Monthly Archives: September 2015

From smoking to dual to switching (Snus or E-cig), a story of a pretty normal human behavior!

Thank you Kristin Knoll-Marsh for sharing this on Facebook, since it is in the public domain already I feel comfortable sharing it with you, whether you are in Turkey, In Cyprus, In Northern Cyprus, in the USA, in Sweden or perhaps Azerbaidzjan:

My 66 year old, smoking aunt has watched nearly my entire family switch from smoking to vaping over the past 6 years. She never showed any interest – “too much fuss” she said, so we never pushed it. We even set up a smoking area, on our screen porch, for her when she moved in with us a few weeks ago.

A couple of weeks ago, we were at Walmart and I casually mentioned that a disposable cigalike being sold was the most realistic I’d ever tried and, to my surprise, she bought one! A week or so (and 3 disposable ecigs) later, she mentioned she’d like it if it could be recharged and refilled. So I picked up a rechargeable cigalike, with extra cartos, for her when I was in Walgreens.

Yesterday, my husband and I stopped in a vape shop for supplies and she came in with us. She is now the proud owner of a new, shiny, red mod (100% her idea.)

At the store, she told me, “I’m finding that I’m using it (the cigalike) more often then smoking and I’m really enjoying it. I’m only smoking in the morning. So, I may as well get something better.”

This story, folks, is a perfect example of why we need to keep fighting for diversity in the marketplace. Without that first cigalike and unbiased guidance, in a safe, comfortable and reassuring environment, she was unlikely to walk into a vape shop. This can be extremely important for a smoker’s journey from smoking to vaping. (On a side note, this shop only had 2 straight tobacco flavors. Shop owners would be smart to have more than that for smokers.)

It also shows a classic case of a typical “dual user” that the ANTZ are wringing their hands over. Most dual users just haven’t finished their journey. To do so, they need truthful information and gentle guidance, not pressure to jump in over their head with advanced devices and low nicotine levels or to quit smoking right away.

And it makes an important point that many “dual users” are smokers who had ZERO interest in quitting, yet they are now cutting down their smoking and likely on a path to quit that they wouldn’t have been on with only NRT as an option.

This is what CASAA is all about – getting out truthful information about ALL low-risk alternatives!

”Enjoying reading inside with her first ecig - a much-maligned "cigalike." But it got her started!”
”Upgrading just a couple of weeks later - without any pressure. (Side Note: Unfortunately, this shop only had 2 straight tobacco flavors. It would be nice for smokers to have more options in the beginning.)”

Dual use (snus or e-cig) isn’t bad, it’s good. Possibly even really really good

Friday, September 25, 2015

 An important new study led by Dr. Christopher Russell of theCentre for Drug Misuse Research in Glasgow and presented recently at the 2015 Tobacco Science Research Conference reveals that contrary to the claims of many anti-tobacco advocates, dual use (of e-cigarettes and tobacco cigarettes) is not a negative consequence of e-cigarette use, but a positive outcome that could well stand on a pathway to eventual smoking cessation.

(Russell C, McKeganey N, Hamilton-Barclay T. An online survey of 5,000 vapers’ perceptions and experiences of using electronic cigarettes as an aid to smoking cessation. Glasgow, Scotland UK: Centre for Drug Misuse Research. Presented at the Tobacco Science Research Conference, September 22, 2015.)

In the study, a worldwide internet survey was conducted and was available in seven languages. It was advertised on social media and through e-cigarette fora. The recruitment materials invited the participation of all adults who had ever used an electronic cigarette, even a puff. Importantly, it was not restricted to experienced vapers who had success quitting smoking. There were 7,326 respondents.

The most important study findings were as follows:

  • Of the dual users, 64% reported having reduced their cigarette consumption;
  • Of the dual users, 56% had cut their cigarette consumption by 50% or more;
  • Of the dual users, 81% reported having quit smoking for a period of at least one week;
  • Of the dual users, 70% reported the intention to quit smoking within six months;
  • Of the dual users, 88% reported that they planned to cut their cigarette consumption by at least half in the next six months;
  • Of the dual users, 63% predicted that they would quit smoking completely within six months, and another 27% predicted that they would cut their cigarette consumption within six months.

The Rest of the Story

Although this sample is of course not representative of the population, it does reveal important information about the attitudes and behavior of a large sample of dual users. The recruitment methods likely attracted a sample that had a disproportionately positive experience with electronic cigarettes, so these results should not be generalized to the overall population. However, within this subset of the population, it is clear that there are a substantial number of dual users for whom electronic cigarettes are having substantial positive consequences, even though they have not quit smoking completely.

This is critical information because most tobacco control advocates and groups have argued that quitting smoking is the only potential benefit of electronic cigarettes and that dual use is a negative consequence. These study results call those assumptions into question.

First, it is clear that a large percentage of the dual users had significantly cut down on the amount they smoked. This, in itself, confers substantial health benefits, especially in terms of respiratory symptoms and progression of respiratory disease. It also reduces smoking addiction and makes it easier for these smokers to quit in the future.

Second, it is clear that electronic cigarettes are being used as a part of an overall plan to quit smoking and that dual users largely were committed to eventually quit smoking completely. Even more importantly, nearly two-thirds of the dual users had positive self-efficacy for quitting, predicting that they would be smoke-free in six months time.

