I've been working on this a while and I'm glad to finally have some articles up. When I first started using snus, I heard the term "Harm Reduced Tobacco" thrown around alot, and alot of information about snus here and there, so I wanted to compile all the helpful articles online so that those new to snus or interested in switching can read about the health benefits of switching from cigarettes to snus, and skeptics can read some facts by experts and doctors.
"Swedish Snus cut risk of cancer"
From USAToday
Discussing snus and the need for it on the market to compete with cigarettes, as well as a study on snus users.
9 May 2007
"Tobacco Road Takes a Turn to the Smokeless"
From Wal Street Journal/Health
An article on snus, and the lower levels of carcinogens in snus as well as lack of risks of oral cancer.
27 January 2009
"Snus Ruse"
From Reason Magazine
A little about the EU's ban and the "Quit or Die" option they present. One of my favorite quotes, "...the E.U.'s policy is rather like banning bows and arrows as an intolerable threat to public safety while allowing a free trade in machine guns."
25 December 2004
Study finds smokers prefer Snus and Zonnic over Nicotine Gum
Saturday January 16th, 2010
Jonathan Foulds, MA, MAppSci, PhD
A study was just published comparing the effects of nicotine gum, snus (smokeless tobacco sachets) and Zonnic (new synthetic nicotine replacement sachets) for reducing smoking. The study by Drs Caldwell, Burgess and Crane was conducted with 63 cigarette smokers at University of Otago in New Zealand.
During the study, participants were allowed to use each product for 2 weeks each to reduce their cigarette smoking. The researchers also measure nicotine withdrawal symptoms, cravings for a cigarette, and side effects.
The smokers reduced their smoking by 33% while using nicotine gum, by 37% while using snus and by 42% while using Zonnic sachets. The smokers also had fewer cravings for a cigarette and side-effects while using snus and Zonnic than while using nicotine gum. Overall they said they preferred using snus and Zonnic to using nicotine gum. The researchers concluded that more studies are needed of snus and Zonnic as replacements for cigarette smoking.
This study was interesting in that it took place in a country where neither snus nor Zonnic (both developed in Sweden) are available. Since the time the study took place, the Zonnic manufacturer (Niconovum) has been purchased by the large US tobacco company, Reynolds American. Although not a smoking cessation study, and clearly not definitive, it does provide some evidence that some smokers outside of Scandanavia may prefer these new alternative products as a way to stop smoking.
Zonnic is the brand name for Niconovum’s range of nicotine-delivery products including a sachet or pouch product (like a little white tea-bag) used in this study, an oral spray product, and a gum product. The Zonnic products are currently on the market only in Scandanavian countries. You can find out more about these products at:
http://www.niconovum.se/Products.aspx?id=5142993720952767944
Snus (moist snuff tobacco) is now more widely used by Swedish men than cigarettes, and has recently been launched in other countries, including the United States.
You can access my previous blogs about snus by typing it into the “Search Health Experts” box on the right.
Reference:
Caldwell B, Burgess C, Crane J. Randomized crossover trial of the acceptability of snus, nicotine gum, and Zonnic therapy for smoking reduction in heavy smokers. Nicotine & Tobacco Research..(available online Jan 11, 2010).
Camel Snus Smokeless Tobacco - What is it?
Thursday, January 01, 2009
Jonathan Foulds, MA, MAppSci, PhD
2009 will see further expansion of new smokeless tobacco marketing in the United States, including the national launch of Camel Snus. So what is this product? Snus is a smokeless tobacco product that is very popular in Sweden. It has been used there for over 100 years and so there is reasonable epidemiological evidence on its health effects. Overall, Swedish snus appears to be much less harmful to health than cigarettes, and probably less harmful than other types of smokeless tobacco sold in the United States.
Some recent reports on the health effects of snus in Sweden can be found via the following links: Link
The main characteristics of Swedish snus are that (a) it is an oral tobacco product that has relatively low levels of various toxins, as compared with traditional US smokeless products and (b) it delivers moderately high levels of nicotine to the user.
A recent study by researchers at University of Minnesotta found that Camel snus had levels of carcinogenic tobacco-specific nitrosamines that were much lower than for traditional smokeless products (I.e less than 2 micrograms per gram for Camel Snus, versus 8 for Copenhagen and 12 for Kodiak). Levels of other carcinogens were also lower in Camel and other snus products than other tradional smokeless products. For example, while the new snus products had levels of benzo(a)pyrene of around 3 micrograms/gram, tradional smokeless tobacco products all had levels above 30, and Kodiak Wintergreen had a level of 57.
Camel snus is marketed in metal tins kept refrigerated in stores. Each tin contains 15 small sachets which look a bit like small tea bags, each containing flavored tobacco. When placed under the top lip for about 30 minutes the snus releases nicotine which is absorbed into the blood stream. It is unclear whether the current snus products being marketed in the US deliver enough nicotine to satisfy cravings for a cigarette and potentially help smokers quit. The evidence from Sweden is clear that a large number of Swedish men have successfully quit smoking by switching to snus.
It remains to be seen how the product will be received in the United States. If you want to give up smoking and may need some pharmacological support, it makes much more sense to use FDA approved medicines than to use unproven products that contain carcinogens (albeit in small quantities). However, if you want to continue to enjoy tobacco but want to use a less harmful product, then switching from cigarettes to snus makes sense - but only if accompanied by cessation of smoking.
You can find out more about snus and other potentially less harmful tobacco products at: http://tobaccoproducts.org/index.php/Camel_Snus
Doctors: Swedish snus cut risk of cancer
Posted 5/9/2007 10:59 PM
By Maria Cheng, AP Medical Writer
LONDON — Smokers looking for a less harmful way to get their nicotine fix should switch to Swedish snus -- a smokeless tobacco that puts them at a significantly lower risk of cancer than cigarettes, doctors say in an article posted online Thursday in The Lancet.
Smokers are at least 10 times more likely to get lung cancer than people who use snus, studies showed -- a finding that could challenge bans on snus, particularly in the European Union.
All EU nations now prohibit snus, except for Sweden, which was granted an exemption because of the widespread use of the powder tobacco among Swedes. In the United States, smokeless tobacco is legal, and Swedish snus is being test-marketed in at least two U.S. cities.
"We should not delay in allowing snus to compete with cigarettes for market share," Dr. Jonathan Foulds of the University of Medicine and Dentistry of New Jersey and Dr. Lynn Kozlowski of the University of Buffalo said in analyzing two studies published in The Lancet.
"The banning or exaggerated opposition to snus in cigarette-rife environments is not sound public health policy," they wrote.
One study tracked the incidence of cancer over among nearly 280,000 Swedish men -- some of them snus users, some smokers and some who never used tobacco -- over a 20-year period. The other projected the effect on health if snus were introduced in Australia, where it currently is banned.
Swedish snus makers say the production process there is different from similar products in the U.S., adding that they work hard to remove carcinogens during manufacturing.
But snus is far from harmless; about 30 carcinogens have been found in the smokeless tobacco. In 2004, the Luxembourg-based European Court of Justice upheld a ban on the substance, ruling that the dangers of snus merited its being outlawed.
However, the two studies show snus may not be as harmful as previously thought, and far less harmful than cigarettes.
International researchers followed 279,897 male Swedish construction workers from 1978 to 1992. About 26 percent were snus users, 37 percent were smokers and the rest never used tobacco.
For smokers, the incidence rate of pancreatic cancer was 13 cases per 100,000. That rate dropped to 8.8 cases per 100,000 for snus users.
Among those who did not use tobacco, the rate was 3.9 cases per 100,000.
The study also showed that using snus did not increase the risk of oral cancer, though users might develop mouth lesions where the substance is placed since it generally is tucked inside the upper lip. In addition, using snus can complicate pregnancies and may raise the risk for heart disease.
In the modeling study, Australian researchers found that lifting current restrictions on snus would probably benefit public health if the smokeless tobacco is adopted by people who would otherwise continue smoking.
In Sweden, many smokers have switched to snus, and the country now has one of the lowest smoking rates in the world: less than 20 percent of the population.
Some experts worry that legalizing snus could still have harmful effects.
"As with all tobacco products, snus is not completely risk-free," said Jean King, director of tobacco control at Cancer Research UK. King, who was not connected to either study, said that while snus could help smokers quit, it would be important to prevent snus from being adopted by new users.
Smoking is the top risk factor for cancer, and approximately 1 billion people worldwide are addicted to the nicotine in cigarettes. Tobacco kills one in 10 people globally, and causes 4 million deaths every year.
"For a smoker, quitting all tobacco use is best, but failing that, switching to snus is a good idea," said Dr. Peter Hajek, professor of clinical psychology at Queen Mary University Hospital in London. Hajek was not involved in either study.
"If a sufficient proportion of smokers switched to snus, lifting the ban could be in the public interest," Hajek said.
Your Health This Week
Snus—the safer option for smokers. And more.
By Sydney Spiesel
Posted Tuesday, July 10, 2007, at 11:58 AM ET
Snus snuff may be less deadly than cigarettes
This week, Dr. Sydney Spiesel discusses snus, a snuff product that's safer than smoking, the link between malnutrition and immune deficiency, and a new treatment for stress incontinence.
Got snus?
Question: Snus, prepared from ground tobacco leaves, is a form of snuff that's usually tucked inside the cheek, where its nicotine payload can be slowly absorbed across the mucous membranes of the mouth. Snuff is generally regarded as harmful—in South Asia, for example, it's associated with a higher risk for mouth cancer. Is snus lower risk?
