Tag Archives: WHO

The end of the world – or at any rate the end of China – is upon us!

How proud Dr Margaret Chan (Director-General of the WHO) and Helen Clark (Administrator of the UN Development Programme) must feel of their ringing rhetoric in warning of the catastrophe facing China! (Foreword to Health, Economic and Social Costs of China’s Tobacco Epidemic, WHO 2017)

Tobacco use kills six million people every year and is a threat to health and development…Tobacco use hurts families, impoverishes communities and damages economies and societies…

China – the world’s largest producer and consumer of tobacco – is the epicentre of this epidemic. A staggering 44% of the world’s cigarettes are smoked in China. One million people die of tobacco-related diseases in China every year…Tobacco use is killing or disabling the main wage earner in many Chinese families.. and plunging those already on the margins into poverty.

 If nothing is done…smoking-related diseases are on track to claim more than 200 million lives in China this century…

Splendid clichés and buzzwords abound:

…a huge step towards delivering on the vision articulated in the 2030 Agenda…a world transformed…and no one left behind…the WHO have (sic) joined hands to support realising the commitments…accelerate multisectoral and interagency responses to support full implementation…the broader goal of building a more sustainable and inclusive economy and society…we are united in an unwavering commitment to further the goals…to protect present and future generations from the devastating…consequences of tobacco consumption…in the name of the millions of victims already lost to tobacco, and the millions of lives that still hang in the balance. Amen. (Condensed and paraphrased.)

Then we move on, not just to the Summary, but to the Executive Summary! It, and the rest of the report, was written by the well-named Angela Pratt and her colleague Andrea Pastorelli with the help of no less than thirty-five other people who contributed to this noble endeavour. The Executive Summary, curiously, repeats much of what is said in the Foreword: ‘Tobacco is on track to claim 200 million lives in China this century…’ etc.

Finally we come to the Introduction where, once again, just to make sure we don’t forget, we are told ‘More than 1 million people die in China every year as a result of tobacco use’ and  that ‘This will grow to 2 million annually by 2030, and 3 million annually by 2050 without action to drastically reduce smoking rates.’

They do, at least, set out some of the reasons for this appalling situation:

Fuelling China’s ravenous appetite for tobacco products…is the China National Tobacco Corporation (CNTC), the largest tobacco company in the world and one of the Chinese Government’s most profitable state-owned enterprises…China grows tobacco on more agricultural land than several other large tobacco-producing countries combined…the Chinese Government profits financially from every step in the tobacco production chain…In 2015, the tobacco industry contributed…US$ 170 billion, to the central Government – around 7% of total central Government revenue.

And then they go on a rant against the rulers of China, asking

…whether it is appropriate and ethical for a government to profit directly from an industry that derives its revenue from a product that kills

There’s more:

Tobacco growing causes biodiversity loss from deforestation and land clearing, soil degradation as tobacco growing depletes soil nutrients more than other crops, and land and water pollution as pesticides leak into the soil. Tobacco manufacturing produces a large amount of manufacturing and chemical waste, and cigarette butts when disposed of improperly are washed into rivers, lakes and the ocean where they are eaten by birds, fish and animals. Globally, cigarette butts make up the largest percentage of waste collected during beach cleanups every year.

What to do about it? This is what:

  • Increase tax on cigarettes by up to 100%
  • Institute 100% smoke-free public places
  • Ban cigarette advertising
  • Put horrible pictures on cigarette packs
  • Start mass media campaigns to warn people of the dangers of tobacco use
  • Health care professionals should give smokers cessation advice

Plus this pie-in-the sky:

The conflict of interest inherent in the tobacco industry’s involvement in China must be removed in order for effective implementation of tobacco control policies to be achieved

Wonder of wonders! If all the above measures (known as ‘tobacco control’) are instituted then by various statistical manipulations apparently one can predict by how much the prevalence of smoking will fall within a given period of time. For example, they estimate that:

A 50% increase in the retail price of cigarettes alone could…prevent 20 million premature deaths over 50 years, and save 8 million people from being plunged into poverty because of tobacco-related medical costs. (Emphasis added.)

Of course, any reduction in smoking-related deaths is to be welcomed, but assuming their predictions are correct, what about all the other people who will still die? How are the tobacco controllers going to reduce smoking prevalence to zero? Is that their aim or hope? Then why don’t they say so?

But while all this is going on Big Tobacco and especially the China National Tobacco Corporation are not going to do nothing and (assuming the above-mentioned tobacco control measures are effective) wait for the demise of their industry as smokers buy fewer and fewer of their poisonous products until, perhaps in one hundred years’ time, nobody bothers to buy cigarettes at all.

Just to get a sense of proportion about this, let’s look at another cause of deaths in China: traffic accidents. They cause over 200,000 deaths annually according to the WHO.

How can these deaths be prevented? Abolish traffic! But that would be impractical. So people need education in road safety and traffic regulations must be enforced. That should bring the number down but it’s unlikely it will ever be zero.

But why can’t tobacco be abolished? It serves no useful, let alone essential, purpose.

If the China government is serious about saving the health and lives of a significant proportion of their people they should start by closing down the cigarette factories.

Text © Gabriel Symonds

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