A Nov. 12 e-cigarette summit at the Royal Society in London featured a range of views on European prospects for these new products.

Tobacco harm reduction proponents included Clive Bates, Robert West, Jacques Le Houezec, Konstantinos Farsalinos, Jean Francois Etter and Antoine Flahault.  One presenter summarized the Swedish experience with snus as population-level proof that safer smoke-free products save lives.  He used my published study showing that there were 172,000 deaths from lung cancer – the sentinel disease of smoking – in the European Union in 2002.  If all men in the EU had smoked like Swedes, there would have been only 80,000 lung cancer deaths.

A summit attendee asked if I could update that analysis with more recent data.  In fact, the World Health Organization and the International Agency for Research on Cancer now have 2009 lung cancer mortality information for 27 of the 28 EU countries (Cyprus is the only exception).  I have calculated the number of lung cancer deaths among men that would have occurred at Swedish smoking rates for all of these countries.

Sweden’s lung cancer rate is still the lowest in the EU by a long shot, at 68 deaths per 100,000 men age 45+ years.  Finland’s is the next lowest at 102, which is interesting because snus is still used in some parts of that country, despite its prohibition.  In contrast, Hungary and Poland have the highest rates, at 278 and 222 respectively.

For perspective, two non-EU countries are worth mentioning.  The lung cancer mortality rate in Norway, where snus has contributed to reduced smoking (discussed here and here) was 121, which would have been fourth in the EU. The rate in the United States, where tobacco harm reduction has been trashed by prohibitionists, was 138, which would have placed it tenth, behind Sweden.

In the EU, the 2009 Swedish lung cancer rate was 12 percent lower than in 2002.  This is consistent with declines in most countries’ rates, ranging from -3 percent in Hungary (from 287 in 2002 to 278 in 2009) to -20 percent in Estonia (from 227 to 181) and Malta (from 158 to 126).

While the declines may appear modest or even impressive, the lung cancer death toll among European men of 183,423 is intolerable.  The EU continues to ban snus everywhere except Sweden.  The price for this appalling policy: 99,086 avoidable lung cancer deaths per year, plus more from other smoking-related diseases.

Considering that 91 percent of lung cancer deaths are attributed to smoking, and lung cancer accounts for only 31 percent of all smoking-attributable deaths among men in the EU, the toll from smoking among men in these EU countries is 538,435.

At the Swedish rate, the toll would be 247,570.  That makes the net cost of the EU snus ban 290,865 deaths (assuming that all EU male smokers would adopt snus as successfully as Swedish males).

Recently the European Parliament voted on a new tobacco directive; the results make smokers both losers and winners.  Parliament continued the snus ban but struck down a provision that would have suppressed e-cigarette access.  As Clive Bates noted, “the snus ban tells us that evidence, analysis and even concern for human life are not always that influential in way the EU makes policy.”

The EU snus ban is indefensible and immoral.


Lung Cancer Mortality Rates*, Numbers of Deaths, and Numbers Expected at Swedish Rates Among Men 45+ Years in 27 European Countries, 2009
Country Rate* Deaths Deaths at Swedish Rate
Austria 120.3 2,360 1,334
Belgium 176.8 4,851 1,866
Bulgaria 157.8 2,633 1,135
Croatia 213 2,153 687
Czech Republic 176.7 3,950 1,520
Denmark 129.8 1,859 974
Estonia 180.6 475 179
Finland 102 1,426 951
France 152.9 21,983 9,777
Germany 126.8 28,839 15,466
Greece 176.6 5,280 2,033
Hungary 277.8 5,605 1372
Ireland 124.4 1,055 577
Italy 139.8 25,146 12,231
Latvia 192.5 833 294
Lithuania 188.6 1,139 411
Luxembourg 145.7 154 72
Malta 126 124 67
Poland 221.8 16,250 4,982
Portugal 105.3 2,646 1,709
Romania 182.7 7,528 2,802
Slovakia 167.6 1,567 636
Slovenia 157.5 723 312
Spain 157.9 17,061 7,347
Sweden 68 1,820 1,820
The Netherlands 156.8 6,368 2,762
United Kingdom 120.9 19,595 11,021
All 183,423 84,337

*Deaths per 100,000 men per year, age-adjusted to the World Standard Population. Note: Croatia was not an EU member in 2009.

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