Thursday, 12 April 2012

Snus: they knew all along

Brad Rodu reports on a study recently published in Nicotine & Tobacco Research which shows that Norwegians who believe snus to be dangerous tend not to use it to give up smoking. Nothing surprising about that, of course. What is worrying is that 35% of those surveyed believed that using snus was as dangerous - or more dangerous - than smoking (in fact, it is over 95% safer). This is a troubling statistic, though perhaps unsurprising since many Norwegian doctors remain ignorant of the gulf in potential harm between cigarettes and snus.

The study, by Dr Karl Lund, also found that 32% of ex-smokers used snus to quit, whereas only 14% used pharmaceutical nicotine medication. From this, we can draw the conclusion that if smokers were not ignorant about snus's risk profile, many more Norwegians would be ex-smokers.

Still, at least the people of Norway - having wisely chosen to remain outside the EU - are able to buy snus if they want to. The same cannot be said of we Brits who helped to introduce the EU ban in the first place (see The Art of Suppression. You've read it by now, right?)

The harm reduction potential of snus in tobacco control can seem like a relatively new discovery. It is easy to believe that a clueless anti-smoking movement stamped the product out without realising the possibilities it had for smoking cessation. It was, after all, not until 2004 that Brad Rodu and Philip Cole published the study showing that 200,000 premature deaths could be prevented by adopting a Swedish culture of snus use.

This is not quite true. As early as 1985, the addiction expert M.A.H.Russell had tested snus (Skoal Bandits in fact) and wrote to The Lancet saying:

Our results suggest that this new product could help people trying to give up smoking. It might be cheaper than nicotine chewing gum and would not require a prescription. If all smokers in Britain switched to sachets about 50,000 premature deaths per year might eventually be saved at an annual cost of less than 1,000 deaths from mouth cancer.

This was at a time when snus was believed to cause mouth cancer, a belief that has been known to be false for over a decade. Nevertheless, Russell based his figures on the core principle of harm reduction and understood that 50,000 minus 1,000 still left 49,000, and that this was better than the prohibitionist, quit-or-die fairytales that were dominant in the tobacco control movement even then.

History will not look favourably on the dangerous idiots who banned snus in the EU - especially those who still support the prohibition now that the facts are clear. There were rational voices thirty years ago which went unheeded.

One of Russell's co-authors for the Lancet letter was Martin Jarvis. Today, Jarvis is a trustee of ASH. ASH is truculent, devious and unreliable on almost every matter on which they claim to have expertise. None of their pronouncements of the last fifteen years has not involved at least a half-lie, but their failure to speak out against the EU ban adds cowardice, hypocrisy and gross negligence to the charge sheet.

16 comments:

Mag said...

O/T

Chris, an update.

It’s been more than three months since the “Lavac Incident”. To the best of my knowledge, Lavac has not yet instituted the “proposed” lawsuit :) …. [as if].

I’ll keep an eye on this.

Jean said...

The snus ban makes me think of the 90's blood scandal in France, when health authorities deliberately kept a blood testing product from being imported and used, thus making blood transfer much more dengerous to haemophiles who then got contaminated with AIDS. The details were complicated but some people in charged were finally tried and condemned to prison sentences.
The case of snus is not so different. Health authoriies are deliberately disregarding relevant informations in order to force a decision that will cost many lives. Someone should tell them that their behaviour may have legal consequences.

westcoast2 said...

Gunilla Bolinder of the Karolinska University Hospital in Stockholm quoted in 'Report on NICE Citizens Council meeting Smoking and harm reduction, (http://www.nice.org.uk/media/4EB/13/CCReportOnHarmReductionUpdated300410.pdf)
"She went on to point out that the Greek physician Hippocrates had famously said “First do no harm”, not “Do less harm”. Is it right for doctors to promote any alternative tobacco product, even if such a product is less harmful than smoking? Her answer was an unequivocal no. Moreover, she does not grant snus much of the credit for the fall in smoking that has taken place in Sweden, from 45 per cent in 1969 to 14 per cent in 2007. The arrival of snus, she claims, has simply created a new category of drug user. It is marketed to young people, is often more addictive than smoking, and is not sold with the aim of encouraging users to give up smoking."

The meeting seemed to be an attempt to redefine 'quit or die' as 'Harm Reduction'. The commentary by 'expert' Gunilla Bolinder (amongst others) seemed to hold sway.

The appeal to historical authority seems very persuasive and difficult to argue against. How would you respond to 'Hippocrates had famously said “First do no harm”, not “Do less harm"'?

Jonathan Bagley said...

Bolinder must know what she says isn't true. I was told by a Swede that Swedish women tend not to take snus (discolours the teeth and is seen as unfeminine). It is the male male smoking prevalence in Sweden which is the lowest in the developed world. The fmale smoking prevalence is much more typical.
Recently the Karolinska Institute seems to have been taken over by anti tobacco propagandists, which is a shame.
Bolinder's argument is nonsense in any case. Doctors tell people to take aspirin even though there is a risk of bleeding in the stomach.
Let#s see the life expectancy statistics for snus users.

dearieme said...

