Anti-tobacco harm reductionists spend an awful lot of time claiming those who support tobacco harm reduction are simply the lackeys and stooges of Big Tobacco. But the truly insidious nature of morally driven (as opposed to health driven) tobacco control, is the degree to which those with the power to influence exploit the natural conservatism and caution of policy makers and legislators to deny access to a product with a clear public health benefit.

One can imagine the lobbying that probably went on before the case came before the European Court of Justice in January steering the Advocate-General (AG) to give a subsequent opinion that the EU ban on snus was valid. In a note to the press release announcing the opinion, it was stated that the AG’s view was not binding on the Court and was given “in complete independence” of the Court. That is highly questionable given the AG was one of the judges who heard the case in January, so the chances of the Court going against one of their own colleagues and in turn incurring all kinds of political, medical establishment and activist wrath is unlikely.

The word ‘valid’ is key; I am no legal expert, but the snus ban was ‘lawful’ just as the death penalty in England for sheep stealing was ‘lawful’, but whether the ban was ‘valid’ or (as it has to be in EU law) ‘proportionate’ is another matter entirely.

In fact, Swedish Match who brought the case did argue that the ban was in contravention of EU law on a number of fronts including that the ban discriminated against snus in respect of other allowed tobacco products and was an unjustified restriction on the free movement of goods. But the UK New Nicotine Alliance who joined Swedish Match in bringing the case, argued powerfully on human rights grounds.

Since snus protects against smoking, a ban on access contravenes a right to health. High level of health protection is fundamental to EU law. This is usually taken to mean ‘protection from’ e.g. tobacco. The NNA argued health protection includes enabling people to make choices that help them avoid ill-health.

NNA further argued that the ban on the sale of snus is disproportionate (an unsuitable means to achieve legislators aims, and lacks necessity) and hence contravenes the EU Charter of Fundamental Rights

  • Article 1 ‘human dignity’ as it causes needless suffering and debilitating illness
  • Article 7 ‘respect for private and family life’, because it represents unwarranted interference in personal choices
  • Article 35, ‘health care’, which stipulates that a high level of human health protection shall be ensured in EU policies and activities.

A ban also contravenes Article 12 of the International Covenant on Economic Social and Cultural Rights and Article 1d of the Framework Convention on Tobacco Control on harm reduction.

But despite the welter of clinical evidence showing that snus was less harmful than smoking by several orders of magnitude and the strong rights to health arguments, the AG simply ignored all the evidence that didn’t fit the objections from Finland, Hungary, Norway, the UK and various EU bodies whose grimly familiar points were that, the science was inconclusive (but only if you compare strong science with weak) hence the decision to ban is within legislators margin of discretion; snus is harmful and addictive and a threat to young people.

And the clinical evidence that was swept aside did not derive from a bunch of ‘tobacco stooges’. In many respects, the AG misrepresented and/or ignored the main EU report on snus provided by its own Scientific Committee on New and Emerging Health Risks (SCENIHR) in 2008 including the fact that:

  1. A complete switch from smoking to smokeless would prevent nearly all deaths from smoking-related respiratory disease;
  2. In Sweden, snus may have been a benefit to public health. (Note: one could argue a bit more than ‘may’. Sweden has the lowest rates of tobacco-related mortality in the whole of the EU so the steep decline in smoking against a steep rise in use of snus constitutes at least a very close association. Moreover, Dr Lars Ramström, Director of the Institute for Tobacco Studies, in Stockholm, calculated that allowing the sale of snus across the EU would save 335,000 premature male deaths every year.)
  3. Snus less risky than cigarettes
  4. No evidence of increased of oral cancer

And the list goes on…..

The AG kept banging on about ‘gateway effect’, inevitably the main ‘get out of jail free’ card for any anti-tobacco harm reduction rhetoric. There is a discretion aspect to this (like JUUL devices in the US) so you can see why young people might want to use such products. Notwithstanding the argument that overall it would be better if they didn’t use any nicotine product, for those who do want to carry on with nicotine, why would they switch to something definitely not discrete and clearly more dangerous? Unless they have little choice because you’ve made it really hard, if not impossible, to get hold of the safer product. Instead, you just leave the young people you claim to care about so much to the mercy of cigarettes which you can’t control and wouldn’t dare try to ban outright.

For those who want to keep in the loop with snus, check out #EUforsnus and various other snus groups on Facebook, plus:

And as a stooge of the venal snus industry, here is a shameless bit of product placement as I’m on the promise of a pint at GFN this year. That’s my conflict of interest declaration.

So that’s the first of this weeks’ example of Truth Decay. The expression comes from researchers at the Rand Corporation and represents a view that belief in the truth is being eroded in political life, a process of distrust and disagreement that goes beyond ‘fake news’. Although Rand recognise that there is nothing new in lack of trust in politicians and institutions, they also recognise the baleful influence of social media in sending ‘fake news’ around the world in an instant.

Some quotes from the Rand blog stuck out for me in reflecting how the truth about safer nicotine products is decaying at a faster rate, about how hard it is to break through the miasma of junk science and its partner-in-crime, over-cooked media reporting.

