An International Perspective on Smoking

Published October 16, 2002

After a day at work in Stockholm, Sweden, Lene heads for a nearby lounge where she knows her friends will be, for a big cup of mocha, a snifter full of single malt, and the rich smell of a friend’s cigar. She loves the smell of cigars and pipes, and says it’s much better than most of what you can get in a can or from incense sticks.

Half-way around the world and seven hours later, Joe, after his day’s work, heads for the patio behind his condominium in suburban Chicago, pops open a beer, and enjoys a cigar. Each of the day’s trials are considered and set aside as he studies the cigar’s glowing tip and intricate patterns of smoke. Lulled by a little alcohol and soothed by a little nicotine, his brain down-shifts for a slower-paced evening and eventually a sound night’s sleep.

This is what tobacco means to most of its 45 million users in the U.S. and more than 1 billion smokers worldwide. We all need “time outs” in this world, and our small vices make these retreats possible. Smoking tobacco has drawbacks, of course: Heavy smoking can lead to a long list of health problems, some of them fatal, and people around you may not share your private pleasure. But smoking, like drinking, when done in moderation provides great enjoyment to millions of people.

Scandinavians long ago found a way to enjoy the flavor and pharmachemical effects of tobacco while minimizing the health risks and inconvenience to others. It is a smokeless, non-chewing tobacco called “snus” that Scandinavians have used for more than 200 years. It is similar to snuff, the smokeless tobacco available in most gas stations in the U.S.

Smokeless tobacco is much safer for users than smoking. One estimate is that lifetime heavy smokers die, on average, 6 to 7 years before nonsmokers, while smokeless tobacco users lose just 15 days, or 0.04 years of life expectancy. Widespread use of snus is a major reason why Sweden has the lowest rate of adult smoking in Europe and one of the lowest lung cancer rates.

In late September, an international conference on smokeless tobacco took place in Stockholm. On the program was the potential use of smokeless tobacco to reduce the harm suffered by smokers. The public health benefits from switching are huge: If just 10 percent of the 45 million smokers in the U.S. today switched to smokeless tobacco, the result would be an almost incredible 26.8 million life-years saved.

Professional public health advocates in government and government-financed advocacy groups dominated the conference. Surprisingly, they showed little sympathy for the harm- reduction position. Many simply refused to acknowledge data showing smokeless tobacco to be less hazardous than smoking, insisting instead that the only comparison relevant to the discussion is between smokeless tobacco and complete abstinence.

One person at the conference, David Sweanor, a Canadian tobacco control advocate, seemed to “get it.” People use tobacco primarily for the nicotine, said Sweanor, which releases endorphins (anti-stress hormones secreted by the brain) which cause a euphoric effect. The pleasure of bicycling and long-distance running also comes, at least in part, from the release of endorphins. Urging smokers to switch to smokeless tobacco, then, is in some ways similar to urging bicyclists to wear helmets or long-distance runners to drink water, according to Sweanor. The drug effect is still obtained, but the hazards related to the activity are reduced.

Harm reduction is a familiar approach in virtually all parts of our lives except smoking. We do not see bans on cars and trucks even though they cause thousands of deaths each year due to collisions. Instead, we see laws requiring seatbelts and airbags and limits on the speed of travel. Prescription drugs come in child-proof bottles. Office buildings have sprinkler systems to put out fires. When you go shopping, you find information about fat and sugar on the containers of food products, allowing you to decide how much risk you wish to accept in your diet. Why, then, is harm reduction such a controversial concept when it comes to tobacco use?

Most government agencies in Europe and the US have adopted a stance of zero tolerance: Smoking is bad for you, period, they say. Smokers must quit or face certain death. Any message that deviates from this dogma is condemned as offering false hope to smokers or encouraging children to become addicted to nicotine. These may be legitimate concerns, but they pale alongside the collateral damage being caused by the rigid stance of public health officials.

Thanks to that dogmatic stance, smokers in the U.S. and around the world receive little or no information on the comparative health effects of smokeless tobacco and smoking, or even the different effects of filtered versus unfiltered cigarettes and light versus regular cigarettes. Such information would probably lead to millions of smokers changing their behavior, resulting in vast public health benefits. The information is known to health experts, but it is suppressed by regulators and their allies.

Maybe public health advocates don’t think the average person is smart enough to decide for him or herself, on the basis of clearly presented facts, whether the risk is worth the pleasure of using tobacco. Maybe they fear that any crack in the wall they are trying to build would lessen their ability to raise and spend the public’s money on their campaigns. Maybe they just don’t know the facts.

Whatever the reasons, the public health community has become a threat to the health of the very people it claims to want to help. By disregarding the very real pleasure that millions of people derive from using tobacco products responsibly, they have also become a threat to civil liberties and individual freedom.

It is time to reject exaggerated claims about the hazards of enjoying tobacco products, and begin respecting the liberties of smokers and people who enjoy being around smokers.

Lene Johansen, a nonsmoker, is a journalist affiliated with Eudoxa, a think tank based in Stockholm, Sweden. Joseph Bast, a smoker, is president of The Heartland Institute, based in Chicago.

For further information, contact Heartland Public Affairs Director Greg Lackner at 312/377-4000, 773/489-6447, email [email protected].