Indonesia resists smoking ban

Indonesia is used for shock value: anyone can buy tobacco there. It has failed to ratify the Framework Convention on Tobacco Control, although I find it hard to believe that countries that have ratified the treaty don't have child smokers in their population. (The first (and youngest ever) child smoker I saw was a boy of about 12 working in a restaurant in central Turkey. Admittedly this was several years before Turkey signed the FCTC. But I suspect that it happens in many, many places.)

The tobacco lobby appears stronger in Indonesia than it is here. Indonesia has tobacco farmers. A group supporting them have publicly demonstrated about threatened smoking legislation and complained about the strength of pharmaceutical lobbyists:  

[...] the 100 Percent Love Indonesia Coalition, which claims support from tobacco farmers and plantation owners across the country, said the decree was issued to support the marketing of products such as nicotine gum, inhalers, patches and other nicotine substitution products. 

Authorities in Indonesia remain reluctant to pass laws on smoking, allegedly because of potential harm to the tobacco operations in Indonesia. There is (of course) dispute about whether legislation would damage tobacco interests or only protect people from secondary smoke exposure. A tobacco control advocate claims that other countries with tobacco plantations have successfully passed tobacco control legislation with hurting farmers, but this may be similar to claims over here that the Irish smoking ban didn't hurt pubs.

The current bill against smoking, says Chairman of the Legislative Body Ignatius Mulyono, is biased towards the anti-tobacco lobby.

Ignatius was adamant that the risk to farmers and workers was not negligible. 

“All the parties have looked at the bill together and they believe it will threaten farmers,” he said. “If other countries have applied such regulations, that doesn’t mean we should too.” 

He said he fully supported protecting the public from the dangers of smoking through advertising bans and designating smoke-free areas, but said those policies should be developed with due consideration for the welfare of farmers and workers.

Doesn't that read like a normal politician? one who considers that his role is to serve the public? He will consider a bill that will give due consideration to the livelihoods of those whose livelihoods depends on tobacco.

Dutch under fire for lax tobacco controls

As often this story is told effectively by Chris Snowdon, but the background is as follows. In brief, the Dutch rolled back their smoking ban about a year ago. Shortly afterwards Wiel Maessen of Forces International, a Dutch citizen who had been active in organising opposition to the ban, was approached by Stanton Glantz for an interview, as he was seeking to understand how the ban in the Netherlands had come to be overturned. The interview between these two was recorded.

The ban was reversed for bars with no employees, relying on the argument that the ban was about protecting workers. The fight has not ceased for overturning bans everywhere in the Netherlands. But there is a counter-attack from the international forces of tobacco control. This Dutch pro-tobacco control researcher's blog output over the last year has been four pieces lamenting the renegade tendencies of the Dutch in tobacco control. For not only has the Dutch government partially overturned the smoking ban – it has also cut the funding for the Dutch anti-smoking campaign organisation STIVORO.

The antis' retaliation to this insubordination: here from Stanton Glantz on the lifting of the smoking ban (or the 'failure of policy' on tobacco) and here from an army of professional tobacco control advocates on the cessation of funding to STIVORO and similar measures (or on why the Dutch government is 'abandoning smokers to their fate') – also reported here.

Stanton Glantz's efforts to connect action taken by publicans in the Netherlands to the tobacco industry fail because there is simply no evidence to connect them. Chris Snowdon explains. The other study, promising Dutch smokers an early death because of the direction of Dutch tobacco policy, is hardly more convincing.

Supreme Court refuses to hear appeal on vending machine ban

Isn't it nice that the Supreme Court will avoid wasting court time by refusing to hear a manifestly unjust case, thus avoiding the clear obligation to vote against the government?

There is clearly an alternative option to a vending machine ban: mandating effective age-verification, and using equipment that allows only one sale each time a machine is activated following age verification. Yet the Supreme Court will not allow this case to be made.

