Snus: they knew all along (part 2)

While doing some research recently, I came across a letter in a library archive written by Dr Richard Peto to Dr. B. MacGibbon. Peto was, and is, a highly respected epidemiologist who worked closely with Richard Doll on smoking and health.

The letter is dated 28th June 1984. Two months earlier, the Daily Mail had run a story about Skoal Bandits, an American form of snus made by US Tobacco Inc. who were due to build a factory in Scotland. Shortly thereafter, ASH's director David Simpson started a moral panic about this smokeless tobacco product which ultimately resulted in the EU ban on oral tobacco (1992). See Chapter 4 of The Art of Suppression for the full story.

I do not know who Dr. B. MacGibbon was or why Peto was writing to him, but Peto begins by recommending that some research into the saliva concentrations of snus users be conducted "fairly urgently". He continues...

I have given some further thought to the question of how many cancer deaths would be likely to be caused each year if one-third of the British population were to become habitual tobacco suckers.

Then, basing his figures on data from the US and UK...

This suggests that if about a quarter of the British population took to dipping 100 gms of tobacco a week, then in the long run “only” some 500-1000 excess deaths/year would result (see Appendix [which is a couple of studies, including the influential study by Deborah Winn looking at women in North Carolina - CJS]).

Maybe Skoal Bandits would be worse than SE US snuff, or maybe (especially if you take the advice in the first part of this letter! [ie. to carry out research "fairly urgently" - CJS]) they would be less hazardous. In any case, no matter what epidemiological studies you mount, you probably won’t get even a preliminary answer this century, so as a practical basis for action I suggest you assume that the adoption of Skoal Bandit-like products by a quarter or a half of the British population will cause about 1000 cancer deaths a year. In contrast, tobacco smoking currently causes about 100,000 British deaths a year!

This may be wrong – they could be carcinogenic, and the Asian experience with oral cancer suggests that they could be a lot more carcinogenic than I’ve estimated, but in any case you have most of what you need for political action, viz:

• The risks are not zero
• The risks can probably be reduced by immediately commissionable laboratory research;
• The risks are much, much less than those of cigarette use.

The final thing you need is to know whether they will help avoid tobacco. No proof is possible, but it is noteworthy that among women in North Carolina, where both products have been widely available for decades,

• The proportion of smokers among snuff-dippers is only one-third as great as that among non-dippers, and
• Even among those dippers who smoke, mean cigarette consumption Is significantly lower than among non-dippers who smoke.

I suspect that, no matter what the risks might be, Skoal Bandits and allied products would be allowed to be sold [alas, this prediction was wrong - CJS]. Fortunately, however, the above arithmetic suggests that this may well do more good than harm. In any case, one should try to avoid producing a situation where the warnings or statements about Skoal Bandits etc. are so strong as to divert attention from the much more serious hazards of tobacco smoking.

He concludes by saying:

"The real message is that there is a hazard, but that it’s much less than that of smoking, and that a widespread shift to such products could probably save a lot of lives."

As I mentioned recently, Peto was not alone in seeing the harm reduction potential of snus. In 1985, the addiction expert M.A.H. Russell published a letter in the Lancet, estimating that 49,000 premature deaths would be prevented by a switch from cigarettes to Skoal Bandits. Unfortunately, and not for the last time, the voices of scientists were drowned out by those of activists who were itching for prohibition.

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Snus: they knew all along

Brad Rodu reports on a study recently published in Nicotine & Tobacco Research which shows that Norwegians who believe snus to be dangerous tend not to use it to give up smoking. Nothing surprising about that, of course. What is worrying is that 35% of those surveyed believed that using snus was as dangerous - or more dangerous - than smoking (in fact, it is over 95% safer). This is a troubling statistic, though perhaps unsurprising since many Norwegian doctors remain ignorant of the gulf in potential harm between cigarettes and snus.

The study, by Dr Karl Lund, also found that 32% of ex-smokers used snus to quit, whereas only 14% used pharmaceutical nicotine medication. From this, we can draw the conclusion that if smokers were not ignorant about snus's risk profile, many more Norwegians would be ex-smokers.

Still, at least the people of Norway - having wisely chosen to remain outside the EU - are able to buy snus if they want to. The same cannot be said of we Brits who helped to introduce the EU ban in the first place (see The Art of Suppression. You've read it by now, right?)