New research: That is the question examined in this recent Lancet paper. The researchers followed more than 125,000 Swedish construction workers, for 12 to 26 years, who were nonsmoking users of snus. They found no increase in oral or lung cancers, compared with nonsmokers who did not use any form of tobacco. But they did find an approximately double risk of developing pancreatic cancer, resulting in about 40 more cases of this disease in the 125,000 snus users. Other studies of snus users in Sweden show only tiny increases in heart disease and stroke, two conditions that are significantly higher in cigarette smokers. It would appear, then, that snus—though not risk-free—is safer than smoking.
Implications: Another Lancet paper examined whether introducing snus in Australia (where snuff is illegal, but cigarette smoking is not) would lead to an increase in tobacco use. The authors come out pro-snus: They argue that if snus were made legal, between 14 and 25 nonsmokers would have to start using to offset the gain in average life expectancy from every one smoker who quit and switched to snus.
Conclusion: Currently, more than 5 million people a year die worldwide as a result of tobacco use—in most developed countries, it's the cause of about one out of five deaths. The chronic illnesses associated with it are also terrible. So, these papers on snus put public-health people in a quandary. Should we promote a less hazardous tobacco product? If the goal is to reduce the harm done by tobacco, snus seems a pretty good choice. And yet I find it very hard to get the words out of my mouth. Which leaves me with a troubling question: Are doctors like me—blocked by prejudices from making rational choices—contributing to the harms caused by smoking? I'd better reform my ways.
Source: Wall Street Journal/Health
Link: http://online.wsj.com/article/SB123301644462817757.html
JANUARY 27, 2009
Tobacco Road Takes a Turn to the Smokeless
By KEVIN HELLIKER
About 18 months ago, Russell Stevens gave up cigarettes and took up a new habit -- placing between his lip and gum a tiny pouch of smokeless tobacco called Camel Snus. The 26-year-old Kentuckian says it satisfies his craving for nicotine while exposing him to far fewer risks than did smoking.
Like Mr. Stevens, more Americans are continuing to give up smoking, helping to push cigarette consumption down about 3% each year. To help kick the habit, many smokers turn to safer sources of nicotine -- the addictive but non-carcinogenic ingredient in cigarettes -- such as nicotine gum, patches or lozenges.
But one method that has been gaining ground as a safer alternative to cigarettes -- smokeless tobacco -- remains controversial. A decades-old federal law requires smokeless tobacco to carry a label warning that it is not a safe alternative to cigarettes. The perils include possibly increased risk for certain cancers and cardiovascular disease. And U.S. public-health officials note that no clinical trials have been conducted showing that smokeless tobacco is an effective quitting aid. Adding to the controversy: Some of the biggest cigarette makers are jumping into the non-combustible market.
R.J.Reynolds Tobacco
Tobacco makers are launching smokeless products that have fewer risks than cigarettes.
"There is no evidence that smokers will switch to smokeless tobacco products and give up smoking," Michael Thun, vice president of epidemiology for the American Cancer Society, said in a recent article in the journal CA.
Still, popular brands of smokeless tobacco generally contain far fewer carcinogens than do cigarettes, although some studies indicate the habit isn't risk-free. One recent study showed that some newer brands, with names like Ariva, Camel Snus and Marlboro Snus, have sharply lower levels of a dangerous carcinogen than do older varieties of smokeless tobacco, such as Copenhagen and Skoal. Britain's Royal College of Physicians, which sets health standards in the United Kingdom, has said smokeless tobacco is between one-tenth and one-one thousandth as hazardous as smoking, depending on the specific product. As with all nicotine-replacement products, smokeless tobacco can lead to addiction.
Morgan Stanley estimates that U.S. consumers spent $4.77 billion on smokeless tobacco in 2007 versus $78 billion on cigarettes. Smokeless-tobacco sales have been increasing about 5% or more a year.
Some switchers say the benefits of smokeless tobacco can be immediate and dramatic. After 30 years of smoking more than a pack a day, Deborah Barr required several respiratory medications just to breathe. An analysis of her lung capacity shocked her physician. "He said, 'I've never seen anybody this bad,' " recalls Mrs. Barr, 53, of Richmond, Va. So she switched to Ariva, a tobacco pellet that dissolves in the mouth. "Within three days I could breathe without medication," says Mrs. Barr, who smoked her last cigarette four years ago and still uses Ariva.
No Spitting
For many people, smokeless tobacco conjures up an image of a wad of chewing tobacco bulging from the cheeks of users who spit brown juice. Instead, recent products consist of dissolvable pellets or tiny pouches of tobacco that reside invisibly in the mouth and induce no spitting. The model for these new brands comes from Sweden, where use of spit-free smokeless tobacco, called snus, is more common among men than smoking.
Studies of Swedish snus users have found no elevated incidence of mouth cancer compared with the general population. Other studies, however, have linked snus consumption to cardiovascular disease, albeit at rates far below the risks of smoking, and some research has found a minor link with pancreatic cancer. Many of the studies were performed by the Swedish government, which discourages the use of snus and cigarettes.
Big U.S. cigarette makers have been staking out the smokeless tobacco field. Altria Group Inc., the nation's largest cigarette maker, this month completed its $10.3 billion purchase of UST Inc., the biggest smokeless-tobacco maker and owner of the Copenhagen and Skoal brands. Reynolds American Inc., which owns Conwood Co., a discount smokeless purveyor, this month announced that the Camel Snus brand has performed well enough in test markets to warrant national distribution. Marlboro Snus is available in a few test markets.
"There are probably in excess of 400,000 adults switching to smokeless each year," says Seth Moskowitz, a spokesman for Reynolds American. But the company doesn't know whether switchers succeeded in permanently giving up their previous form of tobacco.
Tommy Payne, Reynolds American's executive vice president of public affairs, says that he himself is a Camel Snus user. When asked, he says the product helped him successfully quit smoking, a habit he says he had practiced for "too long."
Cutting Nitrosamines
A federally funded study by the University of Minnesota's Masonic Cancer Center found that Camel Snus, made by Reynolds American unit R.J. Reynolds, and Marlboro Snus, made by Altria's Philip Morris unit, bear substantially lower levels of nitrosamines, the class of carcinogen that most concerns public-health officials, than do traditional brands. The study, published in the December issue of Nicotine & Tobacco Research, a leading journal of researchers battling tobacco-caused disease, was similar to one done in 2006 measuring the carcinogen in Ariva and Stonewall, two smokeless-tobacco products made by tiny Star Scientific Inc.
"The reduction in carcinogenic...content in the new smokeless tobacco is encouraging," concluded the authors, none of whom had financial ties to industry.
The December study also found that Marlboro Snus contained a very low level of nicotine. By contrast, Camel Snus offers a jolt of nicotine that "has the potential to satisfy those smokers who are looking for a substitute to smoking, and to keep them addicted to this product," the authors said.
An Altria spokesman says the nicotine level of Marlboro Snus has been increased. "Our interest is offering Marlboro Snus to adult smokers who are interested in a smokeless alternative to cigarettes," the spokesman says.
Purveyors of smokeless tobacco aren't marketing it as a smoking-cessation aid, because doing so could force it off the shelves as an unapproved medical treatment. Makers of the products are beginning to push back against such limitations, although they haven't yet altered their marketing pitches.
Star Scientific this month announced that a study it conducted of smokers in withdrawal found that its Stonewall smokeless tobacco and a nicotine lozenge, used separately, proved to be "much more effective" than placebos at satisfying cravings. And Reynolds American is calling for public-health officials to talk openly about the lower risks of non-combustible tobacco products. "I believe that governments, public-health associations, tobacco manufacturers and others should provide consumers with accurate information, based on sound science, on the different levels of risks posed by different types of tobacco products," Susan Ivey, chairman of Reynolds American, said in a speech last year at the University of Arkansas.
Some smokers on their own have long viewed smokeless tobacco as a way out of their habit. During medical school in the early 1970s, Michael Moore was trying without luck to kick cigarettes when a fellow nicotine addict recommended that he switch to smokeless tobacco. The Minneapolis resident stopped smoking and used smokeless tobacco for decades, quitting two years ago at the urging of his loved ones. "I never saw anything in the scientific literature that convinced me it was very dangerous," says Dr. Moore. As a psychiatrist, however, he concedes that rationalization is a symptom of addiction. Dr. Moore says he has no connection to anti-tobacco causes, although his father, a scientist, years ago contributed to research linking cigarettes to disease.
Source: The Roanoke Times
Link: http://www.roanoke.com/extra/wb/154106
Trading smokes for snus may be a safer bet
By Pete Dybdahl
The Roanoke Times
Camel's Snus Frost
About Snus
Originated in Sweden, where it means "snuff."
Snus, which comes in individual tea bag-like pouches, is traditionally often tucked under the upper lip, unlike most American smokeless tobacco.
Because it is under the upper lip, snus produces less saliva and is considered "spitless."
Nicotine levels vary in snus. Camel snus is reported to have about as much nicotine as a cigarette.
Cost at Sheetz is $3.99 per tin.
Source: David Howard, R.J. Reynolds Tobacco Co. and Dr. Brad Rodu, University of Louisville
In the tobacco family, chew and dip are considered the country cousins. When they visit, a murky cup of tobacco juice soon follows.
So it may be a surprise to learn of the Swedish relatives. A neater smokeless tobacco that comes in a small tea bag and doesn't require spitting, tobacco companies say. It arrived in local Sheetz stations last summer. Its name is snus.
