Monthly Archives: January 2019

Faktaruta till DN Replik 3 januari 2019

Fakta och observationsruta med underliggande observationer kring olika typer av intressekonflikter. Ett av de allvarligaste problemen inom folkhälsoforskning och folkhälsoarbete är att motviljan mot andras intressekonflikter effektivt minskar förmågan att nyktert utvärdera egna förutfattade meningar, intressekonflikter och kognitiv dissonans inför besvärliga målkonflikter.

Normalläget är att alltid anklaga förespråkare för skademinimering för grova intressekonflikter och att vara lakejer åt den onda tobaksindustrin. Vi tänkte återgälda vänligheten enligt nedan:

“Rökning” är rökning genom förbränning och inget annat, punkt. Att författarna hänvisar till att e-cig ånga är rök 38 gånger i sin artikel medan e-cigarettånga eller liknande inte används en enda gång, är bedrägligt och missvisande.

Att inte ha med en analys av de data från CAN och Folkhälsomyndigheten som publicerades den 12 december är oärligt och ovärdigt, särskilt med tanke på den forskargärning som Arnetz och Arnetz har i sina CVn.

Att Nilsson och Wiklund väljer att gömma sig bakom andra jobbtitlar som inte klargör att de har djupa personliga och organisatoriska intressekonflikter mot skademinimering i och med både jobb och forskning och kopplingar till kärnorganisationerna som står bakom initiativet Tobacco Endgame, är anmärkningsvärt och klandervärt.

Vi är också mycket förvånad över slutsatser i artikeln som är dragits från den svenska studien i artikeln, eftersom studien indikerar att vattenpipsrökning är associerad med traditionell rökning med maffiga (raka odds) OR 7,69 och för snusanvändning OR  5,0 men för e-cig-användning är OR 1,01 vilket betyder ingen skillnad alls – det är vad författarna borde ha rapporterat, ingen skillnad alls.

Bengt Arnetz publika CV visar framgångsrikt att han varit involverad i forskning och projekt som säkerställt minst 71 miljoner dollar i olika forskningsanslag sedan 1990, inklusive ett 8,5 miljoner dollar i anslag från Vetenskapsrådet och som matchades med 8,5 miljoner dollar från Uppsala universitet för perioden 2008-2017. Väl inom tidsramen för aktuella intressekonflikter. Självklart påstår vi inte styrning eller oegentligheter på något vis, men samtidigt biter de flesta vettiga människor ogärna den uppsättning händer som föder en. Kanske särskilt inte efter avsevärd del i en dryg halv miljard kronor i totala anslag….

Folkhälsomyndighetens forskningsanslag som nämns i artikeln var på 525 000 $ (SEK 4,069,988 enl redovisning hos Folkhälsomyndigheten) och involverade alla fyra författarna och flera universitet. Anslaget var avsedd till att mäta förekomsten av, samt utveckla skolbaserade interventionsprogram mot, vattenpipsanvändning. Vi kan inte hitta de skolbaserade interventionsprogrammen mot ökad användning av vattenpipa som var en av de två delarna i projektet. Vi ifrågasätter dessutom syftet med och om det är etiskt att turbotrimma en del av gjord forskning och återanvända på detta sätt. Artikeln i originalpublicerades redan i september 2016, men har som gubben i lådan fått nytt liv genom att återpubliceras 2018 och nu även i pappersform, med nytt syfte och kopplat till en tveksam debattartikel i samband med lobbyarbetet för att trixa igenom och försvara lagstiftning som både skapar och dödar rökare.

Nilsson och Wiklund får utöver jobb och forskargärningar sägas vara mycket tätt knutna till organisationer som under lång tid erhållit minst 6 miljoner kronor om året för att bedriva sin verksamhet som ”fristående” civilsamhälleorganisationer – under 2018 har stödet närmat sig 10 miljoner kronor – inte vad man normalt tycker indikerar varken fristående eller civilsamhälle i någon egentlig mening. Återigen, vi påstår inte någon som helst finansiell intressekonflikt, men finansering för opinionsbildning kan onekligen skapa ganska kraftiga incitament till intellektuella intressekonflikter.

