Dont forget to go back and read this when you are done below: https://befrits.wordpress.com/2017/06/08/snus-would-have-saved-355000-lives-per-year-in-the-eu-alone/
As you can see, this is blog number 33 and so I hope I am not repeating this little anecdote, even though it does bear repeating.
There used to be a BBC TV political comedy called Yes Minister in which the senior civil servant Sir Humphrey Appleby was consistently trying to derail any initiative by his Minister Jim Hacker, which might not be in the interests of the civil service. One failsafe tactic, should the Minister suddenly announce such a move, would be for Sir Humphrey to say, ‘That’s a very brave decision, Minister’ At which point Hacker would turn pale and instantly drop the idea. Because no politician who is actually in power wants to be regarded as ‘brave’ as that invariably means a risky enterprise which could end in the sack, reshuffled to some low-level post, a loss of votes or even the loss of a parliamentary seat entirely.
So politicians invariably act in accordance with the cautionary principle and if possible kick tricky policy issues into the long grass for somebody else to choke on. And one very tricky issue right now is the evidence of long-term harm from e-cigarettes and similar products being considered in Estonia and Australia.
The Estonian parliament are debating proposals that would impose draconian restrictions on all aspects of e-cigarette availability. In attempting to head off these developments, the Estonian Union of Sellers and Users of E-Cigarettes have submitted two reports to the Estonian Parliament followed this April by a petition to parliament containing over five thousand signatures questioning the legality and substance of their proposals. This automatically triggers a parliamentary legal review.
Judy Gibson of the International Network of Nicotine Consumer Organisations writes, “The first hearing was held on the 18th September and the Estonian group gave evidence in supporting the need for proportional regulation. Whilst many were inclined towards the veracity of Public Health England and Royal College of Physicians’ risk appraisal, others were dissuaded by portents expressed by Dr Maris Jesse, Director of Estonian National Institute for Health Development and former Executive Board member of the WHO.” As they couldn’t decide between the conflicting sources of evidence, they decided to delay until this week on what is supposed to be a final decision. In this case, the grass is relatively short, and hopefully more sensible expert witnesses can come forward to make the case for harm reduction and head off a potential disaster for those wishing to switch away from smoking.
The situation in Australia contrasts with that in Estonia. In a land down under, vaping is banned. The Vaporised Nicotine Products Bill 2017, is a private senators’ bill which seeks to exclude e-cigarettes from regulation by the Therapeutic Goods Administration in order to legalise e-cigarettes in Australia. The Senate Committee recommended that “the Senate does not pass the Bill until further scientific evaluation of the efficacy and safety of e-cigarettes and related products has been undertaken”.
Estonian policymakers appear to be considering all the right evidence, but are being swayed by what they would deem equally credible voices. Similarly, Australian Senators will have access to all the most compelling evidence, but will also hear from ‘expert’ naysayers who could be equally compelling. As I say politicians are incredibly risk averse; moreover, politicians often like nothing more than banning something. It does wonders for the sense of moral rectitude and presents to the media and voters the idea that a ‘problem solved’. Legalising something is another matter entirely.
Comparisons with the UK are illuminating. Here, politicians have not been involved in the process, meaning the evidence has not been comprised by political expedience. Instead it has been left it to health experts to assess the available evidence and devise appropriate public health responses, albeit that the UK has had to sign up to the TPD and no doubt PHE had internal struggles for its approach to prevail. And while both the National Institute for Health and Care Excellence (NICE) and PHE both observe that the jury is out on long-term effects of non-combustible products, the fact that we have not reached that unimpeachable moment of defining certainty, doesn’t stop these health bodies from endorsing such products as aids to quitting smoking or reducing the harm of cigarettes.
Of course, there is no accounting for how the media will report your work. NICE found itself on the wrong end of some misreporting when the Irish press claimed that draft NICE guidelines on smoking cessation services and interventions were warning GPs against promoting the benefit of e-cigarettes to smokers.
The implication was that NICE was at odds with Public Health England on options for delivering smoking cessation programmes. In its recent report, PHE endorsed e-cigarettes saying, “Research trials and stop smoking service data returns both indicate that e-cigarettes can help smokers to quit, may be at least as effective as licensed medications and that an increasing number of people are choosing this option…Stop smoking services should offer an ‘e-cigarette friendly’ approach. This involves being open to the use of e-cigarettes by those who wish to do so, providing behavioural support and offering stop smoking medications alongside an e-cigarette if chosen by the individual”.
In a strongly worded rebuttal of the Irish story, NICE said ““These are new products and naturally results of long term studies are only now emerging – strongly reinforcing the view that e-cigarettes carry a fraction of the risk of smoking”
“We promote e-cigarettes as aids to stop smoking and when used in conjunction with other support, smokers have some of the highest success rates. Our recommendation is that people should receive advice on e-cigarettes so that they can make informed decisions on how to stop smoking”.
“E-cigarettes are now the most popular quitting aid in England with growing evidence of their effectiveness, with similar or better results than nicotine replacement therapies such as patches. A recent BMJ study estimated that, in England, e-cigarettes lead to 16,000 – 22,000 additional smokers quitting a year”
“Our guidance is draft and we are keen to get feedback on the use of e-cigarettes during the consultation.” https://www.nice.org.uk/guidance/indevelopment/gid-phg94
The FCTC has not been impressed by the creation of the Foundation for a Smoke-Free World (FSFW) and posted this statement
Nothing here should surprise anybody, but there have been some indications that not all FCTC members were monolithically opposed to the new products in pursuit of public health gains. Sadly whatever rickety bridge might have been built, construction has probably stopped with this re-iteration of implacable opposition:
“The tobacco industry is introducing new products in pursuit of profit rather than public health. For example, new “heat-no-burn” products contain tobacco and electronic nicotine delivery systems (ENDS) contain nicotine, an addictive substance regulated through appropriate policies under Article 5.2(b) of the Convention related to legislative and administrative measures”.
“Parties to the Convention have agreed to consider applying regulatory measures to prohibit or restrict the manufacture, importation, distribution, presentation, sale and use of ENDS, as appropriate to their national laws and public health objectives. If other novel tobacco or nicotine products emerge, the way that they are treated needs to be considered in the same way”.
Much has been made of the amount of money PMI have committed to the Foundation. By anybody’s calculation, $1bn us a huge pile of cash and left people wondering what PMI hope to achieve. But this is a spending commitment spread over twelve years and as Barnaby Page of E-Cig Intelligence notes, “10% of revenue is a fairly widely accepted yardstick for total spending on marketing, including PR, and it can be significantly higher in consumer industries. This is roughly 0.1% of PMI revenue, in other words 1% of that notional marketing allocation”.