The harm reduction potential of snus in tobacco control can seem like a relatively new discovery. It is easy to believe that a clueless anti-smoking movement stamped the product out without realising the possibilities it had for smoking cessation. It was, after all, not until 2004 that Brad Rodu and Philip Cole published the study showing that 200,000 premature deaths could be prevented by adopting a Swedish culture of snus use.

This is not quite true. As early as 1985, the addiction expert M.A.H.Russell had tested snus (Skoal Bandits in fact) and wrote to The Lancet saying:

Our results suggest that this new product could help people trying to give up smoking. It might be cheaper than nicotine chewing gum and would not require a prescription. If all smokers in Britain switched to sachets about 50,000 premature deaths per year might eventually be saved at an annual cost of less than 1,000 deaths from mouth cancer.

This was at a time when snus was believed to cause mouth cancer, a belief that has been known to be false for over a decade. Nevertheless, Russell based his figures on the core principle of harm reduction and understood that 50,000 minus 1,000 still left 49,000, and that this was better than the prohibitionist, quit-or-die fairytales that were dominant in the tobacco control movement even then.

History will not look favourably on the dangerous idiots who banned snus in the EU - especially those who still support the prohibition now that the facts are clear. There were rational voices thirty years ago which went unheeded.

One of Russell's co-authors for the Lancet letter was Martin Jarvis. Today, Jarvis is a trustee of ASH. ASH is truculent, devious and unreliable on almost every matter on which they claim to have expertise. None of their pronouncements of the last fifteen years has not involved at least a half-lie, but their failure to speak out against the EU ban adds cowardice, hypocrisy and gross negligence to the charge sheet.

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Nicotine wars: Latest

There can now be little doubt that the EU's ban on snus is being maintained at the behest of the pharmaceutical industry. It is not about health. It is not about science. As the Swedish press recently reported, the battle lines are drawn:

In the battle over snus the world's largest pharmaceutical company is in one corner of the ring and the world's largest tobacco company in the other. The battle is about the hundreds of millions of smokers who are trying to quit. Big time lobbying is clearly visible in the EU snus debate. The tobacco industry was most successful in mobilising support for petitions via YouTube and the Internet, while the pharmaceutical industry has achieved success by more selective actions.

“There is clear competition between us and the pharmaceutical industry,” says Swedish Match's Public Affairs Director Patrick Hildingsson. “In the EU there are 107 million smoking consumers both our industries want to reach. The pharmaceutical industry does not want see the success snus has had in helping people stop smoking to spread outside Sweden.”

But Pfizer's Medical Director John Brun does not see snus as competition: “Absolutely not. Tobacco is a major health risk regardless of how it is consumed, which is why we have committed ourselves to reaching out from a health perspective in public debate.”

Pfizer—maker of Nicorette and Champix—does not see snus as competition?! How strange that they should waste so much their time and money lobbying for it to remain illegal (almost as strange as them funding studies into the economic impact of smoking bans). You'd think they'd have better things to do that worry about a niche smokeless tobacco product, unless of course they're worried that it's a more effective smoking cessation aid than their own products.

Instead, they're keen to rush the European Commission into producing its new Tobacco Product Directive, which will address the question of whether the snus ban is justifiable. The following is a letter Pfizer put its name to (along with Anna Gilmore, Luke Clancy and other useful idiots):

Dear President Barroso,

We are writing to you as a group of NGOs, charities, researchers, industry representatives and MEPs representing a majority of Member States and every major major political group, to urge you to bring forward the proposal for a revision of the Tobacco Products Directive at the beginning of 2012, as promised.

... As a signatory of the Framework Convention on Tobacco Control the European Union has a responsibility to implement measures which reduce tobacco use across Europe, and the revision of the Tobacco Products Directive is central to that. As this report will be so important, and undoubtedly controversial, the Council and Parliament will need time to thoroughly scrutinise and negotiate an effective revision. If we do not begin work at the beginning of 2012 we could be in real danger of having to restart the whole process after the 2014 elections. Given our commitment to the Framework Convention on Tobacco Control this is simply not an option.

We are of the view that further delays are not acceptable, and would appreciate if the Commission could inform us of a definitive timetable for the revision of the Tobacco Directive.

The only problem is that the EU's public consultation didn't exactly go Big Pharma's way...