These results also call into question the claims of many anti-tobacco advocates that use of electronic cigarettes is inhibiting smoking cessation by removing the intention or desire to quit. It appears that among at least a subset of dual users, the e-cigarettes are being used as part of a smoking cessation plan and the intention to quit remains. In fact, the level of self-efficacy of these dual users is much higher than we observe in general smokers in the population.

This study certainly points the need for a similar survey to be conducted among a representative sample of smokers who try electronic cigarettes but fail to quit (i.e., a large, representative sample of dual users). However, the preliminary data from this study suggest that the use of e-cigarettes by adult smokers should be viewed as an integral part of an overall plan to quit smoking and improve one’s health. And vaping appears to be helping smokers achieve both.

Lung Cancer Science International reluctantly follow the crowd and advocate sensible policy on Snus and E-cig

After the 16th conference by IASLC (International Association for the Study on Lung Cancer, September 2015 in Boulder, Colorado) I give you some excerpts from the Tobacco Policy Document. I am quite certain that the first excerpt below very succinctly describes and also quantifies the immediate and urgent need to realign world tobacco policy on e-cigarettes and food grade smokeless products simultaneously.

Not doing so and focusing only on e-cigarettes will undoubtedly be suboptimal to addressing the issue in LMIC (Low and Middle Income Countries) who represent both the growth of smoking, and the rapid growth of Lung Cancer incidence.

“Worldwide, lung cancer is the leading cause of cancer death. While the epidemic of cigarette induced lung cancers is now beginning to subside (particularly in men) in many high income countries as cigarette consumption has fallen, worldwide lung cancer deaths are projected to increase in the coming decades as smoking rates increase in low and middle income countries (1, 2). The projected global epidemic of cigarette caused lung cancers is entirely preventable.”

“Adopt policy measures that recognize the probable differences in the lung cancer risk of alternative nicotine delivery products. Adopting policies that favor less dangerous (non- combustible) forms of nicotine delivery over cigarettes would provide a powerful incentive for people who smoke to move away from cigarettes which in turn would have a profound impact on global lung cancer rates in the coming decades.”

“Join together to forcefully implement the World Health Organization’s Framework Convention on Tobacco Control which has among its key provisions increasing cigarette prices via taxation (to at least 70% of the retail price), prohibiting the sale of cigarettes to minors (less than 21 years of age) , enacting and enforcing comprehensive cigarette marketing policies, eliminating tobacco use in public locations, mandating graphic warnings labels on cigarette containers, implementing public education campaigns to discourage the use of cigarettes, and providing tobacco cessation support.”

Media exchange between myself and Swedish Public Health August 21st – Sept 3rd 2015

Dear Reader, finally a reply from Swedish Public Health on my snus Op-Ed article in Sweden’s largest daily. My response to their response is on top, the best known tobacco researcher in Sweden who was kind enough to reply is in the middle, and finally on the end is my initial article from august that really started the nationwide debate in Sweden. What do you think?

Atakan Befrits: Snus is not a cure, but one of the best cigarette alternatives available – Published: September 2, 2015

http://asikt.dn.se/asikt/debatt/snus-ar-inte-ett-allvarligt-folkhalsoproblem/snus-ar-inte-ett-botemedel-men-ett-av-de-basta-cigarettalternativen-som-finns/

If the Swedish Public Health Agency and the National Board of Public Health both advise the FDA not to allow removal of the cancer warning on Swedish snus, even though it was done in Sweden already 2001, that can hardly be considered to be proper, honest or objective, can it?

If India, referring to Sweden and WHO, creates several million new smokers by banning all types of snus, have they then really understood the situation in Sweden with regards to snus and harms from snus?

Professor Gilljam, thanks for the important and illuminating answers to my opinion article, the answer is very much appreciated and does you honor!

As I see it You do not refute one single critical point in my article, and only confirm what I wanted to highlight, that snus is not a serious public health problem in Sweden, and has never been one.

You mention snus in terms that in the current form, has been around for only 16-17 years and that this is not sufficient to rule out any risks associated with snus. This is not true!

Modern pouch snus with a tenfold higher levels of tobacco-specific nitrosamines, compared with current snus, made it’s entry in the Swedish offices around 1980. So we have quite enough ex-smokers (and exclusive snus users) who have used snus for far longer than 35 years, with no measurable severe damage, more than sufficient to rule out serious adverse health effects. The value in terms of public health and individual health benefits, for Sweden as a country for the individuals, cannot be distinguished from if they quit entirely or never began in the first place (always the best option, of course). Furthermore snus in general, as it is produced and used in Sweden, has not given rise to measurable severe adverse health effects in over 100 years. The Swedish Medical Journal magazine’s paper archives (1904-1995) for example, do not even have the world “snus” indexed, but of course it has hundreds of articles on the harmful effects of smoking.

You mention in your reply that Sweden cannot advocate a harmful product. I agree with you completely. Sweden should not advocate snus internationally in any other respect than that it has played an important role in the Swedish smoking, that is lower than any other EU country, without relevant measurable serious injury. So just completely objectively state established facts in a relevant context, basically just tell the truth, and then let the other countries / people make their own health calculations.