Like all American tobacco, snus (pronounced "snoose") carries a warning -- "may cause mouth cancer" or "not a safe alternative to cigarettes." It's a reminder of the hazards linked to tobacco, from stained teeth to terminal illness.
Except researchers say that snus is a safer choice than cigarettes. Replacing smokes with this Swedish export, they claim, reduces the health risks of lighting up.
"In an ideal world, every smoker would just simply quit using tobacco," said Dr. Brad Rodu, a professor of medicine at the University of Louisville who has studied smokeless tobacco for the past 15 years. But that goal is often too hard, he said, and noted just a 5 percent success rate among the 30 million or so American smokers who try to quit each year.
Rodu, whose work was partly funded by unrestricted grants from two smokeless tobacco companies, wants smokers to know their options for "harm reduction" -- beyond high-priced drug store options such as nicotine gum and patches.
So, snus. It means "snuff" in its native Sweden, a country that supporters point to as evidence that snus is safer tobacco.
Swedes consume the majority of their tobacco as snus and tobacco-related deaths there are among the lowest in the developed world, a pair of researchers at Australia's University of Queensland wrote in the journal PLoS Medicine in July.
Snus-ers face a lower risk of cardiovascular disease than smokers, they reported. And snus, which is pasteurized, is much lower in nitrosamines -- the main cancer-causing agents in smokeless tobacco -- than more popular forms of chew and dip used in the United States, which are fermented.
"We think it would be good public health policy to encourage inveterate smokers to adopt less harmful ways of using nicotine," the Australian researchers, Coral Gartner and Wayne Hall, concluded.
But "this is a tobacco product. There is no safe tobacco product," said David Howard, a spokesman for R.J. Reynolds Tobacco Co., maker of the Camel brand snus that has been sold in Sheetz gas stations since July.
Snus critics worry that Sweden's results won't translate to other countries. They point out that Camel markets snus to be used along with cigarettes, not as a replacement, with slogans such as "When you can't smoke, snus."
"There is no suggestion of stopping smoking," Simon Chapman and Becky Freeman of the University of Sydney wrote in a response to their colleagues in Queensland.
In February, a European Union health panel ruled that snus hasn't been proved to help people quit smoking. The American Cancer Society takes that stance, too. Concerns about the hazards of smokeless tobacco, which include cancer of the mouth, have led to a ban on snus in Australia and the EU, except Sweden.
Snus hasn't appeared at downtown Roanoke's Milan Tobacconists, where boxes of cigars and pipes line the shelves. But last week, co-owner David Meyer considered a tin of snus that a reporter brought by.
"I don't think anti-smokers will say, 'Oh yeah, this is a great product,' " Meyer said. But he added, "From a logical standpoint, if you're not inhaling smoke into your lungs, you're better off."
Pluses and Minuses to Snus, Sweden's Cigarette Alternative
By Peggy Peck, Managing Editor, MedPage Today
Published: May 10, 2007
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine . Earn CME/CE credit
for reading medical news
STOCKHOLM, May 10 -- Moist snuff known as snus, Sweden's most popular tobacco Action Points
Explain to interested patients that these studies suggest that snus may be less harmful than cigarettes.
Explain to interested patients that snus use is, however, not risk free.
But that risk is less than the pancreatic cancer risk associated with cigarette smoking, according to two studies published online by The Lancet.
The relative risk of pancreatic cancer among snus users was 2.0 (95% CI 1.2-3.3) compare with the risk in those who never used tobacco, wrote Olaf Nyrén, M.D., of the department of medical epidemiology and biostatistics at the Karolinska Institute and colleagues.
But current and former smokers were almost three times more likely to develop pancreatic cancer (RR 2.8 at the 95% CI) than Swedish men who had never used tobacco products.
Snus is placed under the upper lip and kept there for up to several hours, depending on user preference. It's typically stored in the refrigerator to minimize formation of nitrosamines.
Dr. Nyrén and colleagues analyzed data collected from 279,897 Swedish construction workers from 1978 through 1992, along with follow-up health registry data through 2004. Thirty-one of the men used or had previously used snus and 55% were smokers or former smokers.
In the second paper Corel E. Gartner, Ph.D., of the University of Queensland, Herston, Australia, estimated the potential public health benefit of switching from smoking to snuff using life expectancy data. When analyzed at the population level, they argued, switching could produce a net health benefit.
They found the relative risk of tobacco-attributable mortality in snus users compared with current smokers among those ages 50 and up was 0.10 (0.075-0.125) for cardiovascular disease; 0.30 (0.225-0.375) for upper digestive, pancreatic, bladder, and renal cancer; and 0.034 (0.0255-0.0425) for lung cancer and 0.0 for COPD.
Although the researchers found little difference in health-adjusted life expectancy between smokers who quit and those who switch to snus, (0.1-0.3 years for men and 0.1-0.4 years for women) they noted that for net harm to occur, 14 to 25 ex-smokers or 14 to 25 never smokers would have to start using snus to offset the health gain from every smoker who switched to snus instead of smoking.
"The findings suggest that snus may be a safer form of nicotine that should be sold as a competitor to cigarettes, which is the "most harmful and addictive form" of nicotine, said Jonathan Foulds, Ph.D., M.App.Sci. M.A., and Lynn Kozlowski, Ph.D., of the public health tobacco dependence program at the University of Medicine and Dentistry of New Jersey School of Public Health in New Brunswick, N.J.
In a commentary that accompanied the snus studies Dr. Foulds and Dr. Kozlowski concluded that "we should not delay in allowing snus to compete with cigarettes for market share and we should be prepared to accurately inform smokers about the relative risks of cigarettes, snus, and approved smoking-cessation medications. In light of all available evidence, the banning or exaggerated opposition to snus in cigarette-rife environments is not sound public health policy."
The sale of snus is banned in Australia and in all European Union countries except Sweden.
Swedish Match, a maker of snus, has been marketing its product in the United States since 2001, but Drs. Foulds and Kozlowski said that "most of the big multinational tobacco companies are test-marketing low-nitrosamine snus products."
Dr. Nyrén declared no conflicts; her study was partly funded by a grant from the Swedish Cancer Society. Dr. Gartner also declared no conflicts; the Australian study was funded by the National Health and Medical Research Council. Dr. Foulds is funded by the New Jersey Department of Health and Senior Services, the Cancer Institute of New Jersey, the Robert Wood Johnson Foundation, the National Institutes of Health, and has testified as an expert witness for plaintiffs in suits against tobacco companies. Dr. Kozlowski receives funding from the National Cancer Institute, the Robert Wood Johnson Foundation and has received honoraria from drug companies involved in the development of tobacco-dependence treatments.
Snus Ruse
Why lie about smokeless tobacco when a misleading half-truth will do?
Jacob Sullum | December 24, 2004
The European Union's highest court recently upheld the E.U.'s 12-year-old ban on oral snuff, saying it serves "the objective of health promotion." Since cigarettes, a far more hazardous form of tobacco, are still legally available in Europe, the E.U.'s policy is rather like banning bows and arrows as an intolerable threat to public safety while allowing a free trade in machine guns.
Worse, tobacco consumption patterns in Sweden, the one E.U. country where oral snuff (known there as snus) remains legal, suggest that Eurocrats are contributing to smoking-related disease and death by foreclosing a safer alternative to cigarettes. As the vice president of Swedish Match, the leading snus producer, put it, "Snus is clearly a significantly less harmful product than cigarettes and could play an important role in a much more responsible harm reduction strategy than the current cynical Quit or Die approach."
Swedish Match obviously has a strong interest in reversing the oral snuff ban. But its position has a solid enough empirical basis that prominent European health researchers and a leading British anti-smoking activist likewise have decried the "Quit or Die approach."
In the U.S., where smokeless tobacco remains legal, this approach takes the form of a misinformation campaign that encourages people to think oral snuff is just as dangerous as cigarettes. That belief, which seems to be widely accepted by smokers, is clearly wrong.
Based on the incidence of tobacco-related deaths among users, University of Alabama at Birmingham oral pathologist Brad Rodu estimates that smokeless tobacco is 98 percent safer than cigarettes. The difference is so stark that public health officials have been forced to quietly retreat from their false risk equivalence.
Last year, for instance, Surgeon General Richard Carmona told a congressional subcommittee "smokeless tobacco is not a safer substitute for cigarette smoking"—a claim that is scientifically unsupportable. But in the version of his testimony that appears on the Web site of the Centers for Disease Control and Prevention, he says "smokeless tobacco is not a safe alternative to cigarettes"—the same true but misleading warning that appears on oral snuff packages.
Similarly, a CDC Web page aimed at children asks, "Is smokeless tobacco safe?" The answer: "No way!" But the search listing for the page shows that the question used to be, "Is smokeless tobacco safer than cigarettes?" I suspect the CDC's answer was not "You bet!"
Perhaps the most telling recent change in the official line on smokeless tobacco was made to a pamphlet published by the National Institute on Aging. When I looked at the online version of the pamphlet in March, it said: "Some people think smokeless tobacco (chewing tobacco and snuff), pipes, and cigars are safer than cigarettes. They are not." The passage now reads: "Some people think smokeless tobacco (chewing tobacco and snuff), pipes, and cigars are safe. They are not."
This change came in response to a March 16 complaint from the National Legal and Policy Center arguing that the pamphlet violated the Data Quality Act by disseminating erroneous information. Among other sources, the complaint quoted a 2001 report from the National Academy of Sciences that said "the overall risk [from smokeless tobacco] is lower than for cigarette smoking, and some products such as Swedish snus may have no increased risk" (because they're especially low in carcinogens).
