Karen A Evans-Reeves, Anna B Gilmore and Andy Rowell
Tobacco Control Research Group, University of Bath,
The tobacco industry is under attack. In just two weeks, in May 2016, its tactic of challenging any law that threatens its profits, took a big hit. The arbitration panel, that tobacco giant Philip Morris International (PMI) had hoped would overturn standardised packaging legislation in Australia, published its full ruling that the company’s self-serving claims were inadmissible. Just days later, all four major tobacco companies lost their challenges against both the European Union’s Tobacco Products Directive and standardised packaging legislation in the UK.
This means that from 20 May 2017 EU member states must ensure that health warnings cover 65% of the tobacco pack and are free to introduce standardised packaging for tobacco products. The UK, France and Ireland, which have already enacted standardised packaging legislation, will now go ahead with this brand removal. Further afield Canada, New Zealand, Hungary and Norway are due to follow suit and other countries which have expressed an interest will be buoyed by the way the industry’s legal and trade challenges to plain packs are being soundly rejected. The World Health Organization’s (WHO) slogan for World No Tobacco Day 2016 was “Get Ready for Plain Packaging” recognising that the removal of branded tobacco packaging is “going global.”
Each jurisdiction to consider standardised packaging legislation has received sustained attacks from tobacco companies, using both their own voices and those of third parties which they fund. By commissioning and publicising research reports and opinions from seemingly independent experts, tobacco companies have created not only the impression of a large network of opposition but of an illusory body of evidence, particularly in relation to the industry argument that standardised packaging will increase the illicit tobacco trade.
Key to the industry’s use of third parties is its attempt to shift the paradigm by presenting third parties as ‘independent experts’ and their research as ‘trustworthy and rigorous’ while simultaneously positioning public health academics as ‘advocates’ and ‘zealots’ and their research as ‘advocacy’. This presentation of corporate pawns as informed moderates producing quality work and public health researchers as misguided fundamentalists producing poor quality work is a public relations tactic employed for decades by corporations in relation to environmental and health issues.
Over the last few weeks this tactic has been adopted by the tobacco industry third party, ITIC, in a series of letters sent to Non-Governmental Organisations (South East Asia Tobacco Control Alliance (SEATCA), ASH (UK), EU SmokeFree Partnership), the University of Bath in the UK, and the Editors of Tobacco Control, all of whom had criticised ITIC’s activities, some in letters, reports and webpages. ITIC’s letters made three inter-related claims, each of which we explore in the paragraphs below.
First, that public health research should be seen as advocacy while, by contrast, ITIC’s research (none of which appears to be peer-reviewed) should be seen as high quality. For example, in his letter to the University of Bath the President of ITIC, Daniel Witt, claimed:
“We have become increasingly concerned about how the integrity of reputable institutions and individuals is maligned by overzealous advocacy ….. and ….by what passes for academic research when it is clearly constructed to fulfil an advocacy agenda”.
This denigration of public health research has been strongly criticised by independent experts. In her 2006 verdict in an extortion case against the tobacco industry in the United States Judge Gladys Kessler noted:
“Much of the Defendants’ [i.e. the tobacco industry’s] criticisms of Government witnesses focused on the fact that these witnesses had been long-time, devoted members of “the public health community.” To suggest that they were presenting inaccurate, untruthful, or unreliable testimony because they had spent their professional lives trying to improve the public health of this country is patently absurd”.
The recent high court ruling on the challenges made by British American Tobacco, PMI, Japan Tobacco International and Imperial Tobacco to UK standardised packaging legislation made a similar point, citing Sir Cyril Chantler’s 2015 review of the evidence:
“Chantler … rejected the criticism made by the tobacco companies that those that advised the Government were biased against the industry. Conversely, he articulated scepticism about the methodological efficacy of research results generated by the tobacco companies. He also criticised the tobacco companies for adopting unrealistic criticisms of the output of existing researchers…”
ITIC’s second claim is that it is not a lobby group. Yet based on widely accepted definitions of lobbying, ITIC’s own descriptions of its activities, and the global health communities’ observations of its behaviour, ITIC clearly acts as a lobbying organisation. Indeed, it has persistently boasted of its lobbying success. in 1995, ITIC produced a document which outlined how “ITIC has developed trusted, advisory relationships with key, senior-level policy makers…..[which]…provide channels for private sector expertise to reach the Government before, during and after the official policy-making process. This combination…… provides ITIC and its sponsors a ‘seat at the policy-making table’”. And in 2004, Daniel Witt, ITIC’s President noted: “ITIC is a public policy organization actively working to change public policy in a pro-investment direction.” Although ITIC claims to be an “independent, non-profit research and educational organization” it receives tobacco company funding and has industry representatives on its Board of Directors. Outputs such as the Asia-11 and Asia-14 illicit trade indicator studies, commissioned by PMI and published by ITIC along with global advisory firm Oxford Economics, have been critiqued by Dr Hana Ross (on behalf of SEATCA) for opaque methodology and “unverifiable” results that were “inconsistent with results from other studies” in the region (for more on this issue, read here). In 2014, ITIC was blasted by the WHO for its underhand attempt to destabilise the proposed guidelines on tobacco tax and price policy by convening a meeting with Parties and Observers to the Framework Convention on Tobacco Control (FCTC) immediately prior to the sixth Conference of the Parties (COP6).
