A proposal of effective complementary measures to WHO Framework Convention on Tobacco Control [FCTC]

Luka Solmajer, a tobacco control advocate and pharmacist from Slovenia shares his views on why the economic aspects of tobacco control need urgent action.

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In the year 2010 over 5,000,000 people died because they were addicted to tobacco products. They lost on average 9 years of life and several more years of good health and active life,  so – one would think – there should be very clear, strong economic measures on hand to fight this plague.

When we define smoking as an activity rarely done voluntarily with devastating health effects, we should ask ourselves, how could it be that this product still remains so profitable for the producers and sellers?  Is the WHO FCTC covering the economic aspects of tobacco control in an effective way? As a framework convention, the purpose is to encourage countries to cooperate, confirm a lowest common denominator and then step by step move in a positive direction. However, even a country that has ratified the agreement and has relatively good legislation may experience stalled progress in decreasing smoking prevalence or worse, see increases in smoking rates.

What could guarantee further progress better than to economically discourage the production and sales of tobacco products?

I think a simple measure is available: any country in the world that wants to tackle the smoking problem seriously and efficiently needs to prioritise decreasing the profitability of production and sales of tobacco products to the maximum feasible extent. This can be done by forcing the purveyors of this harmful addiction to pay for the loss of life, the higher health care costs, and loss of work associated with their product. It can be done by implementing incredibly high taxes on tobacco industry profits. The state must take >90% of the industry’s declared profits and put the money back into health and social services in order to compensate for the great loss of life and harm done by tobacco products. For far too long the tobacco industry has profited from addicting, disabling and killing people and it has used the money to influence politicians and lawmakers to its advantage.

Tobacco production and selling should not be profitable due to the high damage to the people and the state.

What could happen if a country decided to do as specified above and really make tobacco unprofitable? There would be huge opposition from the industry, but then the companies would stop their activities and go elsewhere, where they will still be able reap the profits. But once other countries do the same, they will have nowhere left to go. Millions of people will live longer and healthier lives.

I strongly believe this is the equivalent of making tobacco products illegal, without actually doing so. The only counterargument I can think of is the threat the toxic tobacco industry will make about the emergence of black markets and counterfeit cigarettes, but this is only a potential problem there are very effective measures to prevent it. And even if there would be a flourishing black market for cigarettes, it would never be as large and as a harmful as the present state.

Luka Solmajer

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What do you think? Will governments be willing to adopt such a system? Will it lead to fewer smokers?

Share your thoughts below in the comments section.

  • timbone

    “In the year 2010 over 5,000,000 people died because they were addicted to tobacco products.” May I rephrase that? “In the year 2010 over 5,000,000 people died who also enjoyed tobacco products”. A slightly different perspective. In the year 2010 many peoploe died who did not partake of tobacco products.

  • Luka wrote, “The state must take >90% of the industry’s declared profits and put the money back into health and social services” Actually I believe that at least in the US and the UK that would require a drastic tax cut. At the moment in the US, I believe a pack of cigarettes gives a tobacco company somewhere between 25 cents and 50 cents profit, while the government takes about 300 cents ($3) profit on average.

    So yes, I could see it being reasonable to cut tobacco taxes drastically in order to meet this demand. As a side benefit such a move would reduce the burden of poverty on the poor that smoke and also restore some sense of fairness and faith in rightness of government taxation systems. If you read the material at:

    http://pasan.thetruthisalie.co

    you will see that even five to ten years ago, under a much less oppressive tax regime, smokers were being inordinately taxed. The situation today is far worse since taxes have skyrocketed and new studies on obesity and smoking have put their overall medical costs to society even lower since studies indicate smokers and the obese die earlier — not a good thing obviously, but taxes are not an arbiter of good or bad: they're supposed to be economically determined.

    Michael J. McFadden
    Author of “Dissecting Antismokers' Brains”

  • chaswin

    The rate of people over 75 is set to double in the next couple of decades and the dementia rate is also expected to double. Eat, drink, smoke and enjoy life or else spend any extra years with dementia.

  • Man has since its birth has looked to a way of artificially improving his/her mood. I read recently that in Spain “magic” mushrooms were depicted on cave painting murals from 6,000 BC and some African cave paintings from 30,000 years ago are thought from the 'Z' shapes to depict the hallucinations from ingesting a local plant. Tobacco is first recorded in Egypt 2,000 BC, alcohol 7,000 BC in China and cocaine in South America 4,000 BC. You cannot disinvent these drugs and while they can be grown will always be consumed.

