Tobacco.org

• CORCORAN: Ottawa's fruit-flavoured tobacco bomb 

The result was Bill C-32, officially titled The Cracking Down on Tobacco Marketing Aimed at Youth Act -- a misnomer if ever there was one. Today, a year later, what Mr. Harper's Conservatives have delivered instead is an over-the-top law that threatens a global trade war and another bonanza for Canada's already out-of-control contraband cigarette market.

The trade-war potential gathered momentum earlier this month when, according to Inside US Trade, the United States joined Argentina, Mexico, Switzerland, the European Union and other nations in opposition to Ottawa's new anti-bubble-gum tobacco law. At a meeting in Geneva, the nations said Canada's law would restrict trade in regular tobacco products to the benefit of Canadian tobacco producers.

The more immediate impact of the law, however, is a ban on the sale in Canada of virtually all brands of U.S. cigarettes. Guess where that leads? The logical result of a ban on legal imports of Marlboros and Winstons is new demand for illegal supplies through the burgeoning Native-dominated contraband market, a tax-evading multi-billion-dollar industry that already accounts for between 33% to 50% of the Canadian cigarette market. . . .

While this may look like another case of unintended consequences run amok, it more likely is part of deliberate scheming by Health Canada officials and others who are consciously using fruit-flavoured smokes to create a global tobacco trade bomb against the U.S. and tobacco industries in Europe, South America and Asia. . . .

Still, Bill C-32 became law, even though Senator Segal abstained over the trade issue. As a result, Mr. Harper's opportunistic election gimmick, aimed at curbing the use of flavoured tobacco to children, will do nothing to protect children. By further enhancing the power and scope of the contraband market, it will only increase the supply of illegal cigarettes, a prime source of tobacco to the young. At the same time, the government has launched a protectionist scheme that threatens a trade conflict.

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• EDITORIAL: Cigarette Smoking and Bladder Cancer: A New Twist in an Old Saga?  

So far, the changing carcinogenic properties of cigarettes have been studied most extensively for lung cancer, and it is known that this risk has increased over time (13). Furthermore, the relative risks of mortality from "other smoking-related cancers" increased for both men (RR = 2.7 to 3.5) and women (RR = 1.8 to 2.6) when a cohort established in 1959, with follow-up through 1965, and another cohort established in 1982, with follow-up through 1988, were compared (14). In cohort studies carried out in the United States, that reported the RR for current smokers relative to nonsmokers in relation to bladder cancer incidence. No increase in the association was observed in successive and overlapping cohorts in Washington County, Maryland (RR = 2.7 for bladder cancer incidence in current smokers relative to nonsmokers in the first cohort, followed from 1963 to 1988; RR = 2.6 in the second cohort, followed from 1975 to 1994) (15). A similar relative risk (RR = 2.9) was reported in a Hawaiian cohort followed from 1966 to 1988 (16). In a few recent cohort studies, reported RRs of bladder cancer incidence among current smokers relative to nonsmokers were notably higher: 5.7 in Seventh Day Adventists followed from 1976 to 1982 (17) and 5.5 in the Iowa Women's Health Study cohort followed from 1986 to 1998 (18). This evidence is equivocal but certainly does not rule out that the association has grown stronger over time.

The findings of Baris et al. (7) are provocative and are accompanied by a tenable hypothesis. Recalling the steady accumulation of evidence and the cautious inferences that eventually led to the determination that smoking causes bladder cancer, these intriguing findings offer a testable hypothesis that warrants thorough investigation. An important element of this research will be to more precisely, pinpoint the specific role of cigarette additives will be an important element of this research. This study highlights the need for continued vigilance in monitoring the impact of changing cigarette content and design on disease risk, and demonstrates that the public health implications of the changing cigarette content and design are potentially severe.

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• EDITORIAL: Illegal cigarettes can't be ignored  

It is in society's obvious interest, then, to crack down on the rampant trade in contraband cigarettes. And, in fairness, some efforts have been made. Brennan and Benzie report that a law enforcement trial project, in which U.S. and Canadian officers worked side by side this summer on Canadian Coast Guard vessels, led to more efficient cross-border patrolling. Such joint operations should become permanent.

Other ideas include restricting raw materials for large-scale cigarette-making to those with a valid manufacturers' licence and working with native groups to bring about a First Nations tobacco tax equal to the province's. It might also help if government did more work to promote alternate – and legitimate – economic pursuits in First Nations reserves, thereby easing dependence on illegal activities.

