Category Archives: FCTC

Tobacco is the Root of all Evil

A young girl ties tobacco leaves onto sticks to prepare them for curing in East Lombok, West Nusa Tenggara. © 2015 Marcus Bleasdale for Human Rights Watch

The desperate need to deal with the smoking problem by outlawing tobacco could not be more plainly made than in the six bulleted points of ASH’s (Action on Smoking and Health’s) online Daily News of 30 May 2017.

Here they are:

  • Tobacco kills more than 7 million people per year and is costing the world economy USD 1.4 trillion annually

The death toll has gone up from the previous oft-quoted figure of six million per year.

  • Disposed cigarette butts pose a potential ecological risk to the ocean
  • Essex: Dunmow flat fire caused by badly discarded cigarette
  • Tobacco production ‘breaches human rights laws’

These three speak for themselves.

  • Scotland: Scientists find that smoking harms livers of unborn babies

It was discovered in 1950 that smoking causes lung cancer. How many additional harmful effects on human health need to be found before cigarettes are banned?

  • Austria: Study shows increasing the price of tobacco reduces consumption

How far will the price of tobacco need to be increased so that no one can afford to buy it anymore?

Let’s return to the first point: the statistic of seven million people being killed every year at a cost to the world economy of $1.4 trillion. This is from a slickly produced fifty page Discussion Paper, funded by the UK government, entitled ‘The WHO Framework Convention on Tobacco Control: an Accelerator (sic) for Sustainable Development.’

It’s written in the WHO’s usual turgid prose, with the inevitable Executive summary (an ordinary summary wouldn’t cut the mustard, apparently) and patronizingly illustrated with photos of smiling people from what are euphemistically called low- and middle-income countries.

This is the cringe-making style of the writing:

…generate greater awareness of the different narratives and entry-points for effective engagement with non-health sector stakeholders…strengthening governance to address inequalities and social exclusion that drive poor health

We soon come to the point, and this is where I want to make my point:

The paper’s overarching purpose is to support the acceleration of tobacco control efforts as part of broader SDG implementation…

Heaven knows there are enough problems in poor countries – I’m sorry, I mean low- and middle-income countries – with corruption, pollution, repression of women and minorities, child labour, female genital mutilation, religious intolerance, droughts, famines, wars, terrorism, HIV-AIDS, cholera, malaria, tuberculosis, landmine injuries, etc. But now, to these horrendous and seemingly intractable problems in so many parts of the world, we have to add tobacco growing and smoking.

No doubt sustainable development goals (SDG) are important for the greater happiness of mankind and deserving of all the help that rich countries can provide, and it’s clear that poorer countries’ problems are only made worse by growing tobacco and people smoking. But what the writers of this report want to do is to attach the tobacco control agenda to the much broader one of sustainable development.

Of course, people in poor countries are just as worthy as anyone else of being encouraged to stop smoking by having taxes increased on cigarettes and of having the dangers of smoking pointed out to them by horrible pictures on cigarette packs and of reducing exposure to cigarette advertisements by regulating them, etc. But these and other ‘tobacco control’ measures in this context are drops in the ocean.

Now consider if the tobacco controllers campaigned instead, or as well, for tobacco abolition. If this were successful, the demand for cigarettes would go down dramatically, there would be a smaller and eventually no market for tobacco products and all the problems from this cause of damage to human health and environmental degradation would eventually disappear.

It’s not so simple as that, of course, but at least let this objective be clearly stated and let a working party be set up, funded by the UK and other governments and the WHO, to look into the best way to achieve this aim.

Because in the meantime it’s not just unacceptable – it’s outrageous – that a product as dangerous as cigarettes is allowed to be sold.

Text © Gabriel Symonds

E-cigarettes may be hazardous to your health

Is this the beginning of the end for ENDS?e-cigs-again

The acronym – much medical writing is scattered with annoying non-standard abbreviations of this sort – means Electronic Nicotine Delivery Systems. These drug-delivery devices (for that’s what they are) were in the spotlight at a conference in India of the FCTC (there we go again) which means the Framework Convention on Tobacco Control.

Readers of this blog (or of my books) will by now be familiar with my views on the Tobacco Controllers.

As part of the agenda for this five-day conference, the delegates considered a report by the WHO on e-cigarettes; it makes for interesting reading. The bottom line is: WHO has now urged restriction of the sale, promotion and use of e-cigarettes.

Here’s a summary of some of the stated reasons:

 (For the full report visit: www.who.int/fctc/cop/cop7/FCTC_COP_7_11_EN.pdf?ua=1)

The aerosol produced by e-cigarettes contains glycols, aldehydes, volatile organic compounds, polycyclic aromatic hydrocarbon, tobacco specific nitrosamines, metals including lead chromium and nickel, and silicate particles. Many of these substances are poisonous.

