ArticleNov 12, 2006
Cigarette smoking - public health enemy number one
Increasingly, more people in the public-health sector are beginning to
realize that Swedish snus is a possible means to reduce harmful cigarette
smoking. Although the issue remains controversial, the trend is
clear, according to Lars Erik Rutqvist, Vice President, Scientific Affairs
within the Swedish Match Group. Accordingly, it is highly disappointing
that the new Swedish government announced in its budget proposal a
significantly sharper increase in the tobacco tax on snus than cigarettes.
LARS ERIK RUTQVIST, whose previous work
experience includes a period as a professor
of oncology, has himself been involved in
a number of major epidemiological studies
relating to the health effects of Swedish snus.
"In this area, the current research situation
is fairly unequivocal," he says. "It is
well documented that as far as the substantial
health risks associated with smoking are concerned,
particularly different forms of cancer
and cardiovascular diseases, there is no correspondingly
elevated risk for users of Swedish
snus."
Despite these findings, it has been a tough
uphill task to inculcate this knowledge among
people working with public-health issues.
The prevailing attitude is to lump all tobacco
products together. This is the approach taken
by the World Health Organization, for
example, and within the EU the ban on the
sale of snus in all the member countries except
Sweden remains in effect.
Tax is off the target
Another example of this view occurred recently
when the newly elected Swedish government
proposed a 100-percent increase in the
tax on snus in its budget bill, while the tax
increase on cigarettes was 40 percent.
"It is deeply unfortunate from a public
health standpoint to send the wrong signals
to consumers, namely that all tobacco products
are as harmful as cigarettes. This is not
the case," says Lars-Erik Rutqvist.
Lars Erik Rutqvist believes that ideological
and political objections are the main reason
why it has been so difficult to gain a hearing
for the harm-reduction philosophy - that
is, substituting less harmful tobacco products
for cigarettes - among public authorities and
decision-makers. Once people have adopted
an entrenched position, it is difficult for them
to admit that perhaps they could be wrong.
Right focus in the debate
Nevertheless, Rutqvist believes he can discern
an opinion shift. One example is the major
conference on tobacco controls, the World
Conference on Tobacco OR Health, which
was held in Washington, DC, in June. The
conference brought together representatives
of public-health occupations and the research
community from throughout the world. One
of the main conference themes was publichealth
issues in the developing world.
"It was an extremely
interesting conference,
with many speakers in a
number of symposia displaying
a highly positive attitude toward the
idea of harm reduction. The organizers had
invited both skeptical and supportive speakers,
but overall it was a very good discussion
that highlighted the current research situation,
which does after all show that the risks from
using snus are significantly lower than those
from smoking," relates Lars Erik Rutqvist.
In response to the introductory question as to what was the overall objective for the
participants in the symposium - to fight the
tobacco companies, to combat all addictive
substances, or to discuss health-related effects
- the vast majority of participants stated that
their most important objective was to find
ways of reducing the negative health effects of
smoking, which was very pleasing to hear."
Increasing attention is being paid to data
showing that as more and more Swedes switch
from cigarettes to snus, the incidence of serious smoking-related illnesses has declined. Today,
Sweden has the lowest incidence of cancer of
the oral cavity and pancreas in the whole of
Europe, and Swedish men have the lowest
frequency of lung cancer. This trend is often
referred to internationally as "the Swedish
experience."
Task is to spread knowledge
Today, the number of scientifi cally based
objections to snus on health grounds is constantly
decreasing. While Lars Erik Rutqvist
does not rule out the possibility that future
studies could reveal new, hitherto unknown
risks, he still feels that in the overall publichealth
perspective the message given by the
studies conducted to date is clear: there are
significant public-health gains to be realized
by adopting an approach that includes harm
reduction.
Based on his long experience as a physician
and researcher, Lars Erik Rutqvist is convinced
that a pragmatic rather than dogmatic
approach to harm reduction would lead to
significant gains for public health.
"We know after all that half of smokingrelated
deaths occur in middle age. The victims
lose perhaps as much as 20 years of their
life expectancy," he says. "In the light of these
statistics, it is both counterproductive and
irresponsible to adopt a moralizing tone. Dogmatic
public-health representatives keep both
the public and many doctors believing that it
is as dangerous to use snus as to smoke. If that
is what people believe, how are you supposed
to motivate smokers to quit?"
In view of this situation, he sees one of his
own main tasks as being to help make the full
picture regarding what we know today about
snus and smoking better understood among
decision-makers, researchers, physicians and
the general public. People must be given a better
opportunity to make a well-informed decision,
based on facts rather than ideology. When
asked what is his own most important health
advice, he does not hesitate for a second:
"Give up smoking entirely!"