Of the citizens who submitted their opinions, more than eight out of ten, 84 percent, support lifting the export ban on snus. 86 percent of government representatives and 74 percent of industry representatives wish to lift the ban. Only among lobbyists and NGOs is there a slim majority, 56 percent, who want to keep the ban on snus.

The consultation was a disaster for Pfizer because the anti-tobacco extremists neglected to get their NGOs and fake charities to respond en masse. Worse still, tobacco retailers in two countries organised petitions which generated 82,000 responses.

Mind you, those 82,000 people were probably tobacco users so the EU won't be counting them...

The EU Commission, however, dismisses a significant portion of the responses from the 82,000 citizens on the grounds that two-thirds are from Italy and Poland, where tobacco merchants organised petitions.

Some people say the EU is anti-democratic, y'know.

But even if we exclude these two countries, the majority is still for lifting the export ban on snus, 10-6, when respondents are broken down by country.

Bit of a bugger. What if we exclude the public altogether?

DN's review of the 400 responses in this group shows that even among the responses from parliamentarians, municipalities, government agencies and ministries a large majority, 71 percent, support lifting the export ban. 

Ouch! Surely there must be some way to fiddle the figures?

Even when only EU governments and ministries are included, there is still no majority against snus, but rather 3-3.

Damn it! How is the EU supposed to justify its arbitrary, scientifically indefensible prohibition when even politicians won't lend their support?

Oh well, there's only one thing for it...

The European Commission's health directorate claims to have received responses from governments who in other ways support the ban on snus, but refuses to show them.

Bingo!

"You know that public consultation that went against us? You won't believe this, but I've just found a bunch of responses down the back of the sofa. Thousands of them, and all of them support the ban! 


Sorry, you want to what? Oh, you want to see them? Er, yes...erm...ah... Good Lord is that the time? I really must be going..."

Some people say the EU is corrupt as well, y'know.

However, there may yet be a glimmer of hope...

The European Commission has promised Sweden it will take another look at its ban of the tobacco product snus, which is allowed in Sweden but banned elsewhere in the European Union, the Swedish trade minister said on Wednesday.

Trade minister Ewa Bjorling said she had met EU Health Commissioner John Dalli and discussed the results of a survey of EU states about current tobacco laws.

“What I believe is most important is that you base your reasoning on scientific facts. That is what I try to tell Dalli, and I ask the question: Why do you still want to have a ban on Swedish wet snuff when there are other snuff products on the market in the EU, for example Pakistani snuff?,” Bjorling told Reuters.

This was the second time she raised the snus issue with Dalli.

“I think he was listening in a different way this time. The first time he dismissed it simply saying their goal is to get everything away for health reasons,” Bjorling said.

I suppose not dismissing the idea out of hand is some sort of step forward. Interesting to note that the real goal is total prohibition of all tobacco products, but I think we'd worked that out already.

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Snus prohibition

This week I wrote an article for the Swedish newspaper Espressen about the EU prohibition on snus—which most Swedes find baffling (and with good reason). The whole story is recounted in my book The Art of Suppression. This is a very brief overview. Prohibition still kills. Won't someone tell the FDA?

Here is the unedited article in English...

For most of us, the word ‘prohibition’ brings to mind images of Al Capone, Elliot Ness, speakeasies and moonshine gin being distilled in bath tubs. It is widely acknowledged that America’s attempt to use manmade laws to defeat the laws of fermentation was a fiasco. Russia, Finland and Iceland also experimented with bans on alcohol in the 1920s with equally dismal results. Sweden narrowly escaped the same fate in 1922 when a referendum for national prohibition was defeated by the tightest of margins - 49% voted for and 51% voted against.

The violence, crime, ill health and drunkenness that invariably accompanied alcohol prohibition meant that it was repealed in every country that tried it. Finland’s ban was so unsuccessful that by the time it ended in 1934, the Swedish government was complaining about the amount of drink being smuggled in from its supposedly dry-as-dust neighbour.

Bootlegging, gangsterism and poisonings were unintended consequences of prohibition that no government could ignore, but the harmful consequences of criminalising products are not always so obvious. In the case of the European Union’s ban on Swedish snus, the damage remains unseen precisely because the prohibition has ‘worked’. It has ‘worked’ in the sense that few people outside Scandinavia use – or are even aware of – the product. As a means of limiting snus use in Europe, the ban has been a roaring success, but as a public health measure it has failed as grievously as any prohibition in the last two hundred years.