Could it be that introduction of an effective means of giving up smoking threatens the livelihoods of those who make a living from preaching against smoking - smoking pimps, I suppose we could call them? Or am I just becoming ever more cycnical?

Anonymous said...

Living in Norway, as I do, let me tell you a little about the Scandinavian anti tobacco movement. They are amongst the nastiest and most authoritarian anywhere. There is considerable emphasis here on demonising all forms of smokeless tobacco. They clearly regret adopting the "anti smoking" and wish they had simply gone anti-tobacco right from the start. By the way the smoking rates quoted for Sweden are lies.

Jean said...

"First do no harm" is irrelevant. Nobody asks the doctors to give them snus.

"First do no harm" doesn't mean "lock people in so they won't do harm to themselves".

And of course, it still has to be established that snus does harm to anyone.

Mag said...

1
Those in the medical establishment are the last ones who should be quoting “first do no harm” concerning others’ behavior. The medical establishment does good. It also does much harm. This peculiar, medically-produced harm is referred to as iatrogenesis or iatrogenic effect. It usually refers to adverse drug reactions from properly administered drugs, medical errors (e.g., misdiagnosis, surgical errors), and the consequences of poor care (e.g., resulting infections in bed sores from poor care of the bedridden).

The actual leading cause of preventable death and disability, and associated costs, is the medical establishment, i.e., iatrogenesis. In the USA, the smoking “death toll” is estimated at 440,000 per annum. This estimate is based on lifelong risk of tobacco-use that involves 3,000,000-4,000,000 cigarette puffs and also involves a plethora of other correlated risk factors. It is also poorly argued from the population-level to the individual level. For all intents and purposes, it is a statistical death toll where underlying causation in many instances is highly questionable. The causation in iatrogenesis is far, far clearer, discernable at the individual level and estimated for the population level. For example, a person can go into catastrophic failure leading to death/disability within minutes/hours of being properly administered a drug. One estimate of the iatrogenic death toll in the USA is between 780,000 and 1,000,000. This is well over a third of all deaths per annum and dwarfs the tobacco “toll”.

Mag said...

2
“We estimated that in 1994 overall 2216000 (1721000-2711000) hospitalized patients had serious ADRs [adverse drug reactions] and 106000 (76000-137000) had fatal ADRs, making these reactions between the fourth and sixth leading cause of death”.
http://www.ncbi.nlm.nih.gov/pubmed/9555760?dopt=Abstract

Including more sources of iatrogenesis:
Doctors Are the Third Leading Cause of Death in the U.S.
Cause 250,000 Deaths Every Year
From Starfield, B. (2000) Is US Health Really The Best In The World? Journal of the American Medical Association, 284 (4), 483-485.

http://www.naturodoc.com/library/public_health/doctors_cause_death.htm

Including even more sources of iatrogenesis:
Null et al. (2003)
DOCTORS ARE THE LEADING CAUSE OF DEATH IN THE USA.
Cause 780,000-1,000,000 Deaths Every Year

http://www.webdc.com/pdfs/deathbymedicine.pdf

“Global Trigger Tool” Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously MeasuredM
http://content.healthaffairs.org/content/30/4/581.abstract

Mag said...

3
Of the two – the iatrogenic or tobacco tolls – it is the former that should attract very serious scrutiny. But, it has been the other way around, or upside-down. Concerning smoking, there have been thousands upon thousands of antismoking “studies” conducted/funded. Most do not break new ground but simply reinforce the agenda. World Conferences on Smoking and Health have been occurring since the 1960s. In the last few decades there are National Conferences on Smoking and Health. There are now even Conferences for Nonsmokers. Then there are Smoking Cessation Conferences run by the pharmaceutical cartel peddling its useless/dangerous wares. Additionally, there are numerous antismoking lectures and colloquia and speeches and committees and campaigns. Specific institutes for the study of tobacco have been created as sub-centres of university Public Health Departments. There has been a frenzy of antismoking activity over the last three decades. A formidable, lucrative anti-tobacco industry has been created that did not exist 30 years ago. And the bulk of it is all under medical direction. The medical establishment has wreaked social havoc (also iatrogenic), again, to tackle the tobacco “death toll”, and peddled essentially on the basis of the far smaller and highly questionable tobacco “toll” in nonsmokers (SHS).

So we could then ask that if this has been the reaction to the tobacco “death toll”, then there must be an even greater industry addressing/correcting institution-wide iatrogenesis? In fact, there’s not. Compared with the many thousands of antismoking studies, there is but a handful concerning institution-wide iatrogenesis, damning as they are. There are NO conferences – international or national - on institution-wide iatrogenesis whatsoever. There are no specifically-created institutes addressing the issue. In fact, it attracts almost zero attention, just like the assault on the Hippocratic Oath, within the medical establishment itself. The medical administration doesn’t like talking about it or the public knowing about it. This is the same medical establishment that now wants to “fix-up” the world - again. It is just another dangerous symptom. Scrutinizing the medical establishment would reveal how unstable its framework is. It would mean a reasonable evaluation/restructuring of processes/protocols, and a reasonable loss of profits and ill-gotten trust. While it tenaciously maintains the spotlight on its favorite social targets, it avoids scrutiny like the plague. The contemporary medical establishment has been reduced to a production line, a medical industrial complex, where the tenets of the Hippocratic Oath play little or no part. The medical establishment was out of control 30 years ago. It has since entered a sinister phase. And smokers are one of the first to notice the ugly side of the medical establishment in its world-fixing (eugenics) and financially-compromised aspirations.

