Connect with us
[the_ad id="89560"]

Brownstone Institute

Comparing Risks: The Right and Wrong Way

Published

9 minute read

From the Brownstone Institute

BY Anette StahelANETTE STAHEL  

Now, after three years with covid-19, the pandemic is ebbing away worldwide. What’s still high, however, is the number of reports to the pharmaceutical authorities regarding serious symptoms and injuries after covid vaccination. In Sweden, they’ve even continued to increase at a constant rate during the past year.

Ever since the middle of 2021, I’ve tried to evoke an open discussion in the media for something entirely central concerning serious afflictions after vaccination against covid, but to no avail. I’m now making another attempt, admittedly at a late stage, but, there will be future pandemics and epidemics and there are still large groups of people around the world that are recommending vaccination against covid.

The prevention of serious symptoms and injuries is the main reason why people are vaccinated against a disease. That’s why it’s so important that the percentage of subsequent serious afflictions doesn’t turn out to be higher in the vaccinated group than in the unvaccinated one when vaccination against the disease has been started.

The entire vaccinated group must therefore be compared with the entire unvaccinated group in investigations of serious symptoms and injuries that occurred after vaccination or after infection. But when I looked more closely at what the researchers behind the larger, American health authority CDC-favored studies actually compared, I discovered that they’d chosen to compare completely different groups instead.

The comparison they’d chosen was one where they looked at the risks of various serious symptoms and injuries after covid vaccination vs the risks of the corresponding ailments after infection in the unvaccinated – instead of looking at the corresponding risks for the entire unvaccinated group. This meant that the researchers obtained higher risk figures for the option “to abstain from the vaccine” than for the option “to take the vaccine.” In addition, they’d chosen to look at the risks after confirmed infection instead of after estimated, which yielded an even smaller denominator in the division.

The objection that the researchers didn’t set out to determine the most optimal of the choices “to take the vaccine” or “to abstain from the vaccine” doesn’t hold up, because when reading the reports it becomes very clear that the authors consider the comparison between vaccinated and infected unvaccinated to be acceptable, not least via all the tables and diagrams where none other than these two groups are compared.

The American health authorities haven’t corrected this either, in their presentations of the studies (see here slide 26 and here slide 18), and the Swedish Public Health Authority has referred to studies of this type as well, in text passages which clearly showed that the authority considered a comparison between vaccinated and infected unvaccinated to be valid.

This formerly contained the following text, now removed, in translation: “Scientific studies show that there’s a greater risk associated with getting covid-19 than is associated with getting vaccinated. This means that the benefit of getting vaccinated is much greater than the risk of suffering any side effects from the vaccine.” And this formerly contained the following in translation: “Getting sick with covid-19 is associated with a greater risk than is associated with getting a vaccine against covid-19. There’s a much greater risk associated with getting a serious disease that can infect other people than is associated with getting a vaccine against the disease.”

When I then looked at the results of the studies and used official statistics to make a correct comparison instead, I found they showed that the risk of serious symptoms and injuries after vaccination was many times higher than the risk of corresponding infection-related conditions in the unvaccinated state. In total, the risk of serious conditions after vaccination was about 13 times higher than if one abstained from the vaccine, according to this data.

The reason that the adequate comparison is between the risk of afflictions after vaccination and the risk of corresponding afflictions in the unvaccinated state is that the alternative to taking a vaccine isn’t to contract the infection, but to be unvaccinated and thus perhaps contract the infection, perhaps not.

For the unvaccinated, the risk of ingesting viral RNA/DNA isn’t 100 percent, as with vaccination, but very much lower; for covid, the risk has varied between about 0.5 and 15 percent, depending on where on the globe one was located and during what time period one was there (see here, here, and here).

And even if that risk increased if one ended up in situations with higher contagion, it still never got very high. For example, it’s estimated that only about 40 percent of Sweden’s population has had covid, even though it’s now been three years since the pandemic started. Any choice between getting the vaccine and getting the infection never occurs in reality; far from it, and such a comparison is therefore completely irrelevant from a benefit/risk assessment point of view.

I don’t intend to here enter into theories as to the reason for the researchers and health authorities’ choice of too low a denominator in the division; I’ll leave it to the reader to draw their own conclusions on the matter. In any case, this comparison between severe symptoms and injuries after vaccination and the corresponding afflictions after infection in the unvaccinated must come to an end, not to mention after merely confirmed infection. And this applies to both covid-19 and any future pandemics and epidemics. What’s adequate, and always has been, is to compare symptoms and injuries after vaccination with corresponding conditions in the entire group of unvaccinated people.

Scientists must stop making incorrect comparisons, and health authorities must stop claiming that the serious symptoms and injuries linked to vaccination are “very rare,” while at the same time omitting to inform that the risk of corresponding, infection-related afflictions in the unvaccinated state actually is lower. And the critical question which becomes the logical consequence of this rectification, and which we must ask ourselves, is:

If we, after this adjustment, look beyond different corresponding symptoms and injuries and compare the total data of serious conditions after vaccination with the total data of the unvaccinated, is it then possible that we’ll find a predominant proportion of ailments among the vaccinated? Well, it’s definitely possible, and in the case of the covid vaccine, already the figures in the very first, large Pfizer study pointed in that direction. And if so, we have to ask ourselves:

Where’s the sense in vaccinating people and thereby increasing the risk for them to develop serious afflictions of various kinds?