Svenska Myndigheter och Organisationer, amerikanska universitetsvärlden samt Karolinska institutet, Uppsala Universitet och Umeå Universitet är väl kända för en extremt normativ och negativ inställning till skademinimering inom tobak, som resulterar i kraftigt snedvriden och anslagsstyrd och forskningsansats med tydligt politiskt gynnsamma resultat8,9.

Artikel 5.3 i den globala WHO: s ramkonvention om tobakskontroll syftar till att motverka negativ eller förhalande inblandning från tobaksindustrins i arbetet för att eliminera tobaksrelaterade sjukdomar, dödsfall och samhällskostnader. Självklart står vi fullt ut bakom den principen. Samtidigt måste alla positiva och potentiellt positiva utvecklingar välkomnas och utvärderas på egna meriter oavsett ursprung.

Artikel 1(d) i ramkonventionen blev kirurgiskt felöversatt till svenska62004 på ett sätt som var avsett att eliminera snus från alla diskussioner kring skademinimering i Sverige. Den kirurgiska svenska felöversättningen har med hjälp av felinformation om snus exporterats till i princip hela världen som den korrekta ”tolkningen” och tillåter moralism att styra över vetenskap och pragmatism även global. Det är en folkhälsokatastrof av tidigare ej skådat slag att sabotera möjligheten att rädda upp till 7 miljoner liv om året och i samma veva spara upp till 2 biljoner dollar om året som kan användas till annat – Sverige bär huvudansvaret för detta efter 45 år av snus-idioti och vinklad forskning som fortsätter med ominskad kraft 2019.

PS: Charlotta Pisinger från Danmark publicerade en anti-e-cig artikel i Berlingske Tidende7den 27 december som har ett fascinerande likartad ansats och språkbruk som denna debattartikel, nästan för lik för att vara en fullständig slump. Till det kan nämnas att även hon har precis återpublicerat en återanvänd och turbotrimmad studie som publicerades 2014 och bemöttes med mycket kraftig kritik redan då. Kunskapsläget kring e-cigaretter i Skandinavien 2014 jämfört med 2018 kan med fördel jämföras med kyrkans läror om världsalltet före Copernicus jämfört med perioden strax efter Kepler – det finns en hel del kvar att lära. 

* https://skepticalscience.com/docs/Debunking_Handbook_Swedish.pdf

1 https://nnasweden.org/blog/198-graphs-showing-smoking-and-e-cig-in-swedish-youth-2014-2018

2 Tobacco Harm Reduction

3 https://befrits.wordpress.com/2019/01/01/january-1-2019-the-holy-mother-of-all-ethical-train-wrecks-swedish-parliament-december-2018/

4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129320/

5 https://www.folkhalsomyndigheten.se/contentassets/9b0c23490ceb401ba3d0a094a567f6cb/vaccination-av-barn-det-svenska-vaccinationsprogrammet-2008-126-9.pdf

6 https://befrits.files.wordpress.com/2019/01/Ove-Bring-PDF-Ramkonventionen-om-tobakskontroll.pdf.pdf

7 https://www.berlingske.dk/laesere/kampen-om-den-afhängig-nikotinforbruger

https://openarchive.ki.se/xmlui/bitstream/handle/10616/46371/Thesis_Lukasz_Antoniewicz.pdf

9 http://uu.diva-portal.org/smash/get/diva2:1191340/FULLTEXT01.pdf

 

JANUARY 1, 2019 – The holy mother of all ethical train wrecks – Swedish Parliament – December 2018

FCTC 1(d) with mistranslation PNG

The above clear mistranslation to Swedish in 2004 was deliberate and surgical. It effectively got rid of the snus issue as harm reduction - what it also did was get rid of harm reduction period and that is what Sweden has been exporting since 2005. Vera da Costa and Bloomberg simply could not have done what they are doing - had Sweden gone the honest route and started talking candidly about snus already 13 years ago. Not a chance in hell. Sadly this is proof that Nobel Prize Sweden has a huge mountain of responsibility for the global situation. We always want to be a "Moral Superpower", sure I get that, but at the cost of perhaps hundreds of millions of premature deaths? Wow!