Finally, in each letter, ITIC’s President, Daniel Witt argues that public health organisations ought to engage with ITIC given its tax expertise. This position displays a fundamental misunderstanding of the FCTC’s Article 5.3 which aims to protect policy making from the vested interests of the tobacco industry. It also displays a fundamental lack of understanding of public attitudes to ITIC. For example, the World Bank withdrew from an ITIC event in India, following a letter from the Institute of Public Health in the country, similarly, following a letter from ASH (UK), the UK Department for International Development (DfiD) asked ITIC to remove its name, from its list of sponsors on ITIC’s website as DfiD has never been a sponsor, and the WHO has urged all governments not to engage with ITIC.
SEATCA and the University of Bath have respectively published and sent to ITIC detailed rebuttals of ITIC’s letters to them. These rebuttals and the aforementioned high court rulings are unlikely to deter ITIC from trying to influence tobacco control policies such as standardised packaging across the globe and undermining Article 5.3 of the FCTC. But the more people who reject engagement with ITIC, the harder it will be for ITIC to boast that it can get its tobacco industry clients a “seat at the policy making table”.
Latin America, and the global tobacco control community, lost a champion of public health on 1 May 2016. Yul Francisco Dorado was born in Popayán, in southwest Colombia, where he completed his studies in Law and Political Science. At a young age he became interested in the right to health and environment. He became a key leader in the fight against tobacco in Latin America.
With a postgraduate degree in Public Law, he moved to Chile and worked for Consumers International. In 2003, he returned to his native Columbia, where he later established the Latin America regional office of Corporate Accountability International.
Over the last 13 years, he devoted himself to contributing to the creation of national and international networks for tobacco control, as well as the protection of the right to water and healthy environment. His dedicated work as an advocate led him to find a way not only among international organisations, but also among health authorities, the media and general public opinion, for Latin America to trigger alarms on the epidemic of tobacco-related disease and death.
He was a key figure in the movement within Latin America to implement the standards and laws provided by the WHO Framework Convention on Tobacco Control. He worked energetically on high impact campaigns to prevent tobacco consumption, especially among minors. Every year, on May 31, Yul Francisco addressed the media to promote a message during the celebration of the World No Tobacco Day.
Governmental entities understood Yul Francisco’s fight, not only in Colombia, but at an international level. Before he joined Corporate Accountability International in 2005 as Director for Latin America, he worked for Consumers International, supervising and supporting the ratification and implementation processes of the FCTC in Chile, Colombia, Ecuador, Guatemala and Costa Rica.
He travelled all around the world, bringing a message of solidarity and friendship to all meetings, winning the affection and recognition of several international organizations.
Yul Francisco Dorado was a determined leader, teacher and relentless health advocate. His work will live on through his many friends and colleagues who have learned from, and been inspired by him.
Dr Vera Luiza da Costa e Silva, Head of the FCTC Convention Secretariat, paid tribute to his legacy:
“Yul’s impact on the tobacco control movement has, and will undoubtedly continue to save millions of lives. His work has ensured that people are valued above the profits of the tobacco industry and that this industry will no longer be allowed to have a voice in public health policy. Yul will be sorely missed and our COP meetings will never be the same as they will miss his kind and strong presence. Nevertheless, his legacy will live on for its support to the WHO Framework Convention on Tobacco Control”.
Yul’s colleage at Corporate Accountability International Patti Lynn, expressed the personal sadness of many of his friends and colleagues:
“Yul Francisco Dorado, our beloved Latin America Director and dear friend, died on 1 May after a life that touched and inspired so many of us. Yul was recently diagnosed with cancer, and was in Bogota with his family. He was surrounded by love and left in peace. Yul loved life. He loved his family – they were his heart and strength and joy. His colleagues became dear friends and there are so many of us around the world that have learned from and loved Yul. Today is a sad sad day and our hearts are breaking. All of our hearts and prayers are with Yul’s family now. And even through our tears we see Yul’s smile.
We think of how he believed we could accomplish what seemed impossible. And we are deeply grateful for the spirit and determination that he brought to the corporate accountability and tobacco control movements. The FCTC and its implementation are so much stronger for Yul’s work and vision. And we who worked alongside, knew and love Yul are stronger too. We will continue to believe in and accomplish what seems impossible is his spirit. And we will be here for each other now, with care and warmth as he would, to support all who love him through this incredibly sad time.”
Yul Francisco Dorado is survived by his wife and three sons.
Click here to read a celebration of his life by Corporate Accountability International Executive Director Patti Lynn
Video interview with Yul at the 2012 World Conference on Tobacco or Health, speaking about an award for Coporate Accountability International’s work:
This year for World No Tobacco Day, the World Health Organization is urging governments to build on advertising and promotion bans by introducing plain packaging of tobacco products.
