• 10/3/2007
  • Stockholm, Sweden
  • Mark Landler , Andrew Martin
  • New York Times (nytimes.com)

Cooling his heels outside a popular nightclub here recently, Jesper Froberg stubbed out his cigarette and reached for a less harmful pleasure: smokeless tobacco, neatly packed in tiny pouches that look like miniature used tea bags.

“I’m really concerned about my health,” said Mr. Froberg, a maître d’hôtel, who tries to limit his smoking. “This stuff is safer than cigarettes, it’s discreet, and it’s really good.”

Now this form of tobacco is coming to America, in the midst of an intensifying debate over how to define “reduced risk” tobacco products and how to market them. On Wednesday, a House committee is scheduled to hold hearings on whether the Food and Drug Administration should be given the power to regulate tobacco.

Snus (rhymes with loose) is a moist ground tobacco that a user tucks between the cheek and the gum. Unlike chewing tobacco and moist smokeless tobacco — commonly known as dip — snus requires no spitting. Thanks partly to its popularity here, Sweden has the lowest smoking rates in Europe. It also has fewer incidences than its neighbors of smoking-related diseases, including lung and oral cancer.

Snus is not without its dangers. It contains nicotine, which speeds the metabolism, and is as addictive as cigarettes. It has also been linked in a recent clinical trial to pancreatic cancer, though, unlike cigarettes, not to lung or mouth cancers.

With the Sweden experience as a blueprint, the American tobacco industry is looking to snus as a potentially profitable, less dangerous alternative to cigarettes. Philip Morris USA and R. J. Reynolds Tobacco have begun test-marketing it around the country under their most famous names, Marlboro and Camel. But recalling the false promise of “light” and “mild” cigarettes, critics say smokeless tobacco is a Trojan horse, meant to enable companies to hold on to customers who might otherwise quit their tobacco habit outright.

“There is no scientific evidence whatsoever that smokers are able to switch to smokeless tobacco and remain switched,” said Thomas Glynn, the director of cancer science and trends at the American Cancer Society.

Still, Mr. Glynn also believes that if every smoker in the United States were to switch to smokeless tobacco, “in the next decade we would see fewer cancers and less heart disease.”

The European Union banned the sale of snus in 1992, partly out of concern that it would be marketed to young people — a policy that almost derailed Sweden’s membership bid, until a waiver was granted.

There are no such restrictions in the United States, where there is a long tradition of smokeless tobacco and a growing market for it. Moreover, advocates say, snus is less harmful than American dip, which is fermented rather than pasteurized, and can cause mouth cancer.

“I think it’s a potentially huge market,” said Lennart Freeman, president of the North America division for Swedish Match, which dominates the market here, selling some 250 million slim cans of snus a year.

The company has begun to sell snus in tobacco shops in New York, Chicago and other cities. Given the negative perception of tobacco and the restrictions on advertising, though, company officials said it would take time to educate Americans about snus’s advantages over other tobacco products.

In Sweden, snus has existed for some 200 years, enjoying a revival in popularity over the last 20 years. There is little dispute that it has had an impact on smoking habits, at least among Swedish men. In 1976, 43 percent of men here smoked regularly; by 2005, only 14 percent did. During that period, the percentage of men using snus jumped to 22 percent, from 9 percent.

But not everyone who takes up snus is a smoker. And not every smoker stops when they use it. A few continue to smoke daily, while others, like Mr. Froberg, smoke now and then. An estimated 5 percent of Swedish men have quit smoking altogether in favor of snus.

“If you have a product that works well as a smoking-cessation product, then why not use it?” asked Dr. Lars E. Rutqvist, the vice president for scientific affairs at Swedish Match. “Societies should adopt all measures that are effective in combating smoking-related diseases.”

Dr. Rutqvist, an oncologist who used to think snus was “disgusting,” has become one of its most ardent advocates. He argues snus can serve as a less risky alternative for chronically addicted smokers and as a way for less addicted smokers to wean themselves.