My country, the United Kingdom, must take some of the blame. In the 1980s, a smokeless tobacco company set up a headquarters in Scotland where they produced an oral tobacco product similar to snus called Skoal Bandits. Low in nicotine, sweetly flavoured and with a masked cowboy emblazoned on each container, Skoal Bandits were accused of being aimed at teenagers. The British have no history of using snus and, as a result, there was a loophole in the law that allowed its sale to children. Alarmed by this news, anti-smoking groups and the tabloid press led a brief moral panic which resulted in oral tobacco being banned outright in the UK and Ireland. In 1992, the European Commission complained that unilateral bans by member states undermined market harmonization and so decided to enforce a total ban on “new tobacco products for oral use.”

Few noticed and fewer cared about this legislation because hardly anybody in the EEC used these products. It was not until Sweden prepared to join what had become the EU in 1995 that it became a live issue. Aware that Sweden was a nation of snus-users, the European Commission temporarily abandoned its insistence on market harmonization and allowed it an exemption from the ban. The rest of Europe remained indifferent to this little piece of diplomacy, but that was about to change.

The public health basis for the EU’s ban was based on the twin assumptions that snus increased the risk of oral cancer and was a gateway to smoking. The first of these beliefs was plausible since it was well known that some smokeless tobacco products, especially those used in Africa and Asia, contain high levels of carcinogens. What was less well understood, however, was that Swedish snus is a fundamentally different product. Whereas the hazardous ‘tobacco-specific nitrosamines’ can be found in excess of 1,000 parts per million in some chewing tobaccos, levels in Swedish snus are as low as 2 parts per million. Very little was known about the effect of snus use on health when the EU introduced its ban, but when scientists conducted studies in the 1990s, they found no difference in cancer rates between users and non-users. This evidence was so compelling that, in 1999, the EU went to the unprecedented step of removing the ‘Causes Cancer’ warning on snus packaging.

As for the ‘gateway to smoking’ hypothesis, it has become clear in the last twenty years that snus is a gateway from smoking. The revival of snus use in Sweden since the 1970s has been accompanied by an exceptional decline in smoking prevalence. Today, Sweden has the lowest male smoking rate and the lowest lung cancer rate of any developed country. In the North of the country, where snus consumption is at its highest, the smoking rate is lower still. Any lingering fears that snus causes cancer are dispelled by the fact that Sweden also has the third lowest rate of oral cancer (and the fourth lowest rate of pancreatic cancer) of any EU nation.

As public health researchers pieced this picture together, it became clear that European smokers had been deprived of a product that could help them quit cigarettes. One study estimated that 200,000 lives could be saved if the whole EU emulated the ‘Swedish experience’. Britain’s Royal College of Physicians, Action on Smoking and Health, the American Association of Public Health Physicians, the European Respiratory Society, the Norwegian Directorate of Health and the Swedish government have all called for the EU ban to be overturned, but they face resistance from hard-liners in the anti-smoking movement who are anxious to maintain one of the world’s few prohibitions of a tobacco product. The manufacturers of nicotine gums and patches are also keen to maintain their monopoly on the smoking cessation market and have lobbied hard for the ban to remain in place.

This leaves snus in a peculiar position. Despite being a near-harmless substitute for smoking, it is treated like an illegal drug in the EU while cigarettes remain freely available to any adult who wants to buy them. Few Swedes appreciate the role that snus has played in improving the nation’s health and few people outside Scandinavia have even heard of it.

There are no Al Capones or Pablo Escobars smuggling snus into other member states. No one is making counterfeit General in their basements or running illicit bars for snus users. The curious ban on snus has created no mayhem in the streets and yet, by helping to keep nicotine users consuming the most deadly tobacco products, this little known prohibition may be costing more lives than all the poisoned moonshine drunk in 1920s America.

Other recent articles related to The Art of Suppression:

'We should stop panicking about Boozy Britain' (Independent)

'Prohibition fuels firestorm of new dangerous drugs' (City AM)

Patrick Hayes' review of The Art of Suppression (Spiked)

Tom Miers' review of The Art of Suppression (The Free Society)

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A little snus coverage

Apropos nothing, The Guardian has run a little story about a snus.

It's not snuff, it's not snout … it's Snus

Could this brown, sticky Swedish stuff save smokers from their addiction?

It is brown, sticky and can cover your teeth in discoloured drool...

