Virtually harmless tobacco
Wouldn’t that be great? A tobacco product class that through meticulous choice of minimum harm tobaccos and processed with Food Grade technology and Food Grade additives, actually turns out as a Food Grade product?
Pasta, Kimchi, Pickles, Bacon, Processed meats (including “halal” and “kosher” processed meats) are not perfect or totally harmless products, but definitely stuff you can’t, or don’t want to, go without.
What if there was a tobacco product, satisfying and attractive to smokers, no more dangerous than that, wouldn’t that be great?
Well, there is one. Well, nowadays actually 2, I would include high quality vaping products on the list too. The one I am referring to in this post has been around for over 200 years, practically unchanged. The one I am talking about was even classified under the Food Act already in 1971, 44 years ago!
What could possibly create a political and scientific environment where a product that will erase risk and harm is hidden, demonized, ostracized and even gets it’s global life saving capability severely restricted through government sanctioned activities that make future exports near impossible?
The only rational explanation I can think of is vested interests and prestige, coupled with a total case of “Regulatory Capture”.
Below please find a rather sad Christmas story of a country acting like Uncle Scrooge:
“100 years of monitored +10% snus use without serious health consequences is definitely proof of no (or unmeasurably low) harm”
The important and widely used old maxim of “no proof of harm doesn’t mean proof of no harm” can confidently be disqualified in relation to Swedish “snus”. I it however a favourite among anti-nicotine zealots globally, nowhere more so than in Sweden.
What could possibly fundamentally refute the claim that “no proof of harm doesn’t mean proof of no harm” in regards to a certain, closely measured and monitored, product?
Time, that is what. Time!
The maxim is perfectly valid on new products and chemicals entering the market.
It is not applicable however, to a product with over 100 years of monitored use history and product improvement, without any measurable harm, because this is a different beast altogether. Especially so if the product has the capability of switching millions and millions of smokers away from lethal cigarettes.
In fact, this is an altogether benign and useful beast that should be embraced and promoted, a harm reducing beast that only Uncle Scrooges and Abolitionists would even consider trying to ban.
The information, documentation and translations linked to and explained in this post are for the purpose of giving you, the reader, an accurate account of what is and is not known about snus in Sweden. From this post I hope you will find at least something from which to extrapolate also to vaping. I also hope that you will find some useful information that you can use to influence the “Harm Reduction” regulatory framework in your country/context.
The second purpose of this paper to clearly show that ample evidence of safety and efficacy of snus for not smoking, or instead of smoking, (and as a standalone pleasure product), has been present for an extremely long time.
The third purpose is to show that “Tobacco Control” in Sweden deliberately keeps this information from the public and from the government in order to further it’s own agenda, nationally and internationally.
The first, last and most poignant piece of evidence to establish this as fact is that for the first time in history (summer 2015): The Public Health Community and the Transnational Tobacco Industry is perfectly aligned:
Snus products must be suppressed at all costs!
Does not the fact that the cigarette industry and the Public Health communities totally agree on snus, set off about one hundred million warning klaxons sounding in total disharmony?
This going unnoticed or undiscussed is totally unacceptable and is in part responsible for millions of avoidable smoker deaths per year globally.
Potentially hundreds of millions of avoidable smoker deaths this century.
Snus in Sweden has a market share of roughly 50% of all tobacco consumed and has ZERO registered (clinical) serious adverse health effects in over 100 years.
The market share for snus was close to 90% at the start of the 20th century and dropped to a bit over 10% daily adult male use during the extreme cigarette smoking period 1940-1980. Since the beginning of the 1970’s there has been a sharp and steady increase in snus use again, an increase that has coincided with lower smoking rates, now among the lowest in the western world.
At no point in the last century has daily snus use ever been below 10% of the adult male population in Sweden, yet there is not one single registered clinical notation of serious adverse health effects . ZIP!
Sweden is internationally recognized as a leader in Public Health work and also for excellent records keeping. This allows for high quality observational and statistical modelling, as well as excellent epidemiological study of phenomena and observations that impact individual and public health. This has been true since well before 1900, in effect more than 100 years. See translated document here Linked document 1
Tobacco and nicotine use is one of the most intensely studied harmful human habits for well over 60 years, very much so also in Sweden. It is unquestionable that smoking tobacco is very detrimental to health for all smokers and bystanders. Given the current lifespan in Sweden, lifelong smoking has a fatality rate of approximately 50%.
This article posits that IF snus use caused any measurable and discernible serious adverse health effects in healthy human beings, then due to the weight of sheer numbers and the sex difference in usage, >90 men <10 women in Sweden, these serious adverse health effect simply could not have gone unnoticed for over a century.
This paper also posits that if the above is true, then The Kingdom of Sweden (in actual fact Swedish “Tobacco Control”) has suppressed these obvious conclusions for over 40 years, for purely ideological and political reasons, and continues to do so also in 2015.