  • Some of the flavours of e-cigarettes such as cinnamon and cherry pose appreciable health risks.
  • The claim that e-cigarettes are likely to be less harmful than conventional tobacco cannot be quantified due to lack of research.
  • WHO is sceptical of the claimed ability of e-cigarettes to help tobacco smokers to quit, saying that the scientific evidence is scant and of low certainty, making it difficult to draw credible inferences. (Emphasis added.)
  • Consideration should be given to banning the sale and distribution of e-cigarettes to minors and of banning or restricting the use of flavours that might appeal to minors.
  • Consideration should be given to prohibiting by law the use of e-cigarettes indoors and should require companies manufacturing e-cigarettes to introduce health warnings.
  • The involvement of multinational tobacco firms in the marketing of e-cigarettes poses a major threat to tobacco control, because they are promoting smoking through e-cigarette advertising to adults and children.
  • A review of 105 studies analysing the composition of liquids and emissions from e-cigarettes found that 30% of authors had received funding from e-cigarette interests, including from the tobacco industry.

In spite the WHO saying it’s sceptical of the claims that e-cigarettes can help smokers quit, it’s reported in the online Vaping Post (where else) that two Indian scientists have written to the Minister who deals with such matters, requesting him to ‘consider policies that facilitate smoking cessation by providing smokers with safe and regulated tobacco alternatives.’ They also remind us that ‘The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing around six million people a year’. Of these, one million are reported to in India.

To deal with this they call for ‘nicotine replacement therapy supported by advocacy and where possible, psychological support.’ The replacement therapy they have in mind is e-cigarettes, which are supposed to offer ‘a safer and effective way of meeting the physiological demands of nicotine to smokers to help quit or cut down smoking significantly.’ This is the conventional approach, but as I have pointed out before, it’s not noted for its success – 20% at best. Incidentally, the word ‘physiological’ means ‘relating to the normal function of living organisms’, so here it would be more accurate to talk of the pathological (abnormal) demands of nicotine to smokers.

As I have also pointed out before, the reason for the poor results of the conventional approach is that many smoking cessation advocates seem to have wrong-headed ideas about how to tackle the problem; the comments of these two good people illustrate several of these.

For a start, the whole idea of ‘replacement’ therapy is not the best way to go about it. It really means cigarette replacement or nicotine maintenance therapy.

Secondly, although it’s common to talk of an alternative to cigarettes, it needs to be emphasized that you don’t need an alternative to cigarettes. Do you need an alternative for the flu when you’ve recovered?

Thirdly, cutting down cigarettes (as opposed to quitting) does little or nothing for smokers’ health.

The mention of psychological support, however, is at least on the right lines. Smoking is a psychological problem (see my book of this title) for which the right kind of support is of great help for successful quitting. I hasten to say this doesn’t mean the apparent difficulty of quitting is imaginary, but the commonly experienced withdrawal symptoms of nicotine – mainly mild anxiety and nervousness – are mental symptoms. If the smoker can be assisted to demonstrate to himself or herself how these arise it is then very easy to quit smoking for good.

Finally, lets come back to the notion of ‘meeting the physiological demands of nicotine to smokers to help quit or cut down smoking significantly.’ For the reason stated, we’ll replace the word ‘physiological’ with ‘pathological’.

The only reason smokers have a pathological demand for nicotine is because of nicotine addiction. Non-smokers (and those who don’t use e-cigarettes) have zero demand or need for nicotine. To deal effectively with the smoking problem, therefore, a different mind-set is required. If one goes on meeting or satisfying the pathological demand for nicotine, you are stuck in an endlessly self-repeating cycle: each dose of nicotine – whether supplied by ordinary cigarettes or e-cigarettes – creates the demand for the next one.

Therefore, what is needed is to break the cycle. By not putting any more nicotine into your body ever again. By any means

Text © Gabriel Symonds

Tobacco doesn’t need to be controlled; it needs to be abolished

IMG_1202These cigarette machines are ubiquitous in Japan.

Note the ad for Parliament cigarettes. The attractive models imply that smoking is sexy. The wording says something like ‘vivid, strong menthol, crystal blast’. You can undergo this refreshing experience by crushing the menthol flavour capsule in the filter. The small print at the bottom, covering only about 16% of the ad, is a vaguely worded warning about the health risks of smoking and includes advice not to do it.

If you’re under twenty years of age you can’t use these machines because you have to insert a card first which is only obtainable by people over twenty. But isn’t this reverse discrimination? Don’t older people also deserve to be protected from the dangers of smoking?

Flavour capsules are the latest gimmick by Big Tobacco to entice more people to become nicotine addicts. Menthol cigarettes are often wrongly perceived as being less harmful and they may be more attractive to younger smokers than ordinary cigarettes.