The measure is the next logical step in stripping away any hint of glamour associated with smoking. It is also an important way of preventing packaging creating misleading suggestions of some tobacco products being less harmful. There is also evidence that plain packaging enhances the impact of graphic health warnings.
Evidence from Australia, the first country in the world to introduce plain packaging, demonstrates the effectiveness. The UK has now introduced plain packaging. Ireland and France have passed plain packaging legislation, and several other countries are set to follow.
Despite tentative progress in recent years, Germany has historically been one of Europe’s poster children for tobacco control legislative failure. That reputation may begin to change from 20 May, when gory pictures of black lungs, dead bodies and other consequences of smoking will be plastered over two thirds of the surface area of cigarette packs, in line with European Union regulations.
Although some smoke free legislation is in place, lax advertising restrictions have allowed tobacco companies to continue to use advertising billboards in Germany – one of only two European countries which have not yet outlawed such a blatant violation of the FCTC. Even neighbouring Austria, the perennial ‘rogue state’ of European tobacco control, does not allow cigarette billboards.
According to the German Cancer Research Center, 121,000 people die from smoking-related causes each year, representing 13.5% of all deaths in Germany. There are significant regional variations in the country, with the percentage of smoking-related deaths as high as 23% in some places.
The introduction of graphic health warnings signals a pivotal moment which it is hoped will be the beginning of serious tobacco control legislation and the inexorable decline of smoking in Germany.
Ranking of 34 European countries in 2013 according to the Tobacco Control Scale. See http://www.europeancancerleagues.org/images/TobaccoControl/TCS_2013_in_Europe_13-03-14_final_1.pdf
Chris Bostic, Richard Daynard and Tamar Lawrence-Samuel
The history of the Framework Convention on Tobacco Control (FCTC) is filled with one unprecedented victory after another (see page 21). The next milestone for the treaty can—and should— tap the potential of Article 19 to hold the industry liable. Though the implementation of measures in line with Articles 5.3 and 13 has dramatically shifted the way the tobacco industry can operate globally, Article 19 has similar—if not greater—potential to curb the operations of the industry, and therefore the tobacco epidemic. As we look to the next Conference of the Parties (COP) in November, Parties should be looking to make sure that Article 19 achieves its potential.
For many who participated in the drafting of the FCTC, Article 5.3 (protecting public health policies from the tobacco industry) and Article 13 (banning tobacco advertising, promotion and sponsorship) seemed too visionary. Many thought these articles would be politically and technically impossible to implement. But a decade later, Parties are prioritizing these articles— and the effects are startling. Today, tobacco industry marketing is being rolled back across the globe. And dozens of countries have barred the industry from the policymaking table, creating space for effective policies to take hold.
But still the industry continues to be enormously profitable, with the top six corporations raking in $44 billion of profits in 2013. This, in part, because it breaks national laws and is not held accountable for what its products cost society. Governments pay billions of dollars in healthcare costs due to the tobacco epidemic. And evidence continues to mount of the tobacco industry’s illegal activities, which it currently appears to engage in with relative impunity—from illicit trade to widespread and systematic bribery.
To take the next big step in reducing the industry-driven tobacco epidemic, we must be able to hold the industry civilly and criminally liable. We must appreciate the visionary potential in Article 19. And we must take bold, courageous action to realize the world that Article 19 can make possible.
A vast ocean of possibility
Successful civil liability litigation in the U.S. and Canada has proven this tactic has great, global potential. It can provide an avenue for governments to hold the industry accountable for breaking laws, whether it be illegal marketing practices or illicit trade. Financially, it can shift the cost of the tobacco epidemic to the industry, where it belongs, raise the price of tobacco products (which reduces consumption), and provide funds for tobacco control campaigns. And finally, civil liability suits can expose internal industry documents, which provide invaluable insight into the industry’s tactics and help pave the way for even more effective legislation and litigation.
Holding the tobacco industry criminally liable, on the other hand, is admittedly venturing into less tested waters. But the ocean of possibility is vast.
Research on criminal liability provides cause for hope. A successful criminal prosecution would dramatically change the landscape for the tobacco industry. Tobacco executives could face potential prison time for violating tobacco control laws or for misleading people about the lethality of their products. The negative publicity generated with such charges would go far in denormalizing the tobacco industry and would chill the recruitment of talent.
Moral and financial imperative
To be sure, successful implementation of liability measures will prove to be challenging. And it will look different in each country given the range of legal systems across Parties. But the moral and financial imperatives are clear. Parties in the Global South, such as those recently targeted by British American Tobacco’s bribery, are now calling for tools to advance Article 19. These are some of the same Parties who championed Articles 5.3 and 13 during the FCTC negotiations.
We can and must follow these Parties’ visionary lead once again. During COP7, Parties should adopt strong guiding principles to advance implementation of Article 19. These include principles for developing and reforming legislation, and best practices for litigating in civil and criminal liability regimes in both civil and common law jurisdictions and systems.