The fact that public health officials seem less inclined to tell outright lies about smokeless tobacco is a small victory. They are still obscuring the issue by doggedly repeating that smokeless tobacco is not risk-free when the relevant point for a cigarette smoker who is thinking about switching is that it's much less likely to kill him than his current habit.
Meanwhile, their allies in the private sector, unconstrained by the Data Quality Act, continue to explicitly promote the myth that smokeless tobacco and cigarettes are equally dangerous. "Some people believe that using smokeless tobacco is safer than smoking," the American Cancer Society says on its Web site. "This is not true."
The staffer who wrote that might want to ask Michael Thun, the society's chief epidemiologist, for a copy of the December issue of Cancer Epidemiology, Biomarkers & Prevention. That issue includes a study in which a panel of experts estimated that the mortality risk posed by Swedish-style oral snuff is at least 90 percent lower than the risk posed by cigarettes. What makes me think Thun has a copy? He was one of the experts.
Source: Swedish Match
Website: http://www.swedishmatch.com/en/Snus-and-health/Research-on-snus/Swedish-tobacco-habbits/
Snus and pancreatic cancer?
Cancer statistics show no evidence to support a connection between the usage of snus and pancreatic cancer, despite the fact that Swedes consume the most snus in the world. Current epidemiological studies have not provided valid proof for a connection either.
Recently, Swedish and Norwegian media have published alarming reports claiming that snus causes pancreatic cancer. But, is the alarm motivated from a scientific perspective?
The most important and well-established risk factor for pancreatic cancer is smoking. There are also studies that support a connection between alcohol, diabetes and pancreatic cancer.
Has the risk of being affected by pancreatic cancer increased in Sweden relative to the increase in the use of snus?
No, the risk has decreased by 50 percent among Swedish men since the middle of the 1980s, despite the increase in snus usage. The reduced risk has been parallel with the decrease in the number of smokers, which illustrates the significance of smoking as cause of this disease. It is also true that Swedish men, compared with men in all 27 EU countries, run a very low risk of being affected by pancreatic cancer.
[1] The number of new cases of pancreatic cancer among men, age 0 – 85+, per 100,000 inhabitants.
Age standardization according to the population in Sweden in 2000. Source: The Swedish Board of Health and Welfare’s statistic database.
Portion of daily smokers, users of snus (daily + occasionally). The same scale for smokers and users of snus as a percentage. Source: Sweden’s Central Bureau of Statistics/Swedish Survey of Living Conditions.
Number of new cases of pancreatic cancer per 100,000 men in each EU country
AGR (Age Standardized Rate), age standardized number of new cases per 100,000 inhabitants, based on a standard for world population (W). Assessments for 2002, based on the most recent available data. Source: WHO/IARC Cancer data GLOBOCAN 2002: http://www-dep.iarc.fr/
Differing conclusions in studies
The warning in the media about a connection between snus and pancreatic cancer was based on a Norwegian and a Swedish epidemiological study (Bofetta et al, Luo et al). It is generally accepted within epidemiologic science that results from such studies must fulfill a number of criteria in order to draw accurate conclusions on causation. A statistical association alone is not enough. The association found should be strong, the results should be consistent, and there should be a dose-effect relationship, that is, the more snus an individual consumes, the greater the risk.
The two current studies demonstrate none of these criteria: the connection between snus and pancreatic cancer was weak (relative risk <1.5-2), the results were not consistent (the Norwegian study showed an increased risk only among snus users who were also smokers, while the Swedish study observed an increase only among those who did not smoke), and there was no dose-effect relationship. This means that there may well be other explanations for the statistical associations in these studies than that snus causes pancreatic cancer.
There were methodological problems in both studies. For instance, the participants were interviewed several decades ago so it was uncertain whether their tobacco habits had changed during the follow-up period (how many snus users had switched to smoking?) Other problems were the select nature of the participants and the failure to control for other significant life style factors, including alcohol consumption and dietary habits.
The problems with the Norwegian study are such that it was disqualified from a compilation of the scientific literature related to snus and cancer, which was recently published by the equivalent to Swedish Council for Health Care Technology Assessment in New Zealand (Broadstock et al).
Are there studies that do not support a connection?
Yes, there are. In a recently published Swedish epidemiological study by Rosaar et al from 2006, slightly more than 20,000 Swedes were monitored for about 30 years. No association was found between snus usage and smoke-related cancer (including pancreatic cancer).
Unmotivated cancer scares
It is well-established in biomedical science that several high standard studies must show consistent and unambiguous results before there is reason to issue warnings to the general public. In certain studies, even coffee, sugar and alcohol have been associated with risk increases for cancer that have been statistically significant. But, as with snus, there are other studies showing no association. Consequently, there is no motivation for media alarm or warnings about cancer to the general public - either for these products or for snus.
Source: Swedish Match
Link: http://www.swedishmatch.com/en/Snus-and-health/Research-on-snus/Swedish-tobacco-habbits/
"With Swedish tobacco habits, 200,000 lives would be saved each year within the EU."
A study that has attracted much attention, The Burden of Mortality from Smoking: Comparing Sweden with other countries in the European Union, by Professor Brad Rodu and Professor Emeritus Philip Cole of the University of Alabama, Birmingham, USA, was published in the European Journal of Epidemiology in February 2004 (volume 19, pages 129-131).
In the study, the authors state that there are approximately 50 million male smokers of 25 years of age or older in the member states of the European Union (prior to the enlargement of the Union) and that almost 500,000 die annually of tobacco-related diseases, that is, various types of cancer, heart diseases and cardiovascular diseases. According to Rodu and Cole, Swedish men consume approximately the same amount of tobacco as men in other EU member states, but the proportion of smokers is extremely low because so many of the Swedes choose to use tobacco in the form of snus. In the study, the authors calculate statistically that nearly 200,000 lives could be spared each year if all men in the EU adopted Swedish tobacco habits.
Health risks of smoking compared to Swedish snus.
Daniel Roth H, Roth AB, Liu X.
Roth Associates, Inc., Rockville, Maryland 20852, USA. hdroth@comcast.net
Interest in tobacco harm reduction strategies has raised the question of the comparative health risks of cigarette smoking and use of other tobacco products. Although there appears to be a general belief that a unique smokeless tobacco product called Swedish snus has fewer health risks than cigarettes, no one has systematically reviewed the literature and compared the data on health risks in a quantitative manner. We reviewed the literature to identify all analytic epidemiologic studies that provided quantitative risk estimates associated with Swedish snus and cigarette smoking in a single population, using a common reference group. Seven studies were identified that addressed eight health outcomes. Although few in number, these seven studies do provide quantitative evidence that, for certain health outcomes, the health risks associated with snus are lower than those associated with smoking. Specifically, this is true for lung cancer (based on one study), for oral cancer (based on one study), for gastric cancer (based on one study), for cardiovascular disease (based on three of four studies), and for all-cause mortality (based on one study). This review has likely omitted many of the adverse effects of cigarettes, but probably few of the potential health effects of snus. Continued investigation of the reduced health risks of Swedish snus compared to cigarette smoking is warranted.
Source: Article Base
Link: http://www.articlesbase.com/business-articles/swedish-snus-and-the-health-235231.html
Swedish Snus and the Health
Posted: Oct 13th, 2007
There is a certain link between lung cancer and tobacco using. Although Sweden is similar to the rest of Europe when it comes to tobacco consumption, there are a lot less cases of lung cancer among Swedish people then in the rest of Europe. The reason behind this is what the Swedish call snus, and the rest of the world knows as Swedish snus.
Swedish snus is a type of tobacco that is placed under the lower lip, allowing the nicotine to be absorbed by the body. As it is not inhaled, it does not affect the lungs; however, there are concerns that it may cause gum cancer. But as these are still just speculation, the fact remains that fewer Swedish die of lung cancer than anywhere else in Europe.
However, Swedish snus is mostly used by males. This, together with the effect snus has on human health has lead specialists to talk about “the Swedish experience”. Snus has caused tobacco use to have a unique pattern in Sweden. The tobacco consumption is very similar to that from the rest of Europe; however, the great majority of men prefer snus instead of smoking, reducing the cases of lung cancer. Women, however, only use it to a limited extent, with most of them sticking to traditional smoking. Although Swedish snus is as popular as smoking, women hardly ever use it, and the percent of Swedish women getting lung cancer is as high as everywhere else in Europe.
As the figures speak for themselves, it seems that smokeless tobacco consumption makes the difference between males and females. With more users progressing from smoking to snus than the other way around, this can only be a positive thing. More over, snus can be used in places where smoking is prohibited; and with more and more public places banning smoking there is even expected an increase in the use of smokeless tobacco. This can only mean one thing: even fewer cases of lung cancer.
Although studies have shown the benefits of Swedish snus versus traditional smoking, it has yet to be cleared from the possible negative effects it may have on health. It may be safer than smoking, but there may be smokeless tobacco effects other than those traditionally associated with tobacco use. Recent studies that have focused on smokeless tobacco versus smoking effects have revealed that the number of cancer deaths amongst smokeless tobacco users are not higher compared to non – tobacco users. As well as that, Swedish snus users do not have problems with their hemoglobin concentrations, WBC (white blood cell) count, cholesterol or triglyceride levels or blood pressure.
