Each year, more than 400,000 persons in the US die from smoking-related diseases. This is more than double the number that die from alcohol, drugs, traffic accidents, AIDS, murder and suicide. These were the findings of the American Council on Science and Health (ACSH) in a report published at the end of last year.
In its report "Helping Smokers Quit: A Role for Smokeless Tobacco?" the ACSH discusses the strategies pursued to date by authorities and other bodies to reduce the harmful effects of cigarette smoking. The authorities' strategies are often based on intolerant attitude towards all types of tobacco products. In this report, they are compared with Harm Reduction, which is based on the observation that most smokeless tobacco products, such as Swedish snus, are significantly less harmful than cigarettes. Therefore it is better for smokers to replace cigarettes with other less dangerous products, according to proponents.
The Swedish Experience
This is a strategy from which the authorities should also learn, according to the ACSH, which cites what is called the Swedish Experience. This experience is documented in a large number of epidemiological studies with such findings as:
- The incidence of lung cancer among Swedish men has declined over the past 20 years, which researchers link to the fact that Swedish men are smoking less and that many of them have switched to snus.
- There is no demonstrable correlation between the use of Swedish snus and oral cancer.
- Neither has any link been shown between the use of Swedish snus and intestinal or esophageal cancer.
- Mortality in cancer is not elevated among Swedish snus users, and the risk of cardiovascular diseases is much lower in this group than among smokers.
The ACSH´s report includes a summary of scientific reports and studies by Brad Rodu, professor of tobacco studies at the Brown Cancer Center at the University of Louisville. He has long been one of the most prominent proponents of Harm Reduction in the US. Brad Rodu believes that authorities and health organizations have failed to get those whom he terms confirmed smokers to completely abstain from tobacco.
"At the same time, we have a solid scientific foundation to stand on that shows that modern, smokeless products are 98 percent less harmful than cigarettes," said Brad Rodu recently in the magazine Nordic Reach.
Ideological grounds for debate
Why then are the waves of debate still so high when it comes to Harm Reduction? One explanation may be that there are studies that show elevated risks with smokeless tobacco products. These studies were not performed with Swedish snus or equivalent products, however. Through its GOTHIATEK® quality program, Swedish Match long ago virtually eliminated the content of carcinogenic tobacco-specific nitrosamines in its products that can be linked to an elevated cancer risk.
Another explanation is purely ideological, according to Freddi Lewin, who is responsible for scientific issues within Swedish Match North Europe Division.
"The polarization depends on what you believe society can do," says Freddi Lewin. "Opponents of Harm Reduction are working for a completely tobacco-free society and are therefore unyielding in their opposition to every form of tobacco use. Unfortunately, such a goal is almost an unattainable utopia. The World Health Organization (WHO) has published estimates that show the opposite and that smoking will increase over the foreseeable future. This will apply even in the most favorable scenario.
"Balanced information is therefore important so that people can make informed decisions," emphasizes Freddi Lewin who himself is an oncologist.
Evaluation within the EU
"Researchers know, for example, that nicotine does not cause cancer. Among the general public, however, there is still a perception that it is the nicotine that causes cancer. It would be a great help in public health work if authorities and researchers could dispel the myth that all tobacco is equally harmful," continues Lewin.
Despite continued debate, Freddi Lewin nonetheless believes that Harm Reduction is winning ground in the research community.
"An evaluation of smokeless tobacco products is also being performed within the EU. Our hope is naturally that this will result in the Harm Reduction strategy gaining political support, which would be desirable from a public health standpoint," concludes Freddi Lewin.