Without a doubt, litigating against the tobacco industry is costly and intimidating. But many governments are already locked in defensive legal battles with the industry as it turns to litigation more and more to undermine strong tobacco control policies around the world. If governments are going to be in court with the industry, they should be doing it on their terms, proactively holding the industry liable for its myriad of abuses. And to do so, they need tools and guidance for implementation of Article 19 from the treaty, the Secretariat, and the COP. We have the ability to bring the untapped potential of Article 19 into fruition and to rein in the tobacco industry as we have never seen before. We have no time to lose. We must act, as a global community, now.
A study published by Tobacco Control in December 2015 by a team of New Zealand and Australian researchers explored extending the concept of plain packaging one step further – to the cigarette stick itself. New Zealand is moving towards introducing plain packaging; incorporating dissuasive cigarette sticks would put it at the forefront of innovative tobacco control measures.
As New Zealand moves towards legislating for plain packaging of cigarettes, the Government should consider measures that extend and improve upon Australia’s model, ASPIRE2025 researchers believe.
In this study, based on an online survey of 313 New Zealand smokers, our researchers and colleagues in Australia have found that cigarette sticks with printed health warnings or unattractive colours could enhance the effects of plain packaging and further reduce the appeal smoking has to young people.
Professor Janet Hoek says the team tested reactions to images of four cigarette sticks that either featured printed warnings or had unattractive colours, such as yellow-brown and green.
“We found that smokers were significantly less likely to choose the test sticks and found all significantly less appealing than the status quo — a white cigarette with a brown filter tip,” she says.
A “minutes of life lost” graphic that went from one minute near the tip up to 15 near the butt had the strongest aversive effect relative to the other sticks tested.
“Requiring cigarette sticks and rolling paper to feature such a graphic, or to be produced in dissuasive colours, would likely increase the impact plain packaging will have on those who smoke, while also deterring others from taking up smoking,” Professor Hoek says.
View a short video about this research here:
Study abstract: Background
Standardised (or ‘plain’) packaging has reduced the appeal of smoking by removing imagery that smokers use to affiliate themselves with the brand they smoke. We examined whether changing the appearance of cigarette sticks could further denormalise smoking and enhance the negative impact of standardised packaging.
We conducted an online study of 313 New Zealand smokers who comprised a Best–Worst Choice experiment and a rating task. The Best–Worst experiment used a 2×3×3×6 orthogonal design to test the following attributes: on-pack warning message, branding level, warning size and stick appearance.
We identified three segments whose members’ choice patterns were strongly influenced by the stick design, warning theme and size, and warning theme, respectively. Each of the dissuasive sticks tested was less preferred and rated as less appealing than the most common stick in use; a ‘minutes of life lost’ stick was the most aversive of the stimuli tested.
Dissuasive sticks could enhance the effect of standardised packaging, particularly among older smokers who are often more heavily addicted and resistant to change. Countries introducing standardised packaging legislation should take the opportunity to denormalise the appearance of cigarette sticks, in addition to removing external tobacco branding from packs and increasing the warning size.
Hoek, J., Gendall, P., Eckert, C., & Louviere, J. (2015). Dissuasive cigarette sticks: the next step in standardised (‘plain’) packaging?. Tobacco control, tobaccocontrol-2015. doi:10.1136/tobaccocontrol-2015-052533
For more information, contact:
Professor Janet Hoek
University of Otago
Across forty years I’ve come to recognise many factoid-driven myths about smoking that just won’t die. If I asked for a dollar each time I had to refute these statements, I’d have accumulated a small fortune.
Their persistence owes much to their being a vehicle for those who utter them to express unvoiced but clear sub-texts that reflect deeply held beliefs about women, the disadvantaged, mental illness, government health campaigns and the “natural”.
Let’s drive a stake through the heart of ten of the most common myths.
1. Women and girls smoke more than men and boys
Women have never smoked more than men. Occasionally, a survey will show one age band where it’s the other way around, but from the earliest mass uptake of smoking in the first decades of last century, men streaked out way ahead of women.
In 1945 in Australia, 72% of men and 26% of women smoked. By 1976, men had fallen to 43% and women had risen to 33%.
As a result, men’s tobacco-caused death rates have always been much higher than those of women. Women’s lung cancer rates, for example, seem unlikely to reach even half the peak rates that we saw among men in the 1970s.
But what about all the “young girls” you can see smoking, I’m always being told. In 2014, 13% of 17-year-old male high school students and 11% of females smoked. In two younger age bands, girls smoked more (by a single percentage point).
Those who keep on insisting girls smoke more are probably just letting their sexist outrage show about noticing girls’ smoking than their ignorance about the data.
2. Quit campaigns don’t work on low socioeconomic smokers
In Australia, 11% of those in the highest quintile of economic advantage smoke, compared with 27.6% in the lowest quintile. More than double.
So does this mean that our quit campaigns “don’t work” on the least well-off?
Smoking prevalence data reflect two things: the proportion of people who ever smoked, and the proportion who quit.
