Christian Engström, Pirat

22 november 2012

Some Scientific Data on Snus

Filed under: snus — Christian Engström @ 11:31

Smokers who switch to snus get almost as good health gains as those who succeed in giving up tobacco completely

Three weeks ago I published an open letter to all anti-snus lobbyists, asking them what scientific studies on snus they have based their opposition to snus on. So far, not a single anti-snus lobbyist has responded, neither the Smoke Free Partnership (who are otherwise very active on the subject), nor any other organization.

I find this rather odd, considering how keen lobbyists in general usually are when it comes to arranging meetings with members of the European Parliament. Since I am genuinely interested in learning why they (and DG SANCO at the European Commission) are opposed to this traditional Swedish smoke free product, I have sent another mail to the Smoke Free Partnership and some other anti-snus lobbyists today, inviting them to meet me in Brussels.

Time will show if they respond, or if they feel that they are not in a position to answer my question.

In the meanwhile, I would like to share a link to a very thorough article arguing in favour of snus as a help for smokers who want to quit, but find it difficult to do so cold turkey.

The article is written by Clive Bates, who is a former Director of the UK public health charity Action on Smoking and Health. Although he now works in an unrelated field, he has written the article expressing his own views out of concern is for smokers who would like to quit but find it hard.

I will cite the beginning of the article here:

Death by regulation: the EU ban on low-risk oral tobacco

Is it right to ban certain types of smokeless tobacco from sale in the European Union?  The short and unequivocal answer is  ’no’.But surely banning any type of tobacco can only reduce the size of the overall tobacco market and therefore be good for health?  No, not at all, it just isn’t that simple…  

This post gives my personal take on this important public health issue.

The reason for allowing it on the market is that smokeless tobacco is an effective substitute for smoking, but far less hazardous to health than cigarettes.  The chart to the left puts it quite well. It models the effect on life expectancy of switching from smoking to a type of smokeless tobacco (‘snus’ or Swedish oral snuff) at a given age. These are dramatic findings.  Given the addictiveness of nicotine and how difficult some smokers find quitting even if they really want to, banning this option amounts to death by regulation.   What has gone wrong?

Switching provides a substantial health benefit to smokers who switch, in fact switching is not that much different to quitting smoking altogether. Furthermore, the risks of the product itself (the bottom red line) are quite low (Gartner et al 2007 – see SCENIHR p117).   However, these products are banned in law the EU (other than in Sweden), and smokers have been denied the option to switch to this much lower risk way of taking nicotine.

A group of us concerned about public health policy set out the arguments for this in 2003 (Bates et al 2003) and the arguments haven’t changed since.  They have only strengthened as more evidence has become available. As Gartner et al conclude:

Current smokers who switch to using snus rather than continuing to smoke can realise substantial health gains. Snus could produce a net benefit to health at the population level if it is adopted in sufficient numbers by inveterate smokers. Relaxing current restrictions on the sale of snus is more likely to produce a net benefit than harm, with the size of the benefit dependent on how many inveterate smokers switch to snus.

Despite this, these products are banned in the European Union under Tobacco directive 2001/37/EC article 8 (other than in Sweden).   Worse still, and in the face of abundant evidence that supports the lifting of this ban, the EU appears ready to maintain or extend it in a new tobacco directive (see consultation [PDF see p4-6]) and comments from the Commission (here and here).

This is wrong at many different levels. In the sections that follow, I’ll address three major policy failings under the following headings:

  1. Public health science ignored and abused
  2. Ethics and consumer rights violated
  3. EU legal principles disregarded

Read more at Clive Bates blog

As I have said, I would be very interested to hear how both DG SANCO (the General Directorate within the European Commission responsible for the Tobacco Products Directive) and any anti-snus lobbyists would respond to the arguments that Clive Bates presents in his article.

14 kommentarer

  1. Is this really a Pirate question or are you following the Green party party line?
    Or have you dropped your voting strategy on this?

    Kommentar av Jerker Montelius — 22 november 2012 @ 12:25

  2. @Jerker: No matter if it is a pirate-question or not, all politics should be based on facts and not feelings or opinions. So in that perspective the question abouts the ”snus” (I prefer the term snuff) is very much a pirate-question..

    Kommentar av Pontus — 22 november 2012 @ 13:06

  3. Fact based policy making is a Pirate Party standpoint, as well as fighting corruption within the EU, and this issue seems to have a bearing on both.

    But primarily I said before the elections that if an opportunity would arise to do something about the ban on snus, I would do what I could in that situation. (This is the only thing outside the party program that I said anything about in the election campaign, so it’s part of my personal platform rather than the party’s.)

    When I said that I didn’t really expect any such opportunity to arrive, but now that it has I’ll try to see if it’s possible to do something good.