This Bloomberg article kicks off with a comment on the PMI investment, but then goes on to paint what is still a sketchy future for Big Tobacco in the world of alternative nicotine products. Painting by numbers with lots of unfilled sections and not all of the colours available.
No doubt though that smoking is declining in many parts of the world, not least in Japan where the latest monthly sales data from Japan Tobacco must have made uncomfortable reading for shareholders. In August, the company cut its domestic sales forecasts as the big switch over to HnB products continued apace
Please find below an English translation of Op-Ed article published early morning June 8th 2017, in Swedish Aftonbladet. All credits in entirety to the Snus Commission and its members.
PDF of the translation for dissemination here
Snus would save 355,000 lives
Gigantic health impact if the EU had used tobacco the way Sweden does
Significantly fewer people die in tobacco-related diseases in Sweden than in any other EU country. We know what the difference is due to, the authors write.
DEBATE June 8th 04.00 CET
DEBATE. Significantly fewer people die from tobacco-related diseases in Sweden than in any other EU country. This is despite the fact that Swedes consume as much tobacco as in other EU countries. In fact, in 24 of the 27 other EU countries tobacco related mortality is more than twice as high as in Sweden.
We know what this difference is due to. In Sweden we use snus and therefore we smoke less. Snus is certainly not a health product, but you do not die from using snus, but you do die from smoking. And that is a non-trivial difference that both the Swedish government and the rest of the EU, seem to find remarkably easy to disregard.
The Snus Commission’s third report published today, answers a very central issue in this context: How many lives would have been saved if the consumption of snus and cigarettes followed the same pattern in the EU, as in Sweden?
The results were more appalling than we could imagine. The study is based on a processing of epidemiological data on tobacco-related mortality from the WHO. The report shows how many deaths the different EU countries, plus Norway, would have if the rest of Europe switched from cigarettes to snus to the same extent as Sweden has done. The study looks at men over 30 years of age in each EU country. Men, because it’s mainly men who have been using and are currently using, snus.
The figures show that 355,000 lives per year would have been saved if the EU used snus and smoked at levels like Sweden. Looking at the number of lives that could have been saved with a Swedish tobacco consumption, of course, the most populous countries come in at the top. The numbers are nevertheless startling:
In Poland – 46 730 people’s lives had been saved every year. For Germany the figure is 44 473, for Italy 37 160. Britain then follows with 36 452, followed by France where 33 693 lives could have been saved, and so on.
If we instead look at mortality per 100,000 inhabitants, Sweden has the lowest with 152. The EU average is 373 lost lives per 100,000 inhabitants due to smoking. The highest, Hungary, lands at 699.
It’s not the accuracy of the exact numbers we need to focus on, but rather the orders of magnitude. Based on this, some conclusions can be drawn. Above all, it is surprising that the Swedish government does not seem to want to push the issue that the EU should abolish the obsolete decision to ban snus within the Union.
355,000 saved lives per year is a very strong reason.
We argue that the time is just right to act on the snus issue. Secondly, the European Court of Justice in Luxembourg is currently handling a case regarding snus sales in the UK, where Sweden is invited to be a referral body. And thirdly, the EU’s fundamental rationale against snus has become obsolete.
When Sweden was given a permanent (national only, not EUPDF Aftonbladet SnusComm Op-ed english) derogation from banning snus in the EU negotiations, the EU rationale was that no new tobacco products should be allowed in the EU countries.
This argument has now been made obsolete by the EU with the recent release of e-cigarettes into the EU market. There is extensive epidemiological research on the snus, not at all equally available for e-cigarettes. A proven product to save the lives of smokers is kept banned, while a different and unexplored product gets the go-ahead.
So, Stefan Löfven and Annika Strandhäll, don’t miss this opportunity! Do seize the opportunity and tell the EU that they banned the wrong tobacco product.
Unless Sweden informs the EU about the relative difference in danger between cigarettes and the snus, who will? Here also, the government and relevant authorities have a responsibility towards their own citizens. In 2016, Ipsos research asked the Swedish people how dangerous it was to smoke compared to using snus. Every fourth Swedish person thought it was equally dangerous. Among women, that proportion was 45 percent.
In the EU countries, there is absolutely no way of knowing what the facts really look like. Namely that snus can save lives. Because nobody has told anyone.
If our authorities had done their information work at home, and the government done so at EU level, the Snus Commission wouldn’t have been necessary at all.
But now here we are and we plan to continue, simply because it is so much more important to save lives than protect old principles.
Underlying report in English for download here: http://snuskommissionen.se/wp-content/uploads/2017/06/Snuskommissionen_rapport3_eng_PRINT.pdf
Translated by Erik Atakan Befrits of NNA Sweden and INNCO.org, all mistakes are mine
(firstname.lastname@example.org – 0046 764 156046)
PDF version of letter here: Example His Excellency the Ambassador letter May 21 2017
REGARDING ECJ C 151/17
May 21st, 2017
His/Her Excellency Mr/Ms ……..
Permanent Representation of the ……
Possible decision by your country to respond to Court of Justice of the European Union, Reference C-151/17, regarding lifting the ban on snus as Tobacco Harm Reduction.
We are grateful for the determination showed by your country and the institutions of the European Union in the battle against smoking. Yet even with good intentions the fast-moving nature of technology and fresh scientific research sometimes means that aspects need to be reviewed by the institutions outside the normal cycle of Directives.
New Nicotine Alliance Sweden, and the global umbrella consumer organisation INNCO represent the interests of smokers who wish to find a safer alternative to smoking cigarettes.
We are writing to you about one anomaly which is currently being assessed by the European Court of Justice; that is the complete ban on the smoking substitute snus outside of Sweden.
We would like to bring to your attention a legal case before the ECJ to which the New Nicotine Alliance (UK) is a party. We would be grateful if you could bring this letter to the attention of your relevant ministry.
In the event your country decides to file a reply to the ECJ, we see great value in this opportunity to provide you with the most recent facts and context.
The issue of the ban on the sale of snus is perplexing to the nicotine users we represent because Sweden, where 18% of men use snus, is doing far better than anywhere else in the EU at reducing smoking and tobacco related disease.
Two months ago, The New Scientist reported that only 5% of Swedish men smoke in their 30s – the lowest rate of smoking in the EU
If there was any evidence that using snus was remotely as harmful as smoking, then there might be grounds for keeping this ban. However, this is not the case:
- EU Commission: “It is undeniable that for an individual substitution of tobacco smoking by the use of moist snuff [snus] would decrease the incidence of tobacco related diseases.”: SCENIHR (2008)
- World Health Organisation: Snus is “considerably less hazardous than cigarettes”: page 273 WHO Tob. Reg. Report 951
In a letter to The Times of London, veteran research professionals Farsalinos, Le Houezec, Polosa and Ramström wrote that not only did Sweden have by far the lowest rates of lung cancer and heart disease in Europe but that “younger Swedish men, who are the highest users of snus, have the lowest levels of oral, oesophageal and pancreatic cancer.”