I suspect it may be for the same kind of reason that the Scottish Parliament refused to allow a trial of radio-controlled vending machines – that it would put them behind in the tobacco control league tables. Juvenile or what?

Cancer Research urges Durham University to give back tobacco company money

Further to this story, Cancer Research UK has advised Durham University to return the donation that it received from British American Tobacco.

From the point of view of CRUK, it seems that tobacco company money, uniquely among the gifts from over 2,000 donors to the Durham University scholarship fund, is likely to have been given solely and cynically to promote the sales of tobacco in Afghanistan. All other donors are of course completely above board, without any ulterior motive, no corporate responsibility brownie points or prospective markets in Afghanistan (the beneficiaries of the fund are Afghan women scholars). Among all the people who have donated money, only the tobacco donation demonstrates the true evil of capitalism, where every apparently generous act is ultimately a selfish one, and all the other donors are innocent philanthropists.

Cancer Research UK funds studies on cancer. I wouldn't claim that its tobacco research forms a significant share of all the research it funds, but Cancer Research UK indicates that applicants for research grants in tobacco must follow a research agenda that favours tobacco restrictions. This seems to me back to front: announcing the policy prescriptions of the research before research has been done. In order to get the research money you have to accept a certain conclusion before even starting. You will get money for twisting the data to fit CRUK's ideas about tobacco policy, but not for mounting an effective challenge to it. For example, such a challenge could point out that if policies are too restrictive, criminals will get a foothold on the market with unregulated tobacco, which is potentially more dangerous to human health than regulated tobacco.

This is why I would quarrel with Cancer Research UK's claim that 'tobacco cash is bad for your moral health'. Cancer Research UK has no brief to lecture people about their morals. I don't consider their conditions for tobacco research grants particularly ethical.

New Zealand tables move to ban tobacco displays

After a long struggle with retailers, the New Zealand cabinet has approved anti-tobacco measures including a ban on the display of tobacco in shops. The measure will go to Parliament in a bill and, if passed, will be implemented next year.

Previously New Zealand had declined to implement a display ban citing lack of evidence and expense. It is unclear what has changed. The drive appears to come from the Maori affairs select committee and the associate health minister Tarania Turia, who is confident that New Zealand can become smoke free by 2025.

The only UK report on New Zealand's plans to eradicate smoking is in the Telegraph: readers don't seem very impressed, judging by comments left. The plans are criticised by both tobacco companies (BAT NZ) and retailers as they are likely to fuel the already thriving illicit market.

ASH Scotland's vision of a new dawn

For some reason my pc won't cope with pdfs just now, so I went to another place to read the new Beyond Smoke-Free document issued yesterday by ASH Scotland. Surprisingly it doesn't describe a smoke-free Scotland, but one in which tobacco is increasingly regulated. They are less ambitious than I thought, and the name of the document is definitely a misnomer (they are still at the stage of 'Towards Smoke-Free').

The opening image shows a family of four blissfully jogging in the sunshine. I think the implication is meant to be that smokers don't (or perhaps can't) jog.

A brief summary of the doc is as follows.

Part 1: Prevention
Short term
More youth involvement in prevention initiatives
Targets for young people post-2014
Prevention work at local level
Display ban
Tackle illicit tobacco
Tobacco control issues included in Curriculum for Excellence

Medium term
Further reduce visibility: promote law in the UK for standardised, unbranded packaging
Money seized from smuggling to go to youth prevention initiatives
Award scheme for retailers that choose not to sell tobacco

(note: 'TOBACCO IS UNIQUELY DANGEROUS ... it is not a normal product and should not be sold as such': I am not sure if this is thought be a scientific claim.)