 

Faktaruta till Replik i DN: Fact box on COI in DN article 22 December

Dear all,

I am currently active on multiple levels trying to provide truthful content and relevant commentary on the situation in Sweden. I am over time growing more and more confident that my 2012 analysis holds. An analysis that Sweden has successfully delayed acceptance and universal application of Tobacco Harm Reduction, by almost half a century. With the current trajectory the WHO and many with her calculate total premature loss of life due to smoking (and totally unnecessarily toxic Smokeless formulations) will be a billion people or thereabouts this century. Delaying Harm reduction in tobacco by 30 years pre FCTC, materially negatively impacting how the FCTC was formulated and subsequently applied, and a further 20 years post FCTC anti THR – is probably a world record that will be very very difficult for anyone to beat. Why anyone would want to try to do so eludes me, but then again there are definitely moves to have overweight parents declared unfit, and so on and so forth.

Originally first published results:

Letter to Government

Graph tweet

Ove Bring PDF Ramkonventionen om tobakskontroll.pdf – This PM by Sweden’s most respected International Law and Treaty Law jurist is acknowledged as valid (but action refused due to clash with policy) by Ministry of Foreign Affairs and the Public Health Agency and National Board on Health and Welfare and finally the Ministry of Health and Social Affairs.

Swedish Parliament on December 12th, 2018 enacted a massive expansion of our smoke free laws and doubly bizarrely included vaping in all existing and new smoke free areas. This was done despite crystal clear and irrefutable data showing that the already record low smoking in Sweden dropped again, like a sinking rock, with the introduction of vaping.

A full billion people, of whom the vast majority are and are increasingly going to be, in Low and Middle Income Countries desperately trying to lift their broader standard of living, will this century be trudging down a long and arduous and expensive road to premature death from smoking, a road that is lined with disease, loss of income and loss of productivity. How much of this would have, or at least could have, been avoided by Sweden simply calling a spade a spade?

Snus was added to smoking as a fully legitimate TC target as a last ditch effort in circa 1993 under the guise of the “Gateway theory” in order to avoid the accumulating and overwhelming evidence that snus was in fact probably not even legitimate as a blip on the public health radar at all. That the Gateway theory for snus has been totally eviscerated and proven to go clearly and massively in the opposite direction, didn’t hinder the argument to be successfully being applied to e-cig. Unless we do something about the false basic premise here, this argument will usable again and again and again – always backed by cited bullshit on “Peer reviewed” record from Sweden and regurgitated in the form of citations abroad. Add to this a thorough understanding from anti-THR science, that is analogous to Pharaonic Egypt. If you plant the Nile plains with only Pharao’s seed and the ensuing yearly inundation is all Pharao’s water down to the last drop – then the entire crop is going to be Pharao’s crop.  

Sweden has achieved a large part of becoming the global leader of “western standard” economies in terms of low smoking through 30 years of intense public information campaigning, true. Sweden also achieved a large(r) part of becoming the global leader of “western standard” economies in terms of low smoking through almost 40 years of having +98%-99,6% harm reduced snus as the most commonly used assisted method for no longer smoking in men and now fast increasing also with women – this happended despite our government and public health bodies and even the Institute awarding the Nobel Prize in Medicine, doing their absolute damndest to stop it.

Sweden was just about to achieve the next to last large part of becoming the ultra stellar  global leader of “western standard” economies in terms of low smoking by wide adoption of e-cigarette experimentation getting the whole population under 5% daily smoking, and moving steadily toward unimaginably (ludicrous, to use a Musky term) low smoking rates in youth – along with Iceland and Norway. Norway has almost no youth daily smoking thanks to snus use instead – something they argue in European Court of Justice is nothing less than a full blown epidemic (epidemic of lower smoking would be more correct – but that runs into problems with the Siracusa principles). Iceland does not have snus and is incredibly proud and boastful of huge success despite snus being banned since 1995. Useful information here though is that Iceland’s government tobacco company has seen 400% growth in sales of “traditional coarse nasal snuff – Neftobakk – since 1995. Interesting to note here is that all the tobacco for this **unregistered and unmeasured government produced traditional product** that is not in any statistics, is that all the tobacco is high grade snus tobacco purchased from Swedish Match and the consumers mix the end product with a bit of water. What do you get then? Snus! QED.