Indeed, the evidence supporting the comparative safety of snus was so compelling, that in 2015 the US Food and Drug Administration chose snus as the first nicotine product to be authorised (FDA authorisation)
We are intending to mount a media campaign on this issue and sincerely hope that your country will take this opportunity to demonstrate that the EU process is able to be responsive to EU citizens and open to transparently advancing scientific data.
Prior to launching our campaign, we would appreciate meeting with you, and/or relevant representatives from your country, to listen to your understanding of the evidence.
There is a consensus amongst a large global collective of prominent scientists and tobacco control professionals, (largely independent from institutionalized supranational and national tobacco control institutions), that the internationally generally accepted assessment from Sweden on snus is a misrepresentation of the science, the potential for harm reduction, and finally the positive health economics of snus as a cigarette alternative product.
Should your country decide make an observation to the ECJ on this matter, may we offer a suggestion for one possible reasoned and evidence based position. Though further research may be warranted, there is sufficient compelling and robust evidence present that snus offers smokers a significantly safer alternative to cigarettes, and as such snus should be made available to adult consumers in the EU. The current snus ban should be lifted and snus should be regulated in line with the TPD provisions for e-cigarettes and other novel tobacco products. This cohesive category of harm reduction products would then best be closely monitored for future regulatory fine-tuning, and strictly enforced in terms of age restrictions to ensure the products are not made accessible to minors.
We feel that this would be a logical and non-discriminatory approach, an approach also offering 100 million smokers in the EU one further proven harm reduced alternative. In effect this would afford the smokers, as well as youth and non-smokers, a considerably higher level of health protection than maintaining the current ban will.
Alternatively or additionally, should your country decide to comment to the ECJ, your country may wish to consider highlighting the absence of any reasonable scientific and health economic evaluation regarding snus use in Sweden. This is indicative of that the more than 150-year tradition of use of snus in Sweden causes negligible or non-measurable health and societal consequences, despite representing 50% of total tobacco consumed in Sweden.
Furthermore and as of 2017, The Swedish Public Health Agency and The National Board of Health and Welfare, both are agencies under the Ministry of Health, have entirely ceased monitoring and reporting data for snus use in the official health determinants surveys and reports. Snus use data has been collected and reported since 1988, but will no longer be.
A clear and very recent indication of the information problem regarding snus, one that may be of interest to your country position on this principally important issue, is that the Karolinska Institute in Stockholm on May 9th 2017, published a definitive correction of a since the early 2000’s widely advertised claim that snus use increases risk of pancreatic cancer.
With this correction, it would seem clear and acknowledged also by science in Sweden, though not yet by policymakers; that snus use does not cause any measurable increases in lung disease, cancer or cardiovascular disease compared to never users of tobacco. In our opinion, the significance and implications of these recent developments cannot be stressed enough. We hope this update may be of informational value to your country.
We would be grateful for the opportunity to discuss this important case further with you or your representatives, at home or in Brussels, and to answer any questions or concerns you may have. We would also greatly appreciate an email from your offices that you have received this communication from us in good order and that e-mail is an acceptable format. If the format is not correct, please kindly inform us on the correct route of communication and we shall immediately resend the documents accordingly.
Erik Atakan Befrits Judy Gibson
NNA Sweden, Chair INNCO.org, Chair
Tel: 0046 764 156046
Please see Appendix 1-3 for supplementary discussion and background documentation that you and your staff may find helpful to further explain the points made in our letter.
All links in the letter and these appendices are live in this version of this document and can be followed directly while reading the text, for easy referencing.
Background to the legal action against the ban on snus, brought by the New Nicotine Alliance, UK
NNA contends that snus fulfils the criteria for a tobacco harm reduction product and hence should be available in the EU. The legal ban on snus denies smokers of the choice of a much safer nicotine product than cigarettes.
The introduction of snus into the EU would form part of a coherent strategy of tobacco harm reduction that help people avoid smoking. The current scientific evidence, and the fact that Sweden, where snus is used, now has the lowest lung cancer and tobacco-related mortality in Europe, indicates that snus is a suitable and appropriate product for individuals who are seeking to avoid smoking and other combustible tobacco products.
The rapid rise in the popularity of electronic cigarettes, a grass roots consumer driven phenomenon, shows that many smokers want to avoid smoking-related harms. There is the potential to reduce smoking when acceptable products are available to consumers; such uptake being at no cost to public funds.
The legal challenge
The Swedish Match legal challenge against the ban on snus
Swedish Match – the main manufacturer of Swedish snus – has brought a challenge in the UK High Court against the ban of the sale of snus. Their legal argument is that the law discriminates against snus compared with cigarettes and with lower risk nicotine products, that the ban is disproportionate, is against the principle of subsidiarity in removing national regulatory discretion, breaches the duty to give reasons for the ban, and is an unjustified restriction on the free movement of goods.
The NNA legal challenge against the ban on snus
NNA asked the UK High Court to be joined to the case as an ‘intervenor’. NNA is acting as a third party in the public interest, and brings added facts and argument to the case.
The New Nicotine Alliance (NNA) submits to the court that the ban on snus is disproportionate given the low risk of snus compared with other nicotine products. It is an unsuitable means by which to achieve the aim of public health protection because it removes from consumers the option to use a safer nicotine product.
NNA argues that the ban is (a) disproportionate, and (b) contravenes the right to a high level of health protection.
Significantly, for the first time in a challenge against UK (and EU) tobacco legislation, NNA argues that the ban infringes human rights. NNA argues that the ban contravenes the EU Charter of the Fundamental Rights vis Art 1 ‘human dignity’, Art 7 ‘respect for private and family life’, and Art 35 ‘health care’.
Art 35 stipulates that a high level of human health protection shall be ensured in the EU policies and activities. NNA argues that the ban is inappropriate as it prevents smokers from having access to a safer product and is an unsuitable means for achieving a high level of health protection.
Progress with the case
The High Court agreed on Jan 26th 2017 that there was a case for a review of the legislation. Because the UK Tobacco and Related Products Regulations 2016 are based on the EU Tobacco Products Directive 2014, the case was referred to the European Court of Justice, on 9 March 2017.
Implications of the case
The ECJ ruling will apply across the EU.
The human rights argument advanced by the New Nicotine Alliance
The New Nicotine Alliance (NNA) legal case is the first time that a ‘right to health’ argument has been used to challenge a bad tobacco control law.
