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:

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”.

Atakan Befrits​


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