I hope that snus can play an important role in the world as a damage-minimizing tobacco product, but without giving rise to large groups snus users who would otherwise never have used tobacco. If it should prove unavoidable that there are young people internationally who start using snus anyway, one may assume that many of them would otherwise have started to smoke, so even then, snus is distinctly positive to public health. Not so good for Tobacco End Game of course, but infinitely better than if they were to start smoking, right?

You mention in your reply that because of aesthetic and cultural reasons snus has no place outside Sweden (what about Norway, USA, Canada?).

Are over 1 billion smokers practitioners of an aesthetics culture? Moreover also, without foreign influences?

300 million people worldwide are using extremely dangerous forms of smokeless formulations(very very dangerous snus, simply put), in their case it is definitely a question of a local cultural expression, compared with Sweden’s about 1 million snus users.

Therefore I simply cannot see any relevance in the comments about the aesthetics and culture. Women do not like to use snus because it is it’s ugly, true. Women might think it was worth it anyway, if they knew that snus is almost just as good as to stop completely with tobacco/nicotine? Accurate information in a relevant context certainly makes my decisions easier to make, do you agree?

Have we not reason to, even a responsibility to, be open with the information that the way we produce our snus in little Sweden, renders the product virtually harmless? That could hardly be considered advocating snus, or could it?

Finally: Well, Sweden does torpedo snus internationally, as much as we can, and all the time. Both actively and passively. Actively through international letters and studies that are taken completely out of the relevant context, and that definitely does not fit other nation’s contexts where hundreds of thousands die each year of smoking and poorly manufactured smokeless tobacco. Passively we torpedo snus internationally through not ever correcting completely erroneous and often malicious conclusions drawn from “Swedish quality research”. This erroneous conclusions, citing Swedish science, then start a new life as “scientific facts from Sweden”, since no one objects.

India has, with main reference to Sweden and WHO, totally banned smokeless tobacco affecting 200 million users! Instead of introducing quality standards equivalent to the Swedish ones, or for that matter the standards suggested by the WHO in it’s Technical Report 955, India blanket banned smokeless instead.

The total ban in India of course makes improvement, taxation and quality control totally impossible. What is infinitely worse, the tax losses from the now banned smokeless tobacco in India is replaced by increased sales of cigarettes, through tax cuts on combustible tobacco.

Professor Hans Gilljam: The cigarette is lethal – but snus is not the cure! – Published: September 1, 2015

The headline sums up my response to Atakan Befrits post “Snus is not a serious public health problem” in which he argues that the Swedish authorities back-stab snus without justification and that this puts obstacles in the way of snus’ deserved global sales opportunities.

Befrits is quite right regarding combustible tobacco, read “the cigarette”, the cigarette is the “Number 1” that has killed more people than all wars and epidemics combined the past 100 years, and the situation is only getting worse.

However, a full 50-year follow-up of chronic smokers was required to understand the extent of the catastrophe. Modern Swedish snus has only been around for 16-17 years, so it will be some time before we know everything about the harm from snus.

I share Befrits view that snus must be far less harmful than cigarettes, but suggesting that Swedish authorities should actively advocate snus internationally is going too far. New research shows that snus causes risks such as cardiovascular disease. Research also shows that traditional Swedish snus is culturally/aesthetically repugnant to many, and therefore snus is not a relevant product internationally.

I argue that the “Tobacco Endgame – Smoke free Sweden 2025” (www.tobaksfakta.se) is a better option to reduce tobacco-related mortality than to peddle snus internationally, a product that few outside Sweden even want.

Atakan Befrits: Snus is not a serious public health problem – Published: august 21, 2015

It is time for Karolinska Institute (KI), the Public Health Agency and the National Board of Health in Sweden to do the right thing and explain how stumblingly near zero the harm from snus actually is in Sweden. They should then refer and recommend that adult consumers make their own informed decisions.

Sweden has a unique responsibility to the world to rectify a 40-year old mistake and potentially save hundreds of millions of lives. It is not the tobacco itself, or the nicotine, that kills. It is the combustion gasses from tobacco smoking, or poor quality tobacco mixed with other dangerous carcinogens, which kill and destroy health.

According to the WHO, one billion people this century will die from smoking given the current developments. Broad international knowledge that a 99% less hazardous tobacco use is quite possible, inexpensive, and furthermore proven in Sweden since 100 years. Snus has every potential to save hundreds of millions of lives worldwide.

Is it then reasonable that Sweden, nationally and especially internationally, continues to push the line that snus is a serious public health problem, when it patently clearly is not?

Would it not be better to cooperate with our public health authorities to maximize the benefits we can realize from snus (e-cigarette) to smokers, while minimizing the use of snus (e-cigarette) among those who otherwise would never have initiated tobacco or nicotine use?

The Swedish government in June 2013 ordered an investigation to be done by the National Board of Health, the Public Health Agency and the Karolinska, to present to the government the total cost and harms to health of total tobacco consumption in Sweden. The report from the National Board could not show a single data point as evidence that snus is a serious public health problem, but clearly showed that about 12,000 die from smoking each year in Sweden. Can anyone draw any other conclusion from that, other than that the harms from snus are below relevant measurable levels in terms of public health?