Although Japan signed up to the WHO Framework Convention on Tobacco Control (FCTC) in 2004, in many ways it hasn’t implemented even the minimum requirements of the Convention. For example, health warnings are meant to cover at least 30% of the surface of cigarette packs and advertisement, and is it acceptable to imply that smoking is sexually attractive?

What is the FCTC anyway? On their website there’s a ‘death clock’ that shows the number of people who have died from tobacco-related diseases since it was inaugurated in 1999 – so far it’s over 85 million. Shocking and scandalous.

But what does it actually do? Some idea can be gleaned from a slickly produced video, with background muzak, of a conference about the activities of the International Tobacco Control (ITC) Evaluation Project of the FCTC. It’s not clear exactly when or where it was held it but it seems the purpose was to show off the progress that had been achieved so far, in what is called, tellingly, tobacco control. You can see this at http://itcproject.org/

The moderator is Professor Geoffrey Fong. He starts by lamenting – as well he might – the huge worldwide death toll that smoking causes and will continue to cause, and emphasises ‘it is even more important to consider ways in which tobacco use can be curbed.’

Note he says curbed, not abolished. Some other tobacco control heavyweights are then wheeled out, such as Ron Borland from The Cancer Council Victoria.

He, similarly, laments how

…the tobacco epidemic is affecting every community in the world, especially the poor, because they tend to smoke more and have more trouble giving up…smoking ends up killing one in two of its long-term users…a terrible scourge on our society and we need to be doing more to get rid of it.

At least he’s talking about of getting rid of it rather than just curbing it.

Geoffrey Fong:

About a billion people could die of tobacco use in the 21st century. The ITC project has brought together over 100 experts…to work on research that is evaluating the policies of the FCTC…so that we can promote stronger, evidence-based actions to reduce tobacco use.

There we go again. Reduce tobacco use, not abolish it.

Next we hear from Professor Simon Chapman, talking above a banner reading ‘Towards a TOBACCO-FREE WORLD’ (sic). Sounds promising. But he just waffles. Repetitively.

Tobacco is globally number one public health problem in the world today. There’s been a revolution in tobacco control in that we’ve had the framework convention of tobacco control. This has drawn together international action against tobacco in a way that’s never been seen before. I’ve been working in tobacco control myself for thirty-five years. I don’t think there is really any research project that’s ever been mounted in international tobacco control which has made the breadth and depth of contribution that the ITC project is making and it’s really just only hitting its straps. I can’t think of any other research project that comes remotely close to generating as much highly strategic and useful research as the ITC project is producing.

Thank you.

Ron Borland again:

…tobacco control requires [cigarette] taxation, smoke free policies and smoking support services…banning advertising…strong messages to the community to get the message through to smokers that smoking is harmful. These messages need to be graphic and show the harms that they are, so smokers become emotionally engaged with the topic. They need to understand in their gut that smoking is harmful, not just in their head. Health warnings on packs can also do this very effectively particularly where you use graphic images of some of the diseases caused by smoking.

So smokers smoke because they don’t know the harm it may do them? And if it’s true that smoking is so harmful, why is tobacco allowed to be sold? Nary a mention of that.

Michael Cummings, Medical University of South Carolina, an unsmiling cancer surgeon:

I work at a cancer center…a third of all cancers are due to smoking…it’s a personal failure on our part not to have addressed this problem fifty years ago…it’s been fifty years and twenty million Americans have died [from smoking]. The first world conference on tobacco and health held in 1967 in New York City had a compelling address by  Robert Kennedy…he talked about what we were up against in terms of the tobacco industry and the need to work in partnership across the globe to address the problems related to tobacco…nothing’s changed.

That’s the point. Nothing’s changed. In fifty years.

Robert Kennedy: ‘We must be equal to the task for the stakes involved are nothing less than the lives and the health of millions of people around the world.’ He was a straight talker and one can only speculate if his life hadn’t tragically been cut short whether he might have been effective in working towards abolishing tobacco.

Geoffrey Fong, with more repetitive waffle:

…because of the magnitude of the tobacco epidemic it is clearly the case that population level approaches need to be taken to curb tobacco use. The FCTC represents an extraordinary opportunity…to address the tobacco epidemic…to move tobacco control forward and push tobacco use down…my hope is that the ITC project can continue in some way to helping provide the kind of evidence that stronger tobacco control measures need to be taken and provide more of a foundation with respect to what works and what doesn’t. We can altogether do something about the number one preventable cause of death and disease in the world, that is, tobacco.

Why does he talk in this way? Curb rather than abolish? Why aim so low? And ‘push it down’. By how much? And how many people will die while he’s trying to to do that?

The only thing that will work to stop the tobacco epidemic is to abolish tobacco.

Text and image © Gabriel Symonds