Tipp-Ex away the truth about safer alternatives to smoking

Campaigning by so-called health groups to ban much less hazardous alternatives to smoking is dangerous, unethical, lazy with facts and […]

Campaigning by so-called health groups to ban much less hazardous alternatives to smoking is dangerous, unethical, lazy with facts and utterly without regard for the people they are supposedly trying to help – see my detailed post Death by regulation.  But they go to a whole new level of awfulness – evil maybe – when it is done with deliberate deception and falsification.  When that happens, it becomes something much darker – in fact as bad, and as deadly, as the worst excesses of tobacco industry PR.  And that is what happened – they used Tipp-ex to erase inconvenient truths in a report intended to inform science based policy on alternatives to smoking. 

It is with real dismay that we have to confront the deliberate falsification of a scientific assessment of smokeless tobacco by a European ‘health’ group, the European Network on Smoking Prevention, as it was known at the time.  The use of Tipp-Ex is only the absurd symbolic tip of the iceberg of deliberate knowing rejection of evidence.   The Swedish newspaper Aftonbladet takes up the story… (in translation below assisted by Google Chrome).


AFTONBLADET , 16 September 2012, Oskar Forsberg


EU research didn’t suit tobacco opponents – so they resorted to Tipp-ex.

Cheating with RESULTS Anti-snuff lobbyists ENSP was commissioned by the European Commission to identify snus in Europe.  They in turn hired a Dutch company - which in its report concluded that snus ban should be lifted across the EU.  ENSP struck rear, and began to remove the documents.
Falsified results Anti-snus lobbyists ENSP were charged by the EU Commission to map out snus in Europe. They, in turn, hired a Dutch company – which in its report drew the conclusion that the snus ban ought to be lifted across the EU. ENSP backpedalled, and started deleting sections of the document


The EU Commission is threatening to ban Swedish snus. But Aftonbladet can reveal that a large part of the EU’s knowledge base is built upon a biased, censored report.

They went so far as to Tipp-ex sections of the report, said a source with deep insight.

In 2003 the European Network for Smoking Prevention, ENSP, was asked by the EU Commission to write a report about Swedish snus.

The job was contracted out to Dutch consulting company Research voor Beleid. In their report, “Lift the ban on oral tobacco,” the Dutch concluded that the snus ban ought to be lifted across the EU.

But when ENSP received the document, the contents of which contradicted its own convictions in the matter, the group decided to re-write the report. What they presented instead was a completely different conclusion: that snus is dangerous and causes cancer in the oral cavity.

Widespread censorship

Sales of snus have been banned in the EU since 1992.When Sweden entered the EU it got a permanent exemption from the ban on the grounds that it would not sell snus to other EU countries.In April 2012 Aftonbladet revealed that EU Parliament was proposing to ban flavours in tobacco. This would, in practice, ban Swedish snus which has always had flavours. The news was received with massive criticism.

The new report was called “Status report on oral tobacco.”

Aftonbladet has had access to both documents. Several sections have been deleted from the original report. Among them is the statement that the criticisms one can level against Swedish snus can also equally be leveled against nicotine replacement therapy products.

But the censorship would prove even more widespread than that. After the final report had been “washed” and re-printed, the anti-snus lobbyists at ENSP found further “faults.” They forgot, however, to delete one half-sentence.

They didn’t manage to reprint the edited text before it had to be officially presented. So, at the last minute, they painted Tipp-ex across the remaining positive statement about snus, said Aftonbladet’s source.

If one holds up the document to a source of light, it’s easy to read the original line:

“An increased frequency of cancer in the oral cavity has been seen among snuff users in North America, but not unequivocally in Sweden.”

After being painted with Tipp-ex, the sentence reads: “An increased frequency of cancer in the oral cavity has been seen among snuff users.”

Only a few copies left

Following the publication, the text was reprinted one more time. The Tipp-ex version that was presented at the 2004 publication is therefore available only in a few copies today.

“One may not flank”

The report offers thanks to many Swedes, among them Hans Giljam, snus critic at the Karolinska Institute and simultaneously advisor to pharmaceutical giant Pfizer, the maker of anti-nicotine medication Champix, a connection which Aftonbladet has previously reported about.

