What does smokeless tobacco look like

Smokeless tobacco: don't condemn snus

DER STANDARD has published an article based on a meta-analysis by a research team at the National Institute of Cancer Prevention and Research in Noida, India, which states that smokeless tobacco - this also includes snus, i.e. tobacco in sachets that in the mouth - Has a negative impact on cardiovascular health. Smoke-free tobacco is therefore just as dangerous as cigarette smoking.

As the scientific director of the Nicotine Institute Vienna, I have been dealing with the topics of prevention, quitting smoking, but also the reduction of tobacco-related damage for more than 20 years. Therefore, allow me to clarify a few things here: Not all tobacco products have the same hazard potential. This would also make things too easy: For example, snus is a traditionally made in Sweden and arguably the most scientifically researched smoke-free tobacco product. According to many experts, it is at least 90 percent safer to use than smoking cigarettes.

"The Swedish Experience"

Here are a few facts: In Sweden, snus - distribution is not permitted in Austria - has replaced cigarettes as the most widely consumed tobacco product, especially among the male population. The prevalence of smoking among males has fallen to an international record low of five percent, while the proportion of those who consume snus every day is around 20 percent. In Austria, depending on the survey, we still find 25 to 30 percent tobacco consumers, the vast majority of whom are smokers.

This change in tobacco consumption habits in Sweden has helped Swedish men have the lowest tobacco-related mortality rates in Europe. Oral and pancreatic cancer rates are also unprecedentedly low. This development is often referred to in the literature as "the Swedish experience".

No cancer warning on snus cans

For the past 30 to 40 years there has been extensive scientific research into the health effects of Swedish snus in Sweden. Independent research groups at several Swedish universities came to similar results. On the one hand, these show that there is no significant connection between the consumption of Swedish snus and cancer, including oral cancer or cardiovascular diseases (heart attack, stroke).

This was also the reason why the European health authorities decided in 2001 (!) To remove the cancer warning from snus cans. Since no tobacco smoke is inhaled when consuming snus, there is also no significant connection between snus and chronic lung diseases such as COPD, chronic bronchitis and emphysema. The three disease groups cancer, cardiovascular diseases and chronic lung diseases are responsible for around 90 percent of the increased mortality in connection with cigarette smoking.

Speculative Effects

This opens up the scientific discussion: What significance do snus and other alternative nicotine-containing products such as e-cigarettes or new heat-not-burn products have with regard to reducing tobacco-related damage, both on an individual and societal level?

In some studies, a prognostically unfavorable effect of snus consumption in patients with a diagnosed cardiovascular disease has been mentioned. The researchers themselves indicated that these observations may be due to methodological weaknesses rather than an actual adverse effect of snus. Such unfavorable effects of snus remain speculative. The doctor should be allowed to note that in advanced heart disease, many activities are controversial. (Ernest Groman, July 3, 2018)

Ernest Groman is a doctor and university lecturer at the Medical University of Vienna as well as scientific director of the Nicotine Institute Vienna.

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