12,000 Swedes die every year due to smoking in Sweden. At the same time, the government and the Public Health Agency of Sweden want to severely limit smokers' opportunities to quit. They say that harm reduction, with e-cigs and snus, is a myth. Why is this so? Vejpkollen wonders.
This is a debating text. Do you think differently? Write in the comments section or send a reply to debatt@vejpkollen.se
It is the smoke that kills the smoker. The burning of tobacco. The embers. The temperature. The toxins produced when tobacco burns. The smoker gets his nicotine by inhaling a cocktail of poisons. It may be tasty, but it's deadly.
In the same way that access to clean syringes for drug addicts decrease the damages of a drug addiction, alternative nicotine products help smokers to avoid the harm of inhaling nicotine. It is about making a habit, an addiction, less harmful. Today, smokers can become smoke-free, without giving up either nicotine or the pleasure of smoking.
And that should be easy. After all, it is a matter of life and death. Harm reduction for smokers is not just a gimmick to sell smoke-free products like snus and e-cigarettes. Even if harm reduction works, it has a side effect. Harm reduction is about the smoker's life. There is no 'hidden' agenda here. And the fact that some companies want to make money from smokers wanting or needing to quit smoking is neither strange nor new.
The war on smoking
Because everyone wants to make money from nicotine, and nicotine sells.
Currently, tobacco companies (with snus and nicotine pouches) and pharmaceutical companies (with nicotine medicines and the good graces of the state) have the largest market shares, i.e. 'customers' who want to quit smoking. The e-cigarette companies are also at war, albeit on a smaller scale and with fewer resources.
You can think what you want about this, but in the end there is really only one winner in this war, and it is the smoker. If a smoker is given more opportunities to opt out of cigarettes, in favor of less harmful products, it can have huge consequences, not only for the individual, but also for people around smokers and for future generations. When cigarettes mean 'death and misery', the alternatives mean 'life and opportunity'. It just is.
Choices and options
Effective harm reduction must offer smokers functioning tools and good incentives to give up cigarettes. It is about attracting rather than punishing. A harm reduction alternative must therefore be more attractive than the 'original'. That's why e-cigarettes, nicotine pouches (and nicotine gum) can taste like candy, fruit OR tobacco. Not to attract non-smokers or curious young people. It's about persuading smokers to CHOOSE the alternatives. And that taste buds are different, even among smokers. And it works. It is a growing market solution to a huge public health problem.
Smokers are considered scum
This is a difficult nut to crack for our traditional health organizations. You know, the ones that for decades have freely devoted themselves to fighting the tobacco companies, stigmatizing smokers, mobilizing the whole society against smokers, portraying smokers as less desirable elements and a burden to us all. They have been able to say just about anything about smoking, tobacco companies and smokers, more or less unchallenged, without anyone questioning them.
The tobacco industry has behaved badly enough historically to absolve their antagonists of responsibility and the anti-tobacco lobby's message has guided policy: smoking is the devil's invention, smokers have chosen 'sin' and smokers should be eradicated along with tobacco companies. Over time, smokers have become so de-normalized that their existence is seen as downright provocative. Smoke-free is a nice word. To be a smoker is to be weird - abnormal.
Giving smokers human dignity
Harm reduction is fundamentally about restoring a kind of human dignity. It is about reaching the smoker, but more importantly listen on the smoker - ask the questions: "What do you WANT and what do you NEED?"
The problem, and it is becoming increasingly clear that this is precisely the problem, is that a harm reduction strategy gives the smoker, and hence the smoking, a kind of affirmation. A harm reduction philosophy actually recognizes that smoking is a positive experience, at least for the smoker. That the smoker actually finds that smoking offers benefits, that it is an enjoyment and a social tool, not just a nuisance. It is about the realization that nicotine has positive effects for the smoker, despite being addictive, that smokers smoke because they like it, despite the risk of death.
It's about nuance. Not stigmatizing. It is about understanding, not rejecting.
Harm-reducing products give smoking a boost a value by challenge that very value. By being better.
Challenging on all levels
And this can't stand it established tobacco control system.
It is based on the attitude that smoking is like a plague and should treated as a disease. Smokers are seen as addicts - and stigmatized as a result. According to this model, smokers are victims of greedy tobacco companies, sick, a bit stupid and in need of care - whether they want it or not.
There is an air of exclusion and contempt throughout. Misunderstanding and bullying.
The idea that smoking has any direct value for the smoker does not fit into this equation.
"Hands on the duvet"
"But how else can we protect young people? We need to show them clearly that smoking and nicotine have no benefits whatsoever. They get brain damage from nicotine and just want more," scream today's most respected anti-tobacco activists.
The message from our beloved health organizations is reminiscent of when religious fanatics once claimed that masturbation was directly harmful to the brain. The solution was threats of hell and catechism. "Hands on the blanket!"
The children got a very distorted view of reality. And of course they were very curious, because pleasure is attractive, even if it is 'dangerous'. Even if you become a masturbator. Or a smoker. On the sly, if necessary.
"Fine medical products"
I think about it when I listen to Tobaksfakta's four-hour seminar in Almedalen on how they want to protect children from new nicotine products, focusing on e-cigarettes, snus and nicotine pouches. Every speaker uses harm reduction as a buzzword throughout, something invented by the tobacco companies. That e-cigarettes and snus are less harmful than smoking tobacco is called a myth. The fact that new nicotine products are replacing smoking among young people is seen as a threat, an obstacle to 'progress'. A sign of tobacco companies' innovative greed - a challenge!
Smokers to be cured
According to the Public Health Agency, smoking cessation is a medical project. Something that is already addressed by "proven" medicines. Smokers do not need alternatives to smoking tobacco. They need care.
"There are a lot of great smoking cessation products that are medical that you can use to quit smoking" says Josefin P. Jonsson, Head of Unit at the Public Health Agency of Sweden, in his presentation for Tobaksfakta in Almedalen.
Medicines are not up to scratch
The public health authority's version of the catechism is, of course, nicotine patches, nicotine gum and psychotropic drugs such as Champix.
"Fine products" Really?
According to a review of randomized control trials in British Cochrane systematic reviews these products, in combination with interventions, have an effectiveness of 5 to 10%. 1 in 10 quit smoking with the help of nicotine patches and the like. Fewer as time goes on.
What if Alvedon only helped one in ten people get rid of their pain? Would that product even be on the shelves? No, probably not. But Nicorette is a billion-dollar seller. Maybe because every doctor recommends it, with the public health authority's advice behind you?
E-cigarettes are twice as effective
E-cigarettes, on the other hand, have a efficiency of almost 20 percent, according to Cochrane. With few direct side effects other than transient coughing, and a significantly lower cost to the user compared to patches, champix and therapy. E-cigarettes are also popular with UK smokers, being used in one in three quits. The corresponding popularity figures for other smoking cessation products are less than 10%. 1.6% of smokers prefer Champix.
At the same time, British studies show that nearly two-thirds of the country's 3.6 million vejpers are ex-smokers.
If anything, this is a sign of effective smoking cessation. Or rather, harm reduction. The health risks of using e-cigarettes are, according to the UK Public Health Agency, 5% of risks compared to smoking. The Agency believes that harm reduction interventions for smokers can reduce mortality among smokers in the country dramatically.
The myth of tobacco control
But all this is just a "myth" according to the Public Health Agency. Despite the fact that the sender is corresponding authority in one of the world's most respected countries for tobacco control.
The truth is that it must remain a "myth". Otherwise, the whole Swedish tobacco control system will collapse like a house of cards. If smoking declines because of alternative, less harmful sources of nicotine, the basis for funding organizations like Physicians against tobacco, Psychologists against tobacco, We who do not smoke, Non smoking Generation and their joint think tank Tobacco facts.
Effective harm reduction is a direct threat to their business, those who annually receives millions from government money, distributed by the Public Health Agency, to fight smoking. It is no coincidence that these organizations now choose to highlight a new "threat" to fight. It is no longer about saving the lives of smokers, it is about saving a system that benefits them. It's about their jobs and credibility, not about tobacco companies' greed or quest for new customers.
Parliament wants to investigate injury risks
If smokers, or would-be smokers, young and old, choose to use e-cigarettes and other alternative nicotine products instead of cigarettes, it is a win for public health. There is no doubt about that. The risks of nicotine are not unknown, in fact they are the mainstay of our traditional nicotine medicines, and they are acceptable risks. The harms of smoking, on the other hand, are so great and well known that they must at least form the basis of a comparison between the alternatives. Anything else is unethical. This is also recognized by a majority in the Swedish Parliament.
Much to the chagrin of the public health authorities.
Public health authority wants a taste ban
According to the Public Health Agency, a comparison in harm risks between different nicotine products is "unnecessary" reveals Josefin P. Jonsson in Almedalen.
The myth must remain a myth. Otherwise, as I said, the whole house of cards will fall. Instead, they continue to push the issue of restrict the supply of e-cigarettes and other nicotine products. With more frenzy than before.
This became apparent during the seminar in Almedalen that the Public Health Agency of Sweden has already taken a position in favor of the comprehensive e-liquid flavor ban proposed by government investigators in Sweden. Only tobacco flavors should be allowed (whatever that is). It is a ban that will greatly reduce the incentive for smokers to even consider swap the cancer sticks for a good e-cigarette. And yes, youth, who are always in the line of fire, will likely to smoke more instead. The majority of those who have ever used a vejp product, smoke even before trying an e-cig. Why change, if it doesn't taste better?
Order restored
But in this way, order is restored. The smoker no longer has access to competitive alternatives and can return to his or her place as 'patient'. The children are encouraged to keep their hands on the quilt (and sneak a smoke instead). Pharmaceutical companies remain the 'savior' with their obviously substandard and fundamentally undesirable products as the only option on the market. Tobacco companies can continue to sell their cigarettes, while the small companies dedicated to enticing smokers to quit using e-cigarettes disappear altogether (their sales remain at 90 percent of e-juice that tastes different from tobacco - they WILL close down).
12,000 die every year
If our authorities continue on this path, cheered on by their allies in the form of government-funded lobby groupssmokers will continue to die. At a rate of around 12,000 a year. Almost as many as succumbed to COVID-19 in 2020-2021.
Fixed. Every. year.
Is that what we want?
Stefan Mathisson
editor-in-chief Vejpkollen
And former smoker who now vejpar
In fact, this is a completely absurd position.
This parallel may shed some light.
Mp is against us driving a car.
How would we react if seat belts, airbags and crumple zones were banned because it is not safe to drive, you should stop driving.