If we look at the most disadvantaged group, we find that a far higher proportion take up smoking than in their more well-to-do counterparts. Only 39.5% have never smoked compared with 50.4% of the most advantaged – see table 9.2.6).
When it comes to quitting, 46% of the most disadvantaged have quit compared to 66% of the least disadvantaged (see table 9.2.9).
There is a higher percentage of the disadvantaged who smoke mainly because more take it up, not because disadvantaged smokers can’t or won’t quit. With 27.6% of the most disadvantaged smoking today, the good news is that nearly three-quarters don’t. Smoking and disadvantage are hardly inseparable.
3. Scare campaigns ‘don’t work’
Countless studies have asked ex-smokers why they stopped and current smokers about why they are trying to stop. I have never seen such a study when there was not daylight between the first reason cited (worry about health consequences) and the second most nominated reason (usually cost).
For example, this national US study covering 13 years showed “concern for your own current or future health” was nominated by 91.6% of ex-smokers as the main reason they quit, compared with 58.7% naming expense and 55.7% being concerned about the impact of their smoking on others.
If information and warnings about the dire consequences of smoking “don’t work”, then from where do all these ex-smokers ever get these top-of-mind concerns? They don’t pop into their heads by magic. They encounter them via anti-smoking campaigns, pack warnings, news stories about research and personal experiences with dying family and friends. The scare campaigns work.
4. Roll-your-own tobacco is more ‘natural’ than factory made
People who smoke rollies often look you in the eye and tell you that factory made cigarettes are full of chemical additives, while roll-your-own tobacco is “natural” – it’s just tobacco. The reasoning here that we are supposed to understand is that it’s these chemicals that are the problem, while the tobacco, being “natural”, is somehow OK.
This myth was first turned very unceremoniously on its head when New Zealand authorities ordered the tobacco companies to provide them with data on the total weight of additives in factory made cigarettes, roll-your-own and pipe tobacco.
For example, data from 1991 supplied by WD & HO Wills showed that in 879,219kg of cigarettes, there was 1,803kg of additives (0.2%). While in 366,036kg of roll-your-own tobacco, there was 82,456kg of additives (22.5%)!
Roll-your-own tobacco is pickled in flavouring and humectant chemicals, the latter being used to keep the tobacco from drying out when smokers expose the tobacco to the air 20 or more times a day when they remove tobacco to roll up a cigarette.
5. Nearly all people with schizophrenia smoke
It’s true that people with mental health problems are much more likely to smoke than those without diagnosed mental health conditions. A meta-analysis of 42 studies on tobacco smoking by those with schizophrenia found an average 62% smoking prevalence (range 14%-88%). But guess which study in these 42 gets cited and quoted far more than any of the others?
If you said the one reporting 88% smoking prevalence you’d be correct. This small 1986 US study of just 277 outpatients with schizophrenia has today been cited a remarkable 1,135 times. With colleagues, I investigated this flagrant example of citation bias (where startling but atypical results stand out in literature searches and get high citations – “wow! This one’s got a high number, let’s quote that one!”).
By googling “How many schizophrenics smoke”, we showed how this percolates into the community via media reports where figures are rounded up in statements such as, “As many as 90% of schizophrenic patients smoke.”
Endlessly repeating that “90%” of those with schizophrenia smoke does these people a real disservice. We would not tolerate such inaccuracy about any other group.
6. Everyone knows the risks of smoking
Knowledge about the risks of smoking can exist at four levels:
Level 1: having heard that smoking increases health risks.
Level 2: being aware that specific diseases are caused by smoking.
Level 3: accurately appreciating the meaning, severity, and probabilities of developing tobacco related diseases.
Level 4: personally accepting that the risks inherent in levels 1–3 apply to one’s own risk of contracting such diseases.
Level 1 knowledge is very high, but as you move up the levels, knowledge and understanding greatly diminish. Very few people, for example, are likely to know that two in three long term smokers will die of a smoking caused disease, nor the average number of years that smokers lose off normal life expectancy.
7. You can reduce the health risks of smoking by just cutting down
It’s true that if you smoke five cigarettes a day rather than 20, your lifetime risk of early death is less (although check the risks for one to four cigarettes a day here).
But trying to “reverse engineer” the risk by just cutting down rather than quitting has been shown in at least four large cohort studies such as this one to confer no harm reduction.
If you want to reduce risk, quitting altogether should be your goal.
8. Air pollution is the real cause of lung cancer
Air pollution is unequivocally a major health risk. By “pollution”, those who make this argument don’t mean natural particulate matter such as pollen and soil dusts, they mean nasty industrial and vehicle pollution.
The most polluted areas of Australia are cities where pollution from industry and motor vehicle emissions are most concentrated. Remote regions of the country are the least polluted, so if we wanted to consider the relative contributions of air pollution and smoking to smoking-caused diseases, an obvious question to ask would be “does the incidence of lung cancer differ between heavily polluted cities and very unpolluted remote areas?”
Yes it does. Lung cancer incidence is highest in Australia in (wait for this …) in the least polluted very remote regions of the country, where smoking prevalence happens also to be highest.