Back to the new round of train wreck ethical travesty in Sweden. The data was in. The data was crystal. The Government had it months ago and if they didn’t, then it was because the Public Health bodies kept it from them – I don’t know which it is and I don’t know which would be the greater scandal?

The data is irrefutable and solidly disqualifies policy in any other direction that the one suggested by the data. Unless of course Sweden was willing to bet the total credibility capital of the entire Swedish Public Health establishment and the red-green hued political parties in Government and what is left of a tattered Nobel Prize reputation – that just like in Asterix, the sky was about to fall on our heads. (This could very well have happened! According to many, who to a man and woman disagree with a postmodern relativist view on policy based evidence making, the level of public health science acumen in Tobacco Control could very well mean authors choosing to cite Goscinny R., Uderzo A., Miraculix, Broccoli A., et al. to an article on “Skyfall theory’s important role in substantiating the nicotine gateway theory” and hoping the reviewers (are there reviewers?) would let it slide with a chuckle. Clearly though with the premise that the evidence cannot emerge until later but will do so with 102.5% certainty and thus absolutely valid for policy and legislation. Note here please that “later” (but not 102.5%) is something up for periodic review and renewal every ten years or so… Sublimely elegant really.

Solution to this monumental conundrum: Pass the law before the data is out! But of course not before the data is out because that would be unethical. Hmmm, how does one achieve this logical double Salkov of disingenuity?

The March 2018 law bill was silently and fast as hell de-moth-balled and “sprung” on and through parliament in the shortest time recorded in peace-time Sweden. This happened  despite Sweden standing without a legitimate new government at the moment and in the middle of the biggest Parliamentary cluster waltz in modern history. (The EU initially stopped the bill in June 2018 because we refused to remove flavour markings on snus – The Horror – How was it then that the EU did not protest this time, after all the offending bit was still in the bill package!?)

The bill in its final format was released to the public on Friday December 7th, debated in Parliament on Tuesday December 11th (you have to click the link and see a report of the travesty with me and Bengt Wiberg from #EU4Snus) and finally voted on in the afternoon of  Wednesday December 12th. Nothing too bad about snus happened as the centre and right are waking up to snus and coffee and beginning to realise what is going on (The liberals are not included here – aren’t liberalism and extreme fascist tendencies sort of mutually excluding political leanings – I always thought so – Silly me!).

Reds, greens, Mussolini liberals and Christian Democrats sealed the fate of vaping as we know it. We (they!) enacted a widely expanded smoke free law framework, even to the extent of banning publicans from choosing to have a small portion of their outside service area reserved for smokers. All vaping was magically included in this and it still passed, and herein lies the royally screwed up skullduggery boo-boo in all its gory glory.

The Parliamentary vote was on the 12th, same day as the data-sets on the biggest collection of tobacco use data ever in Sweden were released. This was the first major one since 2016 and the biggest one ever in Sweden.

SWE BoysSmokingSnusEcig 2018 PHA CAN CAN

 

SWE GirlsSmokingSnusEcig 2018 PHA CAN

DATASETS FOR ABOVE AND BELOW: Collection CAN+PHA 2018 december 13

I think most of readers of this piece will agree that had these graphs been verified and placed before each MP before the vote – the smoke free laws would not have included vaping/e-cig?

The data was published the same night – basically available first thing in the morning of the 12th. The below two graphs are the only two representations we have seen so far superimposing the three different datasets on each other to give a more whole overview (the originals were tabulated differently and from separate sources, for extra obfuscation).

To this date we believe we are the only ones who have made the effort to collate and graphically represent the data in a useful format (useful is here in the sense of positively useful as based on hard facts and with relevant context – lying through your teeth by obfuscating what the data means and ripping it totally out of context is of course very useful too, depending on your ambitions, but hardly honest).