  • Snus in Sweden used by 300,000 people for not smoking, it saves about 3,589 lives a year and causes up to 11 cases of cancer overall (Wickholm 2005)
  • Snus in Sweden used by 700,000 people who have never smoked, as a mild stimulant and addictive pleasure product, that results in no more than 24 cases of cancer per year, according to a Swedish study from 2005 (Wickholm)
  • The total maximum of 35 cases of cancer a year (if any at all), have for a hundred years not caught any attention from healthcare, and harm from snus is thus so low that it is not meaningful to measure (National Board of Health 2014)
  • If all of Sweden (ten million) took snus daily and nobody smoked, we would have about 12,000 fewer deaths from smoking in Sweden each year, while the snus use would cause a total maximum of 350 cases of cancer per year and no other measurable serious adverse health effects
  • Cancer warnings were removed from snus in Sweden in 2001, since not even the 35 (possible) cases of cancer per million user years mentioned above, could be verified with evidence-based science according to the European Union
  • The Public Health Agency of Sweden has actively (2015) sought to influence the FDA to not allow the removal of the cancer warning on Swedish snus sold there
  • Reduction in risk of continued tobacco use if one switches from cigarettes to snus use is 99.7% according to the figures above
  • A lifetime of snus use causes substantially lower risks than only 3 months of smoking or continued smoking does

So, snus is not harmless, but definitely not a serious “public health problem”.

Center of Public Health USA disseminates gross untruths, and won’t reply to critique

Dear Reader of this LinkedIn blog,

I hope you will believe me when I say that I try to give the benefit of the doubt, and give room for error and correction. After several attempts and reminders to get a response to a vital and lifesaving question for millions of Americans and over a Billion worldwide, I have decided to publish my letter to the NIH internal newsletter. The Newsletter should by all counts have 5,000 recipients directly employed by NIH, quite probably another 5,000 PostGrad researchers who are Intramural at NIH, and finally information from the Newsletter disseminating to another staggering 325,000 Extramural researchers funded by the NIH.

Please read below and I hope you will agree with me that it is respectful, reasonable and generally not very tinfoil hat. No response.

(Hear find link to article on Tobacco Harm Reduction in Sweden’s biggest newspaper by myself: www.linkedin.com/pulse/article/calling-out-public-health-sweden-truth-snus-atakan-befrits)

Dear Mr McManus and colleagues,

My name is Atakan Befrits and I work with Tobacco Harm Reduction advocacy focussing on the Middle East, Asia and Africa regions.

I am writing to you in response to a somewhat unfortunate report in your internal newsletter published July 17th.

I am certain that the report in question was an accurate account of a lecture held by a NIH funded scientist on NIH campus, the statements in it are certainly all hallmarks of Professor Stanton Glantz’s usual lecture commentary on electronic cigarettes in particular and Tobacco Harm Reduction in general.

The reason the report in NIH Records is unfortunate is precisely that it is just that, commentary. Extensive and conclusive commentary derived from conclusions drawn on scant, non existent, or even contrary findings in the actual research, much of which is funded by the NIH.

I scanned the other articles in the issue of The Record, which is freely available online for anyone to read. The other articles that I was reasonably able to form an opinion regarding, seemed accurate enough and penned for easy reading, also by non expert readers.

I therefore gather that the articles are intended for a wide readership, also by non experts in the specific field covered, who work within NIH.

By default, intentionally or unintentionally, there is a tremendous element of influence through this newsletter as a channel, and this influence surely reaches far and wide through the NIH grapevine.

NIH intramurally and extramurally is one of the largest research organizations on the planet and carries immense weight and influence.

Smoking is the biggest avoidable cause of death on the planet and is expected to prematurely kill one billion human beings this century, given the current trends.

Given the two sets of circumstances stated above, the NIH more than any other organization except possibly the WHO, absolutely has to get it right.

Yet in the 17th of July 2015 issue you publish an accurate report of an on campus lecture given by the (arguably) most heavily biased “Tobacco Control” researcher and anti-nicotine advocate in the USA.

Defending the publication with an argument like for example: “It is simply a report from an on campus lecture” (a very real reply from NIH to critique by another renowned voice in the field), would immediately bring on the question if the lecture by Professor Glantz was not very ill-advised in the first place.

May I be so bold as to ask who at NIH invited Professor Glantz to hold the lecture? I am curious if the lecture was pre-screened or if the content was well known in advance and sanctioned?

For your information please find enclosed an open to letter to WHO Director General Mrs. Dr. Margaret Chan from early 2014. The letter is signed by 53 Public Health experts coming from many different specialities. Together they represent some 1,325 person years of tobacco cessation and tobacco control research and advocacy.

They with one voice loudly and clearly say that Professor Glantz view on “Tobacco Control” and “Tobacco Harm Reduction” is wrong, deadly, counterproductive and based in ideology instead of evidence and/or observation.

Thank you very much in advance for your kind attention and reply

With my best regards and respect for the important work carried out by the NIH personnel and affiliated researchers.

