 500 people who die of smoking. (per year)

Then lets add another site of cancer that cannot be attributed directly, but still given the same weight – then we have 2 who get cancer for every 500 who die of smoking. (also per year)

Then lets add also Diabetes with the same weight, and we’ve suddenly got 3 total among the snus users who get seriously ill from snus for every 500 who die of smoking. (per year again)

We mustn’t forget heart disease and cardiovascular death, lets put it at twice the weight as for the other diseases (nicotine !!), we then end up with 5 cases of very serious disease from snus for every 500 people who die of smoking. One in a hundred then. (also per year, again)

About 0.5% -2% risk from using snus compared with smoking is what Swedish and international researchers who are not ideologically controlled claim today and have claimed since 1973. That is as far back we can follow the track of discussing snus in terms of harm reduction in Sweden, as that is when we saw serious exodus among men from cigarettes to snus, 50-100 times less dangerous snus.

Please ask Gunilla Bolinder how many times less dangerous snus is compared to smoking – her best guess. If she answers that we do not know, because there is not enough research on that – then the relevant question could be: Why is that research missing?

My name is Atakan Befrits and I represent INNCO, a global association of civil society organizations that do not receive industrial money and, of course, have no chance of getting a cent from Public Health Agencies. We represent 30 million who quit smoking with “unauthorized methods” (like vaping and snus etc.) and also represent the right to accurate relative risk information for the around 1.4 billion in the world who still use the most dangerous ways of consuming tobacco and nicotine. We managed to gather 17 organizations in Geneva last week when the WHO and the Framework Convention held their global meeting on tobacco strategies (WHO FCTC COP8).

Our central function (INNCO Secretariat) was rejected as an observer to the meeting, despite having fought in many countries, including Sweden for 7 weeks, to ensure that civil society would not be excluded. The Swedish Ministry of Social Affairs answered me 4 minutes after close of business in the afternoon the day before the meeting (after 7 weeks) that they absolutely wanted civil society out.

We (INNCO) were available just outside the meeting venue on 9 occasions during the week but not a single employee or delegate dared / wanted to come and talk to us.

You name Milton and Ramström in rather ad-hom and derogatory terms (Ramström has also been given prize by the WHO for his tobacco work, did you know that?) – but no names about the researcher Scott Tomar refers to. Can you tell me who they would be?

Best regards

Atakan Befrits

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Brev till webbredaktionen på SvD idag om snus och snusforskning

God morgon!

 

Oj vad jag blev förvånad på tunnelbanan hem från att ha lämnat på skolan. Oj! Oj! Oj!

 

Jag läste till och med rubriken fel först. Jag läste rubriken som den nog egentligen borde vara:Experter valde bort studier som visar att snus inte är farligt

(Bolinder, Giljam, Galanti, Larzon, Glantz, Chaloupka, Gupta, Sinha, Malone, Antoniewics – mfl mfl).

 

Mycket av den svenska forskningen härrör sig ur en jättehälsoinsamling som gjordes 1971-1994, den sk. bygghälsokohorten. Utländska forskare har stämt Karolinska för att kräva tillgång till det grundläggande datamaterialet för att kunna reproducera studier och jämföra resultaten. Det har inte KI gått med på och Kammarrätten gav till slut forskaren rätt att få ut materialet men gav samtidigt KI rätten att göra materialet oanvändbart för syftet. Den här kohorten kallas ofta för ”the revolving door cohort” för att de (100% anti-skademinimering inom tobak) som får tillgång till materialet inkluderar eller exkluderar delar av kohorten lite beroende på vad man vill visa.

 

Jag sänder med två vetenskapliga artiklar av Hirsch som kanske är intressanta att kolla igen. Den med 16 patienter med cancer vid snusplaceringen, ni borde kanske kolla med Hirsch under hur många år de samlade in de 16 fallen bland Sveriges ca en miljon snusare? Artikeln anger dessutom ganska klart att det rör sig om i princip samtliga fall i hela Sverige under den insamlingsperioden.

 

Över tid är den svenska beräkningen att rökare dör (av rökningen) en takt av ca 1,2% om året. Under perioden 2010-2012 var siffran från Socialstyrelsen 11,881 om året av sveriges ca 1 miljon rökare (Registeruppgifter om tobaksrökningens skadeverkningar, Socialstyrelsen, 2014).

 

Om vi skojs skull skulle låtsas att alla Hirschs fall rapporterades in som nya fall under bara ett år, och så tar vi som bas (nämnare) att det just är de personerna som snusade ca 1960 och fortfarande var i livet – så ger det 16 fall av cancer orsakat av snus hos 375,000 snusare som snusade men inte rökte ca 1960.

 

16/375,000 = 0,0000426 vilket innebär 0,0024%.

