Tobacco.org

• Judith Mackay: brandishing a sword for health 

In the 25 years that Judith Mackay has been fighting the tobacco industry, she has been described as dogmatic, meddlesome, puritanical and "psychotic human garbage." Jane Parry finds out the truth

Judith Mackay typically starts her day with a session of t’ai chi. Her teacher is strict and demands high standards from her students, but the discipline suits Mackay, as does t’ai chi’s emphasis on harmony and balance.

Mackay, originally from Yorkshire, has lived in Hong Kong for 42 years, and credits living in an Asian society with teaching her about the value of negotiation over confrontation. Despite her reputation as a terrier at the heels of the tobacco industry, she sees herself as an advocate for good rather than an adversary of harm. She sees herself as a promoter of public wellbeing, helping governments and individuals to make decisions that are in the interests of good health.

The shift from activist to advocate happened in the 1980s, when she started working with governments in Asia, particularly China, as a World Health Organization consultant. Since then her name has long been synonymous with persuading governments in the region to adopt tobacco control.

When Mackay turned her attention fully to tobacco control in 1984, she worked alone. . . .

Dr Mackay subsequently became active in the women’s movement, and the transition from working in a hospital to working in tobacco control came with the realisation that smoking was a bigger threat to women’s health than gynaecological problems.

Her first role in tobacco control in 1984 was as founder and director of the Asian Consultancy on Tobacco Control. Then in 1987 to 1989 she was the founding director of the Council on Smoking and Health, subsidised by the Hong Kong government, after which, in 2001, she became a senior policy adviser for the WHO Tobacco-Free Initiative, a position that she still holds. In 2006 she began working with the World Lung Foundation on the Bloomberg Initiative.

At 65, Mackay shows no signs of putting her career on the back burner

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Promoting hand washing, stroke prevention, and tobacco control are recognised at BMJ Group award ceremony 

Ten awards were given, culminating in the Lifetime Achievement award, given to Judith Mackay, a leader in the battle to control tobacco and a woman once described by the tobacco industry as "one of the three most dangerous people in the world," an accolade that Professor Mackay has since worn with pride. . . .

Philanthropists have a long and honourable tradition in medicine, but few have contributed on the scale of Bill and Melinda Gates, whose philanthropy rivals the gross domestic product of a small country. Their foundation was the winner of the Global Leadership award, for focusing attention on the healthcare challenges in developing countries and pouring millions of dollars a year into initiatives such as eradicating polio, tackling neglected tropical diseases, and reducing tobacco use.

Alas, neither Bill nor Melinda was present to receive the award, but a spokeswoman for the foundation said that nothing could have been achieved without its partners, "the key to our success in global health."

A stunning roster of high achievers competed for the final award of the evening, the Lifetime Achievement award, which was voted on by readers on bmj.com. Judith Longstaff Mackay, who has lived in Hong Kong since 1967, first heard the call to campaign against tobacco in 1984.

Reflecting on those days, she said it had been a lonely job at the start. "There were no job opportunities, no pay, and I faced the opposition of the tobacco companies," she said. She had been heartened by support from bodies such as ASH and the Bloomberg Foundation. A consultant to the World Health Organization, she was instrumental in developing WHO's framework convention on tobacco control, to which more than 162 countries are now signed up.

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• Anti-smoking campaigner is decorated for 25-year Asian crusade 

A Hong Kong anti-smoking campaigner who for a quarter of a century has been a thorn in the side of the tobacco industry in Asia was Sunday celebrating a major international award for her crusading work. Dr Judith Mackay, labeled one of the three most dangerous people in the world in a leaked tobacco industry document in the 1980s, has received the British Medical Journal Group's first ever lifetime achievement award.

She topped a poll of 10 shortlisted candidates including world-famous heart surgeon Professor Sir Magdi Yacoub, pioneering US kidney doctor Dr Robert William Shrier and Indian rural health campaigner Dr Hanumappa Sudarshan.

The prestigious publication, which attracted more than 7,000 votes for its poll, praised Mackay for her "tireless and courageous campaigning on behalf of patients and public health."

She has been fighting for tougher tobacco controls in Asia since 1984.

The award recognized her as "one of the first tobacco control advocates in Asia" and said she had played a "leading role" in advancing public policy, articulating the harms of tobacco and "exposing the nefarious tactics of the tobacco industry."

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Lung health warning 

Policymakers need to step up efforts to cut smoking rates in Asia to prevent an "epidemic" of tobacco-related lung disease, medical experts have said at a conference in Mumbai.

Many Asian countries have seen a surge in tobacco use in the last decade, particularly among the young and in urban areas as a result of economic growth. A rise in smoking by women has also been noted.

But ignorance of the health risks remain, especially among the rural poor, while overall tobacco use is adding an economic burden to countries in terms of healthcare and insurance costs plus lost productivity through illness.

Matthew Peters, head of thoracic medicine at Sydney's Concord Hospital, told the 14th World Conference on Tobacco or Health that there were "real and material healthcare benefits" for countries to encourage people to quit.