Atakan Befrits
Tobacco Harm Reduction Advocate
Northern Cyprus

Calling out Public Health Sweden for the truth on snus, august 21st 2015

English translation of Op-Ed in Sweden’s biggest newspaper this morning, probably my only 15 minutes in the limelight:

http://asikt.dn.se/asikt/debatt/snus-ar-inte-ett-allvarligt-folkhalsoproblem/

English translation:

It is time for Karolinska Institute (KI), the Public Health Agency and the National Board of Health in Sweden to do the right thing and explain how stumblingly near zero the harm from snus actually is in Sweden. They should then refer and recommend that adult consumers make their own informed decisions.

Sweden has a unique responsibility to the world to rectify a 40-year old mistake and potentially save hundreds of millions of lives. It is not the tobacco itself, or the nicotine, that kills. It is the combustion gasses from tobacco smoking, or poor quality tobacco mixed with other dangerous carcinogens, which kill and destroy health.

According to the WHO, one billion people this century will die from smoking given the current developments. Broad international knowledge that a 99% less hazardous tobacco use is quite possible, inexpensive, and furthermore proven in Sweden since 100 years. Snus has every potential to save hundreds of millions of lives worldwide.

Is it then reasonable that Sweden, nationally and especially internationally, continues to push the line that snus is a serious public health problem, when it patently clearly is not?

Would it not be better to cooperate with our public health authorities to maximize the benefits we can realize from snus (e-cigarette) to smokers, while minimizing the use of snus (e-cigarette) among those who otherwise would never have initiated tobacco or nicotine use?

The Swedish government in June 2013 ordered an investigation to be done by the National Board of Health, the Public Health Agency and the Karolinska, to present to the government the total cost and harms to health of total tobacco consumption in Sweden. The report from the National Board could not show a single data point as evidence that snus is a serious public health problem, but clearly showed that about 12,000 die from smoking each year in Sweden. Can anyone draw any other conclusion from that, other than that the harms from snus are below relevant measurable levels in terms of public health?

• Snus in Sweden used by 300,000 people for not smoking, it saves about 3,589 lives a year and causes up to 11 cases of cancer overall (Wickholm 2005)

• Snus in Sweden used by 700,000 people who have never smoked, as a mild stimulant and addictive pleasure product, that results in no more than 24 cases of cancer per year, according to a Swedish study from 2005 (Wickholm)

• The total maximum of 35 cases of cancer a year (if any at all), have for a hundred years not caught any attention from healthcare, and harm from snus is thus so low that it is not meaningful to measure (National Board of Health 2014)

• If all of Sweden (ten million) took snus daily and nobody smoked, we would have about 12,000 fewer deaths from smoking in Sweden each year, while the snus use would cause a total maximum of 350 cases of cancer per year and no other measurable serious adverse health effects

• Cancer warnings were removed from snus in Sweden in 2001, since not even the 35 (possible) cases of cancer per million user years mentioned above, could be verified with evidence-based science according to the European Union

• The Public Health Agency of Sweden has actively (2015) sought to influence the FDA to not allow the removal of the cancer warning on Swedish snus sold there

• Reduction in risk of continued tobacco use if one switches from cigarettes to snus use is 99.7% according to the figures above

• A lifetime of snus use causes substantially lower risks than only 3 months of smoking or continued smoking does

So, snus is not harmless, but definitely not a serious “public health problem”.

Author
Atakan Befrits​

FDA (And the EU) want to kill E-cig (and thereby people) but the UK say they are fantastic!

In a comment to the FDA on their work to ultimately regulate e-cig totally out of business for any actor not Pharma or Transnational Tobacco or other International FMCG enterprise like Nestlé or similar. Simply by making the FDA process so onerous, time consuming and uncertain that only companies with a couple of million dollars in pocket change per every 6 months or so will ever have a chance. Especially so since any problem will mean sunk money and lost months of vital revenue. Completely unnecessary deeming regulations will be put in place instead of reasonable consumer protection and child protection measures like with other products, um yeah, like cigarettes for example.

This is pretty much what I wrote to them in a comment:

I am commenting on ANPRM “Nicotine Exposure Warnings and Child-Resistant Packaging for Liquid Nicotine, Nicotine-Containing E-Liquid(s), and Other Tobacco Products” (Docket No. FDA-2015-N-1514)

August 18th, 2015

Dear FDA,

My name is Atakan Befrits and I am a THR consumer and advocate (Snus and vaping products with high nicotine concentrations). I fully support tamper and child resistant packaging and reasonable and appropriate warning labels, reasonable requirements that will not prove overly onerous or prohibitively difficult to include unless the FDA make them so.

I strongly object to any form of overly ambitious regimens for producers, to satisfy requirements from the FDA, that serve no practical purpose for consumer protection. The current proposed deeming regulations serve no such practical purpose for consumer protection but serve well to protect both smoking and protecting large industrial actors (such as the Tobacco Industry) if and when they chose to intensify their efforts in sales of reduced harm consumer nicotine products. I am, smoke-free thanks to snus (before e-cig were invented) and also with a lot of pleasure and very little harm from occasionally using e-cig. This does not make me more prone to relapsing to smoking cigarettes, it makes me less prone to do so.