9. Smokers should not try to quit without professional help or drugs
If you ask 100 ex-smokers how they quit, between two-thirds and three-quarters will tell you they quit unaided: on their final successful quit attempt, they did not use nicotine replacement therapy, prescribed drugs, or go to some dedicated smoking cessation clinic or experience the laying on of hands from some alternative medicine therapist. They quit unaided.
So if you ask the question: “What method is used by most successful quitters when they quit?” The answer is cold turkey.
Fine print on this English National Health Service poster states a bald-faced lie by saying that “There are some people who can go cold turkey and stop. But there aren’t many of them.” In the years before nicotine-replacement threapy and other drugs were available, many millions – including heavy smokers – quit smoking without any assistance. That’s a message that the pharmaceutical industry was rather not megaphoned.
Not true. NHS poster.
10. Many smokers live into very old age: so it can’t be that harmful
In just the way that five out of six participants in a round of deadly Russian roulette might proclaim that putting a loaded gun to their head and pulling the trigger caused no harm, those who use this argument are just ignorant of risks and probability.
Many probably buy lottery tickets with the same deep knowing that they have a good chance of winning.
Ten more myths about smoking that will not die
There’s plainly a big appetite for smoking myth busting, so here are 10 more.
1. Today’s smokers are all hard core, addicted smokers who can’t or won’t give up
This claim is the essence of what is known as the “hardening hypothesis”: the idea that decades of effort to motivate smokers to quit has seen all the low-hanging fruit fall from the tree, leaving only deeply addicted, heavy smokers today.
The key index of addicted smoking is the number of cigarettes smoked per day. This creates a small problem for the hardening hypothesis: in nations and states where smoking has reduced most, the average number of cigarettes smoked daily by continuing smokers has gone down, not up. This is exactly the opposite of what the hardening hypothesis would predict if remaining smokers were mostly hard core.
2. Smoking is pleasurable
Repeated studies have found that around 90% of smokers regret having started, and some 40% make an attempt to quit each year. There’s no other product with even a fraction of such customer disloyalty.
But I’m always amused at some die-hard smokers’ efforts explain that they smoke for pleasure and so efforts to persuade them to stop are essentially just anti-hedonistic tirades. Many studies have documented that the “pleasure” of smoking centres around the relief smokers get when they have not smoked for a while. The next nicotine hit takes away the discomfort and craving they have been experiencing.
This argument is a bit like saying that being beaten up every day is something you want to continue with, because hey, it feels so good when the beating stops for a while.
3. Light and mild cigarettes deliver far less tar and nicotine to the smoker than standard varieties
Several nations have outlawed cigarette descriptors such as “light” and “mild” because of evidence that such products do not deliver lower amounts of tar and nicotine to smokers, and so are deceptive.
The allegedly lower yields from cigarettes labelled this way resulted from a massive consumer fraud.
Cigarette manufacturers obtained these low readings by laboratory smoking machine protocols which took a standardized number of puffs, at a standardized puff velocity. The smoke inhaled by the machine was then collected in glass “lungs” behind the machine and the tar and nicotine weighed to give the readings per cigarette.
But the companies didn’t tell smokers two things. So-called light or mild cigarettes had tiny, near-invisible pin-prick perforations just on the filter (see picture). These holes are not covered by the “lips” or “fingers” of the laboratory smoking machine, allowing extra air to be inhaled and thus diluting the dose of tar and nicotine being collected.
But when smokers use these products, two things happen. Their lips and fingers partially occlude the tiny ventilation holes, thus allowing more smoke to be inhaled. Smokers unconsciously “titrate” their smoking to obtain the dose of nicotine that their brain’s addiction centres demand: they can take more puffs, inhale more deeply, leave shorter butt lengths or smoke more cigarettes.
Today, where use of these descriptors has been stopped, the consumer deception continues with the companies using pack colours to loudly hint to smokers about which varieties are “safer”.
Magnification and location of filter ventilation holes. Author collection
4. Filters on cigarettes remove most of the nasty stuff from cigarettes
We’ve all seen the brown stain in a discarded cigarette butt. But what few have seen is how much of that same muck enters the lungs and how much stays there.
This utterly compelling video demonstration shows how ineffective filters are in removing this deadly sludge. A smoker demonstrates holding the smoke in his mouth and then exhales it through a tissue paper, leaving a tell-tale brown stain. He then inhales a drag deep into his lungs, and exhales it into a tissue. The residue is still there, but in a much reduced amount. So where has the remainder gone? It’s still in the lungs!
5. Governments don’t want smoking to fall because they are addicted to tobacco tax and don’t want to kill a goose that lays golden eggs
This is perhaps the silliest and most fiscally illiterate argument we hear about smoking. If governments really want to maximise smoking and tax receipts, they are doing a shockingly bad job of it. Smoking in Australia has fallen almost continuously since the early 1960s. In five of the 11 years to 2011, the Australian government received less tobacco tax receipts than it did the year before (see Table 13.6.6).
Plainly, as smoking continues to decline, diminishing tax returns will occur, although this will be cushioned by the rising population which will include some smokers.