The illicit tobacco trade didn't appear overnight, and it won't be easily eliminated. But more could surely be done to stanch this dirty business, to protect both government revenues and public health.

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• EDITORIAL: Hoosiers burned in smoke study 

It is safe to say Hoosiers do not look forward to the release of national health rankings with quite the same eagerness folks in Florida and Texas harbor for the weekly round of football polls.

The latest survey, covering one of our several "strong" categories, is out. We ought to be more than disappointed to be number two.

Consistently in the top 10 year after year, Indiana trailed only West Virginia in the percentage of adults using cigarettes in 2008, according to a report released Thursday by the Centers for Disease Control and Prevention. . . .

The Indiana General Assembly couldn't muster the willpower this past session to join the 26 states with comprehensive smoking bans, but Rep. Charlie Brown, D-Gary, vows to renew his push next year.

The City-County Council is close to mustering enough votes to join more than 300 cities with total smoking prohibitions; but sadly, Mayor Greg Ballard says he would veto such a measure for the sake of local business. His stance ignores ample evidence that going smoke-free is not hazardous to the health of bars and eateries.

We do know that smoking -- and, critically important, secondhand smoke -- are killers. And that we arm them, as individuals, as communities and as governments.

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• Editorial - Lebanon has yet to tackle killer smoke 

Even though many other countries have already passed Lebanon by on the issue, and even though a conference blooming with well-meaning rhetoric is no guarantee of future action, it certainly was praiseworthy for the Health Ministry and its National Tobacco Control Program to agitate last week for a comprehensive ban on smoking in public places.

Before even addressing the stale arguments over whether a ban would encroach on personal freedom, a prohibition makes sense purely to keep more humans alive and cut health-care expenses from this country's already catastrophic budget . . .

In case any doubt remains over the meaning of universal protection, we only have to note the smoking bans lately adopted in Bahrain, Syria, Israel, Iraq, Qatar, Turkey and the UAE. Put another way, Lebanon has now fallen behind all those countries on a major human-rights issue - yes, Lebanon has fallen behind Syria in liberating its citizens to be free of murderous second-hand smoke in public places.

But we here in our glass house at The Daily Star should not be the first to cast stones. To illustrate the hurdles a welcome and overdue ban would face, we at the newspaper enjoy a smoke-free work environment - until 9 p.m. Even this would-be watchdog of the public interest seems to respect human rights only some of the time.

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• EDITORIAL: Pass the Atlantic City casino smoking ban 

The legislature, after allowing casinos to escape the statewide indoor smoking ban in 2006, has refused to close this loophole. Lawmakers continually have chosen casino balance sheets over the health of the average Joe. But this is a moral, not economic issue: What amount of money makes it acceptable to put people's lives at risk?

We know the answer: None.

And that's why there's a tobacco stain on New Jersey's soul.

The Atlantic City council has a second chance to do the right thing and pass a casino smoking ban immediately. . . .

Opponents of the ban insist gambling and drinking and smoking go together. Well, actually, they don't. Studies have found that the majority of gamblers don't drink and 82 percent of them don't smoke.

Through all of the debate, one argument remains indisputable: Second-hand smoke kills.

But in New Jersey, cash trumps cancer risks.

"A 100 percent smoking ban would be catastrophic," said Mark Juliano, CEO of Trump Entertainment Resorts. "Right now, we can't face another negative."

Since when is saving lives a negative?

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• Editorial : A righteous war on evil weed  

Four hundred years ago this year, John Rolfe, an enterprising 24-year-old from Norfolk, arrived in the fledgling settlement of Jamestown in the English colony of Virginia. A canny businessman despite his tender years, he saw a chance to make a few bob on an old plant, genus Nicotiana, widely referred to at the time as "brown gold". . .

The tobacco companies will assuredly not answer the call to appear before the committee - fronting up is not in their corporate nature - but Harawira's determination to put the acid on them deserves applause.

It is also in tune with pressure on tobacco coming from other quarters. A Public Health Association conference in Dunedin this month discussed proposals to license tobacco retailers; to ban sales near schools; to require plain packaging bearing only health warnings; and make it easier to sue tobacco firms.

Campaigners are fond of referring to this as the "endgame" of tobacco and are talking about ending the sale of the substance within a decade. It sounds ludicrous, but it makes sense: this is a product which, used in accordance with the manufacturers' instructions, is always harmful to health and typically lethal. If it were invented today, it would be banned.

