by Carl V Phillips
Not lies today, quite. But unforgivable ignorance from those who presume to write about THR. CNBC “reports” (which is to say, runs a free advertisement for Swedish Match; not to suggest that is a bad thing — and indeed, good for them for getting the story — but it is just so blatant it seems a bit embarrassing):
Big tobacco may be scrambling to grab a hold of the e-cigarettes market, but there’s a little-known 700-year old tobacco product from Europe that’s also seen as having big potential.
Snus (pronounced “snoose”) is similar to U.S.-style dipping tobacco. It’s a derivate of snuff with the history records showing its use dating back to the late 1400s. It’s placed inside the upper lip and is either sold loose in tins or in tiny tea bag-style pouches.
Seen as having big potential compared to e-cigarettes? Even restricting to an inaccurate narrow definition of what snoose means, it has been reasonably popular and constantly discussed for decades, and still outsells e-cigarettes by a lot. Note to authors: just because you personally only recently learned about something does not mean that it is news.
I trust I do not have to explain that “snus” is just the Swedish language word for snuff (aka dip, oral snuff, moist snuff), and so does not define a subcategory of smokeless tobacco, though it is also used as marketing term for ST products outside Sweden that the manufacturer wants to declare to be Swedish-style. The author’s failure to understand this results in the later statistics in the article being garbage: Swedish Match’s share of the U.S. “snus” market is fairly meaningless when you have no idea what the author thinks constitutes the market. I would guess it refers to all the products whose manufacturer happens to put “snus” on the label. But that is kind of like looking at someone’s market share for “protein bars” by looking only at products with that phrase in their labeling, ignoring all the various “energy bars”, “nutrition bars”, etc. that are the same category.
The saving grace of the article, for me anyway, was the snarky first sentence. I can imagine that Swedish Match and the other ST manufacturers who are not in the cigarette business get pretty annoyed at the rhetoric coming from some e-cigarette advocates that suggests e-cigarettes are better than ST because ST is part of “big evil tobacco” while e-cigarettes are independent. So you can hardly blame them for sniping back. What many e-cigarette advocates do not seem to realize is that ST (in Sweden, the USA, and elsewhere) was popular long before cigarettes and until fairly recently was dominated by manufacturers who were not in the cigarette business, though that changed with acquisitions and expansions of cigarette brands into smokeless. (Sound familiar?) While I am not going to go look up the numbers, it may already be that a larger portion of e-cigarettes sales than ST sales come from companies that also make cigarettes (and if not, it will probably be the case in a year).
My attention was called to that CNBC article by an e-cigarette blogger posting a note asking if anyone had written about snus before. Really. I am not trying to give this individual a hard time, because s/he is merely one example of a remarkable ignorance among the e-cigarette literati about where THR came from and why we can be confident it really works (and I want to make sure that individual gets credit for learning about it and writing something, though for obvious reasons I am pretty sure s/he does not read this blog and so will never see that).
Less forgivable still are supposed scientific experts who have embraced e-cigarette based THR without ever repenting for — or even correcting — their history of lies about ST. The worst — but by no means only — of these is NJOY’s Richard Carmona, whose lies about ST when he was Surgeon General of the United States may have killed more people than any other single anti-THR liar. He gets paid to tout e-cigarettes now, without ever having corrected or showed remorse for those lies.
All current THR products are great for public health, but no current product is a public health miracle. ST proved that THR works, both in terms of reducing the health risks and having a large impact in at least one population. E-cigarettes have proved that there was pent-up demand for THR in other populations, and that new products could serve some of that demand. But despite optimism from a year or two ago, it seems unlikely that the current version of e-cigarettes will make a much greater a dent in smoking than ST does. Sure, if the market were frozen now, both would continue to replace smoking and provide more public health benefits than the tobacco control industry could dream of providing. But new products are needed — and fortunately are in development.
Each new low-risk product should be embraced for what it is (and understood for what it is not — e.g., if it is not quite as low risk as ST). Inevitably, some companies and going to try to market their THR products at the expense of other THR products (and I am not just talking about pharma), and some bloggers are going to focus on the product aficionado niche. But these represent a lack of genuine support for THR itself, and potentially harm the cause. What’s say we all try to push back against this THR-vs-THR balkanization.