In the meantime, tobacco tax is a win-win for governments and the community. It reduces smoking like nothing else, and it provides substantial transfer of funds from smokers to government for public expenditure.
Those of us who don’t smoke do not squirrel away what we would have otherwise spent on smoking in a jam jar under the bed. We spend it on other goods and services, benefiting the economy too.
6. Most smokers die from smoking caused diseases late in life, and we’ve all got to die from something
Smoking increases the risk of many different diseases, and collectively these take about ten years off normal life expectancy from those who get them.
Smoking is by far the greatest risk factor for lung cancer. In Australia, the average age of death for people with lung cancer is 71.4 (see Table 4.2), while life expectancy is currently 80.1 for men and 84.3 for women.
This means that, on average, men diagnosed with lung cancer lose 8.7 years and women 12.9 years (mean 10.8 years). Of course, some lose many more (Beatle George Harrison died at just 58, Nat King Cole at 45).
If a 20-a-day smoker starts at 17 and dies at 71, 54 years of smoking would see 394,470 cigarettes smoked. At ten puffs per cigarette, that’s some 3.94 million point-blank lung bastings.
It takes about six minutes to smoke a cigarette. So at 20 a day, smokers smoke for two hours each day. Across 54 years, that’s a cumulative 1,644 days of smoking (4.5 years of continual smoking if you put it all together).
So by losing ten years off life expectancy, each cigarette smoked takes about 2.2 times the time it takes to smoke it off the life expectancy that might otherwise have been enjoyed.
7. Smokers cost the health system far more than the government receives from tobacco tax
In June 2015, a senior staff member of Australian libertarian Senator David Leyonhjelm, Helen Dale tweeted:
In Australia, a now old report looking at 2004/05 data estimated the gross health care costs attributable to smoking “before adjustment for savings due to premature death” were $A1.836 billion. In that financial year, the government received $A7,816.35 billion in customs and excise duty and GST on tobacco.
Someone who thought that the fiscal ledger was all that mattered in good government might conclude from this that smokers easily pay their way and perhaps we should even encourage smoking as a citizen’s patriotic duty.
With smokers being considerate enough to die early, these noble citizens lay down their lives early and thus contribute “savings due to premature death” like failing to draw a state pension or needing aged care services late in life. Philip Morris notoriously gave this advice to the new Czech government in 1999.
Other assessments, though, might well point to the values inherent in such assessments. History’s worst regimes have often seen economically non-productive people as human detritus deserving death. Primo Levi’s unforgettable witnessing of this mentality in Auschwitz comes to mind.
8. Big Tobacco is starting to invade low-income nations, now that smoking is on the wane in the wealthiest nations
Sorry, but US and British manufacturers have been aggressively marketing cigarettes in places such as China since the early years of last century. These collectable posters show many featuring Chinese women.
The large populations, the often lax tobacco-control policies and the higher corruption indexes of many low- and middle-income nations makes many of these nirvanas for Big Tobacco.
There are fewer more nauseating experiences than reading the corporate social responsibility reports of tobacco transnationals and then seeing how they operate in smokers’ paradises such as Indonesia. This documentary says it all.
9. Millions of cigarette butts on the world’s beaches leach lots of toxic chemicals into oceans
Cigarette butts are the most discarded items in all litter. Every year uncounted millions if not billions are washed down gutters in storm water and find their way into rivers, harbours and oceans. Cigarette filters and butts contain toxic residue and experiments have shown that placing laboratory fish in containers for 48 hours with leachate extracted from used cigarette butts, 50% of the fish die. From this, we sometimes hear people exclaim that cigarette butts are not just unsightly, but they “poison the oceans”.
But a confined laboratory container does not remotely mirror real life exposures in oceans or rivers. There are some 1,338,000,000 cubic kilometers of water in the world oceans, so the contribution of cigarette butts to the toxification of all this could only excite a homeopath.
If we want to reduce tobacco litter, we need not wander into such dubious justifications. The best way by far is to keep reducing smoking. Industry attempts at portraying themselves as corporately responsible by running dinky little clean-up campaigns or distributing personal butt disposal canisters avoids their efforts to keep as many smoking as possible.
10. Tobacco companies care deeply about their best customers dying early
Naturally, all businesses would rather their customers lived as long as possible so that the cash registers can keep ringing out long and loud. Tobacco companies wish their products didn’t kill so many, but worship the god nicotine for its iron grip on so many.
Visit any tobacco transnational’s website and you will find lots of earnest and caring talk about the companies’ dedication to doing all they can to reduce the terrible harm caused by their products. All the major companies have now invested heavily in electronic cigarettes, so isn’t this a sign that they taking harm reduction seriously?
It might be if the same companies were showing any sign of taking their feet off the turbo-drive accelerator of opposing effective tobacco control policies. But they are doing nothing of the sort. All continue to aggressively attack and delay any policy like tax hikes, graphic health warnings, plain packaging and advertising bans wherever in the world these are planned for introduction.