Mag said...

Comments on Siegel’s current thread might be of interest:
http://www.tobaccoanalysis.blogspot.com/ncr

Mag said...

1
The latest on thirdhand piffle.

This is a release on the University of Califraudia website. It concerns upcoming “research”, about $3.35 million worth, on the piffle.

Even this UC statement concedes that: “Tackling thirdhand smoke is tough because it’s pushing the technological sensitivity of measurements of pollutants,” said UCSF scientist Neal Benowitz, an authority on nicotine metabolism and principal investigator of the TRDRP thirdhand smoke consortium.”

Yep, we’re on the edge of detectability, let alone demonstrable hazard. So to date these fraudsters have nothing. But does that stop the inflammatory rhetoric?

The statement begins with this headline:
“After the smoke clears, danger still lurks”

It then continues with:
“…….in order to determine the scope of thirdhand smoke risk”
“We don’t yet know the degree of risk….”
“We need to find out what risk this pollution poses.”
“Risks to infants and toddlers are of particular concern to consortium scientists.”
“Researchers suspect that children with respiratory diseases like asthma are likely to be at highest risk.”
“But the potential dangers don’t end with direct exposure to smoke”


What risk? There is no demonstrated risk….. and not for the want of trying. Yet these fraudsters speak as if there is a risk that simply needs to be “found” – by them. It’s really just a load of wild, inflammatory, agenda-driven, self-serving speculation. We’re well into the realm of absurdity.

These miscreants note that: “One positive sign he’s found is an uptick in the number of people demanding smoke-free used cars, rental cars, apartments and hotel rooms.”

Why would this be a “positive” sign? The fools have admitted that there is no risk-basis to such conduct. The answer is that although these fraudsters have not demonstrated risk, they carefully use language in their “studies” and press releases that constantly implies risk – just like this latest statement. There is already a segment of the population that believes in “thirdhand piffle risk”.

Mag said...

2
The intent of this group is to warp community attitudes to antismoking through inflammatory propaganda. The overall goal is to force, through manipulated community pressure, smokers to quit:
“The research goes hand in hand with efforts to reduce the number of people who take up smoking in the first place.”
“The thirdhand smoke trail may well lead to changes in attitudes about smoking and to decisions to give up the habit or not ever start it, Matt said.”
“And as we close more research and policy loopholes, we’ll have more ammunition to cut down smoking and save lives.”


The conduct is clearly, in their own words, agenda driven: It is anti-scholarly and anti-scientific. Obscene is that the funding for this “research” enterprise comes from cigarette taxes. Smokers are forced to pay these leeches to manufacture persecutory propaganda.

Mag said...

3
And, of course, where fanatical leeches are involved, there is the requisite self-approbation:
“I think the state of California is very forward thinking to try to pursue this question. If anyone has the expertise to make real progress, it’s this talented, multi-discipline research group,” Benowitz said.
http://research.universityofcalifornia.edu/stories/2012/04/thirdhand-smoke.html

What should be clear is that the language used in the statement does not represent that of impartial enquiry.

Anonymous said...

Please note that from about 2000-2006 when Clive Bates was director of ASH UK, he and ASH UK led a campaign to repeal the EU snus ban.

Unfortunately, the drug industry and many health and anti tobacco groups and activists (who campaigned to enact the EU snus ban) successfully opposed Bates' campaign by lobbying the EU to retain the snus ban (by exaggerating the health risks of snus, by denying the Swedish exerience and the health benefits of switching to snus, by claiming that there was a youth snus epidemic in Sweden that would spread througout the EU, that snus was a gateway to cigarettes for youth, and that tobacco harm reduction was a new conspiracy by Big Tobacco to addict and kill).

Bates became justifiably frustrated dealing with the liars, propagandists and fear mongers at health agencies and anti tobacco groups that he quit working at ASH UK and quit working in public health. Bates now works for the UK government on energy policy issues.

If I wasn't so busy advocating tobacco harm reduction products and policies here in the US, I'd be ables to spend some time and energy urging the EU to repeal its counterproductive ban on snus, which protects cigarette markets and threatens smoker's health.

Bill Godshall
Executive Director
Smokefree Pennsylvania
1926 Monongahela Avenue
Pittsburgh, PA 15218
412-351-5880
smokefree@compuserve.com

Dick Puddlecote said...

Top comment Bill. It kinda shows the current ASH set up as deeply hypocritical, and solely self-serving.

They spent all day today supporting plain packaging, but have done absolutely nada for the past decade making up for their Skoal Bandits error which has arguably led to deaths by their own way of categorising them.

Still, what do they care? Their tax-sponging is safe for another year.