The New Yorker magazine recently published an article,
“Zyn
and the New Nicotine Gold Rush,” that
included a remarkable passage from a discussion between the author and Thomas
Ericsson, a former Swedish Match employee.
It perfectly describes the risks of using snus and nicotine.
“I asked Ericsson whether he had any concerns about the
possible harms of nicotine itself. ‘Of course you should have concerns,’ he
told me. ‘Or you should do risk analysis.’ He walked out of the room and
returned with a large ball of string. The string was exactly ninety-five metres
long, each millimetre representing one of Sweden’s approximate ninety-five
thousand annual deaths. Ericsson slowly unravelled the string until he reached
a piece of tape representing the people who die early from smoking each year.
He moved his fingers down to another marker, a few meters shorter, which
represented the people who die from drinking. He continued shortening the
string, indicating the number of deaths by suicide (fifteen hundred), drowning
(a hundred and fifty), car accidents (two hundred), and workplace accidents
(between fifty and seventy).
“‘You can ask yourself, What are Swedish people most afraid
of? They’re afraid to fly. They’re afraid of wolves. They’re afraid of deer and
other things,’ he said, holding a short length of string. ‘But what you should
be afraid of is the wasp. It kills five to ten people every year.’ Finally,
Ericsson reached the very tip of the string. While working on Nicorette, he and
his colleagues did a risk-analysis calculation that estimated that fewer than
two people per year would die of heart illnesses exacerbated by nicotine use.
Compared with other hazards, he said, ‘this is not a big risk.’”
I have recognized the minuscule risks of snus since 1995, when
I first described the Swedish experience in a peer-reviewed publication:
“Sweden has been the world's largest per capita consumer of
smokeless tobacco (ST) throughout the 20th century, without a resultant oral
cancer epidemic. On the contrary, the
age-adjusted mortality rate for oral cancer from 1960 to 1990 in Sweden was low
and remarkably stable at 2.3 to 3.6 per 100,000 person-years. A retrospective study of 200,000 male snuff
dippers in Sweden found only one case of oral cancer per year. This is in marked contrast to most other
European countries where ST use is essentially nonexistent and where increases
in oral cancer mortality have mirrored earlier increases in cigarette
consumption. The greatest increase in
oral cancer mortality has occurred in France (13.4/100,000 person-years in
1955-59 to 32.3/100,000 person-years in 1985-89).
“It is not surprising to find that Swedish lung cancer
mortality rates have been the lowest in Europe over the past 40 years. These large scale vital statistics from
Sweden and France strongly support the suggestion that if tobacco is to be
used, it should be in the form of ST and not cigarettes. The population that
uses ST in lieu of smoking is, in effect, protected from lung cancer and other
major smoking-related diseases and suffers little or no increased risk of oral
cancer.” (emphasis added, references removed)
In 2004, following my research sabbatical at Sweden’s Umeå
University, I published this:
Rodu B, Cole P. The burden of mortality from
smoking: comparing Sweden with other countries in the European Union. European
Journal of Epidemiology 19: 129-131, 2004. https://www.ncbi.nlm.nih.gov/pubmed/15074568
In that article, epidemiologist Philip Cole and I described “the
mortality currently attributable to smoking in the European Union (EU), and the
change that would result if all EU countries had the smoking prevalence of
Sweden. Almost 500,000
smoking-attributable deaths occur annually among men in the EU; about 200,000
would be avoided at Swedish smoking rates.”
More than 20 years after our estimates were published, the
Swedish Tobacco Experience has become a Gold Rush, meaning that more people are
consuming nicotine and tobacco in a safer fashion.