The Health Advantages of Switching from Cigarettes to Snus
August 21, 2009 by
Phil Dotree
Swedish people have used snus, a form of smokeless tobacco, for quite a while, and Sweden has one of the lowest cancer rates in Europe, possibly partially due to this preference for snus over smoked tobacco. Besides practical benefits--snus don't smell, they don't make the user spit like American chewing tobacco, and their use is easy to conceal--there are some notable health advantages for smokers who choose to switch to Swedish snus. Granted, no tobacco use is infinitely better than any tobacco use, but for those that believe that diminishing the risks of tobacco is more practical than stopping tobacco use altogether, here's a look at the health advantages of switching from cigarettes to snus.
1.Lower risks of lung and oral cancers. A Lancet study found no increased risk of lung or oral cancers in snus users when compared to the general population, a risk that's certainly more powerful for cigarette smokers. Much of this can be attributed to the different curing methods of Swedish snus, which are designed to cut down on active carcinogens in the product. However, there's still an elevated risk of pancreatic cancer among snus users according to the same study, so it shouldn't be considered a completely safe alternative to cigarettes by any means.
2.Respiratory diseases. Obviously, you don't smoke snus, so if you're able to switch from cigarettes you eliminate not only lung cancer risks but risks of other diseases like asthma and emphysema. One study even implied that snus use actually improves the respiratory system of users, though this is a single study and shouldn't be taken conclusively or used as an excuse to start using a tobacco product--another study review by UMDNJ found risks of cardiovascular disease to be increased among snus users as compared to non-tobacco smokers, though nowhere near the level of smokers.
3.Secondhand risks. Second hand smoke risks are also completely eliminated. Even if you don't believe that second-hand smoke causes cancer (and you're in the minority if you hold this view), you've got to admit that secondhand smoke agitates asthma, allergies, and can lead to other respiratory problems, not to mention bad smells and an unpleasant atmosphere for non-smokers. This is effectively eliminated by switching to a smokeless tobacco such as snus.
Source: House Committee On Energy and Commerce
Link: http://archives.energycommerce.house.gov/reparchives/108/Hearings/06032003hearing928/Myers1482.htm
Note: A large article, but it seems praising of Swedish Snus towards the end.
The House Committee on Energy and Commerce
Can Tobacco Cure Smoking? - A Review of Tobacco Harm Reduction.
Subcommittee on Commerce, Trade, and Consumer Protection
June 3, 2003
10:00 AM
2123 Rayburn House Office Building
Mr. Matthew L. Myers
President and CEO
National Center for Tobacco-Free Kids
1400 I Street, N.W.Suite 1200
Washington, DC, 20005
Good morning Mr. Chairman, and members of the Committee. My name is Matthew Myers. I am the President of the National Center for Tobacco-Free Kids, a national organization created to protect children from tobacco by raising awareness that tobacco use is a pediatric disease, by changing public policies and by actively countering the special interest influence of the tobacco industry.
Mr. Chairman, I want to thank you for inviting me to testify on the question of whether tobacco, and specifically smokeless tobacco, can cure smoking. The question seems simple and straightforward enough, and so deserves a simple and straightforward response. The answer today is the same as it was almost twenty years ago when the House Energy and Commerce Committee last held hearings on the health effects of smokeless tobacco products. In the absence of the kind of meaningful regulation of both the content and marketing of smokeless tobacco products that could be provided by the Food and Drug Administration (FDA), the answer is no.
Smokeless Tobacco Is A Cause of Serious Disease Let us start with a basic premise: smokeless tobacco products as sold in the United States have been found to increase the risk of oral cancer and other serious diseases. The Surgeon General, the National Cancer Institute, the American Cancer Society, the American Dental Association, the Scientific Advisory Committee to the World Health Organization and numerous other scientific bodies have all determined that there is conclusive evidence that smokeless tobacco products as sold in the United States increase the risk of serious disease. This conclusion is no surprise. Scientists have identified twenty-eight cancer-causing chemicals in these products.
Today we are seeing history repeat itself. Just as we had the last time this committee met to discuss smokeless tobacco, we have a smokeless tobacco industry that refuses to acknowledge the health effects of its products seeking government approval to use health-related claims in advertising whether or not that advertising's primary appeal is to children. In 1985 the then President of the Smokeless Tobacco Counsel testified before this Committee "it has not been scientifically established smokeless tobacco is a cause of any human disease." In April 1999, a spokesperson for the United States Smokeless Tobacco Company, a subsidiary of U.S. Tobacco (UST) was quoted in the Providence Journal as claiming that it has not been "scientifically established" that smokeless tobacco is "a cause of oral cancer. " This statement resulted in the Rhode Island Attorney General suing UST for violating the multi-state settlement agreement's prohibition on making false statements about the health effects of its tobacco products. UST was required to pay $15,000 to the Attorney General's office to fund efforts to prevent youth tobacco use and to formally acknowledge that the Surgeon General and other public health authorities have concluded that smokeless tobacco is addictive and can cause oral cancer.
Just last year, UST claimed in a letter to the Federal Trade Commission (FTC) that "smokeless tobacco has not been shown to be a cause of any human disease." UST would have this committee think that it is new evidence that has motivated it to seek approval to market its products as a safer alternative to cigarettes. The unfortunate reality is that this is a company that has never acknowledged that its products cause harm. How can you have a meaningful discussion about the potential to use a cancer-causing product to reduce the harm from smoking with an industry that won't acknowledge that its products cause harm and hasn't agreed to meaningful government regulation?
Smokeless Tobacco Advertising Has Increased Youth Use There is a second basic point about which there can be no dispute. Twenty-five years ago few young people in this country used smokeless tobacco products. However, in large part in response to a massive marketing campaign that in part portrayed smokeless tobacco use as safer than cigarette smoking, the number of people who used these products and the demographics of who used these products changed in the early 1980's. Smokeless tobacco usage among young males rose dramatically. As a nation we experienced a sixty percent upswing in smokeless tobacco use among young men resulting from a decade of smokeless advertising. The lesson is clear: in the absence of meaningful government regulation, our children are vulnerable to smokeless tobacco marketing that portrays smokeless tobacco use in a manner that kids find acceptable. Largely because the major smokeless tobacco manufacturers have fought FDA regulation of both their products and their marketing, our kids are as vulnerable today as they were 25 years ago.
Was it an accident that smokeless tobacco use rose in the 1980's even as the leading smokeless tobacco companies argued that they didn't market to kids? The answer from their own documents is no. According to internal company documents, UST developed a graduation strategy some time ago for hooking kids as new smokeless tobacco users. As one document states:
"New users of smokeless tobacco attracted to the product for a variety of reasons are most likely to begin with products that are milder tasting, more flavored, and/or easier to control in the mouth. After a period of time, there is a natural progression of product switching to brands that are more full-bodied, less flavored, have more concentrated 'tobacco taste' than the entry brand."
UST has also used the addition of flavorings to increase the appeal of its products to children. In 1993, cherry flavoring was added to UST's Skoal Long Cut, an entry or starter product. A former UST sales representative revealed that, "Cherry Skoal is for somebody who likes the taste of candy, if you know what I'm saying."
Many had hoped that when the United States Smokeless Tobacco Company signed its settlement agreement with the states in 1998 its marketing practices would change dramatically. It did not happen because UST has apparently interpreted the broad prohibition against targeting youth as not requiring it to change the kind of advertising and youth oriented imagery that it has previously used that has made its products so appealing to children. A May 2002 study by the Massachusetts Department of Public Health found that UST's overall magazine advertising increased 135% from 1997 to 2001. The study also found that UST's advertising in magazines with high youth readership increased 161% during the same time period. For the period 1997-2001, UST's expenditures in youth magazines increased from $3.6 million to $9.4 million. Thus, smokeless tobacco advertising that appeals to children has continued unabated. One only has to look at the images projected by this advertising to understand its appeal to children. While UST may increase or decrease its advertising in certain magazines for its own purposes when it chooses, the evidence is that the MSA has not provided the legal club that was anticipated. In addition, although the multi-state settlement agreement has limited UST's ability to continue to do brand name sponsorships of some events and teams, UST continues to be a promotional sponsor of both professional motor sports and rodeo and bull riding.
There is a legitimate concern that in the absence of meaningful government regulation of smokeless tobacco products, and how they are marketed the disastrous experience of the early 1980's could be duplicated again today. If that occurred, more lives would be needlessly lost as the result of an effort that started out seeking to reduce the harm caused by tobacco products.
Not All Smokeless Products Are Alike There is a third fundamental point - not all smokeless tobacco products are alike. UST has continued to market products far higher in one cancer-causing class of agents - nitrosamines - than its counterparts in Sweden, despite the technical ability to produce low nitrosamine products. Data concerning Swedish snus is often cited by UST in support of its desire to market its products - all of its products, including its products with very high nirtrosamine levels - as a way to reduce the risks of tobacco use because of some data that indicates that it has not been associated with an increase in cancer in Sweden.
Swedish smokeless products are much lower in cancer-causing nitrosamines than U.S. products. In 1995 the average Tobacco Specific Nitrosamines (TSNA) in Swedish Snus was approximately 5 mg/kg. By 2000 that number had been reduced to 2 mg/kg. An independent study conducted for the State of Massachusetts by the American Health Foundation in 2001 found, in contrast, that while the Swedish snus it tested contained 2.8 ug/g TSNA's, UST's two largest selling products - Skoal and Copenhagen contained 64 ug/g and 41.1ug/g TSNA levels, respectively.