“I don’t know of this report, but I do know of another which came at a later stage and in which I had participated as a writer,” he said.

Is it usual to change scientific texts in EU reports?

“No, the written text should stand on scientific grounds. There isn’t much room to maneuver. One may not flank,” said Giljam.

Paul Nordgren from think-tank Tobaksfakta, which is financed by the Swedish National Institute of Public Health (FHI), had also written a section in the report.

He was also thanked by ENSP, but could not be reached for comment.

I’m disgusted with these people.  While you consider what has happened here, just imagine the tsunami of righteous outrage there would be if a tobacco company or those of us who support the widespread introduction of much less hazardous alternative to smoking had done similar.  Here’s what should happen,

  • The report should be withdrawn
  • ENSP should be declared ineligible to receive any public funds, including and especially from the European Union
  • Someone, somewhere should take responsibility and apologise
  • A lot of people who believe they are health advocates, and are paid as such, are nothing of the sort – they ought to be examining their consciences and looking again at the evidence with some humility

Whilst the falsification is absolutely disgraceful, I doubt there was ever any intention to have an objective assessment of the science as it would have given the European Commission an unwanted rationale for reversing their utterly counter-productive ban on oral tobacco.  More likely is that they were looking for reasons to prove they had been right all along.  If they wanted an objective account of the science and epidemiology, why would they chose ENSP to do the work in the first place – a group with a overt hostility to harm reduction approaches. To emphasise the point ENSP has now changed its name to the European Network for Smoking and Tobacco Prevention.

Though this incident dates back to 2003, they are still at it of course: see this ENSP letter to the European Voice in May this year for an example of denial and obfuscation.

By the way, you can read more on this sort of mendacity about snus in the excellent book, The art of suppression: pleasure panic and prohibition since 1800 by Chris Snowdon.

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23 thoughts on “Tipp-Ex away the truth about safer alternatives to smoking”

  1. This reminds me of the French blood scandal. In the 80’s, the ministry of health deliberately delayed the aquisition of blood testing devices designed to ensure people wouldn’t become HIV positive if they received a blood transfusion. The delay was due to financial reasons (I think they wanted to buy a French product that wasn’t ready soon enough). In the meantime, people suffering from haemophilia got blood transfusion and were contaminated. The scandal became huge a few years later and ended up with some people responsible going to jail.
    I really don’t remember the details and the case was a bit complicated.
    This, in contrast, is relatively clear-cut. The EC is banning a product that would most certainly save a number of lives in the medium term, and they base their decisions not only on doubtful argument, but, as we now know it, on tampered with documents.
    In the 90’s, based on what was known then, they may have had a slightly better case, but in 2012, I’m pretty sure there is room for a legal procedure if they go on with the ban.

    1. Jean – thanks… I would agree with you. There is a strong case that continuing with this ban would be unlawful under EU rules. I addressed some of that towards the end of my longer post on smokeless tobacco in the EU, Death by Regulation. Unfortunately, the EU saw off a legal challenge from Swedish Match in 2004. The arguments were tenuous then, but complete unsustainable now.

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  3. On the subject of how many mainstream health organisations are in denial or deceit about reduced risk alternatives to smoking, a friend reminds me that the philosopher Friedrich Nietzsche has much to say…

    On sinking to the level of the worst excesses of tobacco industry PR:

    He who fights with monsters might take care lest he thereby become a monster. And if you gaze for long into an abyss, the abyss gazes also into you.

    On losing sight of the health goal and believing its only about fighting the tobacco industry:

    To forget one’s purpose is the commonest form of stupidity

    On the group-think that allows them to avoid responsibility for saying and doing the most stupid things:

    Insanity in individuals is something rare – but in groups, parties, nations and epochs, it is the rule.

    On the complete lack of empathy and cynical disregard for the health and welfare of smokers:

    But thus do I counsel you, my friends: distrust all in whom the impulse to punish is powerful!

    And of course on harm reduction versus “quit or die” strategies:

    That which does not kill us makes us stronger.

  4. Pingback: EU Commission threatens to ban Swedish snus based on falsified ENSP scientific report

  5. I concur with Clive.

    Banning smokeless tobacco or e-cigarettes is inhumane because it threatens consumer and public health, while making false and misleading claims about the health/safety risks/benefits of smokefree tobacco/nicotine products is unethical.

    It appears that the following articles reference the same proposal (to ban smokeless tobacco and e-cigarettes) by EU Commissioner John Dalli.

    EU Health Commissioner John Dalli proposes banning all smokeless tobacco and e-cigarettes (in German) / (in English automated translation)

    David Atherton: The European Union and Big Pharma

    Bill Godshall
    Executive Director
    Smokefree Pennsylvania
    1926 Monongahela Avenue
    Pittsburgh, PA 15218
    [email protected]

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  7. Apart from anything else, denying smokers access to alternative products, some of which (e.g. snus)are proven to be vastly less hazardous than smoking,arguably violates Article 27 of the 1948 Universal Declaration of Human Rights -namely “Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits”. Smokeless products and e-cigarettes are without doubt ‘scientific advancements’compared to combustible tobacco products and as such convey significant benefits!

    1. Adrian – thanks… it is an interesting argument. I suspect there will have been little agonising over this. But that is more a measure of how casual public health officials can be about rights. For me, any kind of public health paternalism needs to be scrutinised very carefully through the lens of civil liberties… that’s sometimes a subtle call, balancing various freedoms (exchange, choice, speech), taking account of the compromise of freedoms through addiction, individual versus population effects (should one person be stopped from doing the right thing, because you are worried someone else will do the wrong thing?). Interesting stuff – but unlikely to have much of an airing when the directive comes to be finalised.

  8. Clive – sadly I think you are correct in your assumption. But at the same time, the evidence is getting stronger all the time that products like snus and e-cigarettes are more effective than pharmaceutical nicotine products. Hence I still like to think that there will be some kind of tipping point when the penny finally drops. But a key obstacle is getting any kind of political traction given the level of ignorance about tobacco harm reduction in those circles.

  9. I fail to see what the argument is about. Until criminal proceedings are brought against EU health commission members for corruption, nothing concrete can be achieved. Arguing about health issues, or various arguments for and against THR, might feel good but doesn’t achieve a lot. The problem isn’t the facts, it’s the people paid to ignore them.

    Step 1 is to find out who has jurisdiction over criminal acts within EU government, step 2 is to have a police fraud forensic examination of the personal financial affairs of health commission members and especially the commissioner.

    No one in their right mind would stand up against measures that are proven to reduce smoking rates by 40% (as seen with Snus in Sweden) or potentially reduce them by as much as 60% (as seems to be possible with e-cigarettes, given the relative popularity of ecigs vs Snus). Only someone being paid to do so would prevent such measures being introduced and as a result either prevent the saving of hundreds of thousands of lives, or kill on a massive scale (depending on your point of view). We already know that the Snus ban, in effect, kills at least 70,000 EU citizens a year, i.e. 10% of the 700,000 a year who die from smoking-related disease; although that might be an under-estimate.

    When is something going to be done about that by those with the power to progress such an investigation?

    Little can be done about corrupt staffers in national health departments due to the highly-effective revolving-door staff trick – government employees offered high-pay jobs in the pharmaceutical industry after leaving government employ – which leaves no paper trail to convict with; but EU committee members must be receiving cash and it’s someone’s job to track that down.

    Please stop arguing about things that will have very little effect and do something about the main issue. Find out who is receiving the pharma cash and fix the problem. Everybody knows what the facts are; providing more and better facts isn’t going to do much when the people who make the rules are paid to ignore the facts.

    1. Chris – I’m inclined to agree with half of what you say – that there should be much harder accountability for those implicated in these life-threatening decisions. But I don’t know what legal strategy would work though. There isn’t a criminal offence that covers this to my knowledge, even if we might think of it as ‘criminal’.

      Where I disagree is about making the case for this… you have to win people over and challenge the people saying it shouldn’t be done. Eventually, we will get people to see this issue differently – but that will be through argument, not coercion.

      1. I suppose it requires a two-pronged attack in reality – publicity of the science and logic surrounding THR, and criminal investigations of commission members.