Excellent examples from 2015 of this work continuing are 2 letters to the FDA in the USA, warning them against the dangers of snus. See letters from Swedish Public Health trying to influence the FDA here: SWEDEN PHA 2015 FDA, and here SWEDEN NBPHW 2015 FDA.
Sweden has long argued that “snus” is a serious Public Health problem, despite that this is demonstrably the exact opposite of the objective truth.
International experts have long since proven this and alerted Swedish authorities, but without result.
In early 2013 a group of these international experts wrote an open letter to Mrs. Maria Larsson, then Swedish Minister of Public Health, urgently urging for an evidence based and observation based investigation on snus as a vital tool against the smoking epidemic. Please read the letter in perfect english here: Linked document 4.
A similar letter, signed by a further 47 international experts was also sent one year later to Mrs Margaret Chan of the WHO. Read this letter here: Linked document 5. To the best of my knowledge Director General of the WHO, Mrs Margaret Chan, found the letter crucial to recycle immediately, probably in order to save the rain forests.
Sweden was different. In a historical first, Minister Larsson and the Cabinet of Ministers in Sweden ordered a thorough investigation with the clear objective of providing best available numbers on ill health from tobacco use, all forms of tobacco use. By logic this needed to adequately quantify the harms from snus use. Please find original and translation here: Linked document 6. This order, and a relevant budget to perform it, was tasked to the National Board on Health and Welfare together with the Institute that awards the Nobel Prize in Medicine, The Karolinska Institute.
The problem it seems was that the same bodies who were tasked with quantifying the truth on harms from snus, are the exact same bodies with the most to lose from performing the job adequately. So they didn’t.
The resulting report was published in February 2014, the title referring only to harms from 50% of tobacco used in Sweden, cigarettes. These 50% are the same 50% that we already have almost perfect information on, namely cigarettes.
Basically the Government specifically asked for the truth on snus. Since that would be suicide for the “Quit-or-Die” movement, Tobacco Control resorted to specifically lying instead.
Bizarrely, a direct order from the Government to come clean resulted in Tobacco Control taking an even more polarized position on the issue of snus and Tobacco Harm Reduction. Digging in it’s proverbial heels to the point of arriving at a position from which it cannot ever hope to truthfully recover from, with any semblance of “grace” intact.
The “misnamed” report, published only in Swedish is called “Registry data on the harms from smoking”. This is hugely misleading as it totally omits to mention that the Registry data on the harms from snus use is ZERO. That the registry data on snus is ZERO is the only really relevant finding that should have been reported.
If you read Swedish or know someone who does, then the report in it’s entirety can be found here: Rökningens skadeverkningar
It is clear from the first page that no data on snus will be in the report. It is clear that this is in direct violation of the objective and directive from Government. There are certainly mentions of snus in the report, they are to 100%, unsubstantiated scaremongering; except for nicotine effects in pregnancy (no nicotine should be consumed during pregnancy).
Important publications from Swedish “Tobacco Control” are always published also in English and widely advertised and spread at conferences.
This report is published only in Swedish and also named in a way that I believe is intended to avoid archive searches for harms from snus. This report has never been seen again since the press conference.
The report’s findings that raised the levels of deaths from cigarettes to a whopping 12,000 per million user years however, is frequently used to argue for harsher measures on snus.
Considering the name of the report (that omits 50% of all tobacco) and the conspicuous absence of data on snus, although specifically asked for, the statistical level of serious adverse harm from 50% of tobacco use in Sweden (Snus) must be ZERO.
This has obviously been true also when Snus accounted for 90% of tobacco consumed, around 1910, as in 1910 harms would come almost exclusively from snus use.
In all likelihood the ill-health from “snus” use is slightly greater than ZERO, as with almost anything else one can come to think of. But logically so incredibly close to 0 so as to never have warranted any closer scrutiny.
Almost all forms of serious ill health that are exclusive to the female sex, even when very very rare, have been documented clinically, studied, and can be found in Swedish health records and statistics. The same is true for exclusively male ill health.
Looking at the last century it is therefore perfectly safe to say that any serious adverse health effects from snus use would have been noticeable and predominantly male, predominantly on par with prostate problems. This would certainly have been noticed, noted and studied.
Yet there is absolutely no trace in any records or databases. Nothing. The best calculation, and the only one ever to be published was by Seppo Wickholm and published in 2005. He calculates the maximum likely ill health from snus to 35 cases of cancer per million user years. Way way below detection levels. Please find a translation of the relevant bit here: Wickholm 0515 translation. If you would like to see it as it was published in 2005 in Swedish Journal of Dentistry and in the database of Karolinska Institute, then find that here: wickholm_0515
The information, or lack thereof, above is quite sufficient to make draw quite a few conclusions with a degree of certainty high enough to displace any concerns that would justify using “no proof of harm is not proof of no harm” or “the precautionary principle” in the way global experts working in “Tobacco Control” propose we continue doing.