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Tobacco firms ‘obstructing global treaty’ 

THE tobacco industry in Southeast Asia is “systematically obstructing” the implementation of a global treaty on curbing smoking and tobacco use, a regional advocacy network warns.�

Since it took effect in 2005, the implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in the region has been undermined by “insidious tactics” of Big Tobacco, the Bangkok-based Southeast Asia Tobacco Control Alliance (Seatca) said.

“The abuses of corporations like Philip Morris International, British American Tobacco and Japan Tobacco International have ranged from attempting to write tobacco-control laws and blocking the passage of key legislations in the Philippines, Laos and Cambodia, and using so-called corporate social responsibility [CSR] to circumvent laws and regulations in Thailand,�Malaysia, Cambodia and the Philippines,” Seatca said in a press release.

At a panel discussion during the14th World Conference on Tobacco or Health (WCTOH) in Mumbai, Seatca director Bungon Ritthiphakdee said, “Tobacco-industry interference has been the No.1 obstacle to the WHO FCTC implementation, and countries in the Asean and its neighbors now see protections against this interference as the strongest factor of the treaty.” . . .

Seatca’s conference statement said Article 5.3 of the FCTC “is based on the premise that in public health programs, the tobacco industry is the problem, and NOT a stakeholder.”

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Asian countries should curb tobacco ads: experts 

Asian countries need to do more to outlaw tobacco advertising, promotion and sponsorship, as cigarette firms look to the region for lucrative new markets, health professionals were told Tuesday.

Some 60 percent of the world's population and about 65 percent of young people live in Asia, making it a money-spinning area for tobacco companies who have seen demand fall in developed countries.

Yet despite most countries in the region having ratified a World Health Organisation convention on tobacco control, enforcement of advertising bans is patchy, allowing loopholes to be exploited, a conference here heard.

Doctor Pankaj Chaturvedi, a Mumbai-based cancer surgeon and member of the Action Council Against Tobacco (ACT) India lobby group, welcomed steps to ban smoking in public places and to outlaw direct advertising by tobacco firms.

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• Tobacco Industry Blocking Global Treaty On Smoking In Asean Countries 

The tobacco industry in Southeast Asia is systematically obstructing implementation of a global treaty on curbing smoking and tobacco use, a regional advocacy network warned today.

Southeast Asia Tobacco Control Alliance (Seatca) said since it took effect in 2005, implementation of the WHO Framework Convention on Tobacco Control (WHO FCTC) in the region has been undermined by insidious tactics of big tobacco companies.

It said abuses by tobacco corporations have ranged from attempting to write tobacco control laws and blocking the passage of key legislations in the Philippines, Laos and Cambodia, and using so-called "corporate social responsibility" to circumvent laws and regulations in Thailand, Malaysia, Cambodia and the Philippines.

The region's governments have been vulnerable to interference through the industry's lobbying, public relations dealings and CSR activities, Seatca said in a statement.

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AFP: Asian countries should curb tobacco ads: experts 

Asian countries need to do more to outlaw tobacco advertising, promotion and sponsorship, as cigarette firms look to the region for lucrative new markets, health professionals were told Tuesday.

Some 60 percent of the world's population and about 65 percent of young people live in Asia, making it a money-spinning area for tobacco companies who have seen demand fall in developed countries.

Yet despite most countries in the region having ratified a World Health Organisation convention on tobacco control, enforcement of advertising bans is patchy, allowing loopholes to be exploited, a conference here heard.

Doctor Pankaj Chaturvedi, a Mumbai-based cancer surgeon and member of the Action Council Against Tobacco (ACT) India lobby group, welcomed steps to ban smoking in public places and to outlaw direct advertising by tobacco firms.

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Health Condemn Tobacco Use 

LOCAL and international health experts want Uganda and other developing countries to curb tobacco smoking and reduce salt intake to stem cancer, diabetes, respiratory and heart diseases.

The ailments classified as lifestyle diseases are fast becoming epidemics and will account for 70% of deaths in a few years the experts warned. They said that the problem is global but the hardest-hit are are the poorest and the middle-income countries of Africa and Asia. . . .

The experts were meeting in an International Summit on Chronic Disease at the Kampala Serena Hotel.

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• “Key to the Future”: British American Tobacco and Cigarette Smuggling in China 

Background

Cigarette smuggling is a major public health issue, stimulating increased tobacco consumption and undermining tobacco control measures. China is the ultimate prize among tobacco's emerging markets, and is also believed to have the world's largest cigarette smuggling problem. Previous work has demonstrated the complicity of British American Tobacco (BAT) in this illicit trade within Asia and the former Soviet Union.

