Swedish Research Proving HPV Vaccine Prevents Cancer Mirrors that Country’s Life-Saving Snus Experience

 

Research from the Karolinska Institute in Stockholm and Lund University, published in the New England Journal of Medicine, proves beyond a shadow of a doubt that the human papillomavirus (HPV) vaccine protects women from cervical cancer.  It showed that vaccinated women had only 37% of the risk of contracting that cancer compared with women who weren’t vaccinated (incidence rate ratio [IRR] = 0.37, 95% confidence interval [CI] = 0.21 – 0.57).

Earlier vaccination was even better.  Girls younger than 17 years were 88% less likely to get cervical cancer (IRR = 0.12, CI = 0.00 – 0.34), while protection among women age 17 to 30 was over 50% (IRR = 0.47, CI = 0.27 – 0.75).

These critical findings mirror the Swedish tobacco experience: Snus use helps Swedes avoid the deadly consequences of smoking, acting to some extent as a “vaccine.”  I began chronicling the Swedish experience in 2002, with a series of published studies and, in 2003, Congressional testimony in which I demonstrated how use of snus protected Swedish men from smoking-related lung cancer.

Here is a full list of my published work on the Swedish snus experience, with PubMed links.  Proof of the Swedish snus vaccine is documented in # 10.

Rodu B, Stegmayr B, Nasic S, Asplund K.  Impact of smokeless tobacco use on smoking in northern Sweden.  Journal of Internal Medicine 252: 398-404-2002. https://www.ncbi.nlm.nih.gov/pubmed/12528757 

 

Rodu B, Stegmayr B, Nasic S, Cole P, Asplund K.  Evolving patterns of tobacco use in northern Sweden.  Journal of Internal Medicine 253: 660-665, 2003. https://www.ncbi.nlm.nih.gov/pubmed/12755962

 

Rodu B, Stegmayr B, Nasic S, Cole P, Asplund K.  The influence of smoking and smokeless tobacco use on weight among men.  Journal of Internal Medicine 255:102-107, 2004. https://www.ncbi.nlm.nih.gov/pubmed/14687245

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  

 

Eliasson M, Asplund K, Nasic S, Rodu B.  Influence of smoking and snus on the prevalence and incidence of type 2 diabetes amongst men: the northern Sweden MONICA study.  Journal of Internal Medicine 256: 101-110, 2004. https://www.ncbi.nlm.nih.gov/pubmed/15257722

 Rodu B, Jansson C. Smokeless tobacco and oral cancer: a review of the risks and determinants.  Critical Reviews in Oral Biology and Medicine 15: 252-263, 2004.  https://pubmed.ncbi.nlm.nih.gov/15470264/ 

 

Stegmayr B, Eliasson M, Rodu B.  The decline of smoking in northern Sweden.  Scandinavian Journal of Public Health 33: 321-324, 2005. https://www.ncbi.nlm.nih.gov/pubmed/16087495

 

Rodu B, Nasic S, Cole P.  Tobacco use among Swedish schoolchildren.  Tobacco Control 14: 405-408, 2005. https://www.ncbi.nlm.nih.gov/pubmed/16319364

 

Rodu B.  Snus and the risk of cancer of the mouth, lung, and pancreas.  Lancet 370:1207-1208, 2007. https://www.ncbi.nlm.nih.gov/pubmed/17920914

 

Rodu B, Cole P.  Lung cancer mortality: comparing Sweden with other countries in the European Union.  Scandinavian Journal of Public Health 37: 481-486, 2009. https://www.ncbi.nlm.nih.gov/pubmed/19535408

 

Rodu B, Heavner KK, Phillips CV.  Snuff use and stroke. Epidemiology 20(3):468-469, 2009. https://www.ncbi.nlm.nih.gov/pubmed/19363361

 

Rodu B, Heavner KK.  Errors and omissions in the study of snuff use and hypertension.  Journal of Internal Medicine 265: 207-208, 2009. https://www.ncbi.nlm.nih.gov/pubmed/19019185  

 

Rodu B, Jansson J-H, Eliasson M.  The low prevalence of smoking in the northern Sweden MONICA Study, 2009.  Scandinavian Journal of Public Health 41: 808-811, 2013. https://www.ncbi.nlm.nih.gov/pubmed/24052339  

I have also explored the Swedish experience in my blog (examples here, here, here, here, and here).

