Norway status update: Plain packaging and e-cigs regulated as tobacco

Norwegian Minister of Health, Bent Høie,
showing his standardized tobacco packaging

During the first half of June, the Norwegian government will propose a revised Tobacco directive here in Norway. On a press conference yesterday, on the world no tobacco day, Health Minister Bent Høie talked about some of the changes that will be made. Norwegian newspaper Dagbladet reported from the press conference held at the Cancer Society yesterday. Plain cigarette packages is one of the changes to be made, something that Høie claims have been working very well in Australia. He plays the "Think about the children"-card pretty early on and his plain packaging, that also affects snus-packages, is his way of doing this:

"We must protect children and adolescents. The goal is a tobacco-free generation. We will do this using standardized packaging and remove the advertising effect"

The suggested changes seems to have support in the parliament and is expected to be passed into law before Christmas. Høie brags about the effects of the policy measures taken giving them credit for the fact that Norway has lower smoking rates than ever:

"The policy measures have worked, says health minister. In 1955, the proportion of daily smoking men 65 percent. In 2015 only four percent of youth 16-24 smoked on a daily basis, 30 percent smoke occasionally."

But Høie is worried about the fact that the use of Snus has dramatically increased the last 10 years:

"Snus use has increased dramatically the last decades. 30 percent of men and 18 percent women use snus. It is necessary to reduce."

Ok, so before Høie has even gotten to the topic of e-cigarettes he has proven himself completely unable to critically review statistics and analyse the success of plain packaging, to see the blindingly obvious connection between increased snus and e-cigarette use and decreased cigarette consumption, and to grasp the concept of harm reduction... at all.

First of all, Høie's belief that plain packaging has worked in Australia is a result of lies, lies and even more lies by Australian politicians that will not admit it has been an utter failure. Dick Puddlecote is just one of the people who have written about this. Another one from Christopher Snowdon can be found here. The reality, however, is that is that More Australian Kids Smoke After Plain Packaging. Of course I don't believe that plain packaging will make more kids smoke, but it's pretty obvious that it is indeed a total waste of time, energy and money, and the only possible effect seems to be that Høie and his colleagues will sleep a bit better thinking they've really made a difference.

Then there is the fact that Høie does not seem to see that the connection between increase in snus use and e-cigarettes and decrease in smoking prevalence and onset. In December I wrote that Smoking prevalence in Norway dropping faster than ever, and the accelerated decrease coincides with increased use of snus and later on e-cigarettes. A couple of days ago I also read in another Norwegian online newspaper, hegnar.no about a new nationwide survey showing that the use of snus in Norway reduces the cigarette consumption by 10 million cigarettes... every week! In this context, what the teens themselves say about why smoking isn't very popular any more might be interesting as well. But anyway, convincing Høie that snus in fact is one of the main reasons that Sweden and Norway has the lowest rates of smoking (and lung cancer) in Europe wouldn't necessarily help a lot. Cause Høie doesn't seem to understand the concept of harm reduction very well:

Snus is not as harmful as smoking, but snus is also harmful. We keep getting new documentation on it, at the latest now from Sweden showed that snus during pregnancy increased the risk of stillbirth by 50 percent. It says pretty much.

Yes, Høie, you are right about one thing... this really says a lot: To justify your plain snus packages you have to resort to shady scare tactics, this time using the unborn children. I don't know what documentation he is talking about, but 50% sounds like a lot right? I found this though, from 2010, which shows an increase of 0.2% from 0.3% for non-users to 0.5% for snus users. Granted, this is a 50% increase (actually more) but in my opinion it makes more sense to publish the actual increase of 0.2 percentage points in these cases, because in reality it's not a big increase in risk. 50% sounds like a lot, but in reality 50% of a very small number is ... well an even smaller number. In addition to this the study I linked to has limitations, and one thing I don't see mentioned at all is whether the snus using mothers to be were primarily former smokers. Then again, putting forth a 0.2 percentage point increase when publishing the study probably wouldn't raise many eyebrows... All of the above, however, doesn't really matter. In fact, even if you could prove there was a 50% real chance of stillbirth if you use snus while pregnant, that wouldn't justify putting snus in the same harm category as smoking. There are several things you shouldn't eat, drink or do (google it and you'll end up with a long list) when you're pregnant, but that doesn't mean that non-pregnant people shouldn't.

In addition to plain packaging Høie plans to repeal the ban on e-cigarettes in Norway. But that sounds like great news you say? Well...

We are going to open for the sale of E-cigarettes. Although E-cigarettes also are harmful, it may be an opportunity for people who want to quit with regular tobacco and move to a less harmful product. Opening for sale gives us a completely different opportunity to inform about E-cigarettes. I think many people who are using E-cigarettes believe it is only water vapor coming out, but the nicotine content in the vapor is as high as in normal cigarette smoke. It is not harmless to vape at home when the children are present.

As you can see, Høie is remarkably misinformed about potential harm from e-cigarettes and vaping for a man in his position. What he doesn't mention, but it has been talked about earlier this week in Norwegian media, is how vaping going to be regulated. What this is, of course, is Norway implementing the EU TPD. Again, we see several players in the media, trying to score political points here. Both the Cancer Society and government party FRP has been in the news, trying to make it look like they're the ones that got rid of the e-cigarette ban. The Cancer Society has been very negative to e-cigarettes all along, but now they see that there is really no way that the ban will remain in place, so they've written a letter to the health authorities urging them to repeal the ban. They know very well that this ban will be gone anyway, and now they'll focus on strict regulations. The populists from FRP fronts this as happy news for anyone wanting to quit or reduce smoking.

"This is happy news for the many who want to reduce or stop the use of tobacco. We're repealing a silly ban", says Morten Wold (from FRP)

What FRP and the government is doing is the same thing they did last year, trying to twist the facts and score political points among vapers, while implementing a directive that will limit the number of smokers moving to a less harmful alternative. It is also a directive that they in fact do not have to implement as Norway has a reservation right since we are not an EU member state. They simply don't have the balls to stand up to the EU.

On the positive side, at least it looks like stores will be allowed to display e-cigarettes and do not have to hide them away with the plain tobacco packages. This certainly will save some lives if it lasts.

So, status here in Norway right now: While politicians in the UK and now Italy are forming cross party parliamentary groups to create a reality based debate and work for reasonable regulations of vaping, standing up to the corrupt forces of the EU parliament, Norwegian politicians are either too clueless, careless or stupid to do so. Instead they just jump whenever the EU and Big Pharma says so.

But that does not mean our pro-vaping forces have given up the fight. There are strong forces here, constantly working to counter the attacks on vaping and educate both politicians and the public. Karl Erik Lund is one of them and together with Erik Nord (both from the Institute of Public Health) they strongly criticize Høie's wish to regulate e-cigarettes as tobacco in today's edition of Aftenposten asking "Does Bent Høie care less about smokers' lives than the lives of others?". They claim that 8000 people can avoid premature death if e-cigarettes are not regulated as tobacco and finishes their article with some questions directed to Health Minister Høie (after referring to the RPC report): 

• Is he informed about the material from England? 
• Will he in case reconsider the appropriateness of regulating e-cigarettes as if they were tobacco products? 
• If not, how can we then not believe that the Minister of Health care less about smokers' lives than the lives of others?

As you can see, we have people here in Norway that has the guts to stand up and tell the truth, and that has the knowledge and position to get this into the media. What makes this quite exceptional from Lund and Nord is that they they publish this despite the fact that their employer supports Høies wish for tobacco regulation. Fantastic if you ask me :)