Smokeless Tobacco: Harm Reduction Updates

By Jonathan On Jul 5, 2017

Harm Reduction Updates

Aland Islands

In the ongoing European U nion (EU) preceding that seeks to ban the sale of smokeless tobacco products (known as “snus”) in the Aland Islands there is a new element involved since the EU has directed that only Swedish-registered ships/ferries may continue selling snus. As the shipping lines argue in this article published by the HELSINGIN SANOMAT newspaper:

this recent EU decision has created a distortion in trade since ships owned by the same company sail under the flags of Sweden and Finland. Thus a ship sailing under the Swedish flag are exempt from the snus sales ban because of Sweden’s cultural exemption from current EU law regarding snus sales. However, a ship in the same fleet but under a Finnish flag are prohibited from allowing snus sales because Finland does not have an exemption from EU law like Sweden does today.

Confused?

Yes, we are too since smokers who travel on the ferries to the Aland Islands must now be certain to board only the Swedish-flagged ships if they want to use (purchase) the less harmful snus products during the journey.

History Lesson

Eudoxa’s own Waldemar Ingdahl provides an interesting history lesson in his recent posting on our bulletin board entitled – “Past, present and future in smoking- the Swedish example”. Waldemar notes that the concept of smoking cessation in Sweden first took root with the publication of the book, “Konsten att sluta r?ka” (The art of smoking cessation) in 1959. This historical note stems from the early October 2007 presentation by Karl Fagerstrom at the Society for Research on Nicotine and Tobacco (SRNT) conference Eudoxa attended in Madrid, Spain.

The full summary of Mr.Fagerstrom’s presentation found in Waldemar’s posting is well worth reading especially Mr. Fagerstrom’s comments regarding the demographics of smokers. Mr. Fagerstrom concluded that cigarette users have shifted to smokeless tobacco in Sweden (and will in other nations) since the inveterate smokers of today simply are not going to go “cold turkey” from their cigarettes.

Family Smoking Prevention and Tobacco Control Act

In a 12 November commentary () published in the Buffalo News (USA) newspaper Dr. Brad Rodu – a harm reductionist whom Eudoxa has interviewed in the past – argues that the current legislation in the US Congress that would provide regulatory authority over tobacco products to the US Food and Drug Administration.

Speaking specifically to the potential for harm reduction Dr. Rodu’s commentary states:

“Congress should rewrite those portions of H.R. 1108 and S. 625 (the “Family Smoking Prevention and Tobacco Control Act”) that impose irrational and dangerous limitations on the communication of truthful information about smokeless tobacco and its relative risk vis-a-vis cigarettes. As written, these bills reflect tired myths and a tobacco prohibitionist bias.”

Dr. Rodu’s observations are worth serious consideration by the Congress given his extensive work on this field of study.

Summary

We invite your comments on any relevant subjects regarding tobacco harm reduction. Please encourage others to participate in this Bulletin Board to drive a fuller discussion of public health alternatives:

http://eudoxascience.com

Sincerely,

Dr. Anders Sandberg
Eudoxa

Please Post

Prolonged use of Swedish moist snuff increases risk of fatal cardiovascular disease and stroke
[Press Release 30/11/2007]
A new doctoral thesis from the Department of Environmental Medicine at the Swedish medical university Karolinska Institutet demonstrates that consumers of Swedish moist snuff – a smokeless tobacco called ‘snus’ – run a higher risk of dying from cardiac arrest and stroke. Snus also increases the risk of high blood pressure, a known factor of cardiovascular disease.
The use of snus has increased markedly in Sweden in the past few decades, so much so that it now accounts for half of all tobacco consumption in the country. Over 20 per cent of men between the ages of 18 and 79 are daily users. Consumers of snus absorb as much nicotine as smokers but are spared many of the toxic chemicals that are formed on smoking.
Although snus does not seem to increase the risk of myocardial infarction, one of the studies reported on in this doctoral thesis shows that its consumers run a 30 per cent (approximately) higher risk of fatal heart attack than people who have never used the product. This greater risk is even higher for those who take more than 50 grams of snus a day. Amongst those who suffer non-fatal heart attacks, users of snus have a higher fatality rate in general than non-users, and from cardiovascular diseases in particular.
The studies reveal no greater risk of stroke amongst users of snus; however, users were more likely to suffer a fatal stroke. Users also ran a higher risk of developing high blood pressure, which is a known factor of cardiovascular disease.
Two major population studies were used for the research now published. The first comprised Swedish men between the ages of 45 and 70, living in the counties of Stockholm or V?sternorrland between 1992 and 1994. A total of 1,432 men diagnosed with first-episode myocardial infarction were compared in terms of tobacco habits and other factors with a coeval group of men from the same regions without heart problems.
The second was a study using data from health checks of all workers in the building industry between the years of 1978 and 93. Information recorded at these checks included tobacco habits and blood pressure. Episodes of non-fatal and fatal myocardial infarction and stroke as well as blood pressure readings for over 100,000 snus users and non-users were then plotted up to 2003/4 using national health records. In both population studies, the analyses were confined to non-smokers, as smoking is strongly associated with the use of snus and cardiovascular disease.
Thesis: ‘Swedish moist snuff and the risk of cardiovascular diseases’ by Maria-Pia Hergens, Department of Environmental Medicine, Karolinska Institutet 2007
Katarina Sternudd | Quelle: alphagalileo Weitere Informationen: diss.kib.ki.se/2007/978-91-7357-372-6