The tiny Himalayan kingdom of Bhutan became the world's first smokefree nation when it banned the sale and public consumption of tobacco almost five years ago. People who argue that it couldn't happen here should think again. In 1980, no one would have imagined this country would have smokefree workplaces, never mind bars.

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• EDITORIAL: Blowing Smoke 

On Wednesday evening, the student organization Hopkins Kicks Butts met to discuss its proposal that the University move ashtrays away from the doorways of campus buildings in order to prevent secondhand smoke from overwhelming students on their way to classes . . .

As a private university, Hopkins certainly has the right to ban smoking on campus. But perhaps we do not need to go that far just yet.

Smokers: The News-Letter will continue to support your right to smoke on campus. In exchange, please respect the rights of non-smokers.

Why don't you voluntarily move away from the doorways while smoking? Standing there and allowing smoke to enter campus buildings and the lungs of your non-smoking peers will only ignite tensions that will ultimately result in a campus-wide ban.

And hey, while you're at it, try to quit.

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• EDITORIAL: Unhealthy business 

Once again the profit motive may trump the government in its efforts to improve the general health of the nation. The government had announced the introduction of pictorial health warnings on cigarette packs and had given the industry a six-month deadline to print them as from January 1st 2010; thus joining 30 other countries having similar warnings. . . .

It is reported that a series of meetings between industry representatives and senior officials of the health department has been held in an effort to slow down the implementation of the requirement for pictorial warnings on packets. . . .

We are a desperately unhealthy nation with a poor spread of primary healthcare services; and an even poorer spread of specialist oncology units. The causal linkage between smoking, cancers, and respiratory illness is well known. Our implementation of anti-smoking legislation has been patchy at best and as the tobacco producers are on the retreat in the developed world; they are increasingly focused on the undeveloped and developing world to extend their market footprint. We hope that the government will hold the line and not cave in to assorted pressures. This is sensible governance and clearly to the ultimate benefit of the entire population. Smoking kills - pictorial warnings on packets may lead to fewer of us dying of tobacco-related disease; and we have scant sympathy for the tobacco lobby.

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• Editorial - Cigarette Ban With a Loophole 

The problem with the law is that it did not clearly define what a cigarette is. Traditional definitions revolve around the wrapping. Cigarettes are wrapped in paper; cigars are wrapped in tobacco leaves or paper constituted from tobacco. That seems like a trivial basis for deciding which products may be flavored and which may not.

So far, F.D.A. officials have been deliberately vague in stating whether the ban applies to flavored small cigars that seem comparable to cigarettes and to so-called cigarillos, which are slightly larger but still smaller than traditional cigars.

The agency wisely warned manufacturers that it was examining options to regulate both menthol cigarettes and flavored tobacco products other than cigarettes. It makes no sense to ban flavors in cigarettes and then allow the industry to addict young people to flavored cigars.

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• EDITORIAL: Our view on cigarettes and public health: Bans on outdoor smoking cross a line in the sand  

Scores of municipalities have barred smoking in outdoor public places. Now New York is discussing a ban in its hundreds of parks and 14 miles of beaches. But the rationale that supported earlier bans — to protect non-smokers from the ill effects of secondhand smoke — is missing. . . .

To be harmed by secondhand smoke outdoors, you have to stand right next to the smoker and in the path of his smoke. Prolonged exposure in a park is improbable . . .

Government-imposed outdoor bans, though, are another matter. Rather than protecting innocent victims from harm, they amount to an intolerant majority infringing the personal freedom of an unpopular minority that is harming only itself. Just as people should be allowed to smoke in their own homes (unless they live in condos or apartments that have declared themselves smoke-free), they should also be allowed to smoke outdoors, where smoke is quickly dissipated and enforcement is problematic. And though some smokers regard beaches as giant ashtrays, that's best dealt with through littering laws, not prohibitions.

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• EDITORIAL: It's Not All Smoke  

For the most part, their argument isn't convincing. The law, to take one provision to which the plaintiffs object, requires an increase in the size and severity of warning labels on cigarette packs. The new labels would replace the relatively tame, outdated and small cautionary notes that have appeared on cigarette packaging for decades, appropriately warning consumers -- and, more important, potential consumers -- of the risks of using a uniquely harmful product. It's reasonable to insist that the warnings be made more prominent.