    Around 80% of the price of a packet of cigarettes is taxation in the UK. The upper estimates due to the Laffer Curve of illegal and legal importation is 30% of tobacco sales. Prohibition of alcohol in the USA 1919 to 1933 was a criminal, social and economic disaster. I would much rather the production of tobacco was in the hands of responsible, legitimate manufacturers rather than the raw drugs Columbia and Afghanistan growers of cocaine and heroin produce. I was reading recently a paper where after 20 years daily consumption of crack cocaine and heroin, 66% of addicts have major health problems. Heart failure, cancer and major organ failures. Tobacco like skunk a highly concentrated form of Cannabis may go this way too. There was a night in Christmas Eve 1926 in the USA when poisoned alcohol led to the death of 31 people. This was the source.

    “Frustrated that people continued to consume so much alcohol even after it was banned, federal officials had decided to try a different kind of enforcement. They ordered the poisoning of industrial alcohols manufactured in the United States, products regularly stolen by bootleggers and resold as drinkable spirits. The idea was to scare people into giving up illicit drinking. Instead, by the time Prohibition ended in 1933, the federal poisoning program, by some estimates, had killed at least 10,000 people.”

    As JD Rockefeller noted as someone who was for Prohibition that it had turned honest citizens into criminals and people proudly and openly defied the law. The USA in the last 40 years has spent $1 trillion in trying to curb class A drugs and has seen the death of millions of people from turf wars and consumption. For what purpose? Cocaine was only made made illegal in the UK in 1917 and Sir Arthur Conan-Doyle who created the fictional character Sherlock Holmes depicted him as a regular user of cocaine at 226 Baker Street. Hitherto there was not a social problem.

    History is full of well meaning but misguided prohibitionists, tobacco seems to have adopted its own idealogues and disciples. Act in haste, repent in leisure.

    http://www.slate.com/id/224518

  • George

    I agree that tobacco should be less profitable – to the government. I'm doing my bit by growing my own.
    Regulate that!

  • CyZane

    In Canada they have pushed taxation to such levels that they have created an out of control contraband problem that no, there are no effective measures to neither stop it or prevent it in the future. It is estimated that between 40 – 50% of all smoked tobacco in the provinces of Ontario and Quebec are untaxed native and counterfeit products that are delivered to children to their school yards for about $15.00 – $20.00 a carton of 200 cigarettes. You can get them as cheap as $10.00 per carton if you know where to go.

    These products undergo no quality control, carry no mandated Canadian warnings, are sold to anyone whether of age or not and they allegedly sustain criminal and even terrorist activities.

    Is that what tobacco control wants for the rest of the world too? Already in New York and some other states contraband is becoming a serious problem. Tobacco will never be eradicated as it can easily be grown anywhere. The only thing that pushing for more taxes is accomplishing, is to shift it to the underground market. And yes, it most definitely can have more devastating effects than the controlled legal tobacco market.

  • Are car manufacturers and industries that are poisoning the population to be taxed as heavily ?

  • Becky Freeman

    “Smoking increases the risk of Alzheimer's disease by almost a factor of 2. So contrary to the widely held view that smoking actually protects people from Alzheimer's, it actually increases the risk of the disease,” says Dr. Stanton Glantz, co-author of a study published in the Journal of Alzheimer's Disease.

    http://www.alzheimersweekly.co

  • Becky Freeman

    A reminder that if your post contains personal attacks or insults directed at the author or other readers, it will not be posted. Very happy to post differing opinions as long as they are written respectfully.

  • Charles

    It depends on who you believe.

  • CyZane

    Quite an amazing finding when you consider that Glantz & al came to an insignificant 1.05 OR even after having cherry picked the studies to exclude all those studies authored by researchers that could have been even remotely linked to past or current affiliations with the tobacco industry within 10 years of their study's publication. Never mind that some, or maybe even all, of the ''chosen'' studies that were retained could have been funded by competing pharmaceutical interests, only tobacco industry money can bias a study according to these authors!