NNA’s case to the European Court of Justice is based on EU law and the EU Charter of Fundamental Rights (CFR) . NNA’s argument is that the ban on snus is disproportionate, and that it is contrary to the human right to health. Given the evidence that snus is substantially safer than smoking cigarettes, and that it protects against smoking, it is both unethical and contrary to EU law to deny access to this product.
NNA supports the idea of ‘tobacco harm reduction’ as it is often formulated, in offering smokers and would-be smokers a low risk alternative to smoking. It is as an approach that is preferable to an abstinence only strategy, which is in effect a ‘quit or die’ approach.
NNA also supports the idea that many people like using nicotine and thus – especially if lower risk forms of nicotine are available – there must be major limitations on the ability of the state to interfere with that choice. Tobacco harm reduction recognises that many people find the use of nicotine pleasurable. This is reflected in our arguments that the ban on snus is contrary to the principles of autonomy and choice that flow from Articles 1 and 7 of the Charter of Fundamental Rights of the European Union (CFR).
NNA contends that the ban on snus infringes the human right to health. The availability of snus is an aspect of personal health and personal autonomy by which consumers can avoid the health hazards of smoking. The ban on tobacco for oral use limits smokers’ choice of safer alternatives, by excluding a product that is significantly less harmful to health than cigarettes. The NNA therefore submits that the ban on snus engages issues under European law, in particular those articles in the Charter of Fundamental Rights of the European Union (CFR) that protect autonomy and choice – Articles 1 (human dignity), Article 7 (respect for private and family life) and Article 35 (health care).
Article 1 of the CFR is an overall obligation to respect human rights, and protects ‘human dignity’. The issue of dignity is linked to personal autonomy: a principle by which individuals make choices on the conduct of their life, which presupposes a range of choices.
Respect for private and family life
Article 7 on ‘respect for private and family life’ is a broad-ranging right that is often closely connected with other rights including autonomy such as freedom of religion, freedom of expression, freedom of association and the right to respect for property. Article 7 has been held to apply to issues of quality of life, self- determination, a right to establish relationships, self-identity, choices in relation to medical treatments to prolong life, and decisions on parenthood by insemination techniques.
Rights to health
European states are obliged to further the health of their citizens. The preamble to the European Social Charter  states that: ’Everyone has the right to benefit from any measures enabling him to enjoy the highest possible standard of health attainable’ and Article 11 requires Parties to take measures to prevent disease and to encourage individual responsibility in matters of health.
Moreover, all EU law must take into account ‘health protection’. Facilitating a high level of health protection is required under Title XIV of the Treaty of Lisbon that ‘A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities’. A high level of health protection is relevant to all EU legislation including the Tobacco Products Directive.
The EU Charter of Fundamental Rights stipulates in Article 35 that a high level of human health protection shall be ensured in the definition and implementation of all the Union’s policies and activities. NNA argues that the EU legislators based the TPD law on a limited understanding of ‘health protection’ in violation of Article 35. By banning tobacco for oral use, the EU prevents access to a product that significantly reduces harm to consumers as compared to cigarettes. The EU legislators, we believe, took a narrow definition of ‘health protection’ to mean protection from products, whereas it should have taken a broader public health definition to include making it possible for people to take action to avoid ill-health through the choices they make.
NNA bases its argument on an interpretation of Article 35 of the CFR that a high level of health protection must allow access to snus. A similar argument may be made on the basis of other international treaty obligations.
The relevant obligation is Article 12 of the International Covenant on Economic, Social and Cultural Rights , which has been ratified by 165 countries including all EU states. Article 12 recognizes: ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ and that States Parties must take steps regarding ‘the prevention, treatment and control of epidemic, endemic, occupational and other diseases.’ This has been interpreted by the UN Special Rapporteur on the Right to Health to include access to harm reduction resources for people who use drugs . We similarly argue that Article 12 includes access to tobacco harm reduction resources, ie safer nicotine products.
Tobacco harm reduction is consistent with obligations in the international treaty on tobacco control. All European Union states are signatories to the Framework Convention on Tobacco Control (FCTC), the international health treaty that aims to reduce the use of tobacco . The preamble to the FCTC notes obligations (as mentioned above) under the Article 12 of the International Covenant on Economic, Social and Cultural Rights. Moreover Article 1d of the FCTC specifically refers to harm reduction as one of the defining strategies of tobacco control, which is: ‘a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke’.
As mentioned above the European Social Charter requires states to encourage individual responsibility in matters of health. This view links to a basic principle of public health, which is one of creating the conditions in which people can lead healthier lives. In particular, as stated in the constitution of the World Health Organisation , that: ‘Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people.’  Empowering individuals and communities to take control of their health is a fundamental principle of public health, as set out in the Ottawa Charter on Health Promotion .
Tobacco harm reduction is consistent with the broad public health aim of enabling people to take action to reduce risks to their health. They cannot do that unless they have access to the resources that help them do this. That is why a ban on snus is inconsistent with helping people to lead healthier lives. Snus has to be legalised because snus saves lives.
 Charter of Fundamental Rights of the European Union (2000/C 364/01)
 European Social Charter https://www.coe.int/en/web/conventions/full-list/-/conventions/rms/090000168007cf93
 Open Letter by the Special Rapporteur on the right of everyone to the highest attainable standard of mental and physical health, Dainius Pūras, in the context of the preparations for the UN General Assembly Special Session on the Drug Problem (UNGASS), which took place in New York in April 2016.
 Framework Convention on Tobacco Control http://www.who.int/fctc/text_download/en/
 Constitution of the World Health Organisation http://www.who.int/governance/eb/who_constitution_en.pdf
 Ottawa Charter on Health Promotion. World Health Organization 1986
What do we know about snus?
What is snus?
Snus is a moist, smokeless powdered tobacco. It is sold as a loose powder or pre-packaged in a small sachet (a bit like a mini tea bag). It contains ground tobacco, salt and may contain food-grade smoke aroma flavourings, such as citrus, bergamot, juniper, herb or floral flavours. Most Scandinavian snus is produced in Sweden where it is regulated as a food under the Swedish Food Act. The nicotine content varies among brands.
Is snus an appropriate and acceptable harm reduction product?
Snus fulfils the criteria for a tobacco harm reduction product. It is a low risk nicotine product and delivers acceptable doses to those who use it. In countries in which it is allowed it is popular and has contributed to declines in smoking and smoking related diseases.
How does snus differ from other oral tobaccos?
Snus is a smokeless tobacco. Unlike some other smokeless tobacco types, Swedish snus is not fermented and is pasteurised, which inhibits the growth of bacteria that help the formation of tobacco-specific nitrosamines (an important group of carcinogens in tobacco products). Snus is refrigerated in order to inhibit the growth of toxins.
How is snus used?
Snus is placed between the upper lip and gum. The nicotine is released into the saliva, with the rate of release affected by the amount of saliva. New users experiment (titrate) to find the best rate of nicotine release. http://www.wikihow.com/Use-Snus
Is there a quality standard for snus?
