Green Light for

A medical gives snus a clean bill of health... almost.

By Chris Bickers

The growing movement toward snus appeared to get a major boost in May when the medical journal The Lancet published two studies on the health effects of snus consumption — one from Australia and one from Sweden — and a guest editorial on whether its use should be restricted.

In the Australian study, researchers used the best available data to estimate the likely health impact of snus in Australia, where it is now largely unknown. They concluded that snus is likely to produce little difference in health-adjusted life expectancy between smokers who quit all tobacco and smokers who switch to snus.

“Current smokers who switch to snus rather than continuing to smoke can realize substantial health gains,” concluded Coral Gartner and a research team from the University of Queensland, Australia. “Snus could produce a net benefit to health at the population level if it is adopted in sufficient numbers by inveterate smokers.”

Relaxing the current severe restrictions on the sale of snus in Australia is more likely to produce a net benefit than harm, they went on to say. “The size of the benefit [would be] dependent on how many inveterate smokers switch to snus.”

In the Swedish study, snus users were found to be around twice as likely to contract pancreatic cancer as those who had never smoked. But smokers were still more likely to contract pancreatic cancer than snus users. And snus users were no more likely to contract lung or oral cancer than non-smokers.

Though the new study concludes that Swedish moist snus can be carcinogenic, it nevertheless shows that the risks for users are small, and, as far as can be judged, much smaller than the risks associated with smoking.

“If 10,000 non-smoking snus users are monitored for ten years, according to our data, eight or nine of them will develop pancreatic cancer, as opposed to four amongst those who use neither product,” said project leader Olof Nyrén of the Karolinska Institute of Stockholm. But he made the obvious point that 9,991 won’t. “So the odds aren’t that bad.”

Nyrén and his colleagues studied the tobacco consumption habits of 280,000 Swedish construction workers from 1978 to 1992, and then followed them up until 2004.

Nyrén expressed the de rigueur concern from public health personnel that more than just reliable and accurate measures of the risks of both smoking and taking snus is needed.

“We also need to know the effects of other, alternative methods to cut smoking,” Nyrén said. “We also have to be certain that an increase in snus marketing will not cause addictions in young people who otherwise wouldn’t have started to smoke.

But Jonathan Folds of the University of Medicine and Dentistry of New Jersey and Lynn Kozlowski of the University of Buffalo in New York, who contributed an opinion piece on what the public-health response to snus should be, challenged the idea that a product has to be risk free before it can be recommended.

“Sometimes if a product is ‘not safe,’ this may be grounds for banning the product,” they said. “But such an absolutist position can ignore the complex realities of many of the most important health risks we face. We believe it is preferable that if people become addicted to cigarettes or decide to try tobacco, they can use a product that is markedly less harmful than cigarettes.”

When considered along with mounting epidemiological evidence, the Swedish and Australian studies indicate that there should no delay in allowing snus to compete with cigarettes for market share, said Folds and Kozlowski.

What is snus?
Snus (Swedish for snuff) is finely-ground moist tobacco that comes either loose or in tiny sachets which are placed under the upper lip. It contains nicotine in similar quantities to cigarettes. Each sachet contains from 0.4 to 1.5 grams of tobacco and is held in the mouth, without chewing or sucking, typically for 30 minutes before being discarded. Daily use varies from person to person.

Snus is different from other kinds of smokeless tobacco, because it’s ‘pasteurized’ with heat. It is made by grinding sun-cured and air-cured tobacco leaves, adding water, salt (for taste) and humectants to keep it moist. It is then heated in a process similar to pasteurization.

The heating process reduces the formation of tobacco-specific nitrosamines – chemicals which are potentially carcinogenic and have historically been found at relatively high levels in other forms of oral tobacco, such as some types of chewing tobacco. — Courtesy of BAT

“We should be prepared to accurately inform smokers about the relative risks of cigarettes, snus, and approved smoking-cessation medications,” the scientists said. “In light of all the available evidence, the banning or exaggerated opposition to snus in cigarette-rife environments is not sound public-health policy.”

In one of a number of thoughtful responses to the article, an English psychologist told the Associated Press, “For a smoker, quitting all tobacco use is best. But failing that, switching to snus is a good idea.”

Peter Hajek, professor of clinical psychology at Queen Mary University Hospital in London, added, “If a sufficient proportion of smokers switched to snus, lifting the ban could be in the public interest.”

Brad Rodu, professor of medicine at the University of Louisville and an authority on the relative health risks of tobacco products, said, “I am cautiously optimistic about this interest among manufacturers and public health officials. I am hopeful that it will mean that smokers will get accurate information on risks associated with various forms to tobacco use rather than the misinformation that some individuals and organizations have spread about snus.”

Safer, satisfying, and spit-free are the key ingredients for a modern American revolution in tobacco use, said Rodu. But there’s one missing link: informed consumers. “Most smokers don’t realize that they have these new healthier options. That’s largely because a powerful anti-tobacco movement has been working to prevent smokers from learning the truth about smokeless products.”

Accurate information will allow consumers to make informed decisions, he said.

“The idea of reducing harm through different forms of tobacco is coming of age in mainstream medical discourse. We believe we can offer an alternative to cigarette smokers who are unable or unwilling to give up tobacco.”

As research grows, that concept is growing stronger, he said. “We have been seeing more interest in snus among cigarette manufacturers, and smokeless manufacturers are expanding their product lines to appeal to smokers.”

Cigarette companies looking into snus would include Philip Morris USA with its Taboka brand and R.J. Reynolds with its Camel Snus brand. But more than any other company, said Rodu, British American Tobacco has openly endorsed the manufacture and sale of snus as a strategy for dealing with some of the problems associated with smoking.

In May 2006, BAT launched a test of a snus under the Lucky Strike brand in the home of snus, Sweden. The results have been good. “Our Nordic company first offered our product in just 300 outlets in Stockholm but it is now available in major cities across the country,” a BAT statement said recently.

Snus is also now sold in South Africa under BAT’s Peter Stuyvesant and Lucky Strike brands. Introduced in May 2006, these brands can be found now in some 400 outlets in Johannesburg and Pretoria, BAT said.

“We have also opened our own snus product development facility at our R&D laboratories in the UK, started a limited consumer test in Tokyo, Japan, under our leading cigarette brand Kool and have begun limited sales in Norway,” the company said.

SMOKESHOP - June, 2007