    Tobacco control is going to have to do much better to debunk the known positive effects of smoked nicotine on the brain. http://dengulenegl.dk/English/

  • Janine Cataldo

    Hi I'm one of the authors of the paper on smoking and Alzheimer's disease (AD)that is being discussed here. For five years we searched the literature and found a total of 43 studies that evaluated smoking as a risk factor for AD and when we did the analysis on all of the studies we found the 1.05 RR that you mention.
    It is true –if you simply combined all 43 studies in a single random effects meta-analysis, you would obtain an INACCURATE null result (risk ratio = 1.05; 95% CI 0.91-1.20). All of the studies together said there was no significant relationship between smoking and AD. BUT if you take into consideration whether the study used a strong design such as a Cohort study that follows people over time (giving more meaningful results) rather than a weaker design (case-study design) and whether or not the authors were affiliated with the tobacco industry you get a very different picture and a very different result. We found that the average risk of AD for cohort studies without tobacco industry affiliation of average quality was estimated to be 1.72+0.19 (P<.0005). The available data indicate that smoking is a significant risk factor for Alzheimer’s disease.
    Since we published that paper, several new studies have come out. One, in October 2010, by Rusanen et al. in the Archives of Internal Medicine – In a huge study of 21,123 patients, they found that heavy smoking in midlife was associated with a greater than 100% increase in risk of dementia and AD, more than 2 decades later. These results show that the brain is not immune to long-term consequences of heavy smoking
    http://ca-ppi.org/documents/ar

    For the last two decades, the tobacco industry has been actively funding research that supports the position that cigarette smoking protects against AD, and for the past two decades, the scientific literature has reported conflicting results as to the direction of the association between smoking and AD.

    The Bottom Line : Smoking is a Significant Risk Factor for Alzheimer's Disease

  • Chris Snowdon

    Hi Janine,

    The tobacco industry obviously has an incentive to fund studies that show the benefits of nicotine, just as your colleague Stanton Glantz has an incentive to show that there are no benefits from smoking. I doubt that Glantz's emotional involvement with the tobacco control movement is any less passionate than the industry's desire to stay in business.

    You discard what you say claim are industry-funded studies simply because they are industry-funded. Have you any actual criticisms to make of the studies themselves or is this a form of scientific ad hominem? I expect industry-funded studies to be more likely to produce pro-tobacco conclusions, and I expect studies funded (or led) by anti-smoking advocates to produce anti-tobacco conclusions, but I am not prepared to dismiss either purely because of the source of funding.

    There is a significant amount of evidence that nicotine can be of benefit to Alzheimer's sufferers (eg. http://chembio-newsarchive.umd… which is being pursued by pharmaceutical companies, so it is far from implausible that smoking would have a positive effect on neurological diseases. I understand that there are always biases in terms of researcher bias and funding bias. That is a given. I don't trust any source, I prefer to trust the evidence. Your study seems to rely entirely on trusting sources and I'm not sure I trust your definition of 'industry-funded' nor your definition of what constitutes a 'quality' journal.

  • Hello Janine! Thank you for coming into the discussion yourself as that should make clarity much easier to achieve.
    '
    Since the issue of affiliation and funding seems to play a big role in the Alzheimer's study question, I guess there's no harm in asking as to whether you or the other authors of your paper have ever received funding from sources that might be considered to have a bias in the way the data was gathered or the results developed. It would also be helpful to see the grant proposal that underlay the funding for the work as I have found that in at least some cases grant proposals will promise the grantor study results that will support the grantor's efforts.
    '
    I note that in the other study you referenced, the Financial Disclosures state >> “Dr Kivipelto received honoraria for serving on the scientific advisory board of Elan and Pfizer and serves as a speaker on scientific meetings organized by Janssen, Novartis, and Pfizer.” <<
    '
    Do any of those companies have any funding or other relations with the tobacco or nicotine replacement industries that might render their work questionable or have prevented its inclusion in the meta-analysis if it had been finished earlier?
    '
    Also: while I can see the rationale for excluding studies that might have had connections with tobacco, nicotine replacement, or antitobacco funding sources, the justification for excluding the 18 case-control studies seems to be far weaker, particularly since their inclusion, with a non-significant pooled odds ratio of .91, might have seriously impacted your final conclusion in a direction contrary to that shown by the 14 cohort studies. Is it usual in meta-analytical work to simply discard case-control research when it disagrees with cohort research?
    '
    Thank you again for joining us and addressing these questions yourself as it makes the discussion far more valuable.

    – MJM

  • Belinda345

    I think it would be a very good idea to take the profits out of pharmaceuticals as well. Why should anyone profit from drug manufacture? it sets up a conflict of interest surely.

  • Was heavy drinking as a confounder taken into account?

  • I have just had a quick look and alcohol is a confounder.