Those claims — not to mention his recent decision to take a job at a tobacco company — have put Dr. Rutqvist at odds with colleagues in the Swedish medical establishment. Doctors here are deeply divided about the proper role of snus, with some arguing that its risks should not be discounted.

Snus contains nitrosamines, the same cancer-causing chemicals in cigarettes, but at lower levels. In a recent study of 280,000 Swedish construction workers, published in June in the British medical journal Lancet, snus was found to be a risk factor for pancreatic cancer. There was no evidence of a higher risk for lung or oral cancers among snus users.

Snus also contains plenty of nicotine, which doctors say has dangerous metabolic effects.

This nicotine kick, its advocates say, is what makes snus more effective as a way to quit smoking than patches or gum.

Still, there are no reliable scientific studies on snus as a smoking-cessation tool.

“If you make this widely available, how do you ensure it’s not used as a gateway to smoking?” said Olof Nyren, an epidemiologist who oversaw the construction worker study at the Karolinska Institute in Stockholm. The institute is Scandinavia’s leading medical research center, and its faculty will select this year’s Nobel Prize winner in medicine on Monday.

Critics poke other holes in the arguments of tobacco companies: smoking rates for Swedish women also dropped sharply, from 34 to 15 percent from 1976 and 2005, but relatively few women took up snus. About 4 percent of women now use it.

Smoking opponents say Sweden’s low smoking rate owes more to its strict tobacco control policies than to snus. They say tobacco companies are simply seeking another channel to deliver their product at a time when smoking is banned in restaurants, offices and bars.

“It’s a clever marketing ploy,” said Margaretha Haglund, the director of tobacco prevention for the Swedish National Institute of Public Health. “I’m not a health fascist,” she added, “but I don’t believe the solution to the tobacco problem lies in a new product from the tobacco industry.”

At the moment, there is little scope for marketing snus in the United States, since tobacco companies cannot make health claims without running afoul of the federal government or risking lawsuits. Legislation pending in Congress would let the F.D.A. regulate tobacco and develop rules for companies marketing reduced-risk products.

That prospect has split the tobacco industry. Philip Morris USA, which sells about half the cigarettes bought in the United States, supports the legislation — in part because it wants health claims evaluated by the federal government rather than the tobacco companies themselves.

But Reynolds American, the parent company of R. J. Reynolds, is opposed, arguing that the provisions in the legislation are so onerous that they would make it difficult, if not impossible, to introduce reduced-risk products and market them as such.

Still, with the number of American smokers declining every year — there are now about 45 million smokers, or 21 percent of the adult population — American tobacco companies are expanding aggressively into reduced-risk products, notably dip and snus.

R. J. Reynolds is selling snus under the Camel label in eight test markets across the country. Last year, Reynolds American bought Conwood Sales, maker of Grizzly and Kodiak smokeless tobacco, for $3.5 billion.

Philip Morris USA recently introduced Marlboro snus in the Dallas-Fort Worth area, and it continues to test another snus product, Toboka, in Indianapolis. It is set to open a $350 million plant, near its headquarters in Richmond, Va., that will focus partly on developing reduced-risk products. Analysts said the Toboka test has been disappointing, and some are skeptical of the prospects for other snus products.

“The opportunities to communicate to customers are not very substantial,” said David Adelman, an analyst at Morgan Stanley.

Even here, in the homeland of snus, Swedish Match has to stretch to broaden its appeal.

Its next target is women. At a spotless high-tech production plant in Gothenburg, executives showed off a dainty lavender-colored can, packed with cassis and menthol-flavored snus. But it might not be enough.

At a bar in Stockholm, Frida Brannstrom, 27, who gave up snus a few years ago, mostly for oral hygiene, said the new packaging was cute. Then she added, taking a sip from a sloe gin fizz, “But probably, maybe it gives you cancer.”