Intended for healthcare professionals

Head To Head

Should doctors advocate snus and other nicotine replacements? No

BMJ 2008; 336 doi: (Published 14 February 2008) Cite this as: BMJ 2008;336:359
  1. Alexander W Macara, president, National Heart Forum
  1. 1Bristol
  1. alexandermacara{at}

    Use of snus is less harmful than smoking and John Britton thinks that doctors should suggest it to people who are unable to give up cigarettes. But Alexander Macara argues that it could result in increased use of tobacco

    The use of smokeless tobacco products—–notably snus—has suddenly become controversial. Reasons for this include publicity by the tobacco industry,1 the introduction in England of a ban on smoking in public places,2 recent interest by major multinational companies in acquiring manufacturers of smokeless tobacco products,3 and the publication of comprehensive reports by a scientific committee of the European Commission4 and the Royal College of Physicians of London.5

    Last October the British American Tobacco Company pressed the European Union to reconsider its 1992 ban on snus,1 from which Sweden secured an exemption when it joined the union. Three weeks later the European Parliament called on the commission “to investigate the health risks associated with the consumption of snus and its impact on the consumption of cigarettes.”6

    What is snus?

    Snus is the Swedish word for snuff, which was fashionable to inhale before cigarettes superseded it. …

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