Even more disturbing, a new study just conducted by the American Health Foundation for the Massachusetts Department of Health that examined nitrosamine levels in snuff over the last three decades found that nitrosamine levels actually rose in one of the two most popular American brands in 2003 after declining in 2002. The American Health Foundation found that the TSNA levels in these brands this year were 22.0 and 27.9 ug/g respectively - levels far higher than those found in Sweden at any time in the last thirteen years. These findings are critical to the Committee's consideration because TSNA's are widely accepted as the most serious carcinogens in oral snuff made in the United States.
The American Health Foundation discovered another distinction between American smokeless tobacco products and Swedish snus. The nitrosamine levels of U.S. smokeless products increase once they leave the manufacturing plant and continue to increase the longer they sit on the shelf, in one case by an amazing 137 percent over six months. Swedish snus does not. It is clear that American manufacturers like UST know how to produce low nitrosamine smokeless tobacco products, but have chosen not to do so in their most popular products.
Nitrosamines are not the only harmful component in smokeless tobacco products and this is another distinction between American smokeless tobacco products and those in Sweden. Swedish snus is also controlled for heavy metals found in smokeless tobacco products, like cadmium, lead, nickel and chromium, as well as substances such as arsenic, BaP's, and pesticides. None of those controls apply to American products. It is for these reasons that organizations like the Scientific Advisory Council to the World Health Organization in November 2002 distinguished between the evidence that it found conclusively linked U.S. smokeless tobacco products and oral cancer and the evidence that it found that the health effects of Swedish Snus were more uncertain.
There is a third distinction between what is described as the Swedish experience and the likely result in the U.S. The marketing and advertising of smokeless products in the United States and Sweden is completely different. Sweden forbids the marketing and advertising of all tobacco products, and no claims in advertising about relative safety of these products are permitted. In the United States there are few restrictions on the advertising and marketing of smokeless tobacco products, and UST wants to make explicit claims about the relative safety of its products.
The difference in the laws governing marketing in the two countries is critical. When our organization met with representatives of UST and asked if they believed that there was anything to prevent UST from using ads featuring roosters with what we perceived to be youth oriented slogans placed in youth oriented magazines to promote their products as less hazardous than cigarettes, they were quick to say no. They went further. UST said that if they were given permission to claim that their products were less hazardous than cigarettes, it was their belief that the FTC did not have the legal authority to tell them what kinds of ads or magazines those claims could appear in.
Claims of Reduced Risk Could Dissuade Smokers from Quitting There is a fourth fundamental point. Another potential risk to permitting smokeless tobacco to be marketed as a harm reduction mechanism in the absence of meaningful government regulation is that claims of risk reduction could lead smokers who would otherwise quit not to do so. The risk is real. In August 2001, UST announced plans to market a new smokeless tobacco product called Revel. UST is marketing the new product as a way to consume tobacco in places or situations when smoking is not allowed or is not socially acceptable. Many smokers quit after the enactment of restrictions on smoking in the workplace. There is legitimate concern that in the absence of any regulation of where and how smokeless tobacco products are marketed, some current cigarette smokers who would otherwise quit will switch instead to Revel or other smokeless products. This concern is compounded by studies that show that claims of reduced risk can lead consumers to falsely underestimate the relative benefits of quitting versus switching.
There Is Much the Federal Government Can and Should Do To Reduce the Harm of Tobacco Products My fifth point: There is a great deal that can and should be done to reduce the harm caused by tobacco. It is a misplaced priority to focus so much attention on smokeless tobacco in the current environment when there is so much that everyone agrees on that will make a real difference. Let me highlight some of the actions this Congress and the executive branch could take that will reduce the harms currently being caused by tobacco use in our society.
1) The federal government is doing far too little to fund programs or adopt policies that have been proven effective in reducing tobacco use. Comprehensive tobacco prevention programs have been proven to work in every state that has tried them. Yet, the federal government has not funded a meaningful national sustained public education campaign.
2) The federal government is doing far too little to fund cessation programs or to promote and make available the cessation tools that have been proven to help smokers quit. A recent Report conducted at the request of the Department of Health and Human Services laid out a comprehensive plan to encourage and assist smokers to quit. It should be adopted and implemented.
3) The FDA already has authority over FDA approved medicinal nicotine products. These products have been proven to be safe, at least for short-term use, but little has been done to encourage their improvement or to explore their long-term use and potential for harm reduction. Before we turn to a cancer-causing agent as a tool to reduce the harms caused by tobacco, shouldn't we first make sure we have done everything we can to maximize the potential role of safe products that our government has already reviewed and approved? FDA can initiate a review of the use of nicotine replacement products without the need for further legislation, and it should do so.
Comprehensive Regulation of Tobacco Products by the FDA Iis a Necessity My sixth and, perhaps, my most important point: The single most important action this Congress can take to reduce the harm that current tobacco products are causing is to provide the FDA with meaningful authority over all tobacco products. In case we needed further proof, a study conducted by scientists at the Centers for Disease Control and Prevention published in the journal Nicotine & Tobacco Research just last Friday demonstrated once again that without a federal agency that has oversight over tobacco products consumers are being deprived of critical information about the risks of individual products and are being sold products that contain more toxins than are necessary. The study found that even while tar levels in Marlboros have gone down over the last several decades, nitrosamine levels in Marlboros have increased and are higher, in fact, than most locally produced popular brands in other countries throughout the world.
The high nitrosamine levels may provide at least a partial explanation for why cancer rates have not declined as expected when tar levels declined. Don't be confused; the importance of this study is not that we can save lives if we just reduce nitrosamine levels in Marlboros. The real importance of this study is that there are dozens of known carcinogens and toxic substances in current tobacco products that we are not controlling and about which the public is not being informed. This study proves that the reduction of any one toxin may have little impact if you don't control the level of other toxic substances, and that you cannot count on manufacturers on their own to provide this information truthfully and completely to consumers. The lesson is clear - what you don't know will kill you. In the absence of government regulation tobacco manufacturers - smokeless and cigarette - will not produce the least hazardous product possible and consumers will not have the type of complete information needed to make a truly informed choice.
The latest study reminds us that in the absence of a governmental agency with the authority to require manufacturers to test and disclose the toxic substances in their products, claims that any tobacco products reduce the risk of tobacco-related disease should not be trusted or permitted. Our experience with both light and low tar products demonstrates why this is so important. For decades tobacco manufacturers have advertised light and low tar products in a manner that they knew led consumers to believe that these products were safer than traditional cigarettes. The evidence is now conclusive that these light and low tar products have not in fact reduced the overall risk of disease. This public health tragedy could have been avoided if tobacco manufacturers had been required to disclose to the FDA the levels of different toxins in their products and their knowledge about the actual levels of tar and other harmful substances that consumers were receiving.
Mr Chairman, this hearing dramatically underscores the pressing need for Congress to give the Food and Drug Administration the authority to regulate tobacco products effectively. A discussion about harm reduction has to begin with a discussion about providing the FDA with the kind of authority that is necessary to protect consumers, verify claims, and require that all reasonable steps are taken to reduce the harm caused to smokers. Is there a role for smokeless tobacco in a comprehensive effort to reduce the death toll from tobacco overseen by the FDA? No one has the information to make that decision today. The FDA should be open to all strategies that are scientifically based and that will save lives. The decision about what role smokeless tobacco plays in that overall scheme is a decision that can only be made by the FDA after it has all of the relevant information before it.
Why the FDA? The FTC lacks both the authority and the expertise to do the job by itself. I worked at the Federal Trade Commission and was responsible for that agency's tobacco-related activities. The job of the FTC is to stop false, deceptive or misleading advertising. It is not a science-based agency. It lacks the authority to restrict smokeless tobacco marketing that appeals to children or to prevent claims of reduced risk to be used to make these products more attractive to children. It further lacks the authority to evaluate different smokeless tobacco products for relative safety, to require smokeless tobacco manufacturers to disclose to it changes in the product that could impact its relative harm or to require smokeless tobacco manufacturers to lower the level of toxic substances in their products. The FTC is most effective when it is able to work with the FDA with regard to products over which both have jurisdiction. If FDA is given this authority over tobacco products, the two agencies working together could make a very positive difference.
Mr. Chairman, if UST and the other smokeless tobacco companies are serious about reducing the harm caused by tobacco and about assuring that the marketing of its products as less hazardous contributes to public health, they would support giving FDA the strong authority it needs to regulate tobacco products as outlined by the major public health groups. I have no doubt that FDA would have had this authority already but for the opposition of the major cigarette and smokeless tobacco manufacturers. They should not now be rewarded for their opposition to meaningful government regulation by being permitted to make health-related claims that we lack the ability to verify only because of the lack of such regulation.
Does Smokeless Tobacco Help Smokers Quit Cigarettes?
ScienceDaily (Jan. 28, 2009) — Some smokers say they just can’t quit cigarettes. But previous studies of smokers in Sweden have suggested that many have done just that, by switching to smokeless tobacco. While not without health risks, smokeless tobacco is less harmful than cigarettes.
With that in mind, an international team of researchers asked the question, “Should public health officials start promoting smokeless tobacco as a way to reduce the overall harm caused by tobacco?” The answer: “Not so fast.”
According to a study from the University of California, San Diego and Sweden’s Karolinska Institutet, there are important differences between the United States and Sweden with respect to how people use—and quit—tobacco. The study, in the online issue of Tobacco Control, examined data from more than 15,000 individuals in the U.S. who were surveyed twice, a year apart, to get a picture of tobacco use and cessation in the U.S.
