Karl Fagerström, psychologist specializing in smoking, discussed the need to launch new initiatives that contribute to reducing the incidence of smoking in Spain. Thus, he highlighted his numerous presences in Spain to indicate that it is a country “that I love for its way of doing things – so Spanish – in many ways, but I recognize that for some of them certain aspects stick to me. so pragmatically Swedish. For example, it is interesting to note that the incidence of smoking in Spain has remained high and stable for years, without decreasing, and I regret that This serious problem is not solved without taking into account all the advances we have.”
In this way, he indicates that “the Swedish experience in the use of alternative nicotine products to reduce tobacco consumption revealed a striking paradox: although Swedes consume the same amount of nicotine as the rest of Europe, Swedes have far fewer tobacco-related health problems than men.
Thus, the specialist emphasizes that Sweden has simply chosen a less risky way of consuming nicotine, for example “snus or nicotine sachetswhich led to significantly better health outcomes.
“In Sweden, about one in four men consume nicotine, a rate comparable to that of neighbouring countries and the EU. However, Swedes have 38 percent fewer deaths related to tobacco and an incidence of lung cancer 41% lower than the European average” he says. The psychologist believes the key to these superior health outcomes lies in Sweden’s strategic shift towards less harmful nicotine consumption.
“The global public health discourse today demonizes nicotine as the main enemy,” he points out, while assuming that “the Swedish approach demonstrates that nicotine itself is not the main problem in smoking-related diseases, but the way in which it is consumed.” By regulating and encouraging safer alternativesSweden has managed to reduce health risks without imposing a total ban on nicotine, a substance that many consider socially and personally important.
“Nicotine itself is not the main problem in smoking-related diseases, but the way it is consumed”
On the other hand, he believes that “the effectiveness of the Swedish harm reduction strategy is confirmed by the approval by the US Food and Drug Administration (FDA) of the harm reduction claim for snus, based on extensive long-term epidemiological studies. However, the European Union (EU) banned snus, he stressed, adding that “a decision that has not benefited European smokers, given the overwhelming evidence of its minimal harm compared to tobacco. The snus ban sets a bad precedent for regulation without scientific basis and should not be repeated for new and emerging nicotine-containing products, such as nicotine pouches. “The urgency of reassessing EU tobacco policy, focusing on the causes of harm rather than nicotine itself, cannot be overstated, given the potential to save countless lives.”
“Many EU countries face a major public health challenge with a high prevalence of smoking, around 23% among adults, causing around half a million tobacco-related deaths per year.” smoking in men and costs Member States significant amounts of money each year in health costs and lost productivity. “Despite decades of efforts to control tobacco and extensive knowledge of the harms of smoking, Europe is far from achieving tobacco-free status.”
In this context, the European Union must commit to reducing the harm caused by tobacco, warns Karl Fagerströmpsychologist specializing in smoking. “The country’s restrictive stance on harm reduction products, such as banning nicotine pods instead of cigarettes and introducing high excise taxes on e-liquids, contradicts the scientific evidence supporting its effectiveness for quitting smoking and its lower potential for harm. “This overly restrictive approach, which treats harm reduction products in the same way as traditional tobacco products, will cause net harm to public health by discouraging smokers from switching to less harmful alternatives.”
“This overly restrictive approach will cause net harm to public health by discouraging smokers from switching to less harmful alternatives.”
The psychologist points out that countries that have adopted risk reduction strategies, such as Japan and the United Kingdom, provide convincing evidence of their effectiveness. Japan has experienced a rapid decline in cigarette sales following the introduction of heated tobacco products, with sales falling from 180 billion in 2015 to less than 100 billion in 2022.
“In New Zealandwhich supports the use of e-cigarettes to quit smoking, now sees a smoking rate of 6.8 percent, down from more than 12 percent just a few years ago. “In contrast, countries that have banned or taken a restrictive approach to nicotine alternatives, such as Australia and many EU countries, have seen a slower reduction in smoking rates.” And he goes on to say that “the experience of Sweden, with a smoking prevalence of 5.6%highlights the significant public health benefits of adopting harm reduction strategies, with mortality rates from tobacco-related diseases significantly lower than in the EU.
Arguments against harm reduction often rely on the demonization of nicotine and concerns about its use among young people. However, “there is long-standing evidence that nicotine, while addictive, makes little, if any, direct contribution to smoking-related disease.” So, the theory that harm reduction products act as a gateway to smoking has been widely disproven, as youth smoking rates have declined as the use of alternative nicotine products has increased. “This is the case in countries like the United States and New Zealand. Moreover, IFlavor bans intended to protect Youth overlook studies showing that non-tobacco flavours, particularly menthol and mint, in alternative products significantly help adult smokers quit smoking. “Importantly, well-balanced regulations and age restrictions can effectively address concerns about youth use without compromising potential harm reduction benefits for adult smokers.”
Therefore, public health policy “must strike a balance between intended benefits and unintended harms.” An overly cautious approach “based on unfounded fears and the precautionary principle will harm smokers by restricting access to reduced-risk products.” Rather, Karl Fagerströmwarns that “regulators should adopt risk-proportional regulation, similar to that applied in most countries with alcohol, which clearly distinguishes between products Tobacco harm reduction through conventional cigarettes“He stresses that “this approach, which includes the active promotion of safer alternatives for those who cannot or do not want to quit smoking without help, is essential to reduce smoking prevalence and improve public health outcomes in the EU”.
Sweden’s success in reducing tobacco-related harm through alternative nicotine products provides a valuable model. “It is time for Spain and EU countries in general to reconsider their position on nicotine and embrace harm reduction as a a viable and effective public health strategy. “Countries can significantly reduce the burden of disease by adopting a more nuanced, evidence-based approach to tobacco control.”
“In Spain is under review new anti-smoking plan and I believe that the Spanish government has a golden opportunity to help reduce the high rates of smoking. I am convinced that adopting a pragmatic view swedish style based on the use of smoke-free alternatives to nicotine can be an important contribution,” he concludes. Karl Fagerström.
