News; Jan 8, 2003 CET

The Swedish experience arouses interest in research circles

In a health context, the role of snuff (snus) as a significantly better alternative to cigarette smoking has created attention at a number of major international conferences during the past half year. The experiences cited have mainly derived from Sweden.

In the search for methods to reduce the harmful impact of tobacco, Sweden and the recent changes in Sweden’s tobacco habits, have recently been the focus of attention among researchers and promoters of good health. During the past summer and early autumn, no less than five large conferences have been held around Europe, which in one way or another have addressed the harmful effects of smoking, nicotine dependence and alternative smokeless nicotine products.

THE FACTOR that has created most interest is the »full-scale experiment in health-impact reduction « that is in progress in Sweden, which is how Professor Michael Kunze from the University of Vienna described the situation to participants at the Eighth Central European Lung Cancer Conference in Vienna at the beginning of September. Professor Kunze presented the results of a study showing that the mortality rate among patients suffering from lung cancer and other smoking-related cancer diseases is lower among Swedish males than among Austrians. As a result, Sweden is the first industrialized country to report any significant reduction in the mortality rate among people suffering from tobaccorelated diseases. Professor Kunze and his colleagues say that the explanation can be sought in the major shift that has occurred in Sweden away from cigarettes to smokeless nicotine products. At the end of 2000, this latter category accounted for about half of all nicotine consumption in Sweden.

»Several of the studies indicate that there is no excessive risk of cardiac infarct among snus users, as distinct from cigarette smokers. At the same time, it is generally known that snus is a major help to many smokers who want to quit.«

»THE SWEDISH Experience, « as this phenomenon has become known internationally, is based on the high consumption of snus in relation to cigarettes. This in turn has led to several large epidemiological studies being made. None of them have shown any links between Swedish snus and cancer. Several of the studies indicate that there is no excessive risk of cardiac infarct among snus users, as distinct from cigarette smokers. At the same time, it is generally known that snus is a major help to many smokers who want to quit.

Against the background of these studies, the debate has increasingly focused on snus as an alternative to smoking for people who are nicotine-dependent. Until we have a completely nicotine-free society, which is not likely for some time, many public health representatives claim that it is better to take snus than to smoke. Many argue that this will continue to apply in a reality where a large group will never get over their addiction as long as nicotine exists. And, as noted, the advocates of a harm-reduction approach are growing in number.

THE MOST RECENT EXAMPLE of this change in attitude was confirmed at the scientific conference on nicotine dependence in Santander, Spain, at the beginning of October. One of the agenda items was devoted to Swedish »snus.« In an address, Clive Bates, from Action on Smoking and Health and one of Europe’s foremost opinion lobbyists, proposed that the EU’s ban on snus be lifted and that legislation be passed to instead regulate the limits for undesirable substances in snus.