“In Sweden, many smokers have quit smoking by switching to snus,” said Shu-Hong Zhu, Ph.D., Professor of Family and Preventive Medicine in the UCSD School of Medicine. (Snus—pronounced snoos—is a form of moist, powdered tobacco that comes in a small sachet and is placed under the lip.) “This has piqued a lot of interest, because anything that helps people quit cigarettes could have huge benefits due to the great harm caused by smoking.”
“Historically, there has been no campaign to promote snus to Swedes as a safer alternative to cigarettes,” said Hans Gilljam, M.D. a Professor at the Karolinska Institutet and a study author. “But snus has been popular among male smokers, and has helped them quit cigarettes. In fact, Swedish men have a higher smoking cessation rate than Swedish women, few of whom use snus.”
The researchers looked for a similar effect among U.S. smokers, but didn’t find one. Like their counterparts in Sweden, U.S. men are much more likely than women to use smokeless tobacco. But it does not boost their rate of quitting smoking.
Zhu explained, “With an ongoing tobacco control effort, men in the U.S. seem to be quitting smoking at higher rates than men in Sweden. And U.S. women are quitting at the same rate, unlike their counterparts in Sweden.”
These findings are important because there has been a vigorous debate in the international public health community about whether tobacco control programs should stop advocating complete tobacco cessation and start promoting smokeless tobacco as a less-harmful alternative to smoking. If Sweden’s results were to be replicated in a longitudinal study from another country, it would support promoting smokeless as a harm-reduction strategy.
The current study examined data from the Tobacco Use Supplement to the Current Population Survey, 2002, with one-year follow-up in 2003. Results showed both male and female smokers in the U.S. appear to have higher quit rates for smoking than their Swedish counterparts, despite greater use of smokeless tobacco in Sweden.
Over a one-year period, the study tracked the quit rates, and the rates of switching from one form of tobacco to another, of more than 15,000 adult participants. It showed that:
Among U.S. men, less than one percent of current smokers switched to smokeless tobacco during the 12 month study.
Only 1.7 percent of former smokers turned to smokeless tobacco.
Men’s quit rate for smokeless tobacco was three times higher than for cigarettes.
Even though men were far more likely to use smokeless tobacco products than women, overall, they had no advantage over women in quitting smoking (11.7 percent vs. 12.4 percent).
The Swedish data showed just the opposite: Swedes who use smokeless tobacco are likely to keep using it, rather than switching to other tobacco products. Their habit is relatively stable. By comparison, Swedes who smoke cigarettes are more likely to switch to other tobacco products, such as smokeless tobacco. Their habit is less stable.
“Many public health officials and scientists have cautioned that the Swedish results may be unique to Sweden,” explained Zhu. “This research confirms that idea.”
Background
Some have proposed that a campaign to promote smokeless tobacco as a safer alternative to cigarettes would lead to improved smoking cessation and reduced tobacco-related death and disease. Those who oppose this approach are concerned that it could dilute the overall anti-tobacco message and have a negative net impact on public health compared to current, proven tobacco control strategies.
It is difficult to gauge the likelihood of either a benefit or detriment to public health from promoting smokeless tobacco, because the arguments for each involve assumptions about population behavior, and empirical data to verify these assumptions are hard to obtain.
This work was supported in part by a supplemental grant to the Moores UCSD Cancer Center from the National Cancer Institute.
Authors on the current study include: Zhu, Julie B. Wang, Anne Hartman, Yuerong Zhuang, Anthony Gamst, James T. Gibson, Hans Gilljam, and Maria Rosaria Galanti. Authors’ research affiliations include: University of California, San Diego, National Cancer Institute, Information Management Services, Rockville, Maryland, and Karolinska Institutet, Stockholm, Sweden.
Source: Tobacco Truth Blog, Dr. Brad Rodu
Link: http://rodutobaccotruth.blogspot.com/
Tuesday, September 1, 2009
Snus Use Lowers Risk for Multiple Sclerosis; Smoking Raises Risk
Multiple sclerosis (MS) is a chronic disease in which the immune system attacks and damages myelin, the substance that insulates nerves and facilitates transmission of electrical signals along the spinal cord, the mode by which the brain communicates with the rest of the body. It is a complicated disease, an excellent summary of which can be found here.
There are no definitive causes of MS; genetic and environmental factors may play a role. Several research studies indicate that smoking increases the risk for the disease by approximately 50% (RR = 1.5, 95% CI = 1.3 – 1.7).
Researchers at the Karolinska Institute of Environmental Medicine in Stockholm have just released a new study of tobacco use and MS, which was published in the September 1 issue of the journal Neurology. They compared tobacco use among persons diagnosed with MS (cases) with a group of controls derived from the Swedish population. This experimental design, called a population-based case-control study, is common in epidemiology.
Readers of this blog are familiar with relative risk (RR), which is used by some epidemiologic studies to measure the association of a risk factor and a disease. The measure of association in the present study was the odds ratio (OR), and its interpretation is essentially identical to the RR and is accompanied by a confidence interval (CI), which is the range within which the RR lies with 95% confidence.
Lead author Anna Hedström and her colleagues report that, compared with nonusers of tobacco, smokers had significantly elevated risks for MS. The OR for male smokers was 1.8 (CI = 1.3 – 2.5), and the OR for smoking women was 1.4 (CI = 1.2 – 1.7). The risk increased with the cumulative dose of smoking (measured in pack-years, that is, packs per day times years of smoking), which adds to the overall validity of the association. For example, compared to nonusers of tobacco, men who had up to 5 pack-years of smoking had an OR = 1.4 (CI = 1.0 – 2.0), while men who had 16+ pack-years of smoking had an OR = 2.9 (CI = 1.7 – 5.1).
In contrast to smoking, the study found that snus users had lower risks for MS than nonusers of tobacco. These lower risks were present among snus users of 5+ package-years who never smoked (OR = 0.4, not statistically significant) and who had smoked (OR = 0.3, CI = 0.1 – 0.9), the latter being statistically significant.
A previous study by the American Cancer Society showed that smokeless tobacco use may be protective for Parkinson’s Disease (a neurologic illness) (RR = 0.22, CI = 0.07 – 0.67). The Karolinska Institute study provides evidence that smokeless tobacco may provide protection for multiple sclerosis as well.
Source: Tobacco Truth Blog, Dr. Brad Rodu
Link: http://rodutobaccotruth.blogspot.com/
Wednesday, August 19, 2009
Heart Attack and Stroke Risks from Smokeless Tobacco Use: Next to Nil
The International Agency for Research on Cancer (IARC) is a component of the World Health Organization with a mission “to identify the causes of cancer so that preventive measures may be adopted and the burden of disease and associated suffering reduced.” It is therefore not surprising that IARC staff have played a prominent role in exaggerating the cancer risks of smokeless tobacco use. The IARC anti- smokeless tobacco campaign has been led by Paolo Boffetta.
Boffetta, a cancer epidemiologist, departed from his field of expertise to complete (with co-author Kurt Straif) a review of the risks for heart attack and stroke among smokeless tobacco users in the U.S. and Sweden. The analysis has just been published by the British Medical Journal.
Boffetta reported that the summary relative risk (RR) for heart attack among smokeless tobacco users was 0.99, with a 95% confidence interval (CI) of 0.89 to 1.10 (For a discussion on how to interpret RRs and CIs, see my recent post). For stroke, Boffetta reported a minimal increase in risk (RR = 1.19) that was not statistically significant (CI = 0.97 – 1.47). Thus, the main finding in this study is that smokeless tobacco users have no excess risk of heart attack or stroke.
Given the importance of that conclusion, why did the researchers (in their BMJ abstract) and subsequent media coverage ignore it, focusing instead on fatal heart attack/stroke, one of two subgroups? It is because smokeless tobacco users had very small elevations in risk for the fatal events. For fatal heart attack the RR among smokeless users was 1.13 (CI = 1.06 – 1.21), and the RR for fatal stroke was 1.40 (CI = 1.28 – 1.54). Boffetta was unable to demonstrate that the excess risks were related to how much or how long smokeless tobacco had been consumed, two important characteristics that would have strengthened the validity of the findings.
There is a serious omission in this study. Boffetta divided all heart attacks and strokes into two subgroups, fatal and non-fatal. Boffetta found that smokeless users had no significant risk for all heart attacks and strokes but had elevated risks for fatal cases. It logically follows that smokeless users probably had LOWER risks for NON-FATAL heart attacks and strokes. But Boffetta provided no information about these subgroups, and the reason is obvious: it wouldn’t add to the health hysteria.
Here is the take-home message for smokeless tobacco users: You do not have elevated risks for heart attack and stroke. Although your risk for heart attack and stroke is the same as that of non-users of tobacco, there is a slight increased chance that, if one occurs, it could be fatal. This may be due to the effects of nicotine on the circulatory system, or it could be due to some other undiscovered factor that is associated with smokeless use. As Boffetta acknowledged, “the magnitude of the excess risk is small.”
In the article’s introduction, Boffetta wrote that smokeless tobacco “products have been proposed as an alternative to cigarettes and other smoking products under the claim of a smaller, or negligible, risk to health.” This study adds to the scientific evidence that, compared with cigarettes, the risks from smokeless tobacco are indeed vastly “smaller, or negligible.”
Research Summary: Snus
Thursday, January 12, 2006 | 6:43 PM
By Dr. Dean Edell
BACKGROUND: Using moist snuff or chewing tobacco, called snus, carries almost very little risk of oral cancer and provides a better alternative than any normal powdered dry snuff or smokeless tobacco product. According to University of Alabama at Birmingham researchers who compiled results from studies done over the past 16 years, the swedish moist form of smokeless tobacco called snus provides significant harm reduction both from regular tobacco and traditional smokeless or chewing tobacco.
