ECD: Of course, e-cigarettes are not the only alternative to smoking. Snus is regarded as one of the safest alternatives and some experts we have interviewed believe it contains no measurable risk at all. In your opinion, has the banning of Snus caused the death of smokers in the UK?
Adrian: Times have changed since the EU ban on snus was originally imposed and even hard-line tobacco control advocates now acknowledge that snus is much safer than cigarettes. So the reasoning for maintaining the ban seems more political than scientific, especially given that some smokeless products that are potentially much more harmful than snus are legally on sale. Quite bizarre really!
Perhaps the best answer would be to replace the specific EU ban on snus with a comprehensive overhaul of EU tobacco and nicotine regulation. I’d hope that this would put all nicotine-containing products under the same regulatory umbrella, classify them according to risk, and ensure that consumers are informed accordingly so that they can self-regulate their risk.
To get back to your question, according to one study over 200,000 premature deaths might be avoided annually in just fifteen EU countries if smoking rates were as low as in Sweden, which is attributed in large part by many observers to the Swedish preference for snus instead of cigarettes. So intuitively, it’s very tempting to say ‘yes’. However, without snus having been on sale legally in the UK it’s not really possible to give a definite answer. This is because we don’t know what the UK consumer reaction might have been to snus being made available as an alternative to cigarettes.
It’s not sufficient to just put a less harmful product like snus on the shelves in the hope that consumers will buy it; it has to have consumer relevance and sufficient utility to stimulate trial and repeat purchase. The same is of course true for E-cigarettes and any other less harmful cigarette-alternative. This is where public health backing, rather than criticism, of the launch of such products can play a vital role in getting the message across to the consumer, even if these products originate from the tobacco industry.
ECD: Do you see parallels between Snus and E-Cigarettes?
Adrian: Absolutely, there are definite parallels here. Both products offer smokers nicotine-providing alternatives to cigarettes at a vastly reduced relative risk, primarily because of users not having to inhale tobacco smoke. Both products also offer the consumer some elements of the ritualistic aspects of smoking that medicines don’t. And Sweden offers a good example of how preferences have changed when consumers are given the choice. That doesn’t mean to say that either type of product would necessarily have a universal attraction for smokers. But even if only a small minority of smokers switched, the public health benefits could still be considerable.
A regrettable parallel is that the opposition of some to cigarette alternatives such as snus and E-cigarettes seems to be born out of an absolutist view that the use of tobacco products (or anything resembling them) should be eradicated from modern-day society. Prohibition didn’t work for alcohol in the US and I see no reason why it should work for tobacco either. Some detractors claim that making cigarette alternatives like snus and E-cigarettes available encourages dual-use in combination with cigarettes and thus delays quitting smoking. But the same criticism could equally well be directed towards medicinal nicotine products marketed to relieve cravings during temporary abstinence from smoking.
Finally, I’d say that the current controversy about both snus and E-cigarettes is indicative of the fact that current models of tobacco and nicotine regulation have outlived their usefulness. Urgent revision is required to help, rather than hinder, consumers being able to make healthier choices if they either don’t want to, or can’t, quit their nicotine dependence entirely. E-cigarettes and the voices of the many E-cigarette users world-wide could prove to be a powerful catalyst for change in this regard; as someone who has long had a passionate interest in tobacco harm reduction, I certainly hope so!
Many thanks to Dr Payne for sparing us the time for this interview.
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