Harm reduction gives snus key role in reducing cigarette smoking
During the past few years, harm-reduction strategies have assumed an increasingly prominent position in the international tobacco debate. This was apparent from the impassioned debate at - among other forums - the major international tobacco congress held in Helsinki in August 2003, when one of the agenda items was snus as a means to reduce smoking.
There too, it was evident from the presentations charting the limited success of anti-smoking efforts that, forty years after the dangers of smoking were first clearly established, cigarettes still hold a firm grip on their consumers.
Although the dangers of smoking have been well documented at least since the 1960s, some 1.2 billion people worldwide still smoke. While it is true that consumption in the industrialized countries is declining by about 1.4 percent annually, it is increasing steadily at roughly the same rate in developing countries.
The World Health Organization (WHO) has declared that there is nothing to indicate that the harmful effects of smoking will diminish during the next few decades. The organization maintains that smoking will be the direct cause of 500 million deaths among today's global population.
In the developed countries, most governments and organizations dedicated to public health have been working to reduce smoking since the 1970s. The focus has been on trying to remove all tobacco products from the market, primarily through information campaigns and other measures directed mainly at young people to prevent them from starting to smoke. In addition, measures have been taken to protect non-smokers from passive smoking.
"It has naturally been difficult for all those involved to accept that tobacco consumption has proved impossible to eliminate and that it seems as though we must live with harmful tobacco use for a long time to come, contrary to the optimistic goals." This is how Inger Wahlberg, for many years the head of research at Swedish Match, explains the sometimes heated debate about harm reduction.
It could be claimed that the efforts to support adult smokers trying to quit have been inadequate, as regards both the public-health campaigns and the healthcare sector. The words of the well-known British tobacco researcher Richard Doll are often quoted: "Smokers have been viewed as hopeless cases locked into their nicotine dependence."
As a result, a number of independent tobacco researchers in many countries have begun to question the focus of the anti-smoking lobby. They note that there is nothing to suggest that smoking will cease - or even decrease - to any great extent within the foreseeable future. Should we not, in that case, revise our public-health strategies and consider how we can most effectively reduce the harmful effects - particularly for the large number of people who already smoke?
Two researchers - Nigel Gray and Peter Boyle - from the epidemiological and biostatistical department of the European Institute of Oncology in Milan, expressed their views as follows in an article in the September 2003 edition of the highly regarded medical research journal The Lancet:
"There are lessons to be learned from the real-world experiment in harm reduction with snus in Sweden. The most important is that nicotine addiction can be diverted from cigarettes to an orally absorbed nicotine-delivery product. If it is accepted that nicotine addiction is here for the foreseeable future, a new and better range of addictive recreational nicotine is needed. Any risks linked with such a product are dwarfed by the magnitude of the tobacco problem. This product will not be achieved without political acceptance of the concept."
Based on these and similar arguments, a growing number of researchers have begun studying "the Swedish Experience" and presented their results in scientific journals and at various conferences during the past two years. Clive Bates, Director of Action on Smoking and Health (ASH) in London, summarized his views in a document entitled EU Policy on Smokeless Tobacco in February 2003. He and the other authors emphasized the need for anti-smoking campaigns to have a clear purpose: "The aim is not in itself to campaign against tobacco but to reduce the burden of disease and death, mostly from cancer, cardiovascular disease and lung disease, arising from tobacco use."
With this as their starting point, the researchers argue that tobacco use should be regulated in such a manner that consumption is steered toward less hazardous products.
"It is an interesting development, which in practice ought reasonably to lead to the establishment of limit values for tobacco products," comments Inger Wahlberg. "It is clear that harm-reduction strategies have been reinforced by the success of Swedish snus in the Nordic region. You could say that, thanks to the limit values we have arrived at through our own research and established for our GOTHIATEK® standard, Swedish Match has in effect adopted its own self-regulation, focusing on the most important factor for tobacco consumers - namely, to reduce the health risks."
Bo Aulin, Senior Vice President, Corporate Affairs at Swedish Match, points out that there is also another dimension to harm-reduction strategies: "Everyone - especially smokers - has the right to full and correct information about the risks associated with different products. The EU ban on the sale of snus is a major obstacle denying tobacco users the opportunity to inform themselves about, and choose, a tobacco product that has been scientifically proven to be considerably less hazardous to health than cigarettes." The five researchers agree with this point, saying that the debate should not get bogged down in "pro-snus and anti-snus" arguments but is instead about "the right of smokers to be able to choose harm reduction, as opposed to the health establishment's insistence that the only choice open to smokers is to quit - or die as a cigarette addict."
The debate about possible approaches to regulating tobacco products and their contents points to a future in which the ban on snus could be replaced within the EU by a system of limit values, perhaps inspired by Swedish experience with Swedish snus. This line of thought has been followed up by a number of researchers working in the US, who also favor regulation or control of tobacco products with a view to developing less hazardous nicotine-based alternatives to cigarettes.
At the Third International Conference on Smokeless Tobacco, held in Stockholm during September 2002, David Sweanor of the Non-Smokers' Rights Association expressed the view that harm-reduction strategies implied "a role for the use of oral tobacco to reduce the risks for smokers and those exposed to tobacco smoke."
Dr. Brad Rodu of the Department of Pathology at the University of Alabama, was quoted in the Birmingham News during December 2002 as saying: "I believe that the Swedes have shown that if safer products existed, smokers could switch to them. It is not nicotine that kills. It is smoking."
GOTHIATEK® - harm reduction in practice
Swedish Match's success with Swedish snus is based on a deliberate strategy aimed at creating a tobacco product that involves as few risks as possible for consumers.
This concept had already been expressed earlier in the vision conceived by Stefan Gelkner in the mid-1980s: "The use of our snus products should not involve greater health risks than those from food products in general, and this fact should be known to consumers and public authorities."
Today, Gelkner is President of Swedish Match's North Europe Division, which includes Swedish snus. Together with former research head Inger Wahlberg, he led the development of Swedish snus as a distinct product category.
Swedish Match's Swedish snus is produced in accordance with a proprietary product and quality standard based on a number of limit values for the contents of Swedish snus and a strict quality standard for the entire production process, from raw materials to storage in retail outlets. Through a rigorous selection process for purchasing, newly developed methods for handling and processing tobacco and adaptation of the production process to the standards that apply to foodstuffs, Swedish snus has become a functioning alternative for reducing the harmful effects of tobacco consumption - which is the purpose of the harm-reduction strategy.