The Gothiatek standard, a voluntary quality standard for snus products, has maximum levels for constituents, including nitrosamines, metals, nitrite, agrochemicals, mycotoxins and aldehydes.
Is snus safe and are there any long-term health effects?
Snus is considered by scientists to be 95%, and possibly closer to 99%, less risky than smoking.
Snus poses no respiratory risk. Respiratory diseases, predominantly lung cancer, chronic obstructive pulmonary disease (COPD) and pneumonia account for 46% of deaths due to smoking, according to the Scientific Committee on Emerging and Newly Identified Health Risks, 2008.
Individual studies can produce contradictory findings so evidence must be sought from overviews of key studies and pooled results. A recent systematic review and meta-analysis examined the evidence relating to snus and health across six major Swedish, Norwegian, Danish and Finnish studies, up to 2010. This concludes that the evidence provides scant support for any major adverse health effects of snus: snus is not associated with cancers of the oropharynx, oesophagus, pancreas, or heart disease or strokes. Compared with smoking snus poses about 1% of the risk of cancer or cardiovascular disease. https://www.ncbi.nlm.nih.gov/pubmed/21163315
Snus and lung cancer in Sweden
The rise in the use of snus has resulted in Sweden having the lowest lung cancer mortality and tobacco-related mortality in Europe. It is estimated that if the Swedish smoking prevalence was extrapolated to the rest of the EU, there would be a 54% reduction of male mortality from lung cancer. (Rodu B. and Cole, P. 2009. “Lung Cancer Mortality: Comparing Sweden with Other Countries in the European Union.” Scandinavian journal of public health 37(5):481–86.)
Health effects of switching to snus
Given the lower risk profile for snus it has been calculated that the life expectancy of smokers who switch from smoking to snus is little different to the life expectancy of those who stop smoking altogether. The authors of this study conclude that: ’Individual smokers who switched to snus instead of continuing to smoke and new tobacco users who only used snus rather than smoking would achieve large health gains compared with smokers’.
This finding is confirmed by a recent analysis of six major studies which found that switching from smoking to snus is associated with major reductions in morbidity and that switching to snus appears to have much the same reduced health risk as quitting smoking.
Does snus pose a risk to others?
Snus poses no risk to others, such as work colleagues and family members as there is no combustion and consequently no ‘second hand’ smoke and no risk of fire.
Snus and stopping smoking
Snus is now the most popular product for smokers in Sweden and Norway when they wish to stop smoking and the success rate is higher when using snus than when using pharmaceutical Nicotine Replacement Therapy products.
Has snus replaced smoking in Sweden and Norway?
Consumers in both Sweden and Norway are choosing to use snus rather than to smoke. There has been a major increase in the use of snus and a concomitant decline in the smoking of tobacco. In Sweden, snus overtook cigarettes in 1996; In Norway the rise of snus and the decline in smoking resulted in male use of snus overtaking cigarettes by 2006. This happened despite snus use in Sweden and Norway occurring in a context where active promotion of the product was banned and health authorities warned smokers against snus use.
What are the levels of smoking in Sweden?
The prevalence of current adult smoking in Sweden in 2014 was 11% and Sweden now has the lowest prevalence of smoking in the EU. In the same survey in 2014 the prevalence of adult current smoking in the UK was 22% (European Commission. Attitudes of Europeans towards Tobacco and Electronic Cigarettes. European Commission; Brussels, Belgium: 2015. Special Eurobarometer 429).
‘Daily smoking’ is even lower in Sweden at 8% compared with 19% in the UK in 2014.
Smoking is fast disappearing in some groups of Swedish men: in 2016 in the 30 to 44 years age group only 5% are daily smokers, less than a quarter of the level in the UK men. https://www.folkhalsomyndigheten.se/documents/statistik-uppfoljning/enkater- undersokningar/nationella-folkhalsoenkaten/2016/Tobaksvanor-nationella-resultat-tidsserier-2016.xls
How does the use of snus reduce smoking?
Snus is used to avoid the uptake of smoking, to stop smoking, and to reduce smoking.
The decline in Sweden and Norway has come about by smokers using snus to avoid smoking, and by the fact that younger nicotine users are choosing to use snus rather than to smoke, and that the uptake of snus does not lead to tobacco smoking.
( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245639/ and https://www.ncbi.nlm.nih.gov/pubmed/27834883 )
Overall in Sweden and Norway the total level of tobacco use has remained stable or declined – what is most important is that there has been a major shift away from smoking.
Snus can therefore be considered protective against smoking.
Might other factors in Sweden account for the switch to snus?
No. Sweden has implemented fewer tobacco control measures than the UK. Laws on tobacco use and promotion are less strict that in the UK. They don’t have a fully ‘comprehensive’ smoking ban. Smoking is allowed in designated purpose built smoking rooms in some workplaces and some public places like airport terminals. Smoking is also permitted in designated smoking areas outside in train stations and bus terminals. They don’t have especially high tobacco taxes. There is a ban on tobacco advertising and promotion, but advertising and promotion is allowed at points of sale, as are tobacco product displays. There are total restrictions on tobacco sponsorships.
The clear difference between Sweden and the UK is due to snus. Overall the UK ranks number 1 in implementing tobacco control measures, whilst Sweden ranks joint 9th in 2016. http://www.tobaccocontrollaws.org/legislation/country/sweden/summary
Sweden consistently gets far better results with fewer controls on smoking.
What does the Royal College of Physicians, Tobacco Advisory Group say about snus?
‘The availability and use of an oral tobacco product known as snus in Sweden, documented in more detail in our 2007 report…demonstrates proof of the concept that a substantial proportion of smokers will, given the availability of a socially acceptable and affordable consumer alternative offering a lower hazard to health, switch from smoked tobacco to the alternative product. Particularly among men, the availability of snus as a substitute for smoking has helped to reduce the prevalence of smoking in Sweden, which is now by far the lowest in Europe…Trends in snus use in Norway are similar to, and perhaps stronger than, those in Sweden, and there the use of snus is strongly associated with quitting smoking.’ Royal College of Physicians, Tobacco Advisory Group (2016). Nicotine without smoke: Tobacco harm reduction
Legal status of snus
Snus is banned from sale in the EU (except in Sweden).
The UK Tobacco and Related Products Regulations 2016 and EU Tobacco Products Directive 2014 on which it is based states that ‘no person may produce or supply tobacco for oral use’. Tobacco for oral use is defined as:
A tobacco product which is –
(a) intended for oral use, unless it is intended to be inhaled or chewed; and
(b) in powder or particulate form or any combination of these forms, whether presented in a sachet portion or a porous sachet, or in any other way’.
