Experts nicely “SLAM” lack of honest and relevant snus information from Sweden

English translation of Op-Ed published this morning in Aftonbladet. Sweden’s largest publication newspaper and news online outlet. http://www.aftonbladet.se/debatt/a/KAq14/snus–rena-rama-halsoframgangen

Snus – an absolute public health success

 18 researchers: Sweden holds the key to a solution that kan bring about the end of smoking

 We are writing as independent public health specialists to note one of Sweden’s great health successes and indicate the urgency to communicate this internationally. That success is the widespread use of low‐risk oral tobacco snus, to quit smoking and as an alternative to high‐risk tobacco in cigarettes. To external experts it is clear that Sweden has achieved notable success in reducing tobacco-related harm.

Given its contribution to better public health in Sweden, evidence-based information on snus should be shared with other countries.  States which have ratified the WHO Framework Convention on Tobacco Control meet in New Delhi today at the global conference on tobacco control. The meeting is an opportunity for Sweden to lead the discussions on practical ways of further reducing the harms caused by smoking cigarettes.

Sweden’s unique health successSweden has the lowest rate of smoking in Europe at 11%, compared with the EU average of 26% [1]. The recent UK Royal College of Physicians report [2] notes the contribution of snus to reducing smoking prevalence in Sweden. The mortality attributable to tobacco among men is lower in Sweden than in any other EU Member State and the use of snus has been an important contributor to this situation [3,4].

The risks associated with snus are of the order of 95% to 99% lower than for smoking, hence the reduced burden of tobacco related disease (cancers, COPD, cardiovascular disease).

Snus is a popular and acceptable alternative to smoking tobacco among Swedish men. It is clear proof of concept that safer nicotine products are attractive to smokers, and that tobacco harm reduction approaches have a significant role to play in helping people to switch from smoking, or to avoid smoking in the first place.

 This complements other tobacco control initiatives, and data from Norway show similar health gains since snus become popular there [5].

Harm reduction (Skademinskning) is mandated in the Framework Convention on Tobacco Control. Three separate strategies are mandated in the English original of FCTC Art 1d [6] which states that “tobacco control” means a range of supply, demand and harm reduction strategies’.

So far, Harm Reduction has been neglected by the WHO FCTC secretariat and member states.

WHO promotes complete bans on smokeless products and other nicotine products, or overly restricting and regulating them when that is not possible, these strategies will cause public health harm and not reduce it.

Swedish snus can be produced at a fraction of the cost of other reduced risk nicotine products such as e-cigarettes. This indicates the very large potential for this intervention to reduce smoking in Low and Middle Income Countries.

It is regrettable that at the last Conference of the Parties in 2014 (COP6), Sweden signed a declaration that incorrectly equates the dangers of Asian and African smokeless products

 The declaration continues to incorrectly equate dangerous products from Asia and Africa that have serious health risks (though much less risks than those of smoked tobacco) with the significantly safer Swedish snus.

As external experts we are  surprised by the reluctance of the Swedish government to acknowledge the contribution of snus on improving public health.  It should be in the interest of public health to provide accurate information to smokers that if they switch to snus, they will dramatically reduce risks to their health [3]. We also encourage the Public Health Agency and the Swedish medical professions to publicise the Swedish experiences with snus.  Also we wish to encourage the Swedish government at COP7, 7-12 November, to present the knowledge that snus represents an important and possibly unprecedented opportunity to reduce the toll of smoking related death and disease.

Despite current tobacco control efforts, smoking is increasing globally. The Swedish government has the opportunity in New Delhi to show that there are effective and acceptable alternatives  that can be used to help bring about an end to smoking.

Anders Milton, med dr, Sverige

Gerry Stimson, professor emeritus, Storbritannien

Ron Borland, professor, Australien

Karl Fagerström, PhD, Sverige

Coral Gartner, professor, Australien

Martin Jarvis, professor emeritus, Storbritannien

Lynn T. Kozlowski, professor, USA

Jacques Le Houezec, PhD, Frankrike

Karl E Lund, Folkhelseinstituttet, Norge

Lars Ramström, PhD forskare, Sverige

David Sweanor, professor, Canada

Peter Hajek, professor, Storbritannien

Jean-François Etter, professor, Schweiz

David Nutt, professor, Storbritannien

Riccardo Polosa, professor, Italien

Konstantinos Farsalinos, kardiolog o forskare, Grekland

Clive Bates, forskare, fd Chef Englands motsvarighet till Tobaksfakta, Storbritannien

Atakan Erik Befrits, researcher INNCO.org och aktivist, Sverige

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