But one aspect of the law seems more problematic, especially given that courts have expanded protections for commercial speech in the past decade or so. The law bars tobacco companies from claiming that one product is less harmful than another unless the FDA determines it's true. So far, so good: Just as the FDA regulates what can be said about the safety and efficacy of prescription drugs, it should have the authority to assess the scientific basis for claims about tobacco products. But the law then goes one step further, specifying that the FDA can't sign off on such claims unless doing so would benefit the health of the population as a whole. Even true speech, in other words, might be banned. The government, which has yet to submit its defense to the lawsuit, will have to make clear why such a stiff restriction on commercial speech is justified and necessary to achieve its goals.

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• Editorial - Big Tobacco Strikes Back 

It didn't take long for tobacco companies to try to evade tough new restrictions on their ability to market to young people. Less than three months after a landmark federal law granted the Food and Drug Administration power to regulate tobacco products, several of the industry's biggest companies filed suit in tobacco-friendly Kentucky. They contend that the law's marketing provisions infringe their commercial free-speech rights.

For the sake of the public's health, we hope this suit is the last gasp of an industry that has a long, sorry history of pretending to market only to adults while surreptitiously targeting young people. . . .

On public health grounds, the tobacco industry does not deserve much latitude to promote its deadly products with colorful images, as opposed to black-and-white text. In a 2006 opinion based on company documents, Federal District Judge Gladys Kessler found that tobacco companies had marketed to young people "while consistently, publicly, and falsely, denying they do so."

Now, the courts must decide how much this rogue industry may be restrained. The health of millions of impressionable young people rides on the outcome.

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• EDITORIAL: COPD—more than just tobacco smoke 

On Sept 12—16, Vienna hosts the European Respiratory Society's annual congress, the largest in pulmonary medicine in the world. As a prelude to the meeting, The Lancet today is devoted to chronic obstructive pulmonary disease (COPD). WHO estimates that 210 million people have COPD worldwide. This number could be higher because many people with COPD often do not seek medical help until the disease worsens. COPD is now an umbrella term to cover emphysema and chronic bronchitis, among others, all of which used to be considered separate conditions. The disease is the fourth leading cause of death in the world, but by 2030 it is expected to be the third, behind ischaemic heart disease and cerebrovascular disease.

With such a high burden, emphasis on better diagnosis, management, and identification of at-risk groups must be achieved . . .

For a long time COPD has been thought of as a smokers' disease, and not without reason. Those who smoke damage their lungs and create the pathophysiological environment for this disease. However, as Holger Schünemann points out in a Comment in today's issue, a worldwide ban on tobacco would indeed benefit health substantially both at the population and individual level—yet the world is not ready for such a bold ban. Sundeep Salvi and Barnes explore the aetiology of COPD and highlight the need for greater focus on risk factors other than smoking. They argue that smoking is not the biggest risk factor for COPD, and that this has been reported as early as 1963. Interest in COPD in non-smokers has increased in the past 5 years, although smoking has still remained the emphasis of most research. . . .

Chronic asthma is also of interest because it carries a greater risk of developing COPD than that caused by smoking. If asthma development is on the increase around the world, COPD incidence is likely to increase as well, perhaps even more so than the current predictions. Biomass fuel (coal, wood, and charcoal) has an exposed population of 3 billion, compared with 1 billion for those exposed to tobacco—making such fuel an important target in COPD prevention. This problem is not just one for developing countries. Even if over half of those who have COPD are non-smokers, the battle against smoking and health promotion to quit smoking should continue. However, the identification and education of those who are at risk from other inhalation exposures, both at home and at work, especially in developing countries, also needs to become a priority.

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• EDITORIAL: Big Brother behind the smoke  

In the spring of 2008, the Tobacco Institute of Japan together with the associations of tobacco retailers and vending machine manufacturers introduced Taspo, "tobacco passport." At the time, the system seemed a reasonable enough solution to one of Japan's perennial problems -- underage smoking. However, Taspo now is reported to have found a new use -- helping investigators track down the movements of criminal suspects.

The Tobacco Institute of Japan, which oversees the Taspo system, revealed recently that personal data and records of specific tobacco purchases at Taspo-required vending machines were handed over to public prosecutors. . . .

One has to wonder whether the accumulation of data by businesses is for marketing research or for other purposes. When even the purchase of a pack of cigarettes becomes part of an information database, the surveillance of people's private lives by technological means has gone too far.

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