Sounds real tempting so far, doesn't it? They're talking about loose snus here, which doesn't come in a bag and is therefore a messier affair. It's much less popular than pouched snus so I'm not sure why they're focusing on that, or why they use a picture of loose snus at the top of the article, but don't worry, it gets better...

– but Snus might be gaining ground as the answer for smokers wanting to give up.

Now you're talking.

Pronounced Snooss, this moist tobacco powder, made in Sweden since the 19th century, is proving a hit worldwide, with sales by manufacturer Swedish Match booming in the US and Canada.

Snus is unlike either snuff, which is sniffed, or chewing tobacco, which releases nicotine only when chomped on. Instead, users squeeze it into rabbit dropping-sized pellets...

Yes, that recognised unit of size: the rabbit dropping.

...or use pre-packed sachets that look like miniature teabags, slipping them under the upper lip for up to an hour. Absorbed into the bloodstream through the lip, Snus has a softer but longer nicotine buzz than cigarettes.

Described as "something they would use in the far northern backwoods" by fan Marcus Rosengren, well-to-do Swedes once considered the use of Snus a bit coarse. In the past 30 years, however, many have switched to it from cigarettes, giving Sweden the lowest number of smokers in Europe.

Yes indeed. The 'Swedish experience'—which could be emulated elsewhere in Europe were it not for alleged health campaigners who say they want to, er, reduce the number of people who smoke...

Meanwhile, in Europe, the Swedes are lobbying to quash an EU ban that permits the consumption of Snus but bans its sale.

As a pre-emptive plug, I should say that the bizarre history of the EU's ban on snus will make up one chapter of my forthcoming book on prohibition. It should be out in September; more details will follow.

Though Snus has been linked to raised blood pressure and an increased risk of pancreatic cancer...

Actually, the pancreatic cancer myth was pretty thoroughly debunked at the start of the year, when the biggest study ever conducted into it found no risk from snus.

...it is not as harmful as smoking.

It is, let's be clear, somewhere in the region of 99% safer than smoking.

Sweden has the lowest rate of tobacco-related diseases in the west, and a low rate of the oral cancers Snus was once thought to encourage.

That Swedish experience again. Can we end the stupid EU ban now?

The Guardian article is welcome and fairly accurate, even if it does make snus sounds more icky than it actually is. Any exposure of the snus issue and, by extension, the folly of anti-tobacco extremists is to be encouraged, and it was good to see twitterati supremo Stephen Fry mentioning it to his three million followers.

How good of him to spread the word and how strange that tobacco control—whose only legitimate function is to help smokers who want to quit to do so—should be so reticent to speak out against the EU ban (although there are some notable, and noble, exceptions). Never forget that until recently, ASH (UK) actively supported the repeal of the ban. That was in the days before Deborah Arnott and pharma-sponsored anti-smoking conferences. I'm sure this is just a coincidence though [cough].

Finally, an amusing advert for snus I've just seen on Youtube. (Disclaimer: I'm not endorsing this particular company, I haven't tried their product and I haven't received any money from them, yadda, yadda, yadda. I just thought you might enjoy it.)

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Harm maximisation

Bit busy at the moment but there are a couple of harm reduction-related stories that you might be interested in.

Via F2C, I see that the BBC has implied that e-cigarettes might have killed a man in North East England.

Gateshead doctor calls for research into 'e-cigarettes'

A doctor from Tyneside has called for more research into "electronic" cigarettes following the death of one of his patients.

The wording of this non-story is extremely vague for the very good reason that there is no evidence that e-cigarettes did—or could—contribute to this man's death. El Beeb doesn't mention that the deceased had been a heavy smoker for decades, nor that the doctor involved—Dr Robert Allcock—is not any old GP, but is on the advisory panel of Smokefree Northeast and campaigns for various anti-tobacco policies. UKVapers has a more sober assessment of the story here.

And via Snus Central, it seems that another alleged health group is turning the screw in its efforts to keep people smoking cigarettes:

The Swedish snus eStore owned by World Wide Snus AB has been shut down and its assets seized. At the time of this writing, we're told a cancer organization in Finland filed suit against the Swedish snus store for allegedly selling snus to customers in Finland. This cancer organization apparently won the suit.