Part 2: Cessation
Short term
Already effective and cost effective but more needs to be done: evidenced based, wide variety of solutions should be offered
Service should be more accessible to hard-to-reach groups
Create quality standards and identify gaps in training provision
Engage in evidenced based social marketing to highlight the dangers of  taking up smoking at any age
Encourage government to replace information about tar and nicotine content with general information about the dangers of smoking and where to go for advice on giving up
Tax increases 5% per year

Medium term
All health professionals should be able to discuss smoking with their clients
All health professionals trained in discussion of tobacco and appropriate referral
Support for developments in smoking cessation

Long term
Significant increase in price of hand rolling tobacco and prohibiting tax and duty free tobacco in the UK

Part 3: Second hand smoke exposure
Short term
Extend laws to areas currently covered by exemptions (prisons, mental health facilities)
Social marketing campaigns to increase people's awareness of the dangers of smoking in vehicles
Interventions to prevent smoking in the home, provision of training in implementing such measures
Consultation on legislation to ban smoking in vehicles
Targets for zero exposure at home and in vehicles: awareness raising

Medium term
All health and education institutions to have smoke-free grounds
Effective harm reduction strategies (e.g. NRT to stop people smoking at home)

Long term
Further limitations to exposure

Part 4: Government, society and industry
Short term
Develop a multi-agency national tobacco strategy for each area of Scotland
Transparent reporting on tobacco interests in article with Article 5.3 of the FCTC
Develop reduced ignition propensity cigarettes: four out of 10 home fire deaths result from tobacco smoking – ensuring that tobacco industry has no say in health policy and no increase in customer base

Medium term
Scottish Government will continue to influence UK government on tobacco control
Government will regulate tobacco promotion, marketing, information provision and sale
More tobacco industry accountability on ingredients
Use influence with developing country partners such as Malawi to improve conditions of tobacco growers, with the aim of cultivating other crops instead.

Long term
Tobacco industry to be made more accountable, tobacco proceeds to finance tobacco control.

***

Well there you have it. One or two measures, affecting packaging, product information and the availability of duty-free products, are reserved issues and cannot be taken forward by Scotland alone.

The issue of what information goes on to a pack of tobacco is included in the present consultation on revising the EU tobacco products directive, which is worth looking at: they wish to get a green card from the whole of Europe to maximise government regulation at a Europe-wide level. You can download the consultation here, and anyone can respond.

Please note that the removal of exemptions in the smoking ban legislation is included as a short-term aim. I don't know whether it includes long-stay hospices or care homes, or only the mental health facilities that we already know are under threat.

LA through the eyes of a resident smoker

We've all read about how badly smokers are treated in California. Here is an eye witness account from a smoker, Juliette, in a guest blog post.

Juliette's own blog is here.

Saving Lives

ASH (Action on Smoking and Health) Scotland today celebrates the news that the public supports 'legislation to support the country's tobacco-related death toll'. Their press release, describing polls which apparently give anti-tobacco a ringing endorsement, declares full public support for all anti-tobacco measures including the tobacco display ban (pending the results of a Court judgement). Sheila Duffy declares:

There is much we can do to reduce the 13,500 deaths caused by smoking each year, prevent young people starting, and help smokers to quit. 

Her figure for smoking related deaths should be noted. I am not clear how these figures are gathered. Another piece of writing from 2004 looks forward to the ban. In it, Dr Mac Armstrong declares that it would save 1,000 lives a year in Glasgow alone. The toll for 'estimated' smoking-related deaths at 13,000, however, is lower than the one supplied by Sheila Duffy, two years before the ban came in.


Both figures have in fact been floating around for the last few years, but there is no sign of 1,000 lives a year being saved. (Whether by coincidence or not, this figure was also given as the toll of passive smokers killed every year by secondary smoke: the ones the legislation was meant to protect.) And let's not forget this story, that heart attack rates went down 17 per cent following the smoking ban: now made nonsense by the fact that the English are claiming only a 2.4 per drop in heart attacks as a result of the smoking ban.


It is not known exactly most people die, and it is impossible to come up with precise numbers for a potential factor in a death, like smoking. What is certain is that the smoking ban hasn't dramatically altered the death rate in any of the ways we were led to believe it would.