For all their unctuous hand-wringing about their mission to reduce harm, they are all utterly determined to keep as many smoking as possible. Big Tobacco’s business plan is not smoking or ecigarettes. It’s smoking and ecigarettes. Smoke when you are able to, vape when you can’t. It’s called dual use and some 70% of vapers are doing just that. The tragedy now playing out in some nations is that too many gormless tobacco control experts are blind to this big picture.
The tobacco industry lost the health argument 50 years ago, and in the past decade the WHO Framework Convention on Tobacco Control (FCTC) developed the antidote to reverse the smoking epidemic. However the tobacco industry is stepping up direct attacks, particularly at WHO. Recently the industry took pot shots yet again at WHO and the FCTC Conference of the Parties (COP) in its mouthpiece, Tobacco Reporter. The article, (Snail Mail, Jan 2016) makes several ludicrous accusations against both WHO and the COP but ends up only incriminating itself. We pull quotes from the article and provide our response.
TR: “Most of the besuited classes that turn up at COP7 will have few insights into the lives of the financially impoverished people who tend to make up the world’s smokers.”
SEATCA: In reality the tobacco industry has been making billions in profits from selling cigarettes to financially impoverished people all over the world. Eighty percent of the world’s 1.2 billion smokers are in developing countries http://www.who.int/mediacentre/factsheets/fs339/en/. Studies have shown that in the poorest households in many low-income countries, spending on tobacco products often represents more than 10% of total household expenditure http://www.who.int/tobacco/research/economics/rationale/poverty/en/. Don’t forget the famous response from the R.J. Reynolds executive when asked why he didn’t smoke: “We don’t smoke that shit! We just sell it. We reserve the right to smoke for the young, the poor, the black and the stupid.”
TR: “People who turn up at COP7 will almost certainly be well-fed and cossetted”
SEATCA: Government officials make up the bulk of the delegates who attend the COP and it seems the industry has no qualms insulting them.
TR: “Wonder whether these smokers really want to trade in what is possibly one of the few enjoyments they have for the few extra years of poverty and struggle …”
SEATCA: Most smokers started smoking when they were still minors and did not know any better. Most smokers (70%) want to quit. What the industry refers to flippantly as “few enjoyments” actually leads to illness for many million smokers. Worldwide, about 6 million people die each year , often painfully, because of smoking. This not only affects smokers – it devastates families, emotionally and financially.
TR: “There are far too many people demonizing smokers…”
SEATCA: The FCTC does not demonise smokers. It does the reverse to help smokers quit. Smokers are addicted to nicotine and exposed to the thousands of harmful chemical compounds in the product. Two out three of the tobacco industry’s long term customers die prematurely because of their smoking, however the industry continues to push this harmful product. FCTC measures are aimed squarely at the industry, protecting non-smokers and supporting smokers to quit.
TR: “… making decisions about cigarette smoking without understanding it.”
SEATCA: There is no misunderstanding because the evidence is in – cigarette smoke contains 7,000 chemical compounds, many of which are carcinogenic.
TR: “People choose to smoke.”
SEATCA: Nicotine addiction is not a choice. Most smokers want to quit but find it hard – the addiction is potent displaying similarities to hard drugs such as cocaine and heroin. For decades, the tobacco industry denied or downplayed the harms of tobacco, and it has engineered its products to enhance their addictiveness. It has fought regulations to protect non-smokers from cigarette smoke, restrictions on advertising, and health warnings to inform the public about the danger of smoking.
The WHO is fulfilling its responsibility to support 180 governments’ obligation to implement the FCTC to reduce tobacco use and reverse the smoking epidemic to save lives. An industry that continues to peddle a product that kills has lost the basic concept of humanity.
Shame on the tobacco industry for exploiting the poor and taking pot shots at the WHO and the COP.
A series of emotional and hard-hitting television ads have been launched in the UK to tell the stories of real former smokers who have been affected by cancer. The ads detail the trauma of diagnosis, the harrowing treatments that they endured and the emotional and physical toll in their lives.
Maggie, a 60 year old former heavy smoker who was diagnosed with mouth cancer when she was 45, says “never in a million years did I think I would get cancer…I never thought for one moment it would be me”. In order to remove the cancer, she had to have one side of her mouth removed and now needs to wear an obturator – a prosthesis in her mouth with false teeth and a piece to replace the roof of her mouth – which allows her to eat and talk.
The ‘16’ in the campaign refers to 16 types of cancers that can be caused by smoking. It aims to raise awareness about some of the lesser-known health impacts among smokers, and inspire them to quit to reduce their risk of developing smoking-related cancers. As Maggie says in the video, although she knew about lung cancer, she had never heard of mouth cancer. She discusses understanding that people enjoy a cigarette, and she did too, but “when I look back at what I had to go through, was it worth it? No. Definitely not.”
Tony, a 55 year old who had to have much of the inside of his neck removed when he was diagnosed with laryngeal cancer talks about how he used to spend a lot of time swimming “but now I can’t because if water does get in there, it’s just straight into the lungs….it’s affected all my life. Everything I used to do, I can’t do anymore.”