I have hundreds if not thousands of instances of inadvertantly swallowing entire pouches of snus and also spilling e-liquid in larger amounts on my skin or splattering in my eyes without any other effects than slight discomfort. Furthermore I would like to add that in the 70’s my mother rushed me to the hospital no less than 4 times to get my stomach pumped after eating cigarettes or cigarette butts. It is now perfectly clear that these instances were completely unnecessary traumas for me, since overdose of nicotine would have induced vomiting and solved the problem. Not unlike most other forms of food poisoning or accidental ingestion, but not applicable to most of the very easily accessible household chemicals causing countless hospitalizations and several (too many) child fatalities every year.

All of the refills and snus products that i buy are already in child resistant packaging and with clear +18 warnings and produced according to food grade standards or GMP.

I keep all my tobacco out of reach for my 2.5 year old. Her access to bleach, detergent, kitchen knives, table top sharp edges and about a million other hazards are infinitely more accessible to her than my nicotine products.

If there will come overly ambitious warnings or claims on e-liquid or smokeless products it would make me angry and less likely to ever trust other information that comes from the FDA. I know quite a bit about who wants what in terms of e-liquid and other nicotine products. From the end result I will therefore also know who was most successful in “swaying” the sentiments of the FDA in any particular direction. Any deviation from a science and evidence based center position by the FDA will be completely evident, including an unwarranted “precautionary principle” direction. FDA knows more about nicotine and nicotine containing products than most other consumer products and there simply is nothing left to be very afraid of, therefore very little need of further precaution.

Simple science based regulations empowering consumers to exercise tobacco harm reductions while protecting children and never users is quite sufficient. No more and no less!

I am a member of CASAA as well as internationally active in the Tobacco Harm Reduction field globally, with a special focus on the Middle East, Asia and Africa regions.

I would like to point out to the FDA that too onerous regulations in the USA will, without any doubt whatsoever as it is already happening, send signals to the rest of the world that Low Risk Nicotine products are actually HIGHER in risk compared to conventional cigarettes. The amount of regulation and the amount of paperwork required in the USA in their eyes reflect the amount of risk with the product.

Too high demands and too onerous processes by the FDA will be quite detrimental to US consumers, and will have the unintended consequence of inadvertently causing hundreds of millions of deaths outside the USA this century through protecting cigarettes from low risk competition. Exactly the opposite of what we all strive for.

The FDA and the EU SANCO and the WHO are the world’s largest net exporters of Health Policy. It is therefore absolutely imperative that also the “bigger picture” implications are factored in when deciding on policy, simply looking at the USA exclusively, although correct in principle, would be to grossly underestimate the impact FDA policy has on Health Policy in LMIC countries globally.

Thank you very much for your consideration,

Atakan Befrits

Turkey/Northern Cyprus

Swedish Public Health lying to the FDA

Very short post:

An EU ruling removed the Cancer warning labels from Swedish Snus in Sweden in 2001. The warning on all snus now reads:

Snus may be harmful to your health and is addictive

Duuuhh! Snus is a tobacco product containing nicotine, so it is both addictive and probably not the best lifestyle choice if you can avoid it! That is not rocket science,  but all in all this is a fair warning without too much scaremongering.

Why on earth would the Swedish Public Health Agency feel a responsibility to, uninvited, write an official statement to the FDA in the USA warning them not to allow cancer warnings removal and a change to warnings in the USA on snus made in Sweden by Swedish companies, making them more similar to the warnings on Snus in Sweden? If snus causes cancer, shouldn’t they concentrate on challenging the EU ruling and have the Cancer warnings re-instated also in Sweden?

Sweden has 50% snus use, of total tobacco, without registering one single fatality from snus use in over 100 years. At the same time Sweden (Yeah, same agency) know that we have almost 12,000 fatalities per year from smoking, a number that would be 24,000 if all the snus users in Sweden smoked instead. Conversely Sweden would have ZERO tobacco related fatalities per year if all the smokers used snus instead.

This is something so bad that the Swedish Public Health Agency feels compelled to warn the FDA against the dangers of reasonable and proportionate warnings on snus and removing the cancer warning?

Oh, by the way, I do write lying in the headline. This is a long long dream of mine to actually manage to get dragged in to court. The really good thing about going to court is that you get to present evidence. Hence the removal of the Cancer warnings in Sweden in 2001. Sad to say though, it seems none of the agencies or NGO’s in Sweden seem to like the idea of meeting the THR scientists in court, so they just quietly allow me to verbally abuse them instead. That’s fun too of course, but it is not my goal.

Check out this bonanza of junk science:

The truth on Dalligate, as told to Politio.eu

G’morning,

You seem to have gotten the Dalli affair a bit backwards (as has everyone else too, so don’t feel bad about it).

He had this enclosed letter from the non affiliated Tobacco Harm Reduction pros around the world a full year before the scandal broke.

Dalli it seems (or whoever it actually was), was trying to make a nice buck by doing the right thing (that should have been done anyway based on the science) at the same time.

The tobacco industry (Swedish Match, a history first?) did the right thing and blew the whistle on this, and got punished pretty brutally for it with a continued “snus” ban.

Resulting loss of life in the EU using Norwegian “snus” adoption rates = 140,000 fatalities per year.