Author

  • Anette Stahel

    Anette Stahel holds a MSc degree in biomedicine and is a former cancer researcher at the University of Skövde in Sweden. She is also a member of Läkaruppropet (The Physicians’ Appeal), the Swedish response to The Great Barrington Declaration.

Before Post

Todayville is a digital media and technology company. We profile unique stories and events in our community. Register and promote your community event for free.

Follow Author

Brownstone Institute

Bizarre Decisions about Nicotine Pouches Lead to the Wrong Products on Shelves

Published on

From the Brownstone Institute

  Roger Bate  

A walk through a dozen convenience stores in Montgomery County, Pennsylvania, says a lot about how US nicotine policy actually works. Only about one in eight nicotine-pouch products for sale is legal. The rest are unauthorized—but they’re not all the same. Some are brightly branded, with uncertain ingredients, not approved by any Western regulator, and clearly aimed at impulse buyers. Others—like Sweden’s NOAT—are the opposite: muted, well-made, adult-oriented, and already approved for sale in Europe.

Yet in the United States, NOAT has been told to stop selling. In September 2025, the Food and Drug Administration (FDA) issued the company a warning letter for offering nicotine pouches without marketing authorization. That might make sense if the products were dangerous, but they appear to be among the safest on the market: mild flavors, low nicotine levels, and recyclable paper packaging. In Europe, regulators consider them acceptable. In America, they’re banned. The decision looks, at best, strange—and possibly arbitrary.

What the Market Shows

My October 2025 audit was straightforward. I visited twelve stores and recorded every distinct pouch product visible for sale at the counter. If the item matched one of the twenty ZYN products that the FDA authorized in January, it was counted as legal. Everything else was counted as illegal.

Two of the stores told me they had recently received FDA letters and had already removed most illegal stock. The other ten stores were still dominated by unauthorized products—more than 93 percent of what was on display. Across all twelve locations, about 12 percent of products were legal ZYN, and about 88 percent were not.

The illegal share wasn’t uniform. Many of the unauthorized products were clearly high-nicotine imports with flashy names like Loop, Velo, and Zimo. These products may be fine, but some are probably high in contaminants, and a few often with very high nicotine levels. Others were subdued, plainly meant for adult users. NOAT was a good example of that second group: simple packaging, oat-based filler, restrained flavoring, and branding that makes no effort to look “cool.” It’s the kind of product any regulator serious about harm reduction would welcome.

Enforcement Works

To the FDA’s credit, enforcement does make a difference. The two stores that received official letters quickly pulled their illegal stock. That mirrors the agency’s broader efforts this year: new import alerts to detain unauthorized tobacco products at the border (see also Import Alert 98-06), and hundreds of warning letters to retailers, importers, and distributors.

But effective enforcement can’t solve a supply problem. The list of legal nicotine-pouch products is still extremely short—only a narrow range of ZYN items. Adults who want more variety, or stores that want to meet that demand, inevitably turn to gray-market suppliers. The more limited the legal catalog, the more the illegal market thrives.

Why the NOAT Decision Appears Bizarre

The FDA’s own actions make the situation hard to explain. In January 2025, it authorized twenty ZYN products after finding that they contained far fewer harmful chemicals than cigarettes and could help adult smokers switch. That was progress. But nine months later, the FDA has approved nothing else—while sending a warning letter to NOAT, arguably the least youth-oriented pouch line in the world.

The outcome is bad for legal sellers and public health. ZYN is legal; a handful of clearly risky, high-nicotine imports continue to circulate; and a mild, adult-market brand that meets European safety and labeling rules is banned. Officially, NOAT’s problem is procedural—it lacks a marketing order. But in practical terms, the FDA is punishing the very design choices it claims to value: simplicity, low appeal to minors, and clean ingredients.

This approach also ignores the differences in actual risk. Studies consistently show that nicotine pouches have far fewer toxins than cigarettes and far less variability than many vapes. The biggest pouch concerns are uneven nicotine levels and occasional traces of tobacco-specific nitrosamines, depending on manufacturing quality. The serious contamination issues—heavy metals and inconsistent dosage—belong mostly to disposable vapes, particularly the flood of unregulated imports from China. Treating all “unauthorized” products as equally bad blurs those distinctions and undermines proportional enforcement.

My small Montgomery County survey suggests a simple formula for improvement.

First, keep enforcement targeted and focused on suppliers, not just clerks. Warning letters clearly change behavior at the store level, but the biggest impact will come from auditing distributors and importers, and stopping bad shipments before they reach retail shelves.

Second, make compliance easy. A single-page list of authorized nicotine-pouch products—currently the twenty approved ZYN items—should be posted in every store and attached to distributor invoices. Point-of-sale systems can block barcodes for anything not on the list, and retailers could affirm, once a year, that they stock only approved items.