[Update: Related to this, here is a presumably planted article touting PMI’s pending new THR products. Notice, to their credit, that they do not suggest anything is wrong with the other THR products but merely note that they do not appeal to everyone. I should also clarify that the Swedish Match planted article also did not denigrate e-cigarettes (except for that “big tobacco” reference). This is the right path for us all to follow.]
Carmona and Dr. Seigel do not get a pass from me for their previous occupations as paid liars for Tobacco Control..
As far as I know, Mike Siegel has never withdrawn some anti-ST claims he made in the not-too-distant past, and has not spoken favorably about ST-based THR.
Just a small history lesson of interest. Snus first appeared in the US a long time ago when Swedish immigrants arrived and missed their beloved snus. Over time snus evolved into dip but it still had strong ties to the original Swedish snuff. Copenhagen is a leading selling brand that started in 1822. “Skoal” is an Anglicisation of skål, a term used in some Scandinavian regions to announce a toast of friendship, with connotations of well-wishing ( I stole the part about Skoal from Wikipedia. I had to look up the word anglicization. I’m giving full discloser)
I can forgive the newbies coming into THR from electronic cigarettes. The public has been so conditioned (brain washed) about the dangers of ST I can give some leeway. The problem I have are with people who clearly know better but continue to lie about ST to try and get some advantage, and that includes people from within both the e-cig community and industry. As an ST user these folks are no better then the worst of the TC gangs. If someone really supports THR that has to include all the forms it may take, and whomever makes it.
I have tried to call out Mike Siegel a number of times on ST and past statements he has made, but he has been evasive at best. The one time he actually responded to my comment on his blog he said he had never dissuaded a smoker from switching to snus. Of course that is entirely different from actually encouraging someone to switch, but that is almost besides the point with his past statements.
I agree that we can forgive newbies. But as soon as someone proclaims himself an expert, like by writing blog posts, “I just don’t know too much about the subject” is no longer an acceptable excuse. After all, we don’t let Stanton Glantz off the hook just because his brain was washed, and then apparently shrunk in the dryer, because he is implicitly claiming to know what he is talking about.
To quibble: If you are going to try to discriminate between styles of ST, “dip” doesn’t do it — that is the most general term possible (e.g., I use it when I want to refer to a collective that includes South Asian products that are not tobacco). Also, it would probably be more accurate to suggest that the products both diverged from their common ancestor. If I had to guess, I would expect that modern American snuff is more similar to the two-century-old common ancestor product than is modern Swedish snuff, but I am not sure.
As for our friend Mike, he wrote this in response to a single outlier study result that had just been published: “These results are important because they question the thinking that smokeless tobacco (or snus in particular) should be promoted as an alternative to smoking cigarettes. They also bring into question the statement that smokeless tobacco is a safer alternative to smoking. While it may be safer in terms of overall mortality, it does not appear to be safer in terms of oral cancer risk. Thus, the unqualified statement that smokeless tobacco is safer than smoking does not appear to be warranted.” http://tobaccoanalysis.blogspot.com/2008/04/large-longitudinal-study-finds.html Not only were the results an outlier (and thus probably wrong), but even if they were right would represent (a) a trivial risk compared to smoking and (b) less oral cancer risk than is caused by smoking. I think this statement qualifies as “dissuading smokers from switching to snus”, at least via the pathway of encouraging those who actively endeavored to tell people they might as well smoke.
And then there is this beauty (and if you think it sounds like the current ANTZ whining about Carmona joining NJOY, you are right) http://tobaccoanalysis.blogspot.com/2006/04/oncologist-switches-careers-from.html “Oncologist Switches Careers: From Fighting Cancer to Promoting It. In a strange turn of events, an oncologist who previously fought cancer through treating cancer patients and researching the causes of cancer is now going to work for a tobacco company and joining the effort to promote cancer to thousands of customers throughout the world. According to a press release issued this morning: “Lars Erik Rutqvist…has been appointed Vice President, Scientific Affairs within the Swedish Match Group.” He then quotes the press release quoting Lars Erik saying “Cigarette smoking presents an important and growing health problem in the world. This must be met by active measures to limit unhealthy activities. In this respect, Swedish Match can make a positive contribution. It is an exciting challenge to contribute to this development. No other single effort for public health is more important than to induce people to refrain from cigarettes and I will continue to work for this, only now from a new position with a broader perspective.” Sounds about right. Mike’s response to that statement is to attack it, and to condemn snus, and thus Swedish Match, and thus Lars Erik. He repeats a couple of pages worth of the usual ANTZ lies about oral cancer (invoking a series of claims that Brad Rodu and I had already debunked by the time he was writing this — South Asian products, statistical errors and such), and continues: “However, he has no business getting up in front of the world and giving us all this crap about how Swedish Match is going to make a ‘positive contribution’ to the public’s health. If Swedish Match really wants to make a positive contribution to the public’s health, then it should simply stop selling its deadly, cancerous products to thousands of Americans and others throughout the world. That would make a positive contribution. … Just do your job and let your new customers die in peace. Spare us the crap.”