Cheerio

Atakan Befrits

(Quite potentially Dalli (or whoever it was) was planning this “Regulatory Racketeering” all along. I can prove that “government replies” in the Public Consultation on the TPD2 in 2010 that gave 89,000 responses compared to the normal 500 was doctored. 462 Government replies came from all over Europe. 62.5% were in favor of lifting the “snus” ban and another 17.5% were neutral to lifting or keeping the ban. Only 20% were in favor of keeping the ban. 

That is a whopping 80% in favor of, or neutral to, lifting the ban on “snus” in the EU. Answers also specifically supplied by actual Government people working with public health, and not those working with the politics surrounding public health.

These answers were all disqualified by Dalli and DG-SANCO and instead each country was officially asked for 1 (one) country view on “snus” with the predictable result that all were negative to lifting the ban.

DG-SANCO also leaked false information to Swedish Anti-Nicotine lobbyists a full 6 months prior to any information becoming public. Anti-Nicotine lobby in Sweden used this information to silence Swedish media by implying that the entire EU was so strongly against lifting the ban on “snus” that Swedish media would only look like complete idiots if they pursued the matter any further. I have proof of the leaks and of course letters from DG-SANCO denying any leakage)

Please find the letter below in full text:

2011-05-31

To:

Mr. John Dalli,

European Commissioner for Health and Consumer Protection

European Commission

B-1049Brussels,Belgium

Copy to:

Michel Barnier, European Commissioner for Internal Market and Services,

José Manuel Barroso, President of the European Commission

Máire Geoghegan-Quinn, European Commissioner for Research and Innovation

Marianne Klingbeil, Deputy Secretary General, Secretariat General, European Commission

Cecilia Malmström, European Commissioner for Home Affairs

Antonio Tajani, Vice- President of the European Commission

 

The advancement of the scientific basis for the EU Tobacco Products Directive

Sir,

As a group of scientists whose research is targeted towards minimizing tobacco-induced diseases we very much welcome your statements that a tougher stance is needed on smoking as a major health threat. We are convinced that the current revision of the EU Tobacco Products Directive can strengthen the effectiveness of the directive to ensure a high level of health protection. But, we are also aware that an optimal result cannot be achieved unless particular attention is given to the advancement of the scientific basis.

We have noticed that the ongoing general discussion around the revision contains various examples of suggestions that are not completely in line with latest scientific evidence. Therefore we would like to highlight both some corner-stones of tobacco science and some recent advances that would constitute essential parts of an appropriate scientific basis for the revision.

From a scientific perspective the provisions of the Tobacco Products Directive should take into account that different tobacco and other nicotine delivery products vary substantially in their health risk and addictiveness. Nicotine is an addictive substance but plays a minor role in causation of tobacco-induced diseases which are mainly caused by the combustion products that accompany the nicotine in tobacco smoke. Consequently, combusted tobacco products represent the most risky nicotine products and non-combusted products are lower in risk. Among the non-combusted nicotine products there is also a wide spectrum of health risk, ranging from highly toxic South-East Asian and Sudanese tobacco products to American snuff, Swedish Snus and non-tobacco nicotine products.

The most logical kind of tobacco product regulation for health protection would be to ban all combusted products and subject combustion-free tobacco/nicotine products to strict regulation according to risk level. An immediate ban of cigarettes and other combusted tobacco products is not feasible, but the possibility of successively phasing out these products over the long term deserves consideration. In the short term, establishing a regulatory framework for all tobacco products is much more feasible and could assist the eventual phasing out of combustible tobacco (Royal College of Physicians, 2008; Le Houezec et al., 2011). Proposals for the design of such regulation are readily available in the third report of the WHO study group on tobacco product regulation (WHO, 2009).

The WHO Framework Convention on Tobacco Control, FCTC, points out (in Article 1) that tobacco control means a range of supply, demand and harm reduction strategies. The “harm reduction strategies” deserve particular attention here, since there is evidence suggesting that such strategies can yield substantial health benefits in tobacco control, if smokers are encouraged to use less harmful nicotine products in appropriate ways (Royal College of Physicians, 2007; European Monitoring Centre for Drugs and Drug Addiction, 2010). The products with the greatest potential for use in tobacco harm reduction are non-tobacco nicotine products and low-toxicity combustion-free tobacco, such as Swedish Snus. It has been estimated that for total mortality, the median relative risks for individual users of such products were 9% and 5% of the risk associated with smoking for those aged 35 to 49 and ≥50 years, respectively (Levy et al., 2004). Another study has elucidated comparative health risks by calculating the shortening of life expectancy due to different patterns of tobacco use. Those who after quitting smoking use snus are estimated to have almost equally small shortening of life expectancy as those who quit all nicotine use (Gartner et al., 2007). There are no corresponding data for non-tobacco nicotine products, but it could be assumed that their effects are similar.

It should further be noticed that switching to a combustion-free tobacco/nicotine product may also be a stepping-stone to subsequent nicotine-free status so as illustrated by analyses of snus use in Sweden(Ramström & Wikmans, 2011).