A completely different picture can be viewed at Psychologists Against Tobacco, a founding member of the Tobacco Endgame – Smokefree Sweden 2025 initiative here(Swedish only, sorry, if you want a translated version then please send emails to Atakan.befrits@gmail.com – If I get more than 5 mails I’ll reallocate time to get it done, along with a peptic ulcer from piteous impotent frustration and rage)

There was a barrage of media and press in the morning of the 12th, the day of the vote. The entire focus was on that the “ever tried e-cig” among youth was up by 70% since 2014 – Ergo the only possible action was the widest possible bans and deterrents to youth e-cig experimentation – any parliamentarian not getting that and voting along those lines would automatically be in gross dereliction of duty to protect innocent youth and must obviously be a Big Tobacco lackey (100% certain Harakiri end of said political career).

The collated and tabulated data from the two major surveys in 2018 can be found in excel format to fiddle with, validate and/or critique here: Collection CAN+PHA 2018 December 13 . As you can see from date in the filename, it took us laymen a bit longer to play catch-up than what was absolutely necessary, in order to ensure each voting member of Parliament had at least been provided with the hard facts in politician friendly format.

Again, sublimely elegant and very well played.

We did send a call to reason already on Monday the 10th though after having read the bill published Friday. We sent in vain hopes that we could create change or a space to breathe. Here I am going to give a big hand to the Sweden Democrats for being fast on the ball and having a good grasp of 1+1=2. The SweDems changed the wording during their debate slot on the Tuesday to include a clear reference to that e-cig should immediately or later be regulated in an entirely separate framework from the smoke-free laws, as the evidence dictates. Basically the entire centre+right (not the Mussolini Liberal Party) are clearly seeing the light and want to decouple snus from tobacco, as tobacco is understood by the Swedish uniquely mistranslated FCTC. A correctly translated FCTC would have eliminated this whole problem entirely and would have shaved 13 years of the half century of delayed acceptance of Harm Reduction in Tobacco (THR). A lot of the politicians individually see cautious reason for optimism also with e-cig (HnB) as harm reduction but so far only the Sweden Democrats seem convinced enough to speak up.

I include below the letter that we did manage to get off to Parliament, Parties, Agencies and the Prime Ministry on the Friday (fast and not very good – we are a very small outfit here and did not get very much help from the pros. They are experts on snus and don’t have the requisite knowledge of vaping, vaping science or the global ping-pong game of cherry-picked science bouncing back and forth between the nicotine delivery technologies and always backed up and corroborated by someone somewhere. The general feeling was that we should be incredibly grateful that a majority of political parties are slowly changing their views on snus, so we must all be nice little boy and girl (and them) experts and show gratitude and encouragement….

Note here again: While we show gratitude for the snus kindness that has zero effect on policy in India, this latest outing is an Op-ed in Dagens Nyheter 22 December against e-cig by 2 veteran hard core ANTZ from UMEÅ U. Co-sponsored by a very credible husband and wife hit-crew from Michigan State U. Both originating from Sweden and both still on the UU (Uppsala University) faculty pages. I don’t know them and haven’t heard of them before so I will presume they are honest and diligent and professional, but they do seem to be Glans fans and that is never a good sign.

Prime Minister’s Office

Head of Legal

Ministry of Foreign Affairs

Head of Legal

Ministry of Health and Social Affairs

Head of Legal

 

2018.12.10

 

CC sent to Left Party, Greens, Social Democrats, Centre Party, Liberals, Moderates, Christian Democrats, Sweden Democrats

Open letter to Swedish Governmental offices and Agencies and political parties regarding “harm reduction” in relation to the proposed new Tobacco Law.

To whom it may concern,

We are representatives of a global network of scientists, professionals and 36 civil society advocacy organisations from 34 countries. We, together with numerous national governments, represent a globally increasing movement in recognition and acceptance that “harm reduction” is clearly mandated in the original FCTC (Framework Convention on Tobacco Control). Harm reduction also in tobacco is clearly a human right and that is enshrined in the rights to health and autonomy.