How did snus come to be banned?
In 1989 the UK Oral Snuff (Safety) Regulations were passed in response to the introduction of the moist snuff marketed as ‘Skoal Bandits’. This ban was quashed on appeal by the manufacturer.
In the EU, Directive 92/41 banned sales of snus, to harmonise rules in that three member states had already banned tobacco for oral use.
In 1995, on accession to the EU, Sweden obtained an exemption from the ban.
In 2001 the Tobacco Products Directive continued the ban.
The ban was also continued in the 2014 Tobacco Products Directive.
Thanks as always to the eminent Bill Godshall of Smokefree Pennsylvania for collecting and disseminating links to research, media, policy and politics surrounding the World War on Tobacco Harm Reduction:
UK government finds record low 17.2% cigarette smoking rate for adults in 2015, acknowledges vaping a reason for decline (from 20.1% in 2010)
Smoking numbers hit new low as Britons turn to vaping to help quit cigarettes
Analysis of 2014 Eurobarometer survey (of 15+ year olds from 28 EU states) data finds:
– Current smokers were 36 times more likely than never smokers to vape nicotine daily,
– Former smokers were 52 times more likely than never smokers to vape nicotine daily,
– Current smokers were 29 times more likely than never smokers to vape daily,
– Former smokers were 39 times more likely than never smokers to vape daily,
– 93% of daily vapers reported vaping nicotine daily,
– 1.08% of total population (15+ years) vaped daily, and 1.00% vaped nicotine daily,
– Just 0.08% of never smokers vaped daily, and only 0.04% vaped nicotine daily,
– 49.1% of daily nicotine vapers reported quitting smoking by switching to vaping,
– 0.0% of daily vapers reported increasing their cigarette consumption, and
– 9.3% of ever e-cig users vaped daily, and 8.6% of ever e-cig users vaped nicotine daily.
The 2014 Eurobarometer survey also found (as detailed in August 2016 article below):
– 6.1 million EU citizens quit smoking cigarettes by switching to vaping,
– 9.2 million EU citizens had reduced cigarette consumption after beginning to vape,
– Just 1.3% of never smokers reported current use of nicotine e-cigs, and
– Just 0.8% of ever tobacco/vapor users reported using vapor first.
Bulgarian Health Ministry says 4.6% of Bulgarians are now daily vapers in Europe’s most prevalent cigarette smoking country, where 31.4% still smoke cigarettes daily.
FDA PATH survey found almost 90% of American youth (ages 12-17) who vaped in past month reported doing so because vaping is less harmful than cigarette smoking, refutes claim (in recent JAMA letter) that flavorings are why youth vape; Saul Shiffman to present this and other PATH findings at SRNT conference March 10 in Florence, Italy.
Study of young adult vapers (ages 18-45) in US finds:
– Daily users of e-cigarettes found them at least as satisfying as cigarettes.
– Satisfaction from e-cigarettes was more likely in more frequent users.
– All daily users reported them as less dangerous than cigarettes.
– Perceived danger from e-cigarettes was higher in less frequent users.
– Daily users of e-cigarettes were more likely to be using non-cig-alikes.
New UB study sheds light on perceptions of e-cigs
Study finds young vapers (ages 16-26) correctly know that vaping is substantially less harmful than smoking cigarettes, and that vaping has made smoking less acceptable
Mintel survey finds UK smokers are still more than twice as likely to use vapor to quit smoking than Big Pharma drugs (62% vs 29%), which is why Big Pharma and its funding recipients have demonized and lobbied worldwide to ban vapor sales and use. But UK news headlines hype drop (from 69%) in percent of smokers who vape to quit smoking.
Survey of customers at 14 vape shops finds 84% reported first buying a vapor product to quit smoking
Four country survey found smokers who tried vaping to quit smoking (compared to smokers who tried quitting cold turkey) were far more likely to report 30 day sustained cigarette abstinence in countries that don’t ban sales of nicotine vapor products (i.e. US & UK) than in countries that banned sales of nicotine vapor products (Canada & Australia).
Brad Rodu: E-cigarette toxic chemical exposure is same as for nonsmokers
Nicotine vapor has far fewer genetic effects than cigarette smoke
Brad Rodu – Heavy Snus Use: Possible Link to Type 2 Diabetes
Brad Rodu: Nicotine, Smokeless tobacco & Tourette Syndrome
BAT Harm Reduction Focus Report 2016: Inspiring Products Driving Change
(new BAT report more accurate than info from all public health agencies, except PHE)
Nitzkin discusses issues on Tobacco Harm Reduction
Log Cabin Republican Gregory Angelo: Vaping is best way to stop LGBT smoking
Scott Ballin discusses Tobacco Harm Reduction
UK vapers urge the Chancellor to recognize benefits of vaping on “No Smoking Day”
Fresh urges smokers to Ditch or Switch to Vaping on “No Smoking Day” (UK)
Responsible Parent’s Response to Child Vaping
Big Tobacco has caught startup fever (about new low risk tobacco/nicotine alternatives)
Proposed BAT acquisition of Reynolds clears US antitrust hurdle
NJOY completes financial restructuring
Marlboro brand value hits record high of US$32.4 billion
North Carolina based Madvapes registers 86 e-liquid products to comply with EU TPD
TMA hires new president and CEO Christopher Greer
GOP Healthcare Reform Legislation
GOP healthcare reform bill would eliminate CDC’s Prevention and Public Health Fund, which wasted $495.3 million of taxpayer money on “Tobacco Use Prevention” (including demonizing and banning use of lifesaving vapor products and very low risk smokeless tobacco products) since 2012 (i.e. $126M-2016, $111M-2015, $105M-2014, $60.3M-2013, $93M-2012), Godshall comments.
“Tobacco Use Prevention” stated purpose “To raise awareness and shift key attitudes and beliefs about the harms of tobacco use and exposure to secondhand smoke in areas of the country with some of the highest rates of tobacco use prevalence.”
FDA Deeming Regulation/Ban
VTA, SFATA, AVA, CASAA urge House Speaker Ryan and Minority Leader Pelosi to support Cole/Sanford bill (HR 1136) to keep many vapor products legal to sell after FDA’s Deeming Ban on August 8, 2018 (by moving the Feb. 15, 2007 predicate date)
Heritage Foundation – Rethinking Tobacco Policy: The Federal Government Should Stop Blocking Alternatives
Joel Nitzkin: Congress, Please Make Smoking Less Harmful
Guy Bentley: A modest reform could mean life of death for the vaping industry
ACSH’s Hank Campbell: Myths, Facts and Fixing Policy on Vaping
4 State AGs (AZ, TX, LA, MI) file amici brief opposing FDA’s Deeming Regulation/Ban on premium cigars
FDA’s lies about and proposed ban for low risk smokeless tobacco products
Nitzkin/Rodu: FDA should get out of the smokeless tobacco industry
Guy Bentley: How the CDC masks the truth about smokeless tobacco
Brad Rodu discusses Tobacco Harm Reduction (and FDA lies about smokeless tobacco)
THR prohibitionists at TCLC endorse and promote FDA’s proposed standard that would ban the sale of >95% of smokeless tobacco products in the US, which would prompt many/most of the 3.2 million cigarette smokers who also use smokeless tobacco (per FDA’s PATH data) to increase cigarette consumption and reduce smokeless tobacco use.