All disease-specific health risks are much smaller for low-toxicity combustion-free tobacco/nicotine products than for cigarettes. “Complete substitution of STP for tobacco smoking would thus ultimately prevent nearly all deaths from respiratory disease currently caused by smoking, which in total represent nearly half of all deaths caused by smoking.” (SCENIHR 2008; p. 113). “It is therefore reasonable to draw a conservative conclusion that substitution of smoking by snus use would, in due course, reduce the cardiovascular mortality that currently arises from tobacco use by at least 50%.” (SCENIHR 2008, p. 114). As far as oral cancer is concerned combustion-free tobacco/nicotine products from South-East Asia andSudan, incur serious risk, while no such association has been found for Swedish snus (Luo et al., 2007). Some earlier studies suggested a possible association between snus and pancreatic cancer (although weaker than the association with smoking). However, the most recently published study, co-authored by one of the authors of the old study, is now rejecting the older conclusions (Bertuccio et al., 2011).

Evidence from Sweden has been summarized by saying: “In Sweden, the availability and use by men of an oral tobacco product called snus, one of the less hazardous smokeless tobacco products, is widely recognised to have contributed to the low prevalence of smoking in Swedish men and consequent low rates of lung cancer.” (Royal College of Physicians, 2008; p. 4), or, “Thus in Sweden, where there has apparently been substantial transfer from smoking to snus, the availability of snus may have been beneficial to public health.” (SCENIHR, 2008; p. 117). A recently published study has further illustrated how the use of snus inSweden has contributed to the decline of smoking in the 1990s (Stenbeck et al., 2009).

Low-toxicity combustion-free tobacco/nicotine products may be beneficial for public health by serving as smoking cessation aids that are easily available for large scale unassisted smoking cessation in the real world outside clinical settings. This is the context in which smoking cessation plays its major role as a public health tool (Chapman & MacKenzie , 2010). Some Swedish studies suggest that Snus may be the most effective aid for self-help quitters and among men the most commonly used one (Ramström & Foulds, 2006; Ramström & Wikmans, 2011). Recent studies inNorwayequally found that quit attempts with snus have yielded a higher success rate than other methods thereby demonstrating that the validity of the Swedish findings is not limited toSwedenwith its specific traditions (Lund et al., 2010; Lund et al., 2011). The combination of high usage and high efficacy that has consistently been found in the Scandinavian studies suggest a high level of efficiency of low-toxicity combustion-free tobacco products as smoking cessation aids in unassisted smoking cessation in the real world. Further, a recent short term randomized study found that Camel snus produces abstinence rates at least equivalent to 4 mg nicotine gum (Kotlyar et al., 2011).

In the discussions regarding public health aspects there have been concerns that there could be a risk of unintended negative side-effects. For example, products like snus might be a gateway to subsequent initiation of smoking in non-smoking adolescents. However, several studies have found that this has not occurred inSweden(Furberg et al., 2005; Ramström & Foulds, 2006; Galanti et al., 2008). Most but not all corresponding studies in the US show results consistent with the Swedish findings in that they do not show that youth smokeless use causes an increased subsequent use of smoked tobacco (O’Connor et al., 2005; Timberlake et al., 2009). There are also concerns that dual use of cigarettes and combustion-free tobacco might weaken the motivation to quit smoking or that switching from cigarettes to snus might strengthen nicotine dependence. However, recently published studies have not found support for these concerns (Frost-Pineda et al., 2010; Ramström & Wikmans, 2011). The risk of all these potential negative consequences could also be minimised through appropriate regulation of all tobacco products.

We have a vision of a tobacco-free society, but along the road towards that goal we must help minimise the health burden of remaining tobacco use through appropriate regulation of all tobacco/nicotine products based on their level of health risk. We hope that the revised EU Tobacco Products Directive will be an effective part of such efforts.

Yours sincerely,

Tony Axell, Senior Consultant, Dept. of Maxillofacial Surgery, Halland Hospital Halmstad, Halmstad, Sweden.

Ron Borland, Professor, The Cancer Council Victoria, Australia.

John Britton, Professor of Epidemiology, University of Nottingham. UK.

Karl Fagerström, Principal Investigator, Fagerström Consulting, Helsingborg, Sweden.

Jonathan Foulds , Professor of Public Health Sciences & Psychiatry, Penn State University, College of Medicine Cancer Institute, Cancer Control Program. Hershey, PA, USA.

Coral Gartner, Professor, The University of Queensland Centre for Clinical Research, Brisbane, Australia.

John Hughes, Professor, Dept of Psychiatry, University of Vermont, Burlington, VT, USA.

Martin Jarvis, Emeritus Professor of Health Psychology, University College, London. UK.

Lynn Kozlowski, Professor, School of Public Health and Health Professions, State University of New York.  NY, USA.

Michael Kunze, Univ.Prof., Institute of Social Medicine, ECDC (European Centre for Disease Prevention and Control), Centre of Public Health, Medical University Vienna, Austria.

Jacques Le Houezec, Consultant in Public Health, Tobacco dependence, Rennes, France

Karl E Lund, Research Director, Norwegian Institute for Alcohol and Drug Research, Oslo, Norway.

Ann McNeill, Professor of Health Policy & Promotion, University ofNottingham.UK.

Lars Ramström, Principal Investigator, Institute for Tobacco Studies,Stockholm,Sweden.

David SweanorAdjunct Professor, Faculty of Law, University of Ottawa, Canada.

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