Latest information is that Finland presented the findings to Swedish Customs. On Tuesday, March 22nd, the Swedish Customs Service and local Police raided the SnusWorldWide.com facilities and seized them along with the inventory and other contents. World Wide Snus AB's bank accounts were simultaneously frozen.

If I'm not mistaken (let me know in the comments) this represents enforcement of the existing EU ban and is not a new restriction. It is illegal to export snus from Sweden for sale in any EU state—and that includes mail order and internet sales. Nevertheless, it is interesting that a "cancer organisation" would go to such trouble to prohibit a product that does not cause cancer.

Hopefully, the EU will see sense and repeal this absurd and counter-productive ban when the new Tobacco Products Directive is issued. In the meantime, Finns will have to buy their snus illegally, or from the US, or get back on the cigarettes.

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No link between smokeless tobacco and pancreatic cancer

A meta-analysis in the current issue of Annals of Oncology has found no association between smokeless tobacco (SLT) use and pancreatic cancer. Authored by no fewer than thirty researchers, including Paolo Boffetta, the study ends by saying:

In conclusion, this large collaborative pooled analysis of noncigarette tobacco use in 11 studies within PanC4 provides evidence that cigar smoking is associated with an excess risk of pancreatic cancer, while, based on small numbers, no significant association emerged for pipe smoking and smokeless tobacco use.

Smokeless tobacco users who had never smoked (the relevant subgroup if we are to see whether SLT causes pancreatic cancer) was 0.62 (0.37-1.04).

Our results on smokeless tobacco use are in broad agreement with a recently published meta-analysis of all published data on the issue, which reported no excess risk of pancreatic cancer in case–control studies. They are, however, at variance with those from another meta-analysis, based mainly on data from two Nordic cohort studies, which suggested that smokeless tobacco is associated with an increased risk of pancreatic cancer.

Why the discrepancy? Partly because, as Brad Rodu and Philip Cole noted at the time, the two Nordic studies failed to control for drinking and smoking status. The widely reported claim that SLT results in a 67% increase in pancreatic cancer risk comes from one of these studies (also co-authored by Boffetta), but this was only achieved by including former smokers, who are known to have an increased risk. Amongst the non-smoking SLT users, there was no elevation in risk.

The new meta-analysis has addressed these confounding factors:

Further, we were able to allow for study design variables and major identified possible confounding factors, including ethnicity, education, BMI, diabetes and alcohol consumption, and to estimate the risk of smokeless tobacco use in lifelong nonsmokers, thus minimizing any possible bias due to residual confounding.

This study should go some way to finally putting the SLT/pancreatic cancer myth to bed. One by one, the scares about SLT, including Swedish snus, have been shown to based on remarkably little evidence. Although it is still widely believed that snus causes oral cancer, this has long-since been disproved by a string of studies (the EU removed the 'Causes Cancer' warning from snus back in 2001). In recent years, those opposing the legalisation of snus in the EU (Sweden has an exemption) have relied heavily on the pancreatic cancer scare. Although not biologically implausible, the epidemiological evidence for this has always been highly suspect and is at odds with population-level incidence of the disease (Sweden's rate of pancreatic cancer is the fourth lowest in the EU).

Health scares tend to cast long shadows, partly because studies like this go unreported in the media. It's possible that SLT will be popularly believed to cause oral and pancreatic cancer for years to come. But the evidence for both claims has never been weaker.

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Tobacco control caught fibbing again

The Swedish National Institute of Public Health (SNIPH) has got itself into hot water after lying accidentally giving the wrong impression to journalists about the health effects of snus.

SNIPH has been waging a vendetta against snus for many years. As you may be aware (if you recall Skoal Bandits), a massively ill-informed burst of prohibitionist fervour in the early 1990s resulted in snus being made illegal in the EU. The reasoning was that it caused oral cancer and was a gateway to smoking. Sweden wisely negotiated an opt-out when it joined the EU in 1995 and since then a mountain of evidence has amassed to show that snus categorically does not cause oral cancer and that is a very effective gateway away from smoking.

The SNIPH would have us believe that the Swedes' incredibly low rate of smoking (just 12%) and correspondingly low rate of lung cancer are in no way way related to the enormous quantities of (basically harmless) snus they consume instead. Nor are they prepared to consider the possibility that if the EU removes its completely arbitrary ban on the world's least hazardous tobacco product, the Swedish experience could be replicated elsewhere.

