EU Snus Ban Costs More Lives

A new report from the Swedish Snus Commission underscores the accelerating human toll of the European Union’s unconscionable ban on smokeless tobacco: “…among men over the age of 30, 355,000 lives per year could have been saved if the other EU countries had matched Sweden’s tobacco-related mortality rate.”  Sweden is the only EU nation in which sales of snus are legal.

In 2009, epidemiologist Phil Cole and I, analyzing data from the World Health Organization and the International Agency for Research on Cancer, reported in the Scandinavian Journal of Public Health that 274,000 smoking-attributable deaths would be avoided if men throughout the EU had the smoking prevalence of men in Sweden (here).  Four years later, I updated that figure to 291,000 (here).       

The Snus Commission report, available here, was produced by a distinguished group of Swedes.  The commission’s chairman is Anders Milton, a physician and former President and Chairman of the Swedish Medical Association, President of the Swedish Confederation of Professional Associations from 1993 to 2001, and President of the Swedish Red Cross from 2002 to 2005.  His collaborators are Christina Bellander, a journalist who previously headed business development at Swedish TV4 and was a Board Member of New Wave Group AB, Mittmedia AB and the Swedish Educational Broadcasting Company; Göran Johnsson, a former member of the Social Democratic Party’s Executive Committee, Board Member of Volvo AB and Chairman of Swedish national television broadcaster SVT from 2011 to 2014; and Karl Olov Fagerström, a WHO-recognized nicotine and tobacco researcher who has authored 150 articles in peer reviewed journals.

The casualty list from the indefensible and immoral EU snus ban continues to grow. 

How Dangerous Is Snus? Don’t Ask New York Times Editors

The New York Times has added more fuel to the anti-tobacco-harm-reduction fire with a December 4 editorial (here) rehashing the somewhat slanted reporting that appeared in the paper’s news pages on November 30.  In two stories that day, the Times explored issues surrounding Swedish Match’s FDA application to change the warnings on its snus products.  As I noted (here), “The Times and their quoted experts did a major disservice to their audience; they failed to report the simple truth, that mouth cancer risk for Swedish snus is next to nil.”

The original warning labels that Congress ordered for tobacco product packages in 1986 were factually wrong and fatally misleading to smokers, chewers and dippers.  Congress didn’t make the warnings more accurate when  it ordered the FDA to regulate tobacco in 2009, it just made them cover more of the package – an action it didn’t take with cigarettes. 

The Times editorial acknowledged that snus is “is less harmful than smoking tobacco,” but it painted Swedish Match’s application as a marketing ploy.  That ignores the critical need to terminate government’s lie about products’ health risks.

The editors echoed tobacco prohibitionists in denying that snus played a role in the Swedish experience.  Said the Times, “reduced smoking rates and lower rates of tobacco-related diseases such as lung and oral cancer” in Sweden since the 1970s “is debatable,” attributing the successes to “various bans, restrictions and public health campaigns.”  The editors failed to consider that the reductions are exclusively seen in men – who use snus and have the lowest lung cancer rate in Europe – not in women, who rank fifth in Europe for lung cancer.

The Times acknowledged that their reporters had “cited independent experts who found that snus is not nearly as lethal as cigarettes,” but it added the qualifier “[snus] is not risk-free either, especially for users who also smoke.”  It is patently obvious that smoking is risky for anyone, including snus users.  It should also be obvious that a smokeless tobacco can labeled “this product is not a safe alternative to cigarettes” encourages smokers to stick with their habit.

The Times editors revisit the discredited gateway theory (“the danger is that snus might lead some nonsmokers and former smokers to…progress on to cigarette smoking”), but they ignore substantial evidence that this has not happened in Sweden (here) or in the U.S. (here).

Summing up, the Times observes: “abstention would be the safest approach.”  That might work in Neverland, but in the U.S., abstention was impossible for the 8 million smokers who died in the 20 years since I first described our government’s warnings as bogus.  That is no one’s definition of safe.

The Swedish Snus Experience Isn’t Finnished

Despite the wealth of evidence demonstrating that snus has helped thousands of Swedish men and women avoid the ravages of smoking, the European Union continues to enforce an irrational ban on snus beyond Sweden’s border. 

I have documented that smoking deaths in Sweden are significantly lower than in all other EU countries (here and here).  A new study clearly demonstrates the differences in smoking rates when snus is available and when it is banned (abstract here).

Snus has been popular in Sweden for 200 years, but it was also used in neighboring Norway and Finland.  In 1995, Sweden and Finland joined the EU.  Sweden applied for and received a waiver on the EU’s existing snus prohibition, thereby allowing Swedes to continue producing and selling within the country.  In contrast, Finland accepted the ban, denying its snus consumers a legal source.  Norway never joined the EU, so snus remained available.

Dr. Jennifer Maki, an economist with the Center for Healthcare Economics and Policy, compared the smoking rates in these three countries before and after 1995.  Maki's figure above shows the rates among men in Sweden and Finland.  Clearly, a decline in smoking levels off in Finland after 1995, while the decline in Sweden continues, despite the fact that it was far lower over the entire period.  As Maki writes, “…in the post-ban period, smoking increased in Finland by 3.47 percentage points relative to Sweden…this estimate can be interpreted as an increase in the smoking rate [in Finland], relative to what it would have been, in the absence of the ban.”

The comparison of Finland and Norway, seen in Maki's chart on the left, also shows the effects of snus use on smoking.  According to Maki, “the smoking rate [decline] in Norway is similar to that in Finland prior to 1995, after which point the rates diverge. Using Norway in place of Sweden as a control produces a result similar to, but not as drastic as, [the Swedish comparison].”

Maki’s conclusions illustrate the impact of snus in Sweden, the impact of the snus ban in Finland, and the utter failure of EU policy:

“The smoking rate among Swedish males is remarkable [sic] low, and continues to decline; given Sweden’s low smoking rate pre-1995, the ability to achieve further reductions post-1995 is notable… The findings presented in this paper provide support for the viability of a harm reduction approach to smoking cessation and suggest that the Swedish Experience could be replicated elsewhere… It may have been underway in Finland prior to the implementation of the ban.  These results are not only meaningful within Finland, but may be applicable to the entire EU.”

Note: I am especially proud of Jennifer’s contribution.  She contacted me when she was a doctoral student at North Carolina State University; I provided materials on tobacco harm reduction, reviewed and critiqued early versions of her thesis and helped her search for Swedish and Finnish datasets.  Her mentor, Professor Barry Goodwin, sponsored my guest lecture at NC State, and I hosted a visit by Jennifer to the University of Louisville so that she could present her work.