Rand say, “it's dangerous if people decide that it doesn't matter if something is factual or not, as long as it advances their interests or conforms to their beliefs.”

Another take is that we are so overwhelmed with information, we just switch off. “Unfortunately, information overload might be making us more vulnerable to disinformation. Garry Kasparov, the chess master and Russian dissident, said: “The point of modern propaganda isn't only to misinform or push an agenda. It is to exhaust your critical thinking … to annihilate truth.”

Rand says the goal in speaking out about Truth Decay “is about getting the public focused on the value of facts and evidence as the basis for good public policy. We need debates based on a common set of facts—not slugfests over competing set of facts, or debates that boil down to opinions about opinions”.

Here is another all too familiar example;

Two researchers at the University of Louisville have revealed a fatal flaw in a well-publicised Glanz paper which claimed to demonstrate conclusively that vaping leads to smoking.

There is a world of difference between somebody who tried a cigarette and never tried another one and somebody who has smoked ninety cigarettes. Whether somebody was at the 1 end or the 90 end at the start of the study was not taken into account. When the two researchers Rodu and Nantaporn reran the analysis taking this variable into account, the supposed link between vaping and moving onto becoming a smoker disappeared. This led them to call for the paper to be retracted.

Carl Phillips covered this and did a razor sharp take down of the response from one of the authors. You can read it all below and I won’t try and summarise as I’ll probably get it wrong. The real worry is that this paper passed peer-review muster, will no doubt be oft-cited by those making submissions to unknowing policy makers and legislators as evidence of a gateway effect while its exposure as a flawed study will disappear not least because it represents the ‘wrong’ narrative for all the vested interests who condemn tobacco harm reduction.

And finally, on the subject of Truth Decay, Clive Bates provided a very useful primer for anybody being interviewed about JUUL use by young people. He advises that it is the journalist who needs to be interrogated as well.

  1. How do we know about the rise of vaping in schools – what is the data and where is the source? How much is anecdotal, what is the source of those anecdotes and how usefully quantified are they?
  2. Has the success of Juul been at the expense of other e-cigarettes – is it adding to the total use or displacing existing use? (You can find data on this)
  3. What is happening to teenage smoking in those places where vaping or Juul is rising (and how do we know?) – is vaping/Juul suppressing cigarette smoking? Judgements on vaping or incomplete and misleading without information on what’s happing on smoking?
  4. What has been the pattern of teenage smoking since vaping increased from 2011? (Clue: teen smoking has fallen sharply)
  5. Are the teen users just messing about with these products and using them occasionally or is it really an entrenched ‘substance use’ issue – these are very different behaviours? What is the frequency distribution of use? How much is daily and how much weekly or monthly? Not all vapers are the same.
  6. How much safer is vaping/Juul compared to smoking? (Clue: much less harmful). This matters a great deal because if the former is displacing the latter, you may be witnessing (and misreporting) a major public health win.
  7. What are the actual risks vaping/Juul compared to non-use? (Clue: not much more – nearly all the health risk of smoking arises from smoke and products of combustion. Smoke is not created in vaping)
  8. If your sources are saying that kids will be addicted to Juul, what is their basis for saying this? Not all nicotine products are ‘addictive’ and it depends how they are used.
  9. What do kids think of vaping compared to smoking? Is vaping making smoking uncool?
  10. Who is promoting these stories and what are they trying to achieve? Would doing what they propose to do address the perceived problem here, or would it cause much wider impacts? (Clue: yes, they are campaigning for regulation that would close down most of the vaping industry, while leaving the cigarette trade untouched)
  11. Have you got to the bottom of where this story is coming from and why? Are you being played by ‘abstinence-only’ activists who essentially want 99% of vaping products de facto banned through burdens of regulation, even if all that would do is to protect the cigarette trade and gift the surviving vaping market to Big Tobacco?
  12. It wasn’t that long ago, we were being told that vaping was rising because of ‘kiddie flavours’ (supposedly like Gummy Bear and Cotton Candy) and that most flavours should be banned… was that explanatory theory of teenage vaping wrong? Was it just a campaign message in favour of yet more damaging regulation?

Clive goes on to say, “I loathe fake news and, even more, the false accusations of fake news hurled at news organisation like the New York Times (I am a subscriber) and CNN when they publish truthful stories that are uncomfortable for the powerful and corrupt. But the extraordinary uncritical hype generated around this vaping story leaves me wondering if anything goes in health and science journalism (or should we recognise it as activism), and we should simply disbelieve everything they report”

I know how he feels. I have spent nearly a quarter of a century talking to journalists and swatting away all the drug myths about gateway theory, the addictive gene, the ‘fact’ that all drugs are cut with rat poison ad nauseum. The media feed off each other and this can ramp up stories way beyond the truth on the ground. In the UK at the moment, there is a lot of noise about young people using Xanax, zombie spice users stalking our streets and an US-style opioid crisis coming our way soon and this is probably what is happening in the US over Juul.

We need a serious discussion about constructing a coherent tobacco harm reduction narrative to fill the holes of truth decay.