Enacting the proposed law may have the negative effect that 35 CSO-NGOs together with the global harm reduced nicotine user community will advise their members to disregard Sweden as a travel destination because of the increased anti harm reduction regulations and possible legal consequences. The proposed law in its current format is unnecessarily damaging to public health, individual health and to the goal of ending cigarette smoking and smoking related disease. The proposed law is a Human Rights to Health violation.

We are writing to your respective offices and to the media in some urgency as new circumstances have come to our attention. These are very positive circumstances and present a unique opportunity to instead implement prospective new knowledge that will not be available until 2020.

In our view these very recent circumstances clearly and urgently indicate that any legal decisions that affect snus and/or electronic nicotine delivery systems are wholly inappropriate to enact at the current time. ​We therefore respectfully ask that the proposed law be voted down, withdrawn or redrafted, as the scientific validity of harm reduction via snus and electronic nicotine delivery systems are not adequately reflected in the proposed law.

 

1.​  ​We have received information that a project has been initiated within Swedish Agency SBU (Swedish Agency for Health Technology Assessment and Assessment of Social Services) to evaluate and assess snus (and e-cig) in relation to smoking and the results are expected no earlier than 2020. This project carries tremendous global value in that adequate and useful quantitative relative risk estimates between Swedish Snus and Smoking have so far to the best of our understanding never been produced or communicated, Nationally or Internationally. Snus is not harmless and should not be communicated as harmless. Nor should there be any misunderstandings regarding that nicotine use should best be avoided in entirety, but if not entirely then at least especially in and before pregnancy and preferably when there is cardiovascular disease present ​unless it is likely that the alternative is continued smoking​. These facts are already known and almost universally agreed, therefore what remains to urgently quantify is the relative difference in risk between snus use and smoking to otherwise healthy and non-pregnant adults, and this announced project within SBU is therefore of immense global value.

2.​  ​It has also come to our attention that a new tobacco law for Sweden was agreed by the Social Committee in Parliament on Thursday December 6th and published online on Friday December 7t​ h​. These steps taken in preparation for a parliamentary debate on December 11t​ h​, with a planned Yay/Nay voting session on December 12t​ h​. In effect this means that the final version was made available to the public​[1]​on December 7t​ h​, and the voting session is less than three full weekdays from that day.

3.​  ​We have received information that there is an initiative underway, with support from the Ministry of Foreign Affairs Treaty office, to correct an obvious mistranslation in Article 1(d) in the Swedish version of the FCTC (Framework Convention on Tobacco Control).

4.​  ​The clearly mistranslated portion has changed the meaning of “harm reduction” as understood, expressed, and intended in 1(d) in the original as a requirement, to instead becoming a de facto ban of “harm reduction” in Sweden. The most obvious effects of this are found in science and policy regarding snus and the international (mis)information enabled by the error. A correction of the Swedish FCTC text, to accurately reflect the true meaning and intent of “harm reduction” as expressed in the treaty and preparatory materials would be a very welcome step forward and have tremendous potential value in the fight against tobacco related disease. We believe a correction would have a positive impact on willingness and ability to affordably achieve UN Agenda 2030 SDG goal 3 targets, also in Low and Middle Income Countries (LMIC) globally, where soon 75% of global smoking takes place.

There is every likelihood that prospective and retrospective results from assessments by SBU in 2020, and a correction in the Swedish translation of the FCTC, can considerably improve and expand the available toolbox that the global health community and public health communities use in “Tobacco Control” work as per the requirements and intentions enshrined in the FCTC.

We therefore respectfully urge political representatives of the Kingdom of Sweden, and her governmental bodies and agencies – to postpone any proposed legislation that negatively affects the ability to exercise and utilize an appreciation of the relative risks of different products– at least until such a time as the two crucial issues in this letter have been thoroughly examined and resolved.

With our great respect for Sweden and her role in promoting health, equity and Human Rights.

 

Atakan Erik Befrits

NNA Sweden (New Nicotine Alliance Sweden)
INNCO (International Network of Nicotine Consumer Organisations)ab@nnasweden.org
+46 764 156046