The new Karolinska/Lund publication also indirectly addresses a topic I’ve discussed: why randomized clinical trials don’t work well for harm reduction.  The NEJM authors underscore the key deficiencies: “Randomized, controlled trials cannot readily evaluate vaccine effectiveness against invasive cervical cancer because of the long lead time (the time from HPV infection to the clinical detection of cervical cancer) and the low risk of cervical lesions after vaccination.”

The long lead times for smoking-attributable diseases and the minuscule risks of vastly safer smoke-free products make population-based studies far more informative for analysis of tobacco harm reduction.

 

CDC 2019 Smoking & Vaping Data

 

The Centers for Disease Control and Prevention has released data from the 2019 National Health Interview Survey (NHIS).  After a short delay, during which I caused the agency to correct an error in their release (here), I can now present the latest figures on smoking and vaping.  Like last year, our government has had the 2019 data for months but has not released any findings.

The prevalence of current smoking was 13.6%, which was not a significant change from 2018 (13.7%); that’s 34.1 million.  Twenty-two percent of Americans were former smokers, the same as the year before. 

Prevalence of current vaping increased from 3.2% in 2018, to 4.3% in 2019.  That translates to about 10.82 million American adult vapers in 2019, up from 8.07 million the year before.  That is the second annual increase and it represents the largest number of vapers since the CDC started tracking e-cigarette use in 2014.

The 10.82 million adult vapers includes 4 million current vapers who are also current smokers.  Think about this: If America’s public health leaders abandoned their war on vaping and instead adopted their British counterparts’ practice of speaking honestly about vastly safer vaping, these 4 million smokers might become completely smoke-free. That would result in an unprecedented smoking decline of 11.7%.    

Despite the misinformation campaign against smoke-free substitutes, the number of current vapers who were former smokers increased from 3.04 million in 2018, to 4.27 million in 2019.  That is over one million more than the year before, and the highest number since tracking started. 

Note that there were 2.55 million never smokers who vaped in 2019, up from 1.71 million the year before.  In addition, the age profile shifted, becoming a little older.  In 2018, over two-thirds of this group were 18-24 years old, dropping to 58 percent in 2019.  About one quarter were 25-34 years old, and ten percent were 35-44 years old. 

Tobacco and nicotine prohibitionists in government and elsewhere continue to portray vaping as dangerous and evil.  Despite this, the number of Americans using this vastly safer smoke-free nicotine delivery system continues to grow, but much too slowly.  The disgraceful and unethical campaign against these products continues to bias smokers against safer options.

 

Discovery & Correction of An Error in the 2019 National Health Interview Survey Release

 

I recently discovered a critical error in the 2019 National Health Interview Survey by the Centers for Disease Control and Prevention.  Here is the story.

When the CDC announced the release of the 2019 NHIS on September 23 here, I downloaded and began using the data.  Right away, I discovered an error that made accurate population estimates impossible.  The flaw essentially underestimated the U.S. population by about 100 million.    

I phoned the CDC and was told that staff would investigate the matter.

The CDC typically releases data as a mass of numbers that cannot be used without a statistics program.  The agency provides computer code for three common programs (named SAS, SPSS and Stata) that help researchers massage the data into usable form.  The codes consist of several thousand lines of directions written in the language of each statistics program.  I found a single line of erroneous code in the SPSS input statements.  On September 25, I emailed my CDC contact with details of the problem and the solution.  He replied on September 28, “We do have an error in our program that is affecting the total population and the point estimates.  We are working on a fix and will re-publish the SPSS program soon on our website.” 

On September 29, the CDC corrected its error.  The only acknowledgement of the correction was a message sent to members of the NHIS Users email list.  The agency failed to make note of the correction on their website, and did not change the date stamp on the page, which still reads, “Page last reviewed: September 23, 2020,” rather than September 29, as it should.  This is inadequate, as many users will not be aware of the error; if they use the original program, their work will be inaccurate. 

The NHIS is the premier instrument for assessing the health of the nation.  For decades, the CDC has used the annual NHIS to count the number of current and former smokers, and the surveys are a valuable source of health-related information for researchers across the globe.  The CDC should better document its errors and corrections.