Third, widen the legal lane. The FDA launched a pilot program in September 2025 to speed review of new pouch applications. That program should spell out exactly what evidence is needed—chemical data, toxicology, nicotine release rates, and behavioral studies—and make timely decisions. If products like NOAT meet those standards, they should be authorized quickly. Legal competition among adult-oriented brands will crowd out the sketchy imports far faster than enforcement alone.

The Bottom Line

Enforcement matters, and the data show it works—where it happens. But the legal market is too narrow to protect consumers or encourage innovation. The current regime leaves a few ZYN products as lonely legal islands in a sea of gray-market pouches that range from sensible to reckless.

The FDA’s treatment of NOAT stands out as a case study in inconsistency: a quiet, adult-focused brand approved in Europe yet effectively banned in the US, while flashier and riskier options continue to slip through. That’s not a public-health victory; it’s a missed opportunity.

If the goal is to help adult smokers move to lower-risk products while keeping youth use low, the path forward is clear: enforce smartly, make compliance easy, and give good products a fair shot. Right now, we’re doing the first part well—but failing at the second and third. It’s time to fix that.

Author

Roger Bate

Roger Bate is a Brownstone Fellow, Senior Fellow at the International Center for Law and Economics (Jan 2023-present), Board member of Africa Fighting Malaria (September 2000-present), and Fellow at the Institute of Economic Affairs (January 2000-present).

Continue Reading

Addictions

The War on Commonsense Nicotine Regulation

Published on

From the Brownstone Institute

Roger Bate  Roger Bate 

Cigarettes kill nearly half a million Americans each year. Everyone knows it, including the Food and Drug Administration. Yet while the most lethal nicotine product remains on sale in every gas station, the FDA continues to block or delay far safer alternatives.

Nicotine pouches—small, smokeless packets tucked under the lip—deliver nicotine without burning tobacco. They eliminate the tar, carbon monoxide, and carcinogens that make cigarettes so deadly. The logic of harm reduction couldn’t be clearer: if smokers can get nicotine without smoke, millions of lives could be saved.

Sweden has already proven the point. Through widespread use of snus and nicotine pouches, the country has cut daily smoking to about 5 percent, the lowest rate in Europe. Lung-cancer deaths are less than half the continental average. This “Swedish Experience” shows that when adults are given safer options, they switch voluntarily—no prohibition required.

In the United States, however, the FDA’s tobacco division has turned this logic on its head. Since Congress gave it sweeping authority in 2009, the agency has demanded that every new product undergo a Premarket Tobacco Product Application, or PMTA, proving it is “appropriate for the protection of public health.” That sounds reasonable until you see how the process works.

Manufacturers must spend millions on speculative modeling about how their products might affect every segment of society—smokers, nonsmokers, youth, and future generations—before they can even reach the market. Unsurprisingly, almost all PMTAs have been denied or shelved. Reduced-risk products sit in limbo while Marlboros and Newports remain untouched.

Only this January did the agency relent slightly, authorizing 20 ZYN nicotine-pouch products made by Swedish Match, now owned by Philip Morris. The FDA admitted the obvious: “The data show that these specific products are appropriate for the protection of public health.” The toxic-chemical levels were far lower than in cigarettes, and adult smokers were more likely to switch than teens were to start.

The decision should have been a turning point. Instead, it exposed the double standard. Other pouch makers—especially smaller firms from Sweden and the US, such as NOAT—remain locked out of the legal market even when their products meet the same technical standards.

The FDA’s inaction has created a black market dominated by unregulated imports, many from China. According to my own research, roughly 85 percent of pouches now sold in convenience stores are technically illegal.

The agency claims that this heavy-handed approach protects kids. But youth pouch use in the US remains very low—about 1.5 percent of high-school students according to the latest National Youth Tobacco Survey—while nearly 30 million American adults still smoke. Denying safer products to millions of addicted adults because a tiny fraction of teens might experiment is the opposite of public-health logic.

There’s a better path. The FDA should base its decisions on science, not fear. If a product dramatically reduces exposure to harmful chemicals, meets strict packaging and marketing standards, and enforces Tobacco 21 age verification, it should be allowed on the market. Population-level effects can be monitored afterward through real-world data on switching and youth use. That’s how drug and vaccine regulation already works.

Sweden’s evidence shows the results of a pragmatic approach: a near-smoke-free society achieved through consumer choice, not coercion. The FDA’s own approval of ZYN proves that such products can meet its legal standard for protecting public health. The next step is consistency—apply the same rules to everyone.

Combustion, not nicotine, is the killer. Until the FDA acts on that simple truth, it will keep protecting the cigarette industry it was supposed to regulate.

Author

Roger Bate

Roger Bate is a Brownstone Fellow, Senior Fellow at the International Center for Law and Economics (Jan 2023-present), Board member of Africa Fighting Malaria (September 2000-present), and Fellow at the Institute of Economic Affairs (January 2000-present).

Continue Reading

Trending

X