No Illusions

I write my column No Illusions in TCS Daily on 31 May 2006.

The WHO sends the wrong message on harm reduction

The Tobacco Free Initiative branch of the World Health Organization has organized the No Tobacco Day worldwide for today, May 31. The event has been held annually for the past 20 years to draw the public’s attention to the preventable deaths and diseases caused by smoking. But this year the event shows how the policies of the WHO’s TFI and the European Union are perpetuating the death toll from smoking.

This year’s theme is Tobacco, Deadly in Any Form or Disguise, clearly taking a position against harm reduction, smokeless tobacco and Swedish snus in particular. This is motivated by the TFI claiming that snus and other smokeless tobacco products offer only the illusion of safety, and that none have been thoroughly evaluated in human studies.

This is contradicted by 50 years of research in Sweden that points to the fact that snus is 98 percent safer than cigarettes (if nothing else because of the lack of combustion near the oral cavity). Statistically, the average life span of smokers is eight years shorter than for non-smokers, but for users of smokeless tobacco it is just 15 days shorter.

Men in Sweden have consistently had the lowest smoking rate in Europe, thanks in part to the use of snus, and the WHO’s own statistics show it: Sweden has the lowest rates of lung cancer in the EU. The same goes for pancreatic cancer, one of the main cancer types associated with tobacco use. What raises Sweden’s figures in the lung cancer statistics is the fact that Swedish women smoke as much as women in other European countries, although this is changing now as more women are also switching to snus.

But the EU’s ban on snus sales everywhere else than in Sweden stands firm. Recently, the Finnish autonomous region of Åland had to back down from selling snus, as the European Commission brought Finland to the European Court of Justice. Together with the December 14 2004, ECJ ruling, the EU’s 12-year ban was legal and binding.

The case for a harm reduction strategy in Europe is strengthened by the fact that Eastern European nations still have high rates of smokers, but nicotine medications favored in the tobacco reduction strategies, like nicotine chewing gums and patches, are far too expensive and unsatisfying to smokers. This has made them unsuccessful. A recent review reported that they only have 7 percent success rate among the smokers who try them.

Smokeless tobacco products provide satisfying doses of nicotine, and they eliminate the smoke, allowing tobacco users to eliminate most of the risks, while achieving a better rate for tobacco use reduction than the prevailing "quit-or-die" policy. With 600,000 deaths each year connected to smoking in the EU, the harm reduction strategy needs to be considered on equal footing.