For motives that are—I'm sure—as pure as the Scandinavian driven snow, various people in and around the EU don't seem all that keen on legalising a product which is about as safe as Nicorette and considerably more effective as a smoking cessation aid. I really can't think why the tobacco control movement would be against such a product.

Having grudgingly accepted that snus doesn't cause mouth cancer (which is intuitively the most likely outcome from a tobacco product used in the mouth), the SNIPH has been on a ten-year fishing expedition to find a 'link' with various other cancers and heart disease.

Last week came a shock new claim. At their conference in Stockholm, the SNIPH announced the results of a new study which showed that snus affects fertility and causes impotency. DN, one of Sweden's biggest newspapers, announced that "nicotine in snus affects potency and also inhibits women's ability to become pregnant." (Article here; translation here.)

This claim came directly from the SNIPH's tobacco control project manager, Asa Lundquist, and generated considerable discussion in Sweden, where over 20% of men are regular snus users. Swedes are used to hearing scare stories about snus (invariably from the SNIPH) and this was no exception. But what makes this scare particularly risible is the fact that the "finding" is a figment of Lundquist's imagination. Although she went on the record to talk about the study, and even approved the DN's article before publication, no such study has ever been conducted and the DN has since printed a correction:

SNIPH backs off on snus and potency

In Wednesday's DN we referred to a new study from the Public Health Institute showing that snus causes erectiledysfunction. No such study exists.

"I nearly fell off my chair when I saw this article," said Stefan Arver, associate professor of endocrinology at the Karolinska Institute. "There is no such study. We have a hypothesis and plan to conduct a study among snus users after the new year."

It's bad enough that researchers announce what they expect to find from a commissioned study (eg. Jill Pell, Manuela Martins-Green). But pretending to have completed the study and making up the result has to be a new low. So please, in the interests of whatever tiny degree of scientific integrity that remains, at least have the decency to begin the research before you start lying to us.

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How harm reduction works

A little story from Iceland tells a bigger story about how tobacco harm reduction could, and does, work in practice...

The sale of cigarettes has decreased significantly this year compared to 2009. According to the State Alcohol and Tobacco Company of Iceland (ÁTVR), sales dropped by almost 13 percent in the first nine months.

However, at the same time the sale of snuff and chewing tobacco has increased by 9.2 percent—at the end of September almost 18.8 tons of snuff and chewing tobacco had been sold in Iceland, Morgunbladid reports.

Cause and effect? Coincidence? Who knows? But if cigarette smokers are happy to switch to snuff and chewing tobacco, what would happen if they had access to snus, which is both less hazardous and—so many people say—more pleasurable than either?

Alas, the sale of snus remains illegal in Iceland, as it is in the whole EU (Sweden excepted).

Way to go, public health prohibitionists!

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Which way will ASH go on snus?

That cradle of democracy, the European Union, is allowing citizens to sort of vote on the Tobacco Products Directive. There are only seven questions so it's worth making your voice heard.

The main issues are the legalisation of snus, regulation of e-cigarettes, graphic warnings, plain packaging and bans on vending machines and tobacco displays—all the things that tobacco controllers have been getting excited about over the past few years, basically.

The snus issue is particularly important (see question below—and note the possibility of banning all smokeless tobacco products!) Click to enlarge.

Of all the suggestions put forward in the EU document, repealing the ill-conceived and scientifically unjustifiable ban on snus is the only one which would have a positive impact on health. The only EU country currently allowed to sell snus is Sweden. Not coincidentally—since snus is 99% safe—Sweden also has the lowest rates of smoking-related diseases.

ASH (UK) will doubtless submit its views to the consultation, but which way will it go? In 2004, an ASH press release said:

ASH believes that there is no logic to the banning of snus, when cigarettes, which are far more deadly, are on general sale, but that snus should not simply be de-regulated.

That was six years ago, however, in the days before ASH developed a cosy financial relationship with pharmaceutical companies who also happen to make 99% safe oral nicotine products of their own. The "independent" anti-smoking charity has been quiet about snus in recent years.

ASH was originally set up, in part, to find ways of making tobacco consumption safer (an aim now wiped from their website). So will they act in the interests of public health or in the interests of the pharmaceutical industry?

You can respond to the online consultation here.

You can read the proposals here.

And everything else is here.

Meanwhile, GlaxoSmithKline has asked the US government to remove dissolvable tobacco products from the market. No conflict of interest there then.

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