It is difficult to imagine more completely anti-THR statements than these. Those posts contain no updates offering corrections or apologies. I wonder if he has ever apologized to Lars Erik? I have never heard him admit he was part of the anti-THR problem, or admit that ST is is the foundation that THR is built on and is the proven low-risk alternative when writing his paeans to the e-cigarette.
Just to emphasize my point here, in case it is not clear: People who make mistakes should make corrections. People who make mistakes that did harm should make apologies and try to undo some of the harm if they can. Mike Siegel does good work promoting e-cigarette-based THR and debunking ANTZ lies. I consider him a friend. But he owes the world some retractions — no less so than do many of the people he calls out every month.
Though not a retraction or an apology for previous comments made on ST, Dr. Siegel did respond favorably to a question that I had posed to him a couple of months back. I don’t remember my exact wording, but it went something like this:
If there was a HnB product (similar to that of an e-cig) on the market that heated a snus-like tobacco (ie., with low TSNAs, etc..) , would you promote it with the same intensity as has been witnessed with your advocacy of the e-cigarette?
His response was that he would (if ever to be made aware of such a product) indeed support such a product as a valid THR alternative to smoking alongside that of the e-cigarette.
This would seem to signify (albeit in a subtle way) a change in stance in his views on ST. Still though….. Rather than being all inclusive, he still appears to focus only on one pathway to harm reduction. This is bothersome to say the least because an advocate for public health should be open to all of the possibilities if the objective truly is to improve the health (and happiness) of the affected.
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I completely agree with Carl about THR on THR hostility – it’s stupid and counterproductive. The true public health objectives are served by increasing the diversity of low-risk options for using nicotine so as to widen the possible appeal. There is no single ‘right answer’ or perfect THR product – the right product is the one that someone want to use instead of smoking.
Three useful read-overs from snus to e-cigarettes
1. Population effects and other scares that never materialised
Many of the same ‘population health’ arguments (gateway, reduced cessation, dual use) have been used to attack snus in the past – leading to a 1992 ban in the EU. However, the exact opposite happened in reality, at least where it isn’t banned. In my response to a recent highly negative BMJ editorial on e-cigarettes, I thought it was important to bring the lessons from snus in support of e-cigarettes: http://www.bmj.com/content/348/bmj.f7686/rr/681015 . We also have a widening group of European academics who see the success of snus as ‘proof of concept’ for harm reduction, and recognise that a ‘lethal error’ was made in the excessive regulation of snus in the EU that should not be repeated: eg. see this letter http://www.clivebates.com/?p=1561 .
2. Elements of success from came outside official ‘public health’
The public health gain in Sweden (and Norway) has three useful characteristics: (1) largely a market based, consumer-driven response – never positioned as a smoking cessation treatment; (2) very light regulation – no-one thought it important to regulate the product down to zero -risk; (3) relentlessly opposed by many public health authorities, including in Sweden.
3. The diminished credibility of anti-THR activists
I think that unless and until the anti-THR activists understand and accept the unambiguous lessons of snus in Sweden and Norway, then they have no standing to pass judgement on e-cigarettes. In Europe, the same people who are anti-e-cigs still think that snus should remain banned – despite evidence that it is responsible for the best outcomes in Europe. Why should anyone serious take them seriously?
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I feel that e-cigs should be marketed as a “smoking cessation device”, (the real truth), so that they are not glorified as another way to smoke. they are a smoking cessation tool, and should be advertised as such..
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