Does the Times Understand the Difference Between Safer and Safe?
August 23, 2007
Jacob Sullum
A study recently published in the journal Cancer Epidemiology Biomarkers & Prevention found “similar exposures to the potent tobacco-specific carcinogen NNK in smokeless tobacco users and smokers.” This is how The New York Times interpreted that finding:
Smokeless tobacco, the kind users put between cheek and gum, is one way to satisfy a craving for nicotine without offensive smoke. But a new study has found that it may be almost as effective as cigarettes in delivering nicotine and carcinogens….
Countering suggestions that smokeless tobacco might be a less harmful alternative for people unable to give up tobacco, the researchers wrote that smokeless tobacco is very risky, and should be discouraged.
Ignore the part about nicotine, which is a red herring: Nicotine is not a carcinogen, and effective nicotine delivery is an advantage, not a drawback, for a cigarette substitute. But the Times is suggesting that smokeless tobacco poses nearly as big a cancer risk as cigarettes, which would be cause for concern. The headline is even scarier: “Hazards: Smokeless Tobacco on Par With Cigarettes.” In other words, using smokeless tobacco is no safer than smoking cigarettes.
In reality, the study dealt with a single carcinogen, not with the overall risks posed by smokeless tobacco vs. cigarettes. The researchers note that “cigarette smoke contains, in addition to NNK, multiple carcinogenic combustion products which are not present, or present in only low amounts, in smokeless tobacco.” (They also note that Swedish-style smokeless tobacco, which is increasingly available in the U.S., contains about half the NNK of the traditional American brands used by the subjects in the study.) They never say the hazards of smokeless tobacco are “on par” with the hazards of cigarettes, or anything like that. In fact, that assertion in the Times headline is contradicted by the article under the headline, which quotes the study’s lead author, University of Minnesota researcher Stephen Hecht, as saying (emphasis added):
The main message of this study is that smokeless tobacco cannot be regarded as safe, because it delivers just as much of one of the carcinogens in cigarette smoke as cigarettes do. While it may be safer than cigarettes, it is not nearly safe enough.
No one who recommends smokeless tobacco as a harm-reducing alternative to cigarettes says it’s completely safe—only that it’s much safer, as you might surmise from the lack of combustion products. Hecht himself does not dispute this fact, which has been confirmed by studies comparing disease rates among cigarette smokers and smokeless tobacco users. When he asserts that smokeless tobacco “is not nearly safe enough,” he is not stating a scientific fact; he is making a value judgment.
The journal article likewise mixes data with moralism. “NNK exposure in smokeless tobacco users as shown in this study presents an unacceptable risk and should not be encouraged,” Hecht and his colleagues declare. Unacceptable to whom? This judgment should be left to individual consumers, with the scientist’s role limited to researching and reporting the risks. In Hecht’s view, perhaps, no risk is acceptable, but the people whose health is at stake may disagree.

** USA Today **

The 6 August 2007 edition of the USA Today newspaper featured a front page article by reporter Wendy Koch (http://www.usatoday.com/news/nation/2007-08-06-snus_N.htm) entitled, “As cigarette sales dip, new products raise concerns.”

One quote/excerpt from this article which should be of particular interest to harm reductionists is this one from New Jersey, USA –

“Smokers should be encouraged to quit tobacco entirely, but they also should be told that smokeless products have fewer risks than cigarettes, says Jonathan Foulds, director of the tobacco dependence program at the University of Medicine and Dentistry of New Jersey.

Foulds says Swedes’ widespread use of snus has helped lower the adult male smoking rate there to among the lowest in Europe. Snus, though legal in Sweden, has been banned in most of Europe as cancer-causing and a gateway to smoking for young people. Cigarettes, however, are legal.

However Mr. Foulds’ comments are countered by tobacco control advocates such as this person from Massachusetts, USA who is quoted in this same article as saying –

“We shouldn’t be out there promoting harm, even reduced harm” — Gregory Connolly, director of tobacco control research at Harvard School of Public Health.

Given the fact that the US government notes there are still 44.5 million smokers – despite years of smoking cessation programs and smoking bans — in the USA hopefully leaders like Mr. Connolly will re-consider their views on smokeless tobacco products as a new form of smoking cessation.

** Heartland Institute **

Dr. Sanjit Bagchi of the free market think tank, Heartland Institute, based in Chicago, USA (www.heartland.org) has an article published in the September 2007 edition of their Health Care News newspaper. Dr. Bagchi’s article is focused on a 16 June 2007 study published in the medical journal, The Lancet, regarding smokeless tobacco products.

Dr. Bagchi’s commentary highlights the research coming from Gartner and Hall at the University of Queensland (Australia) regarding smokeless tobacco use as a form of smoking cessation. The primary excerpt from Dr. Bagchi’s article that harm reductionists should be interested in is noted below –

Coral Gartner and her colleague Wayne Hall took part in the debate, and in a news release they said, “On the Swedish experience, there is a strong prima facie case on public health and ethical grounds for recommending snus (smokeless tobacco) to inveterate smokers who want to reduce their health risks and for considering public policies, such as lower taxes for snus and public information campaigns, to promote its use by smokers.”

** Neo Magazine **

The Swedish monthly magazine Neo – which is similar to The American and Reason magazines (www.ihra.net)