    If you do like cohorts, which I do, as case controlled studies in ETS lead to misclassification, I assume you look upon the Enstrom/Kabat paper, published in the BMJ as being highly authoritative? 118,084 participants over a 38 year period, does this get anymore accurate?

    “Participants 118 094 adults enrolled in late 1959 in the American Cancer Society cancer prevention study (CPS I), who were followed until 1998. Particular focus is on the 35 561 never smokers who had a spouse in the study with known smoking habits.”

    “Conclusions The results do not support a causal relation between environmental tobacco smoke and tobacco related mortality, although they do not rule out a small effect. The association between exposure to environmental tobacco smoke and coronary heart disease and lung cancer may be considerably weaker than generally believed.”

    “The US Environmental Protection Agency has classified environmental tobacco smoke as a known human carcinogen. Chronic obstructive pulmonary disease, primarily asthma, bronchitis, and emphysema, has been associated with exposure to environmental tobacco smoke, but the evidence for increased mortality is sparse.”

    http://www.bmj.com/content/326

  • The report says “Compared with nonsmokers, those smoking more than 2 packs a day had an elevated risk of dementia (adjusted hazard ratio [HR], 2.14; 95% CI, 1.65-2.78), AD (adjusted HR, 2.57; 95% CI, 1.63-4.03), and VaD (adjusted HR, 2.72; 95% CI, 1.20-6.18).”

    “Those smoking more than 2 packs a day.”

    What were the results for 1 pack a day, what was the results for 0.5 packs a day and those who smoked lightly, cigars and pipes. Is there also any data for snus?

    Is the reason that they did not come up with the right results?

    Many friends of mine are committed smokers and even I do not know many who smoke 2 packs a day. Those that I know of tend to have underlying socio-mental issues, was this a confounder?

  • I believe it is fair to note for the record that Janine Cataldo, who worked with Stanton Glantz on the study about Alzheimer's Disease, stopped in here to say this:

    “For the last two decades, the tobacco industry has been actively funding research that supports the position that cigarette smoking protects against AD, and for the past two decades, the scientific literature has reported conflicting results as to the direction of the association between smoking and AD.”

    but has refused to offer any response to the questions that were posed back to her, including this:

    “Since the issue of affiliation and funding seems to play a big role in the Alzheimer's study question, I guess there's no harm in asking as to whether you or the other authors of your paper have ever received funding from sources that might be considered to have a bias in the way the data was gathered or the results developed. It would also be helpful to see the grant proposal that underlay the funding for the work as I have found that in at least some cases grant proposals will promise the grantor study results that will support the grantor's efforts. “

    The question was politely posed, and quite appropriate in light of Ms. Cataldo's own statement, but it has been well over a month at this point, and I believe Ms. Cataldo knows of the request, and yet she has declined to continue her participation and provide a proper response to either this or the other questions raised.

    – MJM

  • Luka wrote, “What could happen if a country decided to do as specified above and really make tobacco unprofitable? There would be huge opposition from the industry, but then the companies would stop their activities and go elsewhere, where they will still be able reap the profits. But once other countries do the same, they will have nowhere left to go…”

    Very interesting idea. Imagine if governments tried doing such a thing with heroin, cocaine, marijuana etc! And, to paraphrase something I just read here somewhere, “The only counterargument I can think of is the threat the drug industry will make about the emergence of black markets and harmful/adulterated/over-concentrated-overdose drugs, but this is only a potential problem there are very effective measures to prevent it.”

    Using government to enforce social behaviors is like using guns in arguments. You should never pull out a gun unless the potential damage from doing so is justified by what might happen if you don't. Pulling out “government” as a weapon to change social behaviors is similar: the damage potential is VERY high and the weapon shouldn't be pulled out unless the damage from using it has been considered and truly judged to be worth the downside.

    In the case of smoking I don't think this judgment standard has been met, and I think there are valid and sincere doubts as to the effectiveness of the use of government even after the damage has been caused.

    – MJM

  • Laylastryle

    YES or even more!! haha!! 🙂

  • Layla

    hehe apparently not everyone is being paid by the tobacco lobbies to troll the anti-tobacco sites & people may have more important things to do? 🙂

  • Actually Layla, I am quite open about my background and “funding” (i.e. basically none other than as author of a book) while Ms. Cataldo, et al, are funded quite lavishly yet fail to offer even the most basic defenses of their work.

    – MJM

  • Layla, are you stating that anyone here is being paid by the tobacco lobby to troll anti-tobacco sites?   Would you care to  name some names? (Including your own as claimant of course…)

    – MJM