Thursday, October 04, 2007

Promoting smokeless tobacco in America – what about Australia?

According to the New York Times Swedish smokeless tobacco (snus) is being actively promoted in the US. Snus (pronounced like ‘loose’) is a smokeless tobacco product packed in tiny pouches that look like miniature used tea bags and which is placed between cheek and gum. I have argued before that, although possibly risky, this product is a much safer alternative to cigarettes and should be promoted and sold in Australia. Currently it is illegal to import smokeless tobaccos like snus into Australia for commercial sale and privately imported snus is subject to a $300 per kilogram import duty.

Lest I be misunderstood I should make it clear that the best advice by far is to never start smoking (ex smokers are still 50% of lung cancer victims) and if you do smoke to quit using all forms of tobacco completely. Quitting at almost any age provides health benefits – even if you have smoked for 40 years and quit at age 60 you will still gain 3.3 years of life on average by quitting. Quitting is difficult but clearly not impossible – there are more ex smokers in the Australian population than current smokers.

But there are 3.5 million Australians who do smoke and large numbers of these people will meet their maker early because of their smoking habits. What to do about that slab of this group of smokers who won’t or cannot quit?

One alternative is to consume NRTs (nicotine replacement therapies) such as Nicobate. Most smokers seek to quit and most smokers have tried such therapies but failed. If a smoker can switch to NRTs even for the remainder of their lives they have probably substantially improved their health prospects.

If this doesn’t work (and hypnotherapy and anything else) doesn’t work then snus seems to me a possible way out. Not ideal - for sure - but much better than smoking cigarettes since the nicotine and tobacco-specific nitrosamines present in tobacco don’t get into your bloodstream by your lungs. It’s a distinct health advantage.

From the New York Times article:

1. A key debate soon to be resolved in the US is how to define “reduced risk” tobacco products and how to market them. On Wednesday, a House committee is scheduled to hold hearings on whether the Food and Drug Administration should be given the power to regulate tobacco. (I'll post on this once informed - this is part of a decade old struggle by the FDA to have tobacco registrered as a drug.)

2. Thanks to its popularity in Sweden this country has the lowest smoking rates in Europe. It also has fewer incidences than its neighbours of smoking-related diseases, including lung and oral cancer.

3. Snus is not without its dangers. It contains nicotine, which speeds the metabolism, and is as addictive as cigarettes. Snus contains nitrosamines, the same cancer-causing chemicals in cigarettes, but at lower levels. In a recent study of 280,000 Swedish construction workers, published in June in the British medical journal Lancet, snus was found to be a risk factor for pancreatic cancer.

4. Philip Morris USA and R. J. Reynolds Tobacco have begun test-marketing snus around the country under their most famous names, Marlboro and Camel.

5. The European Union banned the sale of snus in 1992, partly out of concern that it would be marketed to young people — a policy that almost derailed Sweden’s membership bid, until a waiver was granted. There are no such restrictions in the US where there is a long tradition of smokeless tobacco and a growing market for it.

6. In Sweden, snus has existed for some 200 years, enjoying a revival in popularity over the last 20 years. In 1976, 43% of men here smoked regularly; by 2005, only 14% did. During that period, the percentage of men using snus jumped to 22% from 9%. An estimated 5% of Swedish men have quit smoking altogether in favor of snus.

6. Dr. Rutqvist, an oncologist, who used to think snus was ‘disgusting’ has become one of its most ardent advocates. He argues snus can serve as a less risky alternative for chronically addicted smokers and as a way for less addicted smokers to wean themselves. (Rutqvist now works for a tobacco company.)

7. Snus also contains plenty of nicotine, which doctors say has dangerous metabolic effects. This nicotine kick is what makes snus more effective as a way to quit smoking than patches or gum. Still, there are no reliable scientific studies on snus as a smoking-cessation tool.

8. Smoking opponents say Sweden’s low smoking rate owes more to its strict tobacco control policies than to snus. They say tobacco companies are seeking another channel to deliver their product at a time when smoking is banned in restaurants, offices and bars.

9. Currently there is little scope for marketing snus in the United States, since tobacco companies cannot make health claims without running afoul of the federal government or risking lawsuits. Legislation pending in Congress would let the F.D.A. regulate tobacco and develop rules for companies marketing reduced-risk products.

Issue 9. is complex. The tobacco companies have a well-derved reputation for dishonesty and unethical behaviour. And they obviously seek to survive commercially in the face of declining cigarette sales. But these new products do offer lower health risks and there are benefits from promoting them. It is a tough call.

5 comments:

Sarah said...

I think the great thing about snus, regardless of how much it harms the user, is that it doesn't subject non-users to its harmful effects in the way that cigarette smoking does.

Promoting it here is a great idea, in combination with a total ban on public smoking.

hc said...

Sarah, I agree eliminating passive smoking is a good thing but this is mainly intended to address the health concerns of those who cannot quit.

I want to emphasise that I do not support smokeless tobacco products unconditionally. I think they are risky but lower risk than cigarettes.

Yobbo said...

Snus is pretty popular in Thailand too.

Smoking (by women) is viewed very poorly in asian society (although its fine for men), so a lot of women are taking up snus instead, probably being introduced to it by swedish tourists.

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