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In recent years, the tobacco control community has experienced impassioned and at times acrimonious debate about harm reduction. For years, tobacco control has stood fast on a doctrinaire devotion to an absolutist precept: that tobacco use of any sort was unacceptable. With the advent of nicotine replacement therapy, there was early consternation from some who, like Gertrude Stein, felt nicotine is nicotine is nicotine. Nicotine weaning was one thing, but nicotine maintenance bordered on profanity.
In this issue, we take the debate on harm reduction further by considering a tobacco product, the widespread use of which appears to be associated with significant reductions in lung cancer and myocardial infarction in Sweden. We commissioned a major review of the public health significance of snus,1 an oral tobacco product that has been widely used since the early 20th century and which has seen a prolonged growth in use since the 1970s, a period in which cigarette use mostly declined. This review is the most comprehensive yet published, but it and a related paper advocating the liberalisation of policy on snus availability in Europe2 have immediately generated controversy, as readers of the responses by Tomar et al3 and Kozlowski et al4 will discover.
The editors hope that many readers will participate in this important debate by utilising the journal’s rapid response function. It is our policy to publish all responses, except those which are defamatory. We look forward to the debate this topic deserves.
Please note that the Reference section is incomplete. The page numbers of the four references have been ommited. The correct list is shown here:
Bates C, Fagerstrom K, Jarvis MJ, et al.
European Union policy on smokeless tobacco: a statement in favour of evidence based regulation for public health.
Tobacco Control 2003;12:360-367. [Abstract][Full Text]
Tomar SL, Connolly GN, Wilkenfeld J, et al.
Declining smoking in Sweden: is Swedish Match getting the credit for Swedish tobacco control�s efforts?
Tobacco Control 2003;12:368-371. [Full Text]
Kozlowski LT, O�Connor RJ, Quinio Edwards B.
Some practical points on harm reduction: what to tell your lawmaker and what to tell your brother about Swedish snus.
Tobacco Control 2003;12:372-373. [Full Text]
The errors are much regretted.