- The available data, or lack of data, is not new, it is over 100 years old and continuous in over 10% of male population
- The available data does not support that snus/THR is completely harmless
- The available data does not support that snus/THR should ever be used by non users of tobacco/nicotine or use during pregnancy
- The available data does not support unregulated marketing, or the sales of THR products to persons under 18 years.
- The available data, or lack of data, is not new, it is over 100 years old and continuous in over 10% of male population
- The available data does support that THR products has been successfully used in very large numbers for no longer smoking and as standalone products without any measurable population level or individual harm
- The available data does support that large non smoking but tobacco using populations do exist without causing measurable population or individual level harm
- The data does support that instead of banning smokeless products, a product quality control and improvement strategy, is a better argument
- The available data does support that higher quit rates are possible through attractive and commercially available THR products, and will have few, if any, serious downsides
- The available data does support that blanket-banning smokeless/THR product could (but would’t) increase total numbers of individuals eventually successfully becoming tobacco-free, but at a prohibitively high cost in population level health terms, as well as individual ill-health and suffering and productivity losses
- The available data does support the idea that active support, responsible marketing, and incentivization (which has never been the case in Sweden either) and promotion for, switching from cigarettes to THR products, may have vastly better results, even than those seen in Sweden, with a documented minute risk of unwanted or negative consequences
- The available data does support the potential benefits of truthfully communicating the difference in relative risks and the risk continuum from use of different types of tobacco/nicotine products to smokers
- The available data does support that long term use of THR products differs little, if any difference at all, from long term use of NRT products that are licensed also for long term use and acknowledged to have negligible, if any, serious adverse side effects.
- The available data does support that THR product’s higher acceptance to smokers is a vital improvement over pharmaceutical alternatives, and THR products should be endorsed and supported to all smokers who have tried to quit and failed.
- The available data does support that the 6 Swedes who are smokeless with smokeless for every 1 Swede who is smokeless with NRT’s is makes “Tobacco Harm Reduction” by far the per capita best anti smoking intervention seen anywhere in the world as well as the best anti smoking intervention in absolute numbers.
- The available data does support that “Tobacco Harm Reduction” in the form of various attractive formats and formulations present the largest untapped (free for governments) anti smoking intervention globally.
For how long should we allow hidden or non available data, rule supreme over a vast body of actually available data?
When looking at the report by the Swedish Public Health authorities and the Karolinska Institute, they can with a very high level of confidence say that 100,000 new instances of smoking related disease occur every year in Sweden and almost 12,000 fatalities.
The calculations are based on actual diagnostics statistics and approximations of indirect effects using models based on best current knowledge of smoking related diseases.
Is it likely, or even possible, that given the specific orders from the government, that the report should not at least include some detailed approximation on “snus” related ill-health if there were any?
The report itself therefore constitutes proof that the harm from snus cannot be measured even after a century.
The report therefore also constitutes ample proof that Swedish snus policy is ideological and political and without any basis in scientific fact.
This directly results in thousands of entirely avoidable deaths in Sweden every year, and likely millions globally.
- Harms from snus use are so low as to make them not relevantly measurable and not warranting any attention for over a century
- The trend is clear: “snus” use is already replacing smoking at a 6 to 1 ratio of that of NRT’s supported by the government in Sweden
- There is little (and disputed) in vitro evidence and ZERO in vivo evidence for any serious adverse health effects emanating from this trend in Sweden
- With over 100 years of continuous +10% daily use prevalence in adult males in Sweden, this is more than sufficient “proof of no, or infinitesimally low, serious harm in healthy humans”
- Swedish Public Health agencies and The Karolinska Institute presented the Government with a misnamed and utterly false report indicating danger from “snus”, when the obvious conclusion is the exact opposite
- In 2015 they continue actively spreading this quite deadly falsification of knowledge in unsolicited letters to the FDA that you can find here: Linked document 7 and here: Linked document 8
- This is what the report states about snus translated, here: Linked document 9
It is my fairly firm belief that both the Government, the old Government (september 2014) and the Public Health bodies are fully aware of this but simply do not care.
Politics come first in Public Health, and actual Public Health is pretty far down the list. That is probably why the Swedish Government is rushing through a legislation that will lower switching from cigarettes to snus. See here: International scaremongering legislation
That they are also setting back global Tobacco Harm Reduction for at least a quarter of a century, does not even seem to have registered on their “ethics radar”. Not even a blip.
Breaking International Law does not seem to be a problem, not in Sweden and not anywhere else either: WHO stole harm reduction from the WHO FCTC
Merry Christmas and a Happy New Year 2016.
Let’s put Harm Reduction back in the FCTC in 2016, also in practice
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