    Kommentar av Christian Engström — 22 november 2012 @ 13:12

  4. Pontus: I find it amusing to see the swedish word snus in a english text. However I really dispise when the word snuff is used to describe snus since (in my world) that is the name of the tobacco you use (snort) in your nose.

    Kommentar av morr — 22 november 2012 @ 13:18

  5. Christian, just being curious – Are you a ”snusare” yourself?

    Kommentar av Kung CG — 22 november 2012 @ 13:28

  6. If you compare snus to not using tobacco at all, then it’s pretty clear that snus isn’t healthy. Of course, you can push for snus as a substitute for cigarettes — effectively a medical aid to help people stop smoking. In that case, we should use the ordinary medical policies, which I believe say that you are only allowed to bring in a new drug if it is at least as good as the drugs already on the market. So the relevant things to compare is not snus and cigarettes, but snus and other medical aids to help people stop smoking. If snus can outperform Nicorette it should clearly be allowed. If it offers no advantage whatsoever over Nicorette, it shouldn’t be allowed. We only allow the best medicines, and that is how it should be.

    I certainly prefer it if people use snus instead of smoking in my vicinity, but I don’t know where the science stands on snus versus other means of quit smoking. Just remember to compare it to the right things, if you want to push for it as a smoking substitute — then you should compare it to other smoking substitutes. In and of itself, snus is bad.

    Of course, in Sweden snus is well established, so it should evidently be allowed here (essentially for the same reasons that cigarettes are still allowed in the EU).

    Kommentar av von — 22 november 2012 @ 18:58

  7. @ Kung CG,

    Yes, I use snus and it has helped me cut down my smoking significantly (although I unfortunately haven’t stopped).

    My wife uses snus too, and she has stopped smoking completely.

    Kommentar av Christian Engström — 22 november 2012 @ 23:05

  8. von wrote:

    If you compare snus to not using tobacco at all, then it’s pretty clear that snus isn’t healthy.

    True, everone agrees on that.

    If snus can outperform Nicorette it should clearly be allowed.

    Snus clearly can, at least for some people. This is evidenced by the fact that a lot of people in Sweden and Norway have in fact stopped smoking by swithing to snus, and that these two countries have lower smoking rates than other countries.

    In Clive Bates blog post he quotes the conclusions of two different studies:

    Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence.


    Consistent with Swedish studies, Norwegian data shows that experience of using snus is associated with an increased probability of being a former smoker. In Scandinavia, snus may play a role in quitting smoking but other explanations, such as greater motivation to stop in snus users, cannot be ruled out.

    So not only does it work better than Nicorette for at least some people because of the simple fact that people are different. The availability of snus also appears to have a very clear positive health effect on the national level.

    Kommentar av Christian Engström — 22 november 2012 @ 23:22

  9. […] Three weeks ago I published an open letter to all anti-snus lobbyists, asking them what scientific studies on snus they have based their opposition to snus on. So far, not a single anti-snus lobbyi…  […]

    Pingback av Some Scientific Data on Snus | Tobacco Harm Reduction | — 23 november 2012 @ 4:07

  10. I saw a program listing some potential downsides of introducing snus. I think it may have been the US program 60 minutes, but I’m not sure.

    Anyhow, in the US snus was advertised as something that could be used indoors – when cigarettes aren’t an option. This caused some smokers to start snusing also, to fill in the gaps so to speak.

    Other than that I do agree that the graph indeed looks very positive for using snus to reduce smoking.

    Kommentar av Stefan — 24 november 2012 @ 16:13

  11. […] Nu är det dags för EU att börja föra en faktabaserad politik vad gäller snus, säger Christian Engström. […]

    Pingback av EU-kommissionen vägrar redovisa fakta bakom snusförbudet « Christian Engström, Pirate MEP — 4 december 2012 @ 12:00

  12. […] is high time that the EU adopted a fact based policy regarding snus,” says Christian […]

    Pingback av EU Commission Refuses to Present Facts Behind Snus Ban « Christian Engström, Pirate MEP — 4 december 2012 @ 15:28

  13. […] that EU policy in all areas, but especially when it comes to public health and safety, should be based on facts and science, not on corruption and […]

    Pingback av The Anti-Snus Lobbyists Refuse To Meet Me And Present Facts « Christian Engström, Pirate MEP — 13 december 2012 @ 13:13

  14. […] påstår att snus är hälsosamt i sig, men för den som lyckas sluta röka med hjälp av snus är snuset en livräddare. Det är ologiskt att den minst farliga tobaksprodukten är den enda som är förbjuden inom […]

    Pingback av Bara regeringens flathet hotar snuset i Sverige « Christian Engström, Pirate MEP — 20 december 2012 @ 14:16

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