"No one had tried to separate out the relative risks of the different types of smokeless tobacco products," said lead author Dr. Brad Rodu in an interview. "Although dry snuff increases the risk of oral-cavity cancer, the other types of smokeless tobacco actually have a lower relative risk than we previously thought. Since these other products are much less risky than tobacco smoking, they may be considered as a safer alternative by hard-core, recidivist smokers."
Rodu and co-author Dr. Phil Cole are leading proponents of snus smokeless tobacco as a way of reducing the harm of cigarettes to those people who have extreme difficulty, or who are unable, to quit smoking. Cole is scheduled to debate the dangers of SLT at a symposium in New York City on Wednesday, June 26, sponsored by the American Council on Science and Health.
Snus smokeless tobacco use is a public health concern, say the authors, but the products increase the risk of oral-cavity cancer only minimally as compared to quitting smoking altogether. Rodu, an oral pathologist, and Cole, a cancer epidemiologist, analyzed 21 published studies in the first comprehensive study of the risk of oral-cavity cancer from snus smokeless tobacco since 1986. Their study was published this month in the scientific journal Oral Surgery, Oral Medicine, Oral Pathology.
The UAB researchers found that the relative risk of getting cancer by use of either moist snuff or chewing tobacco is 0.7. The risk rises to 4.0 with use of dry snuff. The authors decided to distinguish the relative risk of cancer from the different types of smokeless products because dry snuff "is an snus smokeless tobacco product used almost exclusively by women, especially in the southern United States."
One drawback of most of the available studies, the authors said, was that they did not take into account participants' alcohol intake and cigarette smoking, two activities that are known to increase greatly the risk of oral cancer.
Examples of Snus smokeless tobacco include Exalt, Ariva, Revel, Stonewall and other forms of Swedish moist snuff or snus. They can be difficult to find.
Dr. Roduh testified in Congress before The House Committee on Energy and Commerce on the harm reduction alternative of snus - the Swedish moist form of smokeless, spitless tobacco. He says, for the one-third of hard-core smokers who have tried and failed to quit, snus provides a safer alternative of tobacco use. For the full testimony, click here.
Source: PR Web
Link: http://www.prweb.com/releases/2009/11/prweb3138264.htmbr>
New Study Reveals Quitting Smoking is Good but Switching to Low-risk Nicotine Products is Usually Better
Prof. Carl V. Phillips, just published in Harm Reduction Journal, shows that for most smokers, immediately switching to a low-risk alternative will lower their risk of dying from their habit more than quitting eventually, even if they use the smoke-free product for the rest of their lives.
Ferndale, WA (PRWEB) November 2, 2009 -- Switching to low-risk nicotine products, like smokeless tobacco, electronic cigarettes, and pharmaceutical nicotine, offers smokers a chance to almost completely eliminate their health risks. While these alternative products still pose some very small health risk, a new study at the University of Alberta School of Public Health in Canada shows that in most cases switching is better for reducing lifetime risk than trying to quit. The study by Prof. Carl V. Phillips, just published in Harm Reduction Journal, shows that for most smokers, immediately switching to a low-risk alternative will lower their risk of dying from their habit more than quitting eventually, even if they use the smoke-free product for the rest of their lives.
For the average smoker, the study finds, smoking for just one more month poses a greater health risk than a lifetime of using one of the increasingly popular low risk products like snuff, snus, the new electronic imitation cigarettes, nicotine lozenges, or some other non-combustion alternative. Switching products is a strategy known as "tobacco harm reduction." "It has long been known that while no nicotine product is completely harmless, harm reduction products pose only about 1% the risk from smoking," says Dr. Phillips, "and this difference is so great that for the average smoker, using a smokeless product for the rest of his life poses about the same risk as 30 days of continuing to smoke." What this means is that most smokers, even those who plan to quit soon, will not quit before damaging their health far more than using low-risk products for a lifetime. Moreover, for some older smokers, smoking for a day or two more poses a greater risk than using a low-risk product for the rest of their life. Since switching products is often much more appealing to smokers than quitting nicotine entirely, this option is more practical than quitting and leaves the former smoker happier and less likely to relapse. Those who switch can still choose to quit entirely later, lowering their risk further still.
Dr. Phillips and his public health research group publish the website www.TobaccoHarmReduction.org, and have worked for years to educate smokers about the advantages of low-risk alternatives. The new study, which also looks at some of the history and politics of tobacco harm reduction, suggests that efforts to promote abstinence as the only healthy choice may be killing thousands of smokers per month. Discouraging switching causes the deaths of far more smokers than could ever die from using low-risk nicotine products for their entire lives.
This study comes on the heels of a major study by Peter Lee, published in another BioMed Central journal, BMC Medicine, that showed that the cancer risk from smokeless tobacco is so small it cannot even be reliably measured. Given the ample evidence about the risks of different products, "there is no scientific basis for denying the benefits of tobacco harm reduction" says Phillips, "and it is time that we offer smokers honest public health interventions rather than the moralizing and deadly 'abstinence-only' approach." The abstinence-only approach leaves many ex-smokers miserable and leaves millions of others no choice but to keep smoking. Some activists object to alternative products because they let smokers stay addicted to nicotine or allow companies to profit from selling the products. But, asks Phillips, "is addiction to a low-risk habit -- not much different from drinking coffee -- really such a problem, or is the profitability of some companies so terrible that it outweighs the millions of lives that could be saved by harm reduction?"
Contact: Dr. Carl V. Phillips, Associate Professor, University of Alberta School of Public Health: cvphilo(at)gmail(dot)com; +1 651-503-6746
Professor Phillips is an epidemiologist and health policy researcher, journal editor, popular educator, and consultant. He and his work group are leading advocates of tobacco harm reduction, and he advises and works with many other organizations who are trying to promote it, some of which are companies that hope to profit from selling low-risk nicotine products. The www.TobaccoHarmReduction.org research group at the University of Alberta School of Public Health is partially supported by an unrestricted (completely hands-off) grant from U.S. Smokeless Tobacco Company. No funder, company, or other organization played any role in initiating, designing, or conducting this research.
Tobacco That Doesn't Cause Cancer?
Thursday, January 12, 2006 | 8:04 PM
By Dr. Dean Edell
Jan. 12 - KGO (KGO) -- One of the New Year's resolutions that often doesn't last is the vow to quit smoking. Now there's an alternative that may help # a safer form of tobacco that does not seem to cause cancer.
Any smoker can tell you, it's an excruciatingly hard habit to break.
Brad Rodu, D.D.S., smoking researcher: "Over 400,000 of them die each and every year because they were unable to quit smoking."
Chip George, lifelong smoker: "I've tried the prescription drugs, the gum, the patches - none of it worked for me."
Well an effective, but controversial alternative to help people quit smoking cigarettes has been around for years. It involves smokeless tobacco products called snus.
Some are hard like candy, but most are like a small moist tobacco packet. You place it next to your gum and unlike American chewing tobacco, there's no spitting and of course no smoke. Research shows it may be a safer alternative.
Snus is usually inserted between the lip and gum. It's been used by folks in Sweden for 50 years which may explain why Swedish men have have the lowest lung cancer rate in Europe. Instead of the conventional message of "quit or die," snus, although controversial, is a different approach.
Anti-smoking researcher Brad Rodu says for those who can't quit it is safer.
Brad Rodu: "We take a different approach and that's called harm reduction. It is in fact targeting the adverse effects of smoking from the activity itself."
Studies show, tobacco smoke contains numerous toxic compounds and it's those inhaled compounds that lead to disease. When compared to snus...
Brad Rodu: "Our research has documented that smokeless tobacco use carries only two percent of the risk of cigarette smoking."
Studies have found no connection between the use of snus and oral cancer, chronic high blood pressure or heart disease. Snus finally helped Chip kick his addiction and perhaps saved his life.
If you're having trouble quitting, this certainly seems worth a try.
Regular smokeless tobacco is linked to oral cancer, whereas this Swedish smokeless product isn't. It's available online and in some tobacco stores.
Source: Health Central
Link: http://www.healthcentral.com/drdean/408/60681.html
Quit Smoking Swedish Style
10/29/2003
By Dr. Dean Edell
The very low smoking prevalence in Sweden has received considerable attention. Sweden was the only country in Europe to reach the World Health Organizations' goal of less than 20% daily smoking prevalence among adults by year 2000. Only 17% of Swedish men smoke. Some have argued that this has been achieved because Swedes use another form of tobacco instead. Sweden has a high level of use of a moist snuff product called 'snus'. Nineteen per cent of adult men and 1% of women are daily users and the trend is increasing. Epidemiological studies have failed to find evidence that snus causes cancers, including oral cancer. Its adverse effects on the cardiovascular system are debated, but are certainly less than those of smoking. Recent studies among former smokers indicate that many men have quit smoking using snus. Forty-seven per cent of current snus users are former smokers and 28% of ex-smoking used snus at their last attempt to stop smoking. The association between high snus consumption and low smoking prevalence has been debated and challenged. It has been argued that snus may be a gateway to cigarette smoking. Recent data has found that among those starting tobacco use in the form of snus, 20% later go on to smoking while the same risk for those not starting with snus is 43%. On balance, there is reason to believe that having snus available to the Swedish population has been of benefit to public health. Repealing the ban on snus in the rest of the European Union might also have some positive effect, depending on the marketing.