 

I detta extrema (worst case) exempel får alltså 1 person cancer i munnen av snus för varje 500 personer som dör av rökning. (per år)

 

Om vi sen lägger på annan cancer som inte går att härleda direkt, men med samma vikt – så har vi 2 som får cancer för varje 500 som dör av rökning. (också per år)

 

Om vi sen lägger på Diabetes med samma vikt så har vi vips 3 som blir allvarligt sjuka av snus för varje 500 som dör av rökning. (per år igen)

 

Om vi sen lägger på Hjärtsjukdom och hjärtkärldöd med dubbelt så hög vikt (nikotinet!!) som för de andra sjukdomarna så är vi uppe i 5 fall av mycket allvarlig sjukdom av snus för varje 500 personer som dör av rökning. En på hundra alltså. (också per år, igen)

 

Ungefär 0,5%-2% risk av snus jämfört med rökning är vad svenska och internationella forskare som inte är ideologiskt styrda hävdar idag och har hävdat sedan 1973. Så långt tillbaka kan vi följa spåret i Sverige för då började svenska män byta farliga cigaretter mot 50-100 gånger mindre farligt snus.

 

Kolla med Gunilla hur många gånger mindre farligt snus är jämfört med rökning – hennes bästa gissning. Om hon svarar att det vet man inte, för det saknas forskning på det – så är väl en relevant fråga i så fall: Varför saknas den forskningen då?

 

Jag heter Atakan Befrits och representerar INNCO, en global sammanslutning av civilsamhälleorganisationer som inte tar emot industripengar och som självklart inte har en chans att få ett korvöre av Folkhälsomyndigheten. Vi representerar 30 miljoner som slutat röka med ”icke godkända metoder” och representerar även rätten till korrekt information om relativa risker för de ca 1.4 miljarder i världen som fortfarande använder de absolut farligaste sätten att bruka tobak och nikotin. Vi lyckades samla 17 organisationer i Geneve förra veckan när WHO och ramkonventionen hade sitt globala möte om tobaksstrategier (WHO FCTC COP8).

 

Vår centralfunktion blev inte insläppt som observatör till mötet, trots att vi legat på Sverige i 7 veckor för att säkerställa att civilsamhället inte skulle stängas ute. Socialdepartementet svarade mig 4 minuter över 5 på eftermiddagen dagen innan mötet (efter 7 veckor alltså) att de absolut ville ha något civilsamhälle där som skulle visa att det faktiskt handlar om människor.

 

Vi fanns tillgängliga precis utanför möteslokalerna vid 9 tillfällen under veckan men inte en enda anställd eller delegat vågade/ville komma och prata med oss.

 

Ni namnger Milton och Ramström i tämligen nedsättande ordalag (Ramström är också prisad av WHO för sitt tobaksarbete, visste ni det?) – men inga namn om den/de forskare som Scott Tomar hänvisar till. Kan ni tala om för mig vilka de skulle vara?

 

Visste ni förresten att en annan KI forskare – Seppo Wickholm – 2005 i tandläkartidningen beräknade total cancerincidens till 35 per miljon snusare och år. Alltså 1 fall av snus cancer (hela kroppen) per 337 dödsfall av rökning per år. Seppo blev raskt medicinsk direktör för Nicorette tuggummi o har mig veterligen varit det sedan dess……

 

Hör gärna av er om ni vill ha en annan bild att balansera med, global expertis från vilken kontinent ni vill finns att tillgå – som kommer säga att Sverige inte beter sig hederligt i denna fråga och det skadar folkhälsan globalt.

 

Med vänlig hälsning

Atakan

 

Best regards

Erik Atakan Befrits
COO INNCO Secretariat
NNA Sweden Chairman
ab@innco.org
http://www.innco.org
http://www.nnasweden.org

+46 764 156046
+90 531 5942910

INNCO.org and NNA Sweden raise no Issues

with WHO-FCTC or article 5.3 and are

registered non-profit NGO-CSO organisations

 

Mexico TV ad against Tobacco Harm Reduction

Frankly an(other) ethical train wreck of epic proportions brought to you by the very people charged with ensuring you can maximise your utility and pleasure with minimum negative impact on your health. I genuinely do not think the inventor of Public Health had production unit (yes you!) maximizing ultra frugal Puritanism in mind.

Train Wreck Mexico anti THR TV ad with Subtitles

 

FDA needs to Think – Not feel – about Tobacco Harm Reduction

We need to Think – Not feel – about Tobacco Harm Reduction

Supplement to FDA docket comment

Please find below uploaded document with a brief explanation on the snus situation in Sweden over 100 years. The reason for uploading is to augment a docket comment submission to the FDA on iQOS as an MRTP. There is absolutely no question whatsoever that the iQOS fulfills the criteria, given the current best available science.

The point of republishing this discussion paper is to assist in lifting the current framework anchor around this class of products. The mental framework should be anchored to the safest products with the longest history of industrial production and widespread use in a well defined and well studied population. Worst case scenarios should absolutely be war-gamed, but the game should extrapolate from the safest anchor point.

PDF 0 registered serious harm in Sweden from snus in 100 years

Le Penseur