FDA/NCI financed extremist Stan Glantz urges FDA to not extend public comment period on proposed cigarette protecting standard that would ban sales of >95% of low risk smokeless tobacco products now on US market, and would prompt many of the 3.2 million dual users of smokeless tobacco and cigarettes to increase cigarette consumption.
More FDA CTP
FDA lets Reynolds’ Natural American Spirit cigarette keep using term “Natural” in brand name and trademarks (after previously claiming it was a banned MRTP claim), FDA agreed to settlement with Reynolds in January that wasn’t made public (requiring removal of terms “Additive Free” and “natural” on brands’ labels, advertising and promotions), anti-tobacco/vapor extremists CTFK and Legacy lies initiative criticize
Note that FDA’s agreement with Reynolds is similar to FDA’s agreement with Altria’s John Middleton allowing “Black and Mild” cigar brands to keep that name (even though the TCA banned the word ‘mild’ as a tobacco brand descriptor), and is consistent with a 2004 statement by Altria’s Mark Berlind about 1st Amendment protections.
CTFK’s Matt Myers and Legacy’s Robin Koval in denial that brand names are protected by the US Constitution, criticize FDA for letting Reynolds keep cigarette brand name.
22nd Century says it withdrew its MRTP application for its very low nicotine cigarettes, and now plans to submit a “more expensive and robust” MRTP application to FDA.
FDA increases fines on retailers that violate the Tobacco Control Act
Trump appoints Noel Francisco for US Solicitor General; Francisco is a Jones Day lawyer who represented Reynolds in lawsuit that struck down FDA’s unconstitutional graphic cigarette warning labels (after Godshall warned Obama’s FDA that its intentionally deceptive warnings may be unconstitutional)
Fort Lauderdale law firm wins $6 million tobacco verdict for WWII veteran’s widow
New Mexico Senate approves bill (SB 231) to impose 76% tax on vapor products, increase cigarette tax from $1.66 to $3.16/pack, increase OTP tax from 25% to 76%
Kansas Senate rejects Gov. Brownback’s proposed tobacco tax increases
Kansas Senate Assessment and Taxation Committee amends, recommends passage of bill (SB 130) to change vapor e-liquid tax from $.20/ml to $.05/ml
CASAA asks Kansas vapers to urge legislators to support and enact SB 130
After NY State Health Commissioner Zucker sends letter to all MDs in NY that grossly misrepresents the evidence on vapor products and urges their support for Gov. Cuomo’s proposed $.10/ml tax on e-liquid, R Street sends letter responding to Zucker .
NY Conservative Party: Block Tax on E-cigarettes
PA Rep. Jeff Wheeland to proposed bill to change PA’s 40% vapor tax to $.05/ml
PA Sen. Camera Bartolotta to proposed bill to change PA’s 40% vapor tax to $.05/ml
CASAA urges PA vapers to send letters of support for bills to tax e-liquid at $.05/ml http://p2a.co/fYelf6m
CASAA urges MN vapers to oppose bill (SF 1052) backed by Reynolds to impose $.30/ml tax on e-liquid.
Frank Chaloupka points out that raising cigarette tax benefits health and economy (OK)
UK Government to increase taxes and duties on cigarettes
Philip Morris Limited (PMI’s subsidiary in UK) urges British government to slightly increase cigarette tax to purportedly encourage smokers to switch to less harmful smokefree alternatives, but PML opposes any substantive cigarette tax increase.
Ironically, in 2015, Philip Morris Limited vehemently opposed a UK cigarette tax increase, and instead urged the UK government to tax vapor products (see page 290)
BAT opposes minimum excise tax on cigarettes in UK, claims it will hurt low
Indiana E-liquid Monopoly Law
Indiana Senate Cmte votes 8-1 for bill (SB 1) to repeal Indiana’s e-liquid monopoly law
Menthol cigarettes will soon be banned (UK)
NJ Assembly/Senate Health Cmtes approve bills to ban sale of flavored vapor products
Clive Bates: Are e-liquid flavours really
Advertising Standards Authority bans billboard showing Santa Claus vaping (UK)
Utah bill (HB 406) to increase minimum tobacco/vapor sale age to 21 years dies in House
Idaho bill to increase minimum tobacco/vapor sale age to 21 years dies in Senate
CASAA urges IL vapers to oppose bill (HB 3208) to raise minimum age for tobacco/vapor sales to 21
Florida bill (SB 1138) would increase minimum age for tobacco/vapor sales to 21
New Mexico Senate approves bill (SB 318) to ban vaping in workplaces after bill sponsor Sen. McSorley falsely claims scientific evidence has found vapor aerosol harms nonusers
Allegheny County (PA) Council protects cigarettes, threatens smokers and vapers, bans vaping in 99% of workplaces (despite no evidence vaping harms non users) after Health Dept, Big Pharma shills, UPMC and MDs lied about vaping risks and benefits, and after County Executive Rich Fitzgerald pressured Democrats on Council to vote for ban.
Univ of Pittsburgh Medical Center commits public health malpractice, protects cigarettes (and UPMC’s future revenue from treating sick and dying smokers) by lying about vapor products, urging Allegheny County Council to ban vaping in 99% of workplaces.
Kokomo and Howard County (IN) ban smoking (and smokefree vaping) in workplaces
Croatian bill to ban vaping in workplaces sent to Parliament for consideration
Tacoma/Pierce County (WA) Health Dept post vaping ban signs that deceive public to believe vaping is as harmful as cigarette smoking.
Arkansas bill (SB 285) to ban vaping in workplaces dies in Senate committee
Access to Vaping
Inmates in Irish prisons may soon have access to e-cigarettes
Vapor Prohibition – Taiwan
Clive Bates: Challenging the proposed e-cigarette prohibition in Taiwan
Clive Bates urges Taiwan to reject proposed cigarette protecting vapor ban
International Network of Nicotine Consumer Organizations urges Taiwan to embrace lifesaving vapor products instead of banning them
R Street’s Eli Lehrer and Ed Anselm urge Taiwan to reject proposed cigarette protecting vapor ban
Derek From: Ottawa could muzzle access to scientific data on vaping (Bill S-5)
Derek From: Vaping laws keep less harmful option out of Canadian’s reach
Derek From: Feds need to rethink anti-vaping legislation
Tyler Dawson – Tobacco control endgame, is it really about saving people?
