You will be getting an absolutely massive amount of flak today, due to the publication of Professor Glantz metastudy.
The study itself, though not on it’s own volition, points out something very very clearly: Public Health knows nowhere near as much as they would need to know, to speak out with the kind of authority that they do on e-cig.
One of the few available sources to use for a ”reality-check” of articles like the Glantz study is, believe it or not, Sweden.
I have written extensively on the fact that nowhere in the health chain in Sweden, from neonatal to post mortem, has there ever been raised a clinical concern regarding harms resulting from food grade smokeless tobacco aka ”snus” use in over 100 years.
Over 10% of the male adult population in Sweden have been 12-hour-a-day-their-entire-adult-lives users of the product for over 100 years. At least 3 full generations of users, yet no clinical mention of harm or suspected harm. That is remarkable, extraordinary and should be very very comforting and reassuring. Actually this is not entirely different from a “security blanket”, but for Public Health professionals, who do seem very anxious about venturing outside their safety zone.
Not unlike coffee, the harms are so low that only lab cultures, and culture based population modeling even come close, to accurately measuring them. In the case of coffee it also seems that the benefits FAR outweigh the risks.
In all likelihood nicotine use without combustion and without toxic additives or production methods will ultimately end up on par to coffee.
The real issue that ought to be studied, but never has, is this:
Since the inclusion of snus in the Swedish Food Act in 1971, and since there are no demonstrative harms, what positive effects on public health has this product had in Swedish society?
If the answer would be zero or negative or positive, fine. Either way, the findings from such a study would signal better study regimes and better questions when studying e-cigarettes.
The problem is that the best intervention (besides just plain quitting, by far the best option) per capita to date, simply has not been studied at all, due to reluctance, obstruction really, from Swedish Public Health.
E-cig and snus should be globally promoted to smokers immediately, and effects, efficacy and side-effects closely monitored for tweaking.
Anything less, given what we know already, is nothing other than “desk-murder”
Actual published numbers from an actual country actually on earth: