Flaw in WHO Framework Convention on Tobacco Control

Editor—Sehmi writes that the WHO Framework Convention on Tobacco Control has a major flaw.¹ However, the main problem with the way the framework convention handles smokeless tobacco is not that it is inadequate but that it is undifferentiated from smoking tobacco. However, in many crucial respects—notably, risk of death and disease—smokeless and smoking tobacco are very different, with much lower risk arising from the obvious physical difference of drawing volatile gaseous and particulate products of combustion into the lungs compared with chewing or sucking the dried and cured leaf.

The framework convention does not handle “harm reduction” at all well—but it may be a very effective health policy to allow markets in smokeless tobacco to develop to enable smokers to stop smoking while continuing to use nicotine in tobacco form. Evidence from Sweden shows the high prevalence of oral snuff (snus) use among men is highly likely to be the reason for Sweden's lowest rate of smoking in the developed world and, as a result, the lowest rates of cancer.²

Policies that bear down on smokeless tobacco, such as attempts to ban it, may have adverse consequences if they cause more people to use cigarettes, or if they remove a much less hazardous option for continuing nicotine use from smokers who are unwilling or unable to stop. The European Union leads the world in this folly by banning products such as snus outside Sweden, despite the evidence that it has a strong public health benefit.³