        We all value the work you and colleagues do on the factual issues. It’s just that some of us are frustrated with the science/logic approach when it cannot possibly sway people who are being paid to bin anything factual in order to protect pharma industry income.

        It’s almost as if people don’t seem to grasp these issues:
        – The pharmaceutical industry stands to lose 50 billion dollars if ecigs become popular. Is it really suggested that the world’s biggest criminal corruptors* will stand back and do nothing about that? That is an unlikely supposition – pharma pulls the strings in many areas connected with health; after all, elements within the UK Dept of Health are the UK’s best example of a regulatory captured agency.
        * See: http://www.eccauk.org/index.php/news-and-blog/pharmaceutical-industry-fraud-fines-reach-new-record-level.html

        – Government agency staff and EU commission staff couldn’t give a proverbial about THR or any other health issue. They are not idealists or anti-tobacco fanatics, they just go to work to earn a living. When offered a richly-rewarded non-executive directorship at a later date, or a sizeable deposit in an untraceable offshore bank account, a percentage will say, “Yes please”. Anyone who says corruption does not exist is living in a fantasy world, the pharmaceutical industry are acknowledged as the world’s largest scale corruptors and fraudsters.

        – Health issues or truth or facts or science are really not the issue here. The biggest problem may be that medics can’t see this. They see everything in terms of medical evidence. Evidence is no use when the people making the rules have been paid off to ignore it. It really doesn’t matter how much evidence you have.

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  11. The four main points I see are the following:
    1) The EC denies citizens the right to profit from technological progress (48 convention indeed, but maybe some binding documents too);
    2) They ban products on health ground but have no consistent basis for doing so (basically the 2004 case, I think, only stronger now);
    3) They make a decision that will probably have grave negative consequences on public health, but of course, they won’t agree on that point.
    4) They are not sincere, which is why they use tampered with documents.

    If we could see the two versions of the report, that could give us an idea of what exactly they decided to erase from it, that is, what they knew they couldn’t argue about. Then, maybe, we’ll be able to link points 3 and 4, that is, show that the EC is deliberately putting people’s health at risk.

    Last point, since the leaking of an already old report comes right after the leaking of the new tobacco directive draft, one can always suppose that it is not a complete coincidence and that the report leaking was designed to send a message to the commission, but that is nothing more than speculation.

    1. The Commission no longer relies on this assessment. Instead they have the SCENIHR Report on smokeless tobacco. This is an expert committee with the purpose of providing impartial advice to the Commission. Its early work was incredibly biased by virtue of poor framing (they were looking at the product as if it wasn’t an alternative to smoking). You can see my critique Useless scientific advice from the EU

      However, the truth would out and some people with integrity advising the committee made sure of that. The final SCENIHR report is much better. Amazingly, the Commission still manages to use this report to justify the ban on snus. But the evidence in the report justifies nothing of the sort – I drew on its finding in my post Death by regulation: the EU ban on low risk oral tobacco. The one thing that the report doesn’t support is a ban on snus.

  12. Brad Rodu points out that Tipp-Ex is just the infantile end of something even more distasteful… bias in a scientific institution, the Karolinska Institute.

    Though the supporters of bans on smokeless tobacco rely heavily on work from Karolinska, he argues this is compromised by important, troubling and unresolved discrepancies that KI researchers have refused to address. He has documented these problems in published letters to journals, and detailed these problems in blog posts:

    … and in an editorial in Dagens Industri last year Debatt: Varför tiger KI om snusforskningen?. An English translation included in his blog post:

    Good question… If anyone from Karolinska cares to comment, or even just cares… do get in touch.

  13. This sickness is not confined to EU commissioners or the Karolinska. It is an epidemic that afflicts the whole of the public health industry. Modern public health policy is driven almost entirely by extreme politics and vested interests. It is utterly dishonest. It undermines science, academia and democracy, usually with the blessing of self serving civil servants and ambitious unprincipled autocratic politicians.

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  16. This misrepresentation of the facts is no different from any of the other lies perpetuated by govt, media or other corporate interest. Witness 9/11. Yes, monumental steel buildings collapse into their own footprint at free fall speed. Sure. It’s quite ironic that we allow them to act as our puppeteers. We far outnumber them and we could change the world in a day. Just need to unite i suppose.

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