Canadian Health Minister Jane Philpott touts contradictory goals of reducing tobacco use to 5% by 2035 while imposing even more bans on lifesaving vapor products
Eric Gagnon: How marijuana makes the obvious case against plain packaging for tobacco products (Canada)
CAMH deceptively conflates its “tobacco free” policy with a “smokefree” policy, opposes cigarette smokers switching to low risk smokeless tobacco products
Experts slam TGA e-cigarette ban as ‘unethical’ and ‘unscientific’ (Australia)
NZ Mauro Party co-leader Marama Fox calls for government subsidization of vapor products (just as it subsidizes Big Pharma drugs) in NZ where vapor sales are banned.
Mauri health group urges NZ Health Ministry to subsidize vapor products for smokers
Smokers shifting onto e-cigarettes ‘is a win’ – Kiwi doctor (John Cameron)
‘I think we’ve got a win’ – NZ doctor believes vaping could shift people from smoking tobacco
Big Pharma funded health and medical groups in Israel upset Health Minister Litzman won’t ban sales of PMI’s low risk heat-not-burn iQOS
Junk Science, Propaganda and Lies
FDA/NCI funded study finds air contains more benzene than e-cig vapor, but study authors (the same ones who falsely claimed vaping emits lots of formaldehyde in the NEJM) deceive peer reviewers, editors and news media again by falsely claiming their new study found “significant levels of cancer-causing benzene” in e-cig vapor.
Science Times article repeats and further hypes false fear mongering claims that vaping emits lots of benzene, along with horror stories about benzene to confuse and scare
Abstinence-only anti-THR extremists at CASA protect cigarettes by falsely claiming just 20% of adult cigarette smokers in US are addicted, repeat hundreds of false fear mongering claims from junk studies to demonize nicotine, lifesaving vapor products, very low risk smokeless tobacco products, low risk cigars, pipes and hookah; deceitfully conflate all tobacco/nicotine products (except Big Pharma nicotine) with cigarettes.
Big Pharma financed ACS and ALA falsely claim cigarette companies sell most vapor products in US, but they will if FDA’s Deeming Regulation (that was aggressively lobbied for by ACS, ALA and other Big Pharma shills) isn’t rescinded or repealed.
Singapore’s Health MinisterAmy Khor falsely claims low risk heat-not-burn tobacco alternatives are “not significantly different” than deadly cigarettes, claims (despite zero evidence) they will addict children and be gateways to cigarettes as reasons to ban them.
Polosa/Howard refute false claims by DHHS funded vaping opponents about “dripping”
Big Pharma/FDA/NIH funded American Heart Association press release falsely claims vaping may increase stroke risk more than smoking (based on totally inapplicable rodent study in which mice were given more than a lethal dose of nicotine daily for 30 days); lazy stupid news media repeat false fear mongering claim without any fact checking.
Mike Siegel: American Heart Association claims that vaping causes severe strokes and is more risky than smoking
Philly Health Cmsnr Farley (who lied about vaping to lobby for NYC’s 2013/14 workplace vaping ban) now falsely claims cigars are target marketed to youth
FDA/NCI/Legacy funded Glantz keeps lying about the modest impact smokefree workplace laws had on heart attack rates (as the vast majority of workplaces were already smokefree before the laws were enacted), comments refute and debunk Glantz
California Health Dept funded Yolo County Health Dept denounces retailers for selling lifesaving vapor products and low risk cigars (but not deadly cigarettes)
California Health Dept demonizes vaping again, and retailers who sell vapor products
Orange County Register hypes Yolo County Health Dept’s demonization of vapor http://www.ocregister.com/articles/percent-746049-county-stores.html
FDA funded junk study authors rely upon Twitter postings in another deceitful attempt to misrepresent why millions of smokers have switched to life saving vapor products
Huff Post runs yet another op/ed that falsely claims vaping is addicting many nonsmokers and is harming vapers
CVS funds study to congratulate itself for ending tobacco (and vapor) sales
CVS press release falsely congratulates itself for nation’s decline in cigarette smoking,
OP-ED :The results do signal a real effect from snus use and risk of developing diabetes
Translation by Atakan Erik Befrits of INNCO.org and New Nicotine Alliance Sweden, FCTC 5.3 compliant civil society NGO’s representing over 20 million successful ex-smokers, with the help of +95% harm reduced consumer nicotine products. All mistakes are my own.
OP-ED · “A single study can never give the final answer to a research question. We would still like to say that the current study is an important addition to the existing knowledge on tobacco and type 2 diabetes” Associate professor Sofia Carlsson and Professor Cecilia Magnusson conclude.
Sofia Carlsson, Associate Professor, Institute of Environmental Medicine, Karolinska Institute
Cecilia Magnusson, Professor, Department of Public Health, Karolinska Institute
As Patrik Strömer writes on SVT Opinion, there may indeed be other explanations for the findings in our study, connecting snus use and type 2 diabetes, than the snus use itself causing diabetes.
For example, we can not rule out that snus users and non-users of snus differ with respect also to other factors that contribute to an increased risk of diabetes.
At the present time there are relatively few studies of snus and type 2 diabetes, and they partly do provide different results. One explanation for different results may be that the previous studies have not been large enough to study consumers who use quite large quantities of snus, which is where we primarily find an increased risk.
Smoking is an established risk factor for diabetes, and a problem in previous studies has been to separate snus effects from smoking as dual use is common.
Our study is the largest to date on snus and the risk of type 2 diabetes. We have thus been able to examine the effect of exclusive use of snus.
We have also, insofar as possible, taken into account other risk factors for type 2 diabetes such as overweight, physical inactivity, heredity, alcohol consumption, and education level.
The results show a so-called dose-response relationship, meaning that the risk of type 2 diabetes increases with the number of cans of snus consumed per week, which reinforces the interpretation that snus is indeed behind the increase in risk.
Finally, experimental studies show that nicotine can inhibit insulin sensitivity, which means that there is a possible biological explanation for that snus can cause diabetes.
Combined, these findings make us more inclined to believe that the results do indicate that snus use does indeed affect the risk for diabetes.
A single study can never give the final answer to a research question. Every one study instead contributes a new piece to the puzzle, and slowly extends the research frontier.
We remain confident in claiming that the current study is an important addition to the existing knowledge on tobacco and type 2 diabetes.
Although we cannot prove that snus causes type 2 diabetes, we think that the public and decision makers have the right to be informed of our research findings.
Good research is characterized by humility and critical reasoning, media headlines sometimes do not reflect this adequately, and we therefore welcome these subsequent discussions.