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.