Methods and Findings

This paper analyses internal documents of BAT available on site from the Guildford Depository and online from the BAT Document Archive. Documents dating from the early 1900s to 2003 were searched and indexed on a specially designed project database to enable the construction of an historical narrative. Document analysis incorporated several validation techniques within a hermeneutic process. This paper describes the huge scale of this illicit trade in China, amounting to billions of (United States) dollars in sales, and the key supply routes by which it has been conducted. It examines BAT's efforts to optimise earnings by restructuring operations, and controlling the supply chain and pricing of smuggled cigarettes.

Conclusions

Our research shows that smuggling has been strategically critical to BAT's ongoing efforts to penetrate the Chinese market, and to its overall goal to become the leading company within an increasingly global industry. These findings support the need for concerted efforts to strengthen global collaboration to combat cigarette smuggling.

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• No ifs or butts  

For the past 25 years, Dr Mackay has been pushing for changes in countries where smoking is regarded as a lifestyle choice rather than a health hazard. And in recognition of those efforts, she will be made an OBE by Queen Elizabeth in a ceremony at Buckingham Palace today.

In her official capacity, she is the senior policy adviser to the World Health Organisation and senior adviser to the World Lung Foundation (WLF). The latter is responsible for taking care of the multimillion-dollar grant from Bloomberg Philanthropies, a fund set up by New York Mayor Michael Bloomberg to encourage tobacco control in poor countries.

In short, she is one of the three "most dangerous" people as far as the tobacco industry is concerned (the others are American campaigner Mike Pertschuk and Canadian Garfield Mahood).

Dr Mackay came to Hong Kong in 1967 after finishing her medical studies and has lived here ever since. Her anti-tobacco efforts began in 1984, when she quit her job at United Christian Hospital after seeing too many patients dying from smoking-related diseases. She decided she could save more lives by helping cut tobacco use.

Her battle began in earnest when she joined the Hong Kong Council on Smoking and Health . . .

Dr Mackay says her most rewarding achievement is the WHO Framework Convention on Tobacco Control, a milestone in the field and only achieved after she lobbied then WHO director general Gro Harlem Brundtland to make it a priority. . . .

"But, in the past eight years, Hong Kong has been lagging behind others in terms of taxation. We have not raised the tobacco tax to a significant level."

She intends to lobby for a "plain packaging" law for cigarettes, meaning that the pack can only carry the brand name and a health warning.

Dr Mackay says her success is due to three elements, being "determined, optimistic and realistic". . . .

She said tobacco control should be top of the agenda for Beijing because mainland smokers consumed one in three of the world's cigarettes.

Dr Mackay said another impact of the Bloomberg initiative is that it created a profession and a paid career path for tobacco control personnel.

Her position with the WLF is her first paid job since she left the Hong Kong Council on Smoking and Health.

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Periodontal Health Status in Pan Chewers With or Without the use of Tobacco 

Conclusions: The results show higher incidence of periodontal diseases in pan chewers who use tobacco compared with pan chewers who do not use tobacco. Based on the results, it was concluded that, although betel nut has deleterious effects on the periodontium, the addition of tobacco leads to a synergistic effect between betel nut and tobacco on the periodontal tissues.

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Role For Gefitinib In Asian Nonsmokers With Lung Cancer Established 

The targeted therapy gefitinib should be considered a first-line therapy for non-smoking Asian patients with adenocarcinoma of the lung, one of the most common types of lung cancer, suggests a presentation at the 33rd Congress of the European Society for Medical Oncology (ESMO) in Stockholm.

Asia has a high proportion of lung cancer patients who are non-smokers, a significant proportion of whom develop a form of cancer known as adenocarcinoma.

"Around 50% to 60% of this population have tumors with mutations in the epidermal growth factor receptor, and we know that patients with such mutations have a significantly better treatment outcome with gefitinib," said researcher Prof. Tony Mok from the Chinese University of Hong Kong.

"Currently, gefitinib and other EGFR tyrosine kinase inhibitors are considered as second line therapy for advanced non-small-cell lung cancers, meaning that the drugs should only be used after cancers fail to respond to the standard cytotoxic chemotherapy."

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Astra's cancer drug Iressa helps Asian non-smokers  

AstraZeneca's cancer drug Iressa should be considered as a first-line therapy for non-smoking Asian patients who develop a common type of lung cancer, researchers said on Monday.

Iressa was once viewed as a likely blockbuster for AstraZeneca but a 2004 study showed that it only helped a small proportion of lung cancer patients. It is sold mainly in Asia and worldwide sales in the first half totalled $125 million.

Asia has a relatively high number of lung cancer patients who are non-smokers, a significant proportion of whom develop a form of cancer known as adenocarcinoma.

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Asian Countries Back Policies to Cut Tobacco Use 

The World Health Organization says health ministers from 11 South and Southeast Asian countries have promised to promote policies to combat the use of tobacco, which claims more than one million lives in the region every year. Anjana Pasricha reports from New Delhi.

The World Health Organization says 500 million young people between the ages of 10 and 24 in South and South East Asian countries are being aggressively targeted by the tobacco industry to make them first-time tobacco users.

Smokers may be giving up cigarettes for other forms of tobacco, such as cigars and roll-your-own brands

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