En la categoría : Bazar
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Autor del texto : Humberto Ramirez Estrella
Fecha de publicación: 28 Oct, 2020

It certainly appears to be. However, more low-risk products are being used today, and the position of Snus as the lowest-risk tobacco (or nicotine) product is being challenged.

The advantage Snus has is the enormous data resource – the unimpeachable national health statistics resulting from Sweden’s unique position in the EU: the lone country in which Snus consumption has been both legal and popular; the obvious effect of widescale Snus consumption instead of smoking (or to be more accurate: the lack of any effect); and the more than 100 clinical trials and studies going back decades.

Sweden’s tobacco consumers are about half and half smokers and snusers: about 1 million of each. This is slightly more than 20% of the adult population. The proportion of snusers has grown in recent decades.

The Snus-consuming proportion of the tobacco consumers are invisible in any health statistics. All other factors are as normal in developed European countries: strong tobacco control policies, a socialised state (perhaps more than most), and very high wealth in comparison to some other regions of the world.

By the late 90s it was known that Snus consumption had no reliably measurable effect on health outcomes. By the early 2000s this was undeniable, and in 2003 Foulds et al showed that it was not possible to find any evidence of negative health impact from Snus consumption in Sweden when mainstream tobacco control people attempt to locate such evidence and are honest about their results.

By the time more than a hundred clinical studies had been carried out, some with very large cohorts, the meta-analyses by those such as the world’s leading medical statistician showed that Snus consumption had no reliably identifiable association with morbidity of any form or with mortality .
Smoking is normally considered, within the tobacco control field, to kill 1% of smokers and ex-smokers per year; so that if 10 million smoke then 100,000 will die annually as a result. There is some debate about this and in some circles it is regarded as either simplistic or unscientific. Whatever else it may be, it is the official position more or less globally. In comparison, no one can be found whose death certificate reads or implies or mentions Snus as a causative factor in Sweden. There are no official deaths resulting from it, in comparison with the 1% of smokers who are reported as dying early due to cigarette consumption.

Health outcomes for ex-smokers who switch to Snus, or for those who totally quit all tobacco and nicotine, are the same.
Most snusers are male, in Sweden. Therefore, men reap the benefits in multiple ways: (a) Sweden may be the only country in the world in which more women than men smoke; (b) Sweden has the lowest male lung cancer and mouth cancer rates in the EU.

Sweden has the lowest tobacco-related mortality* of any Western developed country by a wide margin. (* This is the smoking-related death rate.) Only smokers and ex-smokers are visible in these stats – Snus cannot be shown to be killing anyone.
As 1% of Swedish smokers (~1 million) are reported as dying each year as a result of smoking, as is standard, this is 10,000 annual deaths. In comparison, Snus is not reported as being the cause of any death. In addition it has no statistically-identifiable connection with oropharyngeal cancers (‘mouth cancer’).

As a side note: modern Snus in Sweden is produced to a quality standard called the Gothiatek Standard. This local Swedish industry standard mandates the maximum TSNA (carcinogen) content. There is still a significant carcinogen load even with the process used, but it seems to have no measurable effect on health outcomes. Perhaps the same can be said for bacon sandwiches: use may not be problematic, abuse will be.

On the face of it, Snus is shown to be 10,000 times safer than smoking, in Sweden. It cannot be harmless – but if there is a choice between the two, the best option seems obvious.

Sweden has had to fight the EU every inch of the way on every aspect of this situation: the EU is now and has always been desperate to prevent Sweden from allowing safe products to be sold. Sweden obtained a derogation (an exemption) on the EU tobacco rules (which outlaw Snus) on its accession to the EU in 1994. The EU has been trying to cancel this or find some kind of a workaround ever since. They have been ruthless in their attempts to stop neighbouring countries reduce the burden of smoking-related disease and death via the same method.

Now moving on to the US:

According to Prof Rodu, it is not possible to locate any deaths from oral tobacco use in the USA in the modern era.
The CDC cannot provide the name of any person who is recorded as dying from oral tobacco use in recent years, when asked for this information by senior pathologists.

CDC raw data inspected and tabulated by Prof Rodu does not show any mortality from oral tobacco use in the modern era.
It seems the last two clinical studies of oral tobacco use in the USA could not show any mortality resulting from its use.
The modern situation is clearly very different from the past. Widespread oral cancer and mortality was apparent, in past eras. It looks as if the US manufacturers have looked at the Swedish methods and used some/many/all of their quality control methods. Rodu has a table of carcinogen content for different US products there are differences between them, but some do compare with the Swedish figures.
The main causes of mouth cancer in the USA today are reported as smoking, excess drinking of alcohol, and HPV. Combinations are thought to be especially potent.

Prof Rodu is the world’s leading senior pathologist specialising in the oral pathology of tobacco consumption. He is an expert in oropharyngeal cancers. He reported that a notable high-profile media report of a US oral tobacco-consuming sports star with mouth cancer did not align with normal mouth cancer presentation from oral tobacco use, but from a type normally associated with the other causes. Apparently this is not a unique case.

The CDC report that 440,000 smokers a year die from smoking (1%). They cannot show anyone dies as a result of oral tobacco use, in the modern era. They also seem extremely unwilling to publicise this fact.

On the face of it…. Yes, indeed you have seen this before – oral tobacco use is about 440,000 times safer than smoking, according to official CDC figures, which they refuse to either publish or acknowledge in any way.

South Asian oral tobacco products are in a very different league.

All reports of mouth cancer associated with oral tobacco use, seen now, refer to India, Pakistan, Bangladesh or other sub-continental products and use. Indeed gutka, paan and other local products are famous for causing mouth cancer.
The ingredient list of such products is fairly long, and includes among others: catechu, slaked lime, areca nut, betel nut, and so on. It seems difficult to call these tobacco products in some cases, as tobacco is neither the sole ingredient nor perhaps even the largest component.

Fake snus is now making an appearance there, and called chaini-khaini. It will no doubt be about as safe as the other products in the region.

There is no connection between any of these products and modern Swedish or American ones. The suggestion that they may be related in some way is fatuous. Indeed it may be more than that: highly disingenuous would be a polite way of putting it.
Tobacco Harm Reduction is the consumer-driven process of choosing safer alternative products.

The core principle of THR is: first remove the smoke. If it has smoke, it’s not THR, so this is a simple enough metric.

Choosing a well-proven ultra-low-risk product such as Swedish Snus has obvious benefits. Some/many modern US products also comply – but see Prof Rodu’s numbers on the comparative TSNA contents.

Newcomers include vaping and HnB. They’re not actually new, but more kind of ‘new-to-you’. We await the same sort of data mountain we have for Snus, that could show these newer alternatives are low risk. They will have to go some way to get the ultra low risk tag Snus has, but the signs are good. After all, a 50% risk reduction compared to smoking would be a public health miracle, and it is impossible the risks are as bad as that.

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