The Wrong Lessons

The EU’s ban of snus provides a cautionary tale for U.S. regulators considering restricting consumer access to electronic nicotine-delivery systems.

By Josh Church

As the proverbial Armageddon for electronic nicotine-delivery systems (ENDS) in the United States draws closer, it has become apparent that the vapor industry as a whole has been found guilty without fair trial. Maybe it’s due to the constant presence of unsubstantiated science and fraudulent claims, or maybe it’s because public health and regulatory bodies both refuse to allocate resources to non-biased research.

It’s almost as if these organizations are selectively blind to the research and science that is happening around the globe, especially if that research enforces the fact that ENDS can be of any benefit to the health of this nation. One thing is certain: The burden of truth is placed squarely on the shoulders of the vapor industry. It is now the job of the industry to prove that ENDS do not represent the decimation of public health, as much of the media and certain public health groups in the U.S. would have you believe.

AS IT CURRENTLY STANDS

Without the allocation of federal resources, the ENDS industry must fund and complete extensive research into combustible tobacco products. This includes but is not limited to the behavioral patterns in regard to users transitioning from combustible products to ENDS products as well as the potential health risks to a person using both products simultaneously.

It’s important to remember in this context that most ENDS manufacturers have no connection to large tobacco companies and have no way to complete this robust amount of research into combustible products. The ENDS industry already has a massive burden in proving that it will not initiate new users of nicotine products, on top of developing methods to eliminate the usage of ENDS among minors.

These two requirements on their own are difficult enough to substantiate without the addition of having to conduct research on combustible tobacco usage patterns. U.S. regulars will not accept any evidence for ENDS without the combustible tobacco research. If this requirement continues past the 2021–2022 deadlines, the U.S. is certain to see an entire product sector be all but eliminated as an option for American smokers.

LOOKING AT OTHER NATIONS

If we look at Europe’s approach to substantiating the public health benefit or threat of ENDS, we see a basis of sound science and a transparent reporting of findings. Studies both for and against ENDS have been available not only for the regulatory bodies and public health departments but also for the general public in many countries.

Millions of dollars have been allocated throughout the EU with the purpose of understanding exactly what this new tobacco technology can mean for public health. While many of these studies highlight that more research needs to be done, a good portion of preliminary findings are showing that there is a positive effect for a person transitioning completely to an ENDS device and continuing to abstain from all use of combustible tobacco products. Cancer research in the U.K. has gone as far as producing informational packets for general practitioners to educate patients about the possible health benefits of transitioning completely to ENDS. This is a far cry from what we see happening in the U.S. It begs the question: “Are European lungs different than American lungs?

New Zealand has set an aggressive goal of becoming a smoke-free country by 2025. While a good portion of this effort is being executed through higher taxation and stricter regulations on combustible tobacco products, ENDS have been given a role as well.

New Zealand is the only country other than the U.S. that allows for the commercial advertisement of pharmaceuticals through public media outlets. While it is still a long way away from allowing ENDS manufacturers to advertise their products as approved smoking cessation devices, it allows the advertisement of ENDS as alternatives to traditional tobacco products.

These advertisements occur not only through radio broadcasts but also on television and other visual outlets. Such actions allow the public to understand both the potential risks and benefits of transitioning to an alternative to the proven deadly combustible cigarette.

PROHIBITION OF HARM REDUCTION

EU regulators’ openness to ENDS is even more remarkable given their history of overreach in tobacco-related issues. In 1992, for example, the EU banned snus in all member states except Sweden. In 1980, Sweden’s smoking rate was 34 percent—in line with adult smoking rates throughout the rest of the EU at the time. Through societal influence and education, among other factors, smoking rates have since declined across the EU. However, in Sweden—where snus remained legal—smoking rates fell much faster. While snus manufacturers were not allowed to sell their product as a reduced-risk alternative, Swedish consumers were able to educate themselves and come to their own conclusion.

Over the next three decades, EU smoking rates leveled off between 23 percent and 36 percent. In Sweden, by contrast, they plummeted to an unrivaled low rate of 5 percent. Many health officials consider a society with a smoking rate of 5 percent or lower smoke-free. You may question whether this transition from combustible cigarettes to snus was due to government marketing campaigns, but this was not the case.

The product and the consumer were left to their own devices. With this reduction of combustible tobacco use, Sweden now boasts Europe’s lowest levels of lung cancer in males, cardiovascular disease and other tobacco-related illnesses.

Some may speculate that the increase in oral tobacco use resulted in more incidences of oral cancer, but this was not the case. Studies across Sweden found that oral cancer rates in snus users were similar to those of never users. It is critical that global regulators, public health groups, and people who either use combustible tobacco products or know a person who does take note of this. Despite such evidence for harm reduction, many still believe abstinence of nicotine and tobacco is the only answer to the public health crisis.

NOT MAKING THE SAME MISTAKES

The U.S. risks learning the wrong lessons from the EU. Regulators should observe these examples and apply them to ENDS. U.S. regulators, health officials and public health groups must be extremely cautious about depriving combustible tobacco users of viable options to reduce their health risks.

History has shown that traditional nicotine-replacement therapies and approaches promoting abstinence have little to no effect on consumers who enjoy or are addicted to nicotine. The example of snus regulations in the EU suggests that prohibition would be the worst option. Regulators and industry representatives need to work